Presentation Authors: Delia Toomey*, Jade Harrison, London, United Kingdom, Anthony Adimonye, Justin Bendig, Pareeta Patel, Surrey, United Kingdom, Nicholas Watkin, London, United Kingdom
Introduction: Urinary tract infections are commonly associated with urethral strictures, but the evidence for bacterial prostatitis is limited to one brief report over 30 years ago.(1) Urethral stricture symptoms and prostatitis-like symptoms are similar and we considered that undiagnosed bacterial prostatitis may be contributing to the patientâ€™s presentation.
Methods: A 3 year prospective observational study was conducted. Male patients with symptomatic penile and bulbar urethral strictures, who were being assessed for urethroplasty, consented to prostate cultures using the a three pot modified Meares and Stamey technique. Patients with concurrent positive urine cultures were excluded. Patients underwent cystoscopic assessment including cystoscopic urine collection (pot 1), stricture dilatation, clean catch urine and prostate massage. Prostate fluid was collected (pot 2) along with post-massage first void urine (pot 3). Samples were individually cultured by a dedicated microbiologist. Culture results were compared with cultures those obtained from a control group of patients with prostatitis-like symptoms over the same time period with no history or evidence of stricture. NIH-prostatitis symptom scores were recorded in both groups. Significance of the cultures was assessed by the a dedicated medical microbiologist who was blinded from the patientâ€™s clinical presentation. Statistical significance was assessed by Chi sq.
Results: 100 patients underwent the 3 pot culture. 57 (Group 1) had a confirmed stricture (15% penile, 56% bulbar, 29% panurethral). 43 (Group 2) had no evidence of stricture. Mean prostatitis symptom scores were 7 for pain, 5 for urinary and 5 for bother in each groups. In Group 1, 47% of patients had a uniquely positive bacterial prostate culture with a recognised uropathogen, and in Group 2 21%. This finding was statistically significant (p=0.0087). Clean catch urine was positive in 15 % of Group 1 and 2.6% of Group 2.
Conclusions: This study has shown for the first time in contemporary practice, that bacterial prostatitis is present in a large number of symptomatic patients with urethral strictures. It is also confirmed to be a statistically significantly higher incidence than in a cohort of patients with clinical prostatitis alone. We recommend validation of our findings and suggest that patients with urethral strictures should be screened and treated for bacterial prostatitis before any urethral reconstructive surgery is undertaken.