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Acute prostatitis in men with urinary tract infection and fever: diagnostic yield of rectal examination findings in the emergency department

Smithson Amat Á, Ramos Lázaro J, Netto Miranda C, Adrián Martín MJ, Bruno Martínez C, Bastida Vilá MT

Servicio de Urgencias, Servicio de Medicina Interna, Laboratorio de Microbiología. Fundació Hospital de l’Esperit Sant, Santa Coloma de Gramenet, Barcelona, Spain.

Objective: The diagnosis of acute bacterial prostatitis (ABP) in men with a urinary tract
infection (UTI) and fever is based on a finding of a painful prostate on rectal
examination. This study aimed to assess the sensitivity, specificity, positive and negative
predictive values (PPV and NPV), and positive and negative likelihood ratios of rectal
examination findings in the diagnosis of ABP associated with UTI and fever.
Methods: We prospectively included 48 men with community-acquired UTI with fever.
Clinical evaluation included a rectal examination and prostate-specific antigen (PSA)
determination which was considered ten reference test for ABP.
Results: Twenty-three patients (47.9%) had a painful prostate on rectal examination and
30 (62.5%) had elevated PSA levels. Thirteen (27.1%) had a positive lumbar fist
percussion; PSA was elevated in 9 (30.7%) of those patients. The sensitivity of rectal
examination findings for a diagnosis of ABP was 63.3%; specificity, 77.7%; PPV, 82.6%;
NPV, 56%; positive likelihood ratio, 2.85; and negative likelihood ratio, 0.47.
Conclusions: A finding of painful prostate on rectal examination in men with UTI with fever
strongly suggests a diagnosis of acute bacterial prostatitis. The low sensitivity and NPV of this
finding means that an absence of pain does not rule out a diagnosis of ABP. Therefore men
with UTI with fever should be treated as if they had ABP.

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