The patient's clinical history, general appearance, and uri-nalysis are often suggestive of acute bacterial prostatitis. A urine culture is commonly positive for a urinary tract infection. A digital rectal examination will usually identify a very tender prostate. In rare cases, fluctuance may be palpable in the prostate, if there is a prostatic abscess. In men who appear toxic or who fail to improve with antibiotic therapy, a transrectal ultrasound may be obtained to rule out a prostatic abscess. An assessment of postvoid residual is performed. The classic diagnostic maneuver for bacterial prostatitis is the three-glass test. The patient is asked to void and collect his first 10 ml of urine. This is sent for culture and is known as VB1. Then the patient is asked to collect a midstream urine sample after he voids about 200 ml. This urine sample is sent for culture and is known as VB2. Then the urologist performs a digital rectal exam and massages the patient's prostate in an attempt to express prostatic secretions (EPS) into a sterile container. A prostatic massage is not always successful in producing sufficient secretions, and for some men, it can be quite uncomfortable. After the prostatic massage, the patient is asked to void again into a container, referred to as VB3, and this sample is sent for culture. If there is an increase in the number of bacterial colonies seen in either EPS or VB3, a diagnosis of bacterial prostatitis is made, and treatment is based on the antibiotic sensitivities of the organisms that were isolated. If there are no bacteria present, but white blood cells are present in the VB3 collection, it is suggestive of nonbacterial inflammatory prostatitis.
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