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Is the Four-Glass Test for Prostatitis Useful?



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Am Fam Physician. 2003 Dec 1;68(11):2244-2246.

Study Question: Is the presence of white blood cells (WBCs) and bacteria in segmented urine samples, prostatic fluid, or semen useful in the diagnosis of chronic prostatitis?

Setting: Outpatient (specialty)

Study Design: Diagnostic test evaluation

Synopsis: Prostatitis traditionally is characterized by inflammation or infection of the prostate gland in association with WBCs, with or without bacteria, in prostate-specific specimens. The authors compared the WBC count and localization rates for bacteria cultures of segmented urine samples (three samples), expressed prostatic secretion, and semen in men with chronic prostatitis and chronic pelvic pain syndrome with those of men without pelvic pain. Eligible men diagnosed with chronic prostatitis and chronic pelvic pain syndrome had to have symptoms of discomfort or pain localized in the pelvic region for at least three of the six months immediately before the study and no history of urinary tract infection in the previous three-month period. A total of 463 men with chronic prostatitis and chronic pelvic pain syndrome and 121 matched control patients were recruited.

Compared with patients in the control group, men with chronic prostatitis and chronic pelvic pain syndrome had a statistically significant higher WBC count in all segmented urine samples and expressed prostatic secretion (P <.01 for all), but not in semen. Of the men with chronic prostatitis and chronic pelvic pain syndrome, 32 percent had 10 or more WBCs per high-power field in expressed prostatic secretion compared with 20 percent of the men in the control group. Compared with 11 percent of the control patients, 14 percent of the men with chronic prostatitis and chronic pelvic pain syndrome had 10 or more WBCs per high-power field in the third urine segment, which is supposed to represent samples from the prostate.

Localization of bacteria was similar in all samples for men with chronic prostatitis and chronic pelvic pain syndrome (8.0 percent) and control patients (8.3 percent). Therefore, none of the specimens would provide a good way to distinguish case patients from control patients in the clinical setting.

Bottom Line: Compared with control patients, men with chronic prostatitis and chronic pelvic pain syndrome have a higher WBC count in segmented urine samples and expressed prostatic secretion, but not in semen. However, a significant number of asymptomatic men also have an elevated WBC count in similar samples. There is no difference in the percentage of positive bacterial cultures in any of the samples compared with controls. The clinical usefulness of the four-glass test to distinguish chronic prostatitis and chronic pelvic pain syndrome is of minimal, if any, clinical usefulness. Chronic prostatitis and chronic pelvic pain syndrome will continue to be primarily a clinical diagnosis. Recent studies have shown a benefit from treatment with terazosin (Daily POEMs, April 2003). (Level of Evidence: 2b)

STUDY REFERENCE:

Nickel JC, et al. Leukocytes and bacteria in men with chronic prostatitis/chronic pelvic pain syndrome compared to asymptomatic controls. J Urol. September 2003;170:818–22.

Used with permission from Slawson D. Clinical usefulness of 4- glass test for prostatitis doubtful. Accessed September 26, 2003, at: http://www.InfoPOEMs.com.

 


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