From the Guidelines
In a urinalysis for prostatitis, the presence of white blood cells (pyuria), bacteria, and sometimes red blood cells, particularly with increased leukocyte esterase and positive nitrites, is suggestive of the condition, as recommended by the European Association of Urology guidelines 1. To diagnose prostatitis, a midstream urine dipstick can be used to check for nitrite and leukocytes, and a midstream urine culture can be taken to guide diagnosis and tailor antibiotic treatment 1. Some key findings in urinalysis for prostatitis include:
- Elevated white blood cells (pyuria)
- Bacteria
- Red blood cells
- Increased leukocyte esterase
- Positive nitrites The "four-glass test" or the simplified "two-glass test" can help diagnose prostatitis by comparing pre- and post-massage urine samples, as recommended by the European Association of Urology guidelines 1. In bacterial prostatitis, culture may identify specific pathogens, commonly E. coli, Klebsiella, Proteus, Enterococcus, or Pseudomonas. However, in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), urinalysis may be normal or show only mild inflammation without clear bacterial evidence. It's essential to note that urinalysis alone is not definitive for prostatitis diagnosis; clinical symptoms, physical examination, and sometimes additional tests like expressed prostatic secretions analysis are necessary for accurate diagnosis and appropriate treatment planning. The European Association of Urology guidelines recommend against routine microbiological analysis of the ejaculate alone to diagnose chronic bacterial prostatitis (CBP) 1. Instead, accurate microbiological evaluation for atypical pathogens such as Chlamydia trachomatis and Mycoplasma species should be performed in patients with CBP 1.
From the Research
Urinalysis for Prostatitis
To diagnose prostatitis, urinalysis is a crucial test. The following are some key findings that may indicate prostatitis:
- Presence of white blood cells (WBCs) in the urine, which suggests an infection 2, 3
- Bacteria in the urine, such as Escherichia coli, Klebsiella, Enterobacter, Proteus, Pseudomonas, and enterococci 4, 3, 5
- Positive urine culture, which can help identify the type of bacteria causing the infection 4, 3, 6
- Elevated levels of prostate-specific antigen (PSA) in the urine, although this is not a definitive indicator of prostatitis 6
Types of Prostatitis
There are different types of prostatitis, including:
- Acute bacterial prostatitis, which is characterized by a sudden onset of symptoms such as pelvic pain, urinary frequency, and fever 2, 3
- Chronic bacterial prostatitis, which is a long-term infection that can cause recurring urinary tract infections and pelvic pain 2, 4
- Chronic prostatitis/chronic pelvic pain syndrome, which is a condition characterized by chronic pelvic pain and urinary symptoms, but no evidence of infection 6
- Asymptomatic prostatitis, which is an incidental finding in patients being evaluated for other urologic problems 6
Antibiotic Treatment
Antibiotic treatment is the mainstay of therapy for prostatitis. The choice of antibiotic depends on the type of bacteria causing the infection and the severity of symptoms. Some common antibiotics used to treat prostatitis include: