Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (253 page)

   Cultures of the post–prostatic massage urine or expressed prostatic secretions are nearly always positive for bacteria. Repeated isolations of the same organism over time confirm the agent.

   Limitation:
Chlamydia trachomatis
will not grow in culture, so negative results by urine and prostatic secretion cultures should be followed by nucleic acid testing for this organism.

   Chronic prostatitis/chronic pelvic pain syndrome (WHO classes IIIA and IIIB)

   A urinalysis should be performed on any patient suspected of prostatitis. The presence of hematuria should be followed up by urine cytology (for carcinoma in situ of the bladder), cystoscopy, and potentially upper tract imaging.

   A urine culture should also be performed to rule out a UTI. A recurrent UTI should be evaluated for chronic bacterial prostatitis (class II syndrome).

   Although bacterial infection has been implicated (especially in class IIIA), no agent has been consistently identified by culture or found by polymerase chain reaction (PCR) testing. Moreover, there is little correlation between histologic evidence of inflammation and the presence or absence of symptoms. The differential diagnosis is one of exclusion:

   There is no low-grade fever (which can occur in the class II syndrome)

   There is no prostatic hypertrophy, tenderness, or edema by rectal examination (as in the class II syndrome)

   There are no systemic or neurologic symptoms (as in urethritis, urogenital cancer, urinary tract disease, urethral stricture, or neurologic disease affecting the bladder)

Suggested Readings

Gamé X, Vincendeau S, Palascak R, et al. Total and free serum prostate specific antigen levels during the first month of acute prostatitis.
Eur Urol.
2003;43:702–705.

Krieger JN, Nyberg L Jr, Nickel JC. NIH consensus definition and classification of prostatitis.
JAMA.
1999;282:236–237.

Nickel JC, Nyberg LM, Hennenfent M. Research guidelines for chronic prostatitis: consensus report from the first National Institutes of Health International Prostatitis Collaborative Network.
Urology.
1999:54:229–234.

Nickel JC, Shoskes D, Wang Y, et al. How does the pre-massage and post-massage 2-glass test compare to the Meares-Stamey 4-glass test in men with chronic prostatitis/chronic pelvic pain syndrome?
J Urol.
2006;176:119–124.

Schaeffer AJ. Clinical practice. Chronic prostatitis and the chronic pelvic pain syndrome.
N Engl J Med.
2006;355:1690–1698.

INFERTILITY

OVERVIEW

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