Catheter Biopsy as a Useful Tool to Establish an Early Diagnosis for Canine Prostatic Disorders

Paclíková K., P. Kohout, M. Vlašín: Catheter Biopsy as a Useful Tool to Establish an Early Diagnosis for Canine Prostatic Disorders. Acta Vet. Brno 2007, 76: 475-485. In the study conducted on 29 pre-selected patients, we intended to evaluate the reproducibility of prostatic catheter biopsy (CB) as a minimally invasive procedure, directly comparing it to another well-established method, namely ultrasound-guided fi ne-needle aspiration biopsy (USG-FNAB). As a direct control we used histopathological evaluation and microbial cultivation of samples obtained by percutaneous Tru-Cut biopsy. Evaluating our data, we found that for establishing proper diagnosis by means of cytology, less invasive catheter biopsy (CB 75.86%) is at least comparable to already proven ultrasound-guided fi ne needle aspiration biopsy (USG-FNAB 72.41%), while catheter biopsy (CB 13 cases out of 29) was signifi cantly (p < 0.0001) more sensitive in actual identifi cation of infectious agents than ultrasound-guided fi ne needle aspiration biopsy (USG-FNAB 2 cases of 29).We believe that an early microbial evaluation of patients suffering from prostatic disorders helps to target antimicrobial treatment in the beginning of therapy, reducing the risk of failure due to bacterial resistance. Dog, urology, prostate gland, FNAB, prostatic massage, prostatic fl uid cultivation The prostate gland, the only accessory sex gland in male dog is located adjacent to the bladder neck in the pelvic inlet. It is a two-lobular gland with fi brous septum in the middle. Limitation of this septum is in the dorsal sulcus, mostly distinct during rectal palpation (Barsanti and Finco 1989). Its major function is secretion of the prostatic fl uid, which is part of the fi rst and third fraction of ejaculate (England et al. 1990). Various prostatic disorders are common in old intact dogs (Barsanti and Finco 1989 Krawiec 1994), as well as in men. Symptomatology of the prostatic disease can be generally found in dogs older than 5.5 years (Krawiec and Heflin 1992). Well-described disorders include benign prostatic hyperplasia (BPH), squamous metaplasia, prostatic infl ammation, both acute and chronic, infl ammation-related prostatic abscedation, (with single or multiple abscesses), prostatic cysts and prostatic neoplasia. Prostatic catheter biopsy is quite a simple method, feasible even in fractious dogs or patients in pain or severe discomfort, when manual ejaculation (collection of third fraction) is not possible (Barsanti and Finco 1989). This method stands on the borderline between invasive and non-invasive methods of examination and it is generally advisable to clients refusing percutaneous biopsy techniques. Fluid obtained by catheter biopsy can be submitted to both cytology and bacterial cultivation. The goal of our study was to evaluate sensitivity of prostatic catheter biopsy as a method in clinical practice partially forgotten and to express its importance in the management of canine prostatic disorders. Materials and Methods Animals Twenty nine male dogs, patients of Veterinary teaching hospital, University of Veterinary and Pharmaceutical Sciences Brno, Czech Republic, were included into the study. The patients were presented between October ACTA VET. BRNO 2007, 76: 475-485; doi:10.2754/avb200776030475 Address for correspondence: K. Paclíková Faculty of Veterinary Medicine University of Veterinary and Pharmaceutical Sciences Brno, Czech Republic Phone: +420 54156 2309 E-mail: paclikovak@vfu.cz http://www.vfu.cz/acta-vet/actavet.htm 2004 and June 2006, with various prostatic symptomatologies, with the age between 4 and 13 years, weighing between 1.5 kg and 80 kg. The most often observed symptoms included: tenesmus, haematuria, urethral discharge, recurrent low-urinary tract infection, dysuria, perineal herniation, lethargy, vomitus and caudal abdominal pain. Some of the patients were referred with a prostatic disease by a local veterinarian. Inclusion criteria For each patient we obtained detailed history (previous and recent problems, diseases and accidents, related to the urinary tract) and complete physical examination was performed accordingly. Specifi c examination of the urinary tract along with prostatic palpation always followed. The evaluation of the urinary tract included routine urinalysis with specifi c gravity analysis and urinary sediment examination after aseptic cystocentesis. Then, routine ultrasonography of the urinary tract followed (Pro Sound 5000 SSD, Aloka Co., LTD, Japan). After that, rectal palpation was performed with the help of caudodorsal abdominal pressure. Rectal palpation was evaluated according to Krawiec (1994); data are presented in the Table 1. Generally, patients included in the study showed clinically manifest prostatic disorders according to history and physical examination, with signifi cant changes revealed by rectal palpation, with or without positive urinalysis. Sample