Diagnosing Prostatitis: urine vs prostate culture

Hello @normandhebert
The same scenario happened to my 65 year old brother. It wasn't until he went to a Mayo Clinic urologist, who did a prostrate culture to properly diagnose the infection. All our local urologists the urine culture to identify the infection, which leads to an incorrect diagnosis. Thank you so much for taking the time to alert others about this problem. You are very kind to sound the alarm and protect others from the pain and unnecessary suffering. Unfortunately, it sounds like your experience is way to common. I can't believe that the local specialists are unaware of the need for a prostate culture. This is crazy to me. Where did you go to get properly diagnosed?

Good morning. Thanks for your reply. I went to Ryan powers, very young and cocky, Dr Kaplan, the same, Dr Agins, all useless, just did urine test, testicular exam and d r e and sent me on my way. Not one of them explained what prostatitis is, how you get it or anything. Finally went to Dr. M. Michael Hayyeri in phoenix. Very kind man. He sat down with me in no hurry and asked me to explain what was going on. When I said, you mean the entire last 4 months? He said, absolutely. He listened attentively and then proceeded to tell me what prostatitis was, how they believe it is acquired although in my case we have no clue because I have never had a UTI in my life, how it is treated and specifically why it is so difficult to treat. I must say that although all the young women in his office are extremely friendly, the office does not seem to be run very well. That being said I would highly recommend him because he is the only one who took the time to listen, and properly diagnose my condition, and he will be my urologist from now on.

Excellent information @normandhebert
Thank you so much for taking the time to educate everyone on this platform. You may save someone from a lot of unnecessary pain and suffering by providing the appropriate diagnostic test name. Now everyone in the group is aware of this test and when to request it. Excellent heads-up. Have a wonderful day 😊

Hello for those who have bacterial prostatitis, I am just wondering how long it takes for it to heal - In other word, how long the prostate will shrink back to normal size?

It is hard for me to make an appt to see a doc, so I went to see a PA-C, who did the DRE and said mine is a little tender. She had me done the urine sample and cultured then the bacteria Enterococcus faecalis is found, she then prescribed me the ampillicin for two weeks. Then no antibiotic for another two weeks. Then she had me done urine culture again, this time the bacteria is serratia marcescens, what she prescribed me this time is bactrim for 28 days. I have been taking it for 3 days but does not have any improvement. Will this help and cure the prostatitis?

Right now urinating is extremely difficult for me (obstruction in the bladder). When I go, I have to strain it and it takes up 1 min to initiate the stream and then little comes out - mostly dribbling. The moment I finish, a min later, I have to go again.

I am just wondering if the urine culture is enough to determine the bacteria that causes prostatitis? Will it be possible that she could have misdiagnosed? Thanks.

@learningstudent, I moved your question to this existing discussion so you can connect with @hello1234 and @normandhebert
- Diagnosing Prostatitis: urine vs prostate culture: https://connect.mayoclinic.org/discussion/prostatitis-saving-you-months-of-pain/

According to Mayo Clinic's info on Prostatitis: https://www.mayoclinic.org/diseases-conditions/prostatitis/diagnosis-treatment/drc-20355771
"If you have acute or chronic bacterial prostatitis, you'll take antibiotics. Acute disease may require intravenous (IV) antibiotics in the hospital for a short period. The entire course of antibiotic treatment is usually 4 to 6 weeks — or longer in some cases."

Hi @learningstudent
You didn't mention the reason it is difficult for you to make an appointment with a doctor? If your situation is the same as my brother's, you need a culture of the prostate, not urine cultures.
Read @normandhebert note above too.

In 2006, I had perineal pain, urinary frequency so bad that I had to carry around a 2lb protein powder container in my car so I could pull over to pee in it. Sometimes off to the side of the freeway. The urgency came with extreme pain that had me whimpering until I could relieve myself. This went on for months before I saw a urologist. I had seen a few nurse practitioners in the interim who took urine cultures, all coming back negative.
When I went to friends homes to visit they started asking me if I was doing drugs because of my frequent trips to the bathroom, even after explaining what was happening. I had to pee sitting down. Not only was my prostate enlarged, but it was inflamed, so there had been some obstruction happening for some time.
I was given antibiotics. One offered Cipro, which I didn't have filled. I used bromelain and quercetin capsules along with cranberry concentrate capsules. These alleviated it for a while. The pain went away. Then the pain came back. This time there was visible blood in my urine. I had a friend who knew a doctor whom he asked to refer me to a urologist. The urologist gave me a DRE, only this time he "milked" my prostate until pre-seminal fluid came out which he put onto a slide. He cultured it immediately in his office under microscope. This was something I've never heard of, but it was standard in his practice. There was no bacteria. He diagnosed me with non-bacterial prostatitis. Gave me antibiotics, Macrobid. This seemed to clear it up. Then it came back again so he gave me a cystoscopy. He didn't see anything suspicious. He did see irritation on the bladder wall. He told me I may have passed kidney stones because I also had flank pain on one side. He remarked that he saw indications of bladder cystitis, which again, non-bacterial.
More antibiotics, vicodin and AZO after the cystoscopy. Then it went away. In 2013, it came back, only this time I had no health insurance. So I couldn't afford to see the urologist. I had to go to a free clinic. I had a part-time job. They gave me a DRE, took a urine sample, all came back negative for infection. Diagnosis: non-bacterial prostatitis with possible cystitis. Antibiotics, Cipro. I went back to the bromelain and quercetin, vicodin, drank green tea only. It got to be so unmanageable that I had to leave the desk job. It went away. I went back to the NP, she did a DRE, she did not take a pre-seminal culture. "We don't do that here," she said. Macrobid and AZO.

Jump to Aug. 2022. Extreme fatigue, frequent urination, dizziness, high blood pressure and back pain.
After X-ray of the back came an ultrasound which showed bilateral hydronephrosis and a 99cc sized prostate. The prostate had been causing me to hold more urine that had backed up to my kidneys. I received a catheter.
The reason I point this out is that I was living with a time bomb. Part of it was my fault for not running to the doctor, however it was discouraging me to see any doctor because of the long wait. These tests were months between. Had I had an ultrasound of my abdomen back in 2006, they may have found something.
I believe that much of what provoked the flare-ups of the prostate were due to extreme prolonged stress, poor sleep due to nocturia, pain and diet and economic stressors. Consequently, the most recent enlargement may have been non-bacterial prostatitis which caused urinary retention- coupled with the enlargement- but that's my theory. I live in a foreign country, was filing for a divorce in a toxic marriage, my mother was dying of cancer in the States, the Covid problem- my cortisol levels must have been through the roof and I was in a constant state of anxiety and inflammation.
I have a urologist here, but they don't milk the prostate. It didn't occur to me to ask them! I may ask them if they do another DRE. I recently had an MRI with contrast of the prostate; still waiting for those results to come - the day before my 60th birthday, of course.
I'd like to thank you for your story about prostatic milking for culture analysis, it's something that they SHOULD know about, and be doing TODAY.

But my urine culture came back positive does it mean that I have uti or bacteria prostatitis? Cuz it causes discomfort and burning and little comes out and I have the urge to urinate all the time and if I hold it for too long the burning will become so intensive that lasts for several hours to a day. She unfortunately did not milk me.

Cuz they have a lot of urologists, but I have seen one before and am a established patient. My urologist only in the clinic every Wednesday and all his schedules have been fully booked. When I called to make N appt they need a referral and then see that I have an urologist already and told me they need to send messages to the care team and when I called my PCP for referral he said he was not able to do anything and did not have access to the system. If I want he said he could write me a referral to other clinics but they do not have my record and deem that my cases not important.