The Prostatitis Foundation



Urinalysis is a basic tool for urologists. If you go to a urologist — no matter what you go for — the office staff will probably ask you to produce some urine, possibly even before you see the doctor. You urinate into a cup, and they send it off to their in-office lab where a quick check for sugar, blood etc is done to screen you for major diseases.

Some of the urine is shipped off to a remote lab for overnight bacterial culturing and microscopic analysis for signs of disease.

This is all fine and of course should be done, but if you have prostatitis, the chances are very high that the Urinalysis will be completely negative, not showing any disease.

Why would this be so? You know you have a disease, something is wrong. It could be that you have an infection and the urinalysis is not showing an infection. The explanation for this could be either that the culture wasn't sensitive enough or cultured for long enough, or that bacteria were not being "shed" from your prostate. The prostate contains several small sacs, or acini, which can trap bacteria. There can be bacteria there, but they don't come out when you urinate.

Diagnostic tests in general can show if you have a disease, but can't show that you don't have it. In other words, if the test is "negative," it could be a "false negative," which does not mean you don't have what the test is looking for.

In any case, the urine test will probably tell you you don't have diabetes or kidney disease or any of a number of metabolic disorders. However, it won't tell you you don't have an infection. To look further for an infection, you'll need a 4-jar test, an EPS culture or a semen culture, or maybe all three. These are all discussed below.

The Four Glass Test

In 1968 two urologists, Meares and Stamey, published a paper about the four glass test for prostatitis. In those days doctors collected urine for examination in sterile glasses. Today, of course, sterile plastic specimen containers are generally used. (Meares EM and Stamey TA: Bacteriologic localization patterns in bacterial prostatitis and urethritis. Invest Urol. 1968 Mar;5(5):492-518.)

Patients are asked to urinate their first 10 ccs of urine into a sterile cup. Then, they are asked to urinate 10 ccs of urine from their midstream into a sterile cup. Next, their prostate is massaged and expressed prostatic secretions are collected. Finally, another 10 ccs of urine is collected to finish the "four glass collection."

Doctors call these samples:

VB1 - voided bladder 1, which represents the urethra.

VB2 - voided bladder 2, which represents the bladder.

EPS - expressed prostatic fluid, which represents the prostate.

VB3 - voided bladder 3, which also represents the prostate.

These samples are all cultured and if one specimen grows far more bacteria than the others, it is felt that the infection has been localized to the urethra, bladder, or prostate, depending on which specimen grows bacteria.

The Two Glass Test

Urologist J. Curtis Nickel has suggested that a 2 glass test may suffice where only the EPS and the VB3 specimen are collected. (Nickel JC: The Pre and Post Massage Test (PPMT): a simple screen for prostatitis. Tech Urol. 1997 Spring;3(1):38-43.)  

The One Glass Test

Urologist Wolfgang Weider, et al., showed that their is a 90 percent correlation between the VB3 specimen having high numbers of white blood cells and the EPS having high numbers of white blood cells. (Schneider H, Ludwig M, Hossain HM, Diemer T, Weidner W: The 2001 Giessen Cohort Study on patients with prostatitis syndrome--an evaluation of inflammatory status and search for microorganisms 10 years after a first analysis. Andrologia. 2003 Oct;35(5):258- 62.)

Cultures and other tests

Once prostate fluid and VB3 specimens are obtained and the white blood cells are counted, the diagnostic workup moves on to searching for microbes in many cases.

The following is a short list of microbial tests that can be done:

aerobic cultures

anaerobic cultures

special cultures for hard to culture organisms

Chlamydia tests

Mycoplasma tests

Ureaplasma tests

Tuberculosis tests

PCR tests

Immune florescence tests

Doctor's comments on urinalysis:
Doctor Comment:

David L. Casey, MD One thing I would say is that urinalysis is often useless, but should be performed at least on the initial visit in case there is hematuria or pyuria/bacteriuria which can change the direction of the workup and treatment. This is probably the most important for patients coming to a doctor early in the course, and obviously chronic patients usually have urinalyses that are unremarkable...however I would hate to have patients (some of who are extremely adamant that things are done exactly as they say despite sometimes being not so well informed) refuse to have a simple urinalysis which could potentially be useful...


The mission of the Prostatitis Foundation is to educate the public about the prevalence of prostatitis
and encourage and support research to find the cause and a cure for prostatitis.

We're sorry you are having to learn about prostatitis, but we're glad you came here, because we think we can help. Please be advised that the Prostatitis Foundation does
not warrant, support, sponsor, endorse, recommend or accept responsibility for any health care provider or any treatment or protocol performed by any heath care provider.

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