obtaining All samples were collected after 24-hour period of fasting, from sedated patients (medetomidine 10μg/kg, butorphanol 1mg/kg, both i.v.). Whenever needed, general anaesthesia was introduced using propofol 1mg/kg i.v.. Then we performed USG-guided aseptic cystocentesis, prostatic catheter biopsy, USG-FNAB, and fi nally Tru-Cut percutaneous biopsy, proceeding from the least invasive method to the most aggressive one. The patient positioning was always in dorsal or dorso-lateral recumbence. Catheter biopsy Preputium was repeatedly fl ushed with sterile saline solution. Then, aseptic catheterisation (sterile canine urinary catheter, lubricated by mesocain gel) of the urinary bladder was performed. All urine was meticulously removed and bladder was fl ushed by sterile saline solution. Catheter was partially withdrawn under the control of rectal digital palpation and left close to the caudal border of prostatic urethra. Afterwards, digital massage of the prostate gland was carefully performed (about 2 minutes). Whenever prostate could not be reached rectally, caudal abdominal massage was performed instead, while the position of the catheter was controlled by ultrasonography. Approximately 1 minute after commencing of massage, negative pressure was gently applied by an assistant, using a 10cc syringe. Moving the catheter back and forth (with the gap of about 10 mm) facilitated fl uid collection. After collecting prostatic fl uid, syringe was disconnected and catheter was left in place for further procedures. Ultrasound-guided fi ne needle aspiration biopsy. Parapreputial region was clipped and aseptically scrubbed. Then, 22G needle put on a 20cc syringe was introduced under USG control deep into prostatic glandular tissue, negative pressure through the syringe was applied and the needle was manipulated within the gland repeatedly. After releasing negative pressure, the needle was withdrawn and its content was pushed out to the slide, as well as to the cultivation media (Amies). Sample evaluation The basic data we obtained from a brief analysis of Hepta-phan strips (pH, total protein concentration, glucose, ketones, urobilinogen, bilirubin and traces of blood) were interpreted in the scale from 0 to ++++ and recorded in the protocol of each patient. The other examinations were performed as usual. The size of the prostate gland was determined by ultrasonography according to Ruel et al. (1997): V1(cm3) = (0.867 × body weight) + (1.885 × age). V2(cm3) = length (cm) × height (cm) × width (cm) × 0.523. V1(cm3) was compared with V2 (cm3) (Table 4). Then position, echogenicity shape and surface were evaluated (Feeney et al. 1987; Lamb 1990; Bell et al. 1991; Lüerssen 1993; Prűfer et al. 2000). 476 Prostatic disease Rectal palpation Bacterial prostatitis Symmetric, apparently painful (acute prostatitis) Symmetric, with no signs of pain (chronic prostatitis) Prostatic cysts Symmetric, solid and enlarged, small fluctuations In case of big cyst, apparent asymmetry with fluctuation Neoplasia Asymmetric, solid and enlarged, not mobile Benign prostatic hyperplasia Symmetric, solid, enlarged, no sign signs of pain Paraprostatic cysts Asymmetric fluctuation in the close vicinity of prostate Prostatic abscess Asymmetric enlargement, solid or with fluctuation Table 1. Diagnostic values for rectal palpation of the prostate gland according to Krawiec (1994) Cytology of samples Cytology was performed blindly on samples obtained from both Catheter biopsy and USG-guided fi ne needle aspiration biopsy without any knowledge of histopathology (Bell et al. 1991; Dorfman and Barsanti 1995; Peter et al. 1995; Baker and Lumsden 1999). Moreover, we established grading system for severity of infl ammation during examination of the urine sediment in × 400 magnifi cation using the light microscope (Table 3). Infl ammation was considered acute whenever neutrophils reached at least 70% of all infl ammatory cells, whereas it was considered chronic whenever macrophages reached the borderline of 50% of all cells (Rebar 1987). Differentiations between cysts and abscesses were performed based on cytology of the aspirate. Histopathology of the prostate Histopathology of each bioptate was performed at the Department of Pathology, Faculty of Veterinary Medicine, and then evaluated according to Atilola and Pennock (1986), Lowseth (1990), Nielsen and Kennedy (1990), and Bell et al. (1991). It was considered confi rmative for evaluation of each less-invasive diagnostic procedure (USG-FNAB and catheter biopsy). Tissue cultivation Any bacterial growth identifi ed from urine after cystocentesis or FNAB sample was considered positive, while only more than 103 of bacteria in 1 ml were regarded for prostatic catheter biopsy (Barsanti and Finco 1989). Statistical analysis The results were put into tables to be analyzed statistically using McNemara ́s test. On specifi c occasions, the Positive correlation test was applied and p value was set at 0.05 for signifi cance and at 0.01 for high signifi cance. Basic r

