For microscopy and culture obtained before antibiotic treatment - the most important but sometimes the most inconvenient to arrange from the Practice. The specimen must be a clean catch (or catheter specimen if there is difficulty in females) * and must be fresh on arrival at the laboratory (or refrigerated, overnight at most, until it can be delivered). The Lab may indicate a suspicion of contamination, rather than true infection on a report if there are a few cells or the organisms are of doubtful significance. The commonest organism cultured is E.Coli, other organisms are more likely to be associated with an underlying urinary tract abnormality, hospital acquired infection or an indwelling catheter.

A further MSU one week after treatment is also important. Persistent, rather than recurrent, infection is common with the presence of urinary tract abnormalities and is not always symptomatic.

We would not recommend routine use of broad spectrum antibiotics unless indicated by M.S.U. culture.

Cytology may be difficult to interpret until the infection is eliminated (as it is the presence of urinary calculi or irradiation cystitis).

Persistent cystitis symptoms with microscopic haematuria, in spite of adequate treatment for any infection present (refer early), may indicate chronic interstitial cystitis or transitional carcinoma in situ ("Malignant Cystitis" - cytology usually malignant).

Asymptomatic bacteriuria - all need investigation (although this is limited in pregnancy when treatment to avoid the common sequel of pyelonephritis is necessary - refer to Antenatal Clinic if need be.

Sterile pyuria - (not presenting as urethritis) - think of TB and other organisms failing to culture on normal media as well as interstitial cystitis.

"Prostatitis" - covers a number of syndromes characterised by varying degrees of perineal and pelvic pain, malaise, painful voiding of urine, poor stream and frequency. Infection with common entero-bacteria as for UTIs is easily demonstrated in some whilst in others the cause is obscure and treatment difficult. Symptoms are not always clearly defined, so microbiological findings are all important as a guide to classification and management.

In all cases before treatment starts, and as far as the patient in pain will allow, the following should be obtained - MSU, expressed prostatic secretions (EPS) from urethra or initial urine after prostatic massage.

Acute bacterial prostatitis - MSU and EPS (if obtained) both cultures positive. (Blood cultures may also be positive).

Can be a very severe illness with occasional septicaemia, prostatic abscess and acute retention. Severe cases need prompt admission. All cases need treatment for 6 weeks with an appropriate antibiotic after initial empirical treatment; Trimethoprim is suitable if the organisms are sensitive. Ciprofloxacin is an alternative in resistant cases.

Chronic bacterial prostatitis - MSU culture usually negative. EPS leucocytosis, culture usually positive.

Six week treatment as above. Relapse needs further investigation followed by more prolonged use of antibiotic or prostatic resection (especially if prostatic calculi are present).

"Non-bacterial" prostatitis - MSU "sterile" on normal media. Therefore, some cases infected with a range of fastidious organisms have been misfiled under this heading. Chlamydia and urea plasma have been implicated, for example, although few respond to Tetracycline treatment. Gonorrhoea and TB can also be missed if not specifically looked for - microbiological help needed at the outset and referral to STD Clinic, if appropriate. Some with completely negative findings, apart from EPS leucocytosis, may benefit from prostatic resection. The possible role of viruses has not been defined.

Prostadynia - MSU no significant cells and sterile on culture.

Sexual dysfunction may be an additional symptom to those listed above. Careful investigation of bladder outlet function and psychological factors needed with treatment according to the findings.