Lab
Expressed Prostatic Secretion
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Expressed Prostatic Secretion
, Prostatic Massage, Segmented Urine Culture, Four Glass Test
Indications
Chronic Prostatitis
Contraindications
Acute Prostatitis
(may result in bacteremia)
Preparation
Patient pre-hydrates before appointment
Patient avoids sexual intercourse for 48 hours prior
Technique
Patient with full
Bladder
and desires to void
Retract foreskin and cleanse penis
See
Clean Catch Urine Collection
Uncircumsized men maintain foreskin retraction
Collect midstream urine for premassage
Urine Culture
Patient stops voiding
Examiner massages
Prostate
from periphery to midline
Not recommended in
Acute Prostatitis
Collect a few drops of secretion from
Urethra
Collect 10 ml of urine for postmassage
Urine Culture
Refrigerate urine samples
Send both samples for urine microscopy of sediment
Send both samples for
Urine Culture
Technique Variations
Four Glass Test
Rarely used
Not found useful in
Chronic Prostatitis
Nickel (2003) J Urol 170:818-22 [PubMed]
Collect first 10 ml of urine (before midstream)
Assesses for
Urethritis
Collect mid-stream pre-massage
Urine Culture
(as above)
Expressed Prostatic Secretions cultured
Post-massage
Urine Culture
of 10 ml (as above)
Interpretation
Findings suggestive of
Prostatitis
Urine
Leukocyte
s >10 WBC/hpf in Post-massage sample
Post-massage
Urine Culture
positive
Pre-massage
Urine Culture
sterile
Pre-massage <1 log colony/ml under post-massage
Findings suggestive of cystitis
Significant bacteriuria in pre-massage sample
References
Meares (1991) Med Clin North Am 75:405-24 [PubMed]
Nickel (1995) Tech Urol 1:162-7
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