The prostate gland, the only accessory sex gland in male dog is located adjacent to the bladder neck in the pelvic inlet.It is a two-lobular gland with fi brous septum in the middle.Limitation of this septum is in the dorsal sulcus, mostly distinct during rectal palpation (Barsanti and Finco 1989).Its major function is secretion of the prostatic fl uid, which is part of the fi rst and third fraction of ejaculate (England et al. 1990).Various prostatic disorders are common in old intact dogs (Barsanti and Finco 1989;Krawiec 1994), as well as in men.Symptomatology of the prostatic disease can be generally found in dogs older than 5.5 years (Krawiec and Heflin 1992).Well-described disorders include benign prostatic hyperplasia (BPH), squamous metaplasia, prostatic infl ammation, both acute and chronic, infl ammation-related prostatic abscedation, (with single or multiple abscesses), prostatic cysts and prostatic neoplasia.
Prostatic catheter biopsy is quite a simple method, feasible even in fractious dogs or patients in pain or severe discomfort, when manual ejaculation (collection of third fraction) is not possible (Barsanti and Finco 1989).This method stands on the borderline between invasive and non-invasive methods of examination and it is generally advisable to clients refusing percutaneous biopsy techniques.Fluid obtained by catheter biopsy can be submitted to both cytology and bacterial cultivation.
The goal of our study was to evaluate sensitivity of prostatic catheter biopsy as a method in clinical practice partially forgotten and to express its importance in the management of canine prostatic disorders.
2004 and June 2006, with various prostatic symptomatologies, with the age between 4 and 13 years, weighing between 1.5 kg and 80 kg.The most often observed symptoms included: tenesmus, haematuria, urethral discharge, recurrent low-urinary tract infection, dysuria, perineal herniation, lethargy, vomitus and caudal abdominal pain.Some of the patients were referred with a prostatic disease by a local veterinarian.

