Comparison of expressed prostatic secretions with urine after prostatic massage - A means to diagnose chronic prostatitis/inflammatory chronic pelvicpain syndrome

Objectives. To compare the analysis of urine after prostatic massage (VB3) with expressed prostatic secretions (EPS) to assess the significance of leu kocyte analysis in VB3 and to give a first hint of the diagnosis of inflamm atory chronic pelvic pain syndrome (PPS) when EPS cannot be obtained. Methods. Three hundred twenty-eight men (mean age 38 years, range 18 to 70) with expressible prostatic secretions were investigated. EPS were stained using the Papanicolaou stain and analyzed for leukocytes per high power fie ld (HPF) (x 1000). Additionally, identical aliquots of first voided urine ( VB 1), midstream urine (VB2), and VB3 were centrifuged, stained (Papanicola ou), and analyzed for leukocytes (x 400). Patients with increased numbers o f leukocytes in VB1 and VB2 (2 or more per x 400) were excluded. For statis tical analysis, Spearman's correlation coefficient for nonparametric tests was used. Results. Of 180 men with less than 10 leukocytes per HPF in EPS, 178 (98.9% ) had less than 10 leukocytes per view field in VB3. In 148 men with 10 or more leukocytes per HPF in EPS, 136 (91.9%) also had elevated leukocyte cou nts in VB3. The presence of elevated leukocytes in VB3 predicted the presen ce of increased leukocytes in EPS with a high certainty: 91.9% sensitivity, 98.9% specificity, and 95.7% accuracy, with a positive and negative predic tive value of 98.6% and 93.7%, respectively. Conclusions. We conclude that the determination of leukocytes in VB3 is a f easible and reliable method compared with the analysis of EPS. However, alt hough this association does not directly prove the significance of VB3 in t hose patients from whom no EPS can be obtained, we suggest this method be t aken into account as an indirect indicator in the diagnosis of inflammation . (C) 2000, Elsevier Science Inc.