title: Detecting urethral and prostatic inflammation in patients with chronic prostatitis.
abstract: OBJECTIVE
  Diagnosis of urethral and prostatic inflammation can represent a challenge. We compare the accuracy of diagnostic methods for detecting inflammation in lower urinary specimens/samples.
  
  
  METHODS
  A standardized protocol was used to evaluate urethral smear, first-void urine (VB1), midstream urine (VB2), expressed prostatic secretions (EPS), and postmassage urine (VB3) in urologic patients with no symptoms or signs of urethritis who were attending our prostatitis clinic.
  
  
  RESULTS
  Of 235 subjects, 60 (26%) had leukocytes detected by the Gram-stained urethral smear, 44 (18%) by the VB1, and only 14 (6%) by the VB2. Compared with the urethral swab, VB1 had 0% to 22% sensitivity and 81% to 98% specificity, and VB2 had 8% to 11% sensitivity. Of 83 subjects with prostatic inflammation, the EPS detected 63 (76%) and the VB3 detected 68 (82%).
  
  
  CONCLUSIONS
  VB1 or VB2 examinations had low sensitivity for detecting urethral inflammation. Examining both the EPS and VB3 proved best for detecting prostatic fluid inflammation. Combining the urethral smear with lower urinary tract localization ("four-glass test") represents an optimal approach for detecting urethral and prostatic inflammation.
authors.affiliation: Department of Urology, University of Washington School of Medicine, Seattle, USA.
authors.forename: J N
authors.initials: JN
authors.lastname: Krieger
authors.forename: R
authors.initials: R
authors.lastname: Jacobs
authors.forename: S O
authors.initials: SO
authors.lastname: Ross
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001437:Bacteriuria / Q000175:diagnosis; D016009:Chi-Square Distribution; D002908:Chronic Disease; D006801:Humans; D007964:Leukocytosis / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D017699:Pelvic Pain / Q000175:diagnosis; D011467:Prostate / Q000378:metabolism; D011472:Prostatitis / Q000175:diagnosis* / Q000382:microbiology / Q000652:urine; D012680:Sensitivity and Specificity; D014526:Urethritis / Q000175:diagnosis* / Q000382:microbiology / Q000652:urine