Inclusion criteria
For each patient we obtained detailed history (previous and recent problems, diseases and accidents, related to the urinary tract) and complete physical examination was performed accordingly.Specifi c examination of the urinary tract along with prostatic palpation always followed.The evaluation of the urinary tract included routine urinalysis with specifi c gravity analysis and urinary sediment examination after aseptic cystocentesis.Then, routine ultrasonography of the urinary tract followed (Pro Sound 5000 SSD, Aloka Co., LTD, Japan).After that, rectal palpation was performed with the help of caudodorsal abdominal pressure.Rectal palpation was evaluated according to Krawiec (1994); data are presented in the Table 1.
Generally, patients included in the study showed clinically manifest prostatic disorders according to history and physical examination, with signifi cant changes revealed by rectal palpation, with or without positive urinalysis.

Sample obtaining
All samples were collected after 24-hour period of fasting, from sedated patients (medetomidine 10μg/kg, butorphanol 1mg/kg, both i.v.).Whenever needed, general anaesthesia was introduced using propofol 1mg/kg i.v.. Then we performed USG-guided aseptic cystocentesis, prostatic catheter biopsy, USG-FNAB, and fi nally Tru-Cut percutaneous biopsy, proceeding from the least invasive method to the most aggressive one.The patient positioning was always in dorsal or dorso-lateral recumbence.

Catheter biopsy
Preputium was repeatedly fl ushed with sterile saline solution.Then, aseptic catheterisation (sterile canine urinary catheter, lubricated by mesocain gel) of the urinary bladder was performed.All urine was meticulously removed and bladder was fl ushed by sterile saline solution.Catheter was partially withdrawn under the control of rectal digital palpation and left close to the caudal border of prostatic urethra.Afterwards, digital massage of the prostate gland was carefully performed (about 2 minutes).Whenever prostate could not be reached rectally, caudal abdominal massage was performed instead, while the position of the catheter was controlled by ultrasonography.Approximately 1 minute after commencing of massage, negative pressure was gently applied by an assistant, using a 10cc syringe.Moving the catheter back and forth (with the gap of about 10 mm) facilitated fl uid collection.After collecting prostatic fl uid, syringe was disconnected and catheter was left in place for further procedures.
Ultrasound-guided fi ne needle aspiration biopsy.Parapreputial region was clipped and aseptically scrubbed.Then, 22G needle put on a 20cc syringe was introduced under USG control deep into prostatic glandular tissue, negative pressure through the syringe was applied and the needle was manipulated within the gland repeatedly.After releasing negative pressure, the needle was withdrawn and its content was pushed out to the slide, as well as to the cultivation media (Amies).

Sample evaluation
The basic data we obtained from a brief analysis of Hepta-phan strips (pH, total protein concentration, glucose, ketones, urobilinogen, bilirubin and traces of blood) were interpreted in the scale from 0 to ++++ and recorded in the protocol of each patient.The other examinations were performed as usual.

Prostatic disease
Rectal Cytology of samples Cytology was performed blindly on samples obtained from both Catheter biopsy and USG-guided fi ne needle aspiration biopsy without any knowledge of histopathology (Bell et al. 1991;Dorfman and Barsanti 1995;Peter et al. 1995;Baker and Lumsden 1999).Moreover, we established grading system for severity of infl ammation during examination of the urine sediment in × 400 magnifi cation using the light microscope (Table 3).Infl ammation was considered acute whenever neutrophils reached at least 70% of all infl ammatory cells, whereas it was considered chronic whenever macrophages reached the borderline of 50% of all cells (Rebar 1987).Differentiations between cysts and abscesses were performed based on cytology of the aspirate.

Histopathology of the prostate
Histopathology of each bioptate was performed at the Department of Pathology, Faculty of Veterinary Medicine, and then evaluated according to Atilola and Pennock (1986), Lowseth (1990), Nielsen andKennedy (1990), andBell et al. (1991).It was considered confi rmative for evaluation of each less-invasive diagnostic procedure (USG-FNAB and catheter biopsy).

Tissue cultivation
Any bacterial growth identifi ed from urine after cystocentesis or FNAB sample was considered positive, while only more than 10 3 of bacteria in 1 ml were regarded for prostatic catheter biopsy (Barsanti and Finco 1989).

