From the Guidelines
A patient with prostatitis is likely to exhibit abnormal findings on a urinalysis, including the presence of white blood cells, bacteria, and elevated leukocyte esterase, as indicated by the European Association of Urology guidelines on urological infections 1. A urinalysis for a patient with prostatitis may reveal:
- White blood cells (WBCs) in the urine
- Bacteria in the urine
- Red blood cells (RBCs) in some cases
- Elevated leukocyte esterase
- Positive nitrites (if bacterial infection present) However, it's essential to note that a normal urinalysis does not rule out prostatitis, as some patients may have symptoms but normal urinalysis results, highlighting the need for additional diagnostic tests, such as urine culture and expressed prostatic secretions (EPS) analysis, as recommended by the guidelines 1. For patients with suspected acute bacterial prostatitis (ABP), a midstream urine dipstick to check nitrite and leukocytes, as well as a midstream urine culture, can help guide diagnosis and tailor antibiotic treatment, according to the guidelines 1. The presence of WBCs and bacteria in the urine indicates inflammation and possible infection in the urinary tract, which are hallmarks of prostatitis, and the elevated leukocyte esterase is an enzyme from WBCs, further confirming inflammation, as supported by the guidelines 1. If prostatitis is suspected based on symptoms and urinalysis findings, treatment typically involves antibiotics and anti-inflammatory medications, with patients also advised to increase fluid intake and avoid irritants like caffeine and alcohol during treatment.
From the Research
Urinalysis Findings in Prostatitis
A patient with prostatitis may exhibit abnormal findings on a urinalysis, including:
- Leukocytes (white blood cells) in the urine, indicating inflammation or infection 2
- Bacteria in the urine, which can be present in cases of bacterial prostatitis 2, 3, 4, 5
- Blood in the urine, which can occur in some cases of prostatitis 5
Types of Prostatitis and Urinalysis
Different types of prostatitis may have different effects on urinalysis results:
- Acute bacterial prostatitis: typically presents with significant bacteriuria and leukocyturia 5
- Chronic bacterial prostatitis: may have positive urine cultures, but leukocyte counts may be lower than in acute cases 2, 3, 4
- Chronic inflammatory prostatitis: may have elevated leukocyte counts in the urine, but negative cultures 2, 3
Diagnostic Value of Urinalysis
Urinalysis can be a useful diagnostic tool in prostatitis, particularly when combined with other tests such as:
- Semen culture: may be more sensitive than urine culture for diagnosing chronic bacterial prostatitis 4
- Expressed prostatic secretions (EPS): can be used to diagnose chronic prostatitis, but may have lower sensitivity than semen culture 2, 4
- Urine culture: can help identify the causative organism in cases of bacterial prostatitis 3, 5