Prostatic Massage

Indications:

Cytological evaluation of cells/fluid from the prostate is a valuable diagnostic aid in the investigation of prostatic disease. The clinical signs associated with prostatic disease often relate to prostatomegaly and include difficulty in defaecation and/or micturation. Occasionally there will also be evidence of blood in the urine or blood at the tip of the penis.

On rectal examination, the gland may be symmetrically enlarged (maintaining a bilobed structure) or there may be unilateral or focal irregularities. These features are of clinical significance and should be noted where possible.

Prostatic Massage

In those patients in which it is possible to palpate the prostate gland per rectum, the following technique facilitates collection of cellular material.

Equipment:

• Urinary catheter of sufficient length to reach the base of the prostate gland
• 10 ml syringe
• Glass slides
• Sterile saline
• EDTA and plain tubes
• 1 operator and 1 assistant

Method 1 - Prostatic Massage

The urinary catheter is passed to the level of the base of the prostate gland. The position of the catheter can be confirmed by rectal palpation. The 10 ml syringe is attached to the end of the catheter and negative pressure applied by the assistant while the operator gently massages the prostate gland per rectum. Only a small amount of fluid/cells will be drawn into the catheter. The negative pressure is released, the catheter withdrawn, and squash preparations made of the material collected at the tip of the catheter.

It may be necessary to disconnect the syringe and flush air or saline through the catheter to dislodge the collected material. When the smears have been made, they should be rapidly dried. The airstream from a hairdryer is ideal for this. Air (warm/cool but not hot) should be directed onto the back of the slide from a distance of 6-8 inches.

Figure 1:

Method 2 - Prostatic Wash

This technique is used to collect additional material for cytological evaluation and microbiological studies. The technique is performed as for prostatic massage, but a small amount of sterile saline is flushed into the prostatic urethra and retrieved during prostatic massage. Samples for culture should be submitted in plain or boric acid containers. Additional material for cytological evaluation should be sent in EDTA since this anticoagulant aids in the cellular preservation. However, it is preferable for cytological evaluation to send air-dried slides of material collected by prostatic massage rather than prostatic wash (the saline may cause cell lysis).

Sample Submission

Unstained glass slides should be submitted in a plastic slide transporter (available from the laboratory upon request). Small (5 ml) boric acid urine containers are also available where bacteriology is required.