Statistical analysis
The results were put into tables to be analyzed statistically using McNemara´s test.On specifi c occasions, the Positive correlation test was applied and p value was set at 0.05 for signifi cance and at 0.01 for high signifi cance.Basic ratio was often expressed in per cent (%).

Urinalysis
Urine was found negative in 7 patients; traces of blood were found in 17 patients (in 5 of them as the only fi nding); proteinuria was discovered in 16 patients (in 5 of them as the only fi nding).A combination of microscopic haematuria and proteinuria was found in 11 patients (and in 5 without any other fi nding).Alkaline pH was found in 7 dogs, while in 1 patient a combination of alkaline pH and haematuria and in 6 of them a combination with proteinuria was found.The urine sediment evaluation revealed similar data, with 7 dogs negative and 11 cases with typical moderate and 4 severe infl ammatory changes (Tables 3 and 5).

Palpation of the prostate gland
Based on criteria set up by Krawiec (1994) (Table 2), after rectal palpation, the preliminary diagnosis of BPH was established in 19 patients, even though histopathology revealed BPH in only 12 cases.In this case, the difference of false positive results was statistically signifi cant (p < 0.05).Chronic prostatitis was discovered by palpation in 4 patients only, while histopathologically the chronic infl ammation was confi rmed in 16 cases.This difference was statistically highly signifi cant for false negative results (p < 0.0006).In 4 patients we discovered acute prostatitis, while in 11 patients fl uctuations (cysts or abscesses) were found: 6 in combination with BPH, 1 along with chronic and 3 along with acute prostatitis (Table 5).

Ultrasonography
By means of ultrasonography, we discovered prostatic enlargement in 28 out of 29 patients, while in one case the size of the gland was decreased (see Table 4 and 5).Based on literature (Feeney et al. 1987;Lamb 1990;Bell et al. 1991;Lüerssen 1993;Prűfer et al. 2000), we attempted to establish the diagnosis of BPH in 14 cases, chronic prostatitis in 12 patients, while cysts or abscesses were observed in 18 cases (Tables 4 and 5).
The diagnosis was based on histopathology and cytology after catheter biopsy and (USGguided) fi ne needle aspiration biopsy.
Histopathology revealed BPH in 12 dogs, chronic prostatitis in 16 dogs and acute prostatitis in 1 dog.There were some other histopathological changes, not necessarily related to the fi nal diagnosis.These changes are listed in Table 6.For transparency, we show relevant data in parentheses for each diagnostic procedure of the scope.
Based on prostatic catheter biopsy we diagnosed BPH in 16 cases (12 based on histopathology), chronic prostatitis in 9 cases (16 based on histopathology) and acute prostatitis in 4 patients (1 based on histopathology).For chronic prostatitis it means 7 false negative cases, which is statistically highly signifi cant difference compared to histopathology (p < 0.009).For acute prostatitis, we found insuffi cient number of patients to make statistical conclusions, so we can only postulate that 1 false positive case of acute .Again, a high number of false negative cases of chronic infl ammation were found.Six patients make a statistically signifi cant difference (p < 0.05) compared to histopathology (see Table 6).
Comparsion of rectal palpation and ultrasonography with cytology (after USG-FNAB or CB) and histopatology After rectal palpation, the same results as after catheter biopsy (CB) were found in 62.04% (n = 18), whereas the same results as after USG-FNAB were found in 55.17% of cases (n = 15).Correlation between rectal palpation and confi rmative histopathology was in 51.72% (n = 15).
Ultrasonography suggested the same diagnosis as all the other methods in 44.82% (n = 13) (Table 6).
Generally, prostatic Catheter biopsy revealed the same results as confi rmative histopathology in 75.86% (n = 22), while USG-guided Fine needle aspiration biopsy revealed the same results as histopathology in 72.41% (n = 21).With that regard, the difference between groups was not statistically signifi cant.

