II. Indications
III. Contraindications
- Acute Prostatitis (may result in bacteremia)
IV. Preparation
- Patient pre-hydrates before appointment
- Patient avoids sexual intercourse for 48 hours prior
V. Technique: Two Glass Test
- 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
- Efficacy
- Lower Test Sensitivity than the Four Glass Test
- High Test Specificity (approaches 100%)
- Nickel (2006) J Urol 176(1):119-24 [PubMed]
VI. Technique: Four Glass Test
- 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)
- Efficacy: Rarely used
- Not found useful in Chronic Prostatitis
- Nickel (2003) J Urol 170:818-22 [PubMed]
VII. Interpretation
- Findings suggestive of Prostatitis
- Urine Leukocytes >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
VIII. References
- Meares (1991) Med Clin North Am 75:405-24 [PubMed]
- Nickel (1995) Tech Urol 1:162-7