Bacterial cultivation
Cultivation of prostatic fl uid obtained from catheter biopsy appeared positive in 13 cases, while cultivation of fi ne needle aspirate gave only 2 positive results (statistically highly signifi cant difference, p < 0.0001), and urine cultivation revealed 6 positive results only.Of these 13 positive patients, 8 suffered from chronic infl ammation, confi rmed by histopathology, whereas in 4 cases, BPH was the reason and in 1 case, acute prostatitis was revealed.Cultivation of aspirate from cysts or abscesses gave 1 positive result out of 9. When we applied our grading system of infl ammation (Table 2), we found that 100% of the sediment with "strong infl ammation" revealed a pathogen by cultivation.On the other hand, we found all samples of "intact" sediment (n = 7), as well as samples containing "erythrocytes only" (n = 7), negative (no pathogen was identifi ed after cultivation).In cultivation of the sediment revealing mild infl ammation, only 3 samples of 11 (27.27%)revealed any pathogen.

Discussion
The reasons why the owners sought the help of a veterinarian were most frequently tenesmus, followed by lethargy of unknown origin, urethral discharge, haematuria and vomitus.According to Read and Bryden (1995), bloody urethral discharge is the most common symptom, observed as the only irregularity in 72% patients.In our study, only 6 480  Dorfman and Barsanti (1995), we observed in various combinations (Table 1).We agree with other authors (White 2000), that rectal palpation, often with caudal abdominal pressure, is essential in physical examination of patient suspect of prostatic disorder.However, we feel that palpation as a tool for establishing preliminary diagnosis, as reported by Krawiec (1994) does not provide suffi cient information, nor does it express enough sensitivity, especially to decide between chronic prostatitis and benign prostatic hyperplasia.In our settings, we found rectal palpation to be dependable only in 51.72% cases in comparison with histopathology.The difference was statistically highly signifi cant (p < 0.0006) for BPH and signifi cant (p < 0.05) for chronic infl ammation.In our opinion, prostatic rectal palpation can be only explained in the context with other diagnostic tests and procedures.In our study, we identifi ed 4 pathogens altogether.Unlike Krawiec and Heflin (1992), reporting E. coli as by far the most frequent agent found in the prostatic fl uid in 70%, we did not observe any other such strong predominance of the pathogen.After cultivation of urine, some quite interesting results were disclosed.In 6 patients (out of 13), the pathogen from the prostatic fl uid was identifi ed, with negative urine cultivation, and, moreover, in patients 9 and 10, different pathogens from prostatic fl uid and urine were isolated, suggesting that the prostate can be easily invaded by different bacteria than the urinary bladder.In light of this knowledge we postulate that cultivation of the urine alone is insuffi cient as a diagnostic procedure for prostatic disorders.
Cultivation of FNAB samples was positive in patient number 21 and 11.In patient 21, Streptococcus pyogenes was isolated from the fi ne needle aspirate, as well as from the abscess cavity.The difference between cultivation of the prostatic fl uid and the fi ne needle aspirate is arguably the most appealing result of our study.authors (Thrall et al. 1985;Ling et al. 1990) reporting the fi ne needle aspirate to be able to disclose the pathogen, in our study the accordance of FNAB and PM was achieved in two cases only.The difference was confi rmed as statistically highly signifi cant.We feel strongly that this may be a good reason to use prostatic catheter biopsy as the fi rst-choice method for primary pathogen identifi cation.The discrepancy can be explained by the small amount of tissue obtained by FNAB, by rather random sample obtaining, and by the fact that prostatic massage stimulates the discharge of the fl uid from the whole gland, which makes the sample more practical to use for examination.Possible contamination of the fl uid from the urinary bladder or urethra does not seem to be a problem, as the same pathogen in the prostatic fl uid as in urine was isolated only in 4 cases, while in two other cases different pathogens in the prostatic fl uid and urine were identifi ed.In the rest of the cases, urine was found sterile, even though the prostatic fl uid revealed a pathogen quite clearly.This is another evidence that the isolated pathogen originates certainly from the prostate gland.Ling et al. (1990) reported accordance in cultivation of the prostatic fl uid with direct glandular tissue cultivation in 80 to 100%.By ultrasonography we used and appreciated the predictive formula set by Ruel et al. (1996) for quantifi cation of prostatic enlargement.However, though otherwise useful, ultrasound seems to be rather too rough to establish a defi nite diagnosis.Diffi culties are apparent especially in differentiating between BPH and chronic prostatitis.Moreover, according to Lamb (1990), the prodromal stage of BPH is ultrasonographically unrecognizable from healthy glandular tissue.On the other hand, early identifi cation of prostatic cavities and, sometimes, differentiation of cysts and abscesses may be helpful.Whenever needed, USGguided aspiration of cavity, and evaluation of aspirate is recommended (Luersen 1993;Prüfer et al. 2000).In our experience, prostatic catheter biopsy revealed better results than the prostatic lavage advocated by some authors.As a major advantage we consider collecting of the fl uid immediately after its discharge into the urethra, so contamination can be almost avoided.Compared to FNAB, a much larger amount of fl uid directly from the gland can be taken as an advantage.Only in patients with general fi brosis of glandular tissue, some problems can be experienced with fl uid obtaining.
Powe ( 2004) considers cytology as a more sensitive method than histopathology in patients with bacterial prostatitis, especially for easier identifi cation of etiologic agents.Although Thrall et al. (1985) describe up to 96% of accordance between prostatic histopathology and cytology, in our study, only 82.76% of results of cytology (after both FNAB and CB) came back from histopathology with the same fi nal diagnosis, while accordance between samples obtained by FNAB and those collected by CB was as low as 75.86%.Extremely diffi cult seems to be the differentiation between chronic prostatitis and BPH.In our study we found a high rate of false negative results for both FNAB (p < 0.05, statistically signifi cant), and CB (p < 0.009, statistically highly signifi cant).Even though some authors give high credit to FNAB, reporting sensitivity up to 80% (Barsanti et al. 1983;Nickel and Teske 1992;Powe 2004) compared to histopathology, in our study we found the accordance of FNAB cytology with histopathology just about 72%, with a small but non-signifi cant increase after catheter biopsy.We feel that prostatic catheter biopsy gives more volume of the directly collected prostatic fl uid, as well as a better reproducible sample for examination.Moreover, it provides better reproducibility of bacterial cultivation.Fine needle aspiration is essential in differentiation of cysts from abscesses and vice-versa.
In summary, prostatic catheter biopsy is often more acceptable for the owner, it is less painful and there is no risk of peritonitis during the procedure (unlike during FNAB-moving needle just withdrawn from infl ammated tissue).Manual ejaculation, recommended by some authors (Kay et al. 1989) is another method of collecting the prostatic fl uid; however, this is less tolerated by patients suffering from prostatic pain.The success rate of such method in patients with prostatitis is around 30% (Barsanti and Finco 1989;Kay et al. 1989).
The goal of our study was to explore prostatic catheter biopsy (CB) as a valid diagnostic procedure.We tried to compare it with other well-established methods, namely rectal palpation, ultrasonography and USG-guided fi ne needle aspiration biopsy (USG-FNAB).Histopathological examination was used as a confi rmative.In the end we succeeded to prove that CB is no worse that USG-FNAB in establishing fi nal diagnosis.Both methods appear less sensitive (highly signifi cantly) in confi rmation of chronic prostatitis.Moreover, in our settings, CB was clearly superior (highly signifi cantly) to USG-FNAB in obtaining samples for bacterial cultivation and fi nal pathogen isolation.Early diagnosis, along with a precise choice of antibiotic treatment is very important for the control of most prostatic disorders.

Table 5 .
Preliminary diagnosis established after urinalysis, rectal palpation and ultrasonography