The more complete and competent the diagnosis of prostatitis, the more effective subsequent therapywill be. The formal approach of a doctor can lead to prolonged and ineffective treatment of the patient. Its task is to identify inflammation of the prostate and all the provoking factors.
How doctors diagnose prostatitis
Prostatitis is diagnosed by a urologist or andrologist. After talking with the patient, the doctor prescribes the necessary tests: first, a standard set (blood, urine, prostate secretions, rectal examination), then, if specified, more detailed and high-tech methods are used: CT, MRI, ultrasound.
Taking the anamnesis
During the initial consultation, the doctor will ask the following questions:
- Duration of sexual intercourse (if it has become shorter, then under what circumstances);
- The presence of discomfort in the groin during prolonged stay in a static position, as well as after drinking alcohol or hypothermia;
- Frequency and speed of urination (are there any difficulties, intermittent flow, do you often have to get up to use the toilet at night);
- Quality of orgasm (still bright or blurred, pain during ejaculation).
The more details the patient remembers, the more complete the clinical picture made by the doctor will be.
Differential diagnostics
The symptoms of prostatitis are similar to those of a number of other diseases:
- Cystitis (spasms when urinating, pain in the lower abdomen).
- Adenoma (difficulty urinating, feeling of heaviness in the groin).
- Prostate cancer (blood in urine, urination problems).
- Rectal pathologies: hemorrhoids, paraproctitis (inflammation), anal fissures, creptitis (ulcerative colitis).
Additional diagnostic methods and the rationale for their use are shown in Table 1.
Table 1. Differential diagnosis of prostatitis
| Illness | Risk Group | Analyzes |
|---|---|---|
| Hyperplasia | Men over 45 with no history of urethritis, catheterization, bladder and urethral trauma (circumstances that may explain pain, blood in urine) | Prostate ultrasound and digital examination |
| Prostatitis | Mostly young men who have recently suffered from fever, hypothermia, in the history of which there are no provoking factors (identical to hyperplasia) | ultrasound, complete blood count (CBC), digital prostate examination |
| Prostate cancer | Men over 45, no history of provoking factors | Prostate ultrasound, PSA analysis, digital examination |
If necessary, other specialized doctors are involved in the diagnosis: proctologist, neurologist, vertebrologist. The last two specialists identify the causes of pain associated with a violation of the structure of the spine, a violation of the nerve endings.
Rectal palpation
Digital rectal examination is the most accessible and informative method for checking the condition of the prostate. During the procedure the doctor pays attention to the following parameters of its structure:
- Volume;
- Density;
- Surface roughness;
- Homogeneity (tissue homogeneity);
- Borders (clarity of contours);
- Save the isthmus (longitudinal seam between the lobes).
In prostatitis, the gland enlarges due to swelling (asymmetry is possible), its consistency is elastic, the longitudinal groove (suture) is not felt and the patient may feel pain when touched.
For a clear picture of this type of diagnosisit is necessaryprepare:
- Do not ejaculate the day before, do not drink alcohol, avoid strenuous exercise, hypothermia and overheating.
- Do not ride a bike for 24 hours, do not use rowing machines (do not injure or massage the prostate in this way).
- Before visiting a doctor, make an enema (a micro enema can be used) to clean the rectal ampoule.
You can feel the prostate at a depth of 3-5 cm from the anus. The doctor performs the procedure with sterile gloves, lubricating the finger with gel. The patient lies on his side with his knees folded or stands in a knee-elbow position.
Laboratory methods
Laboratory methods for diagnosing prostate inflammation include testing for biomaterials for pathogens.
Blood
Based on the results of general and biochemical blood tests (take a capillary from a finger), prostatitis can be suspected at an early stage. The analysis is taken on an empty stomach in the morning. You should refrain from smoking one hour before the procedure.
Significant indicators:
- Leukocytes (blood cells, the number of which increases with decreasing immunity against the background of inflammatory reactions). Usually from 4-9 × 10 ^ 9 units;
- ESR (erythrocyte sedimentation rate). The norm is about 5 units, the increase indicates inflammation or cancer;
- Lymphocytes. Usually their percentage of total blood cell volume varies from 18 to 40 units. Excess means infection.
Men over the age of 40 are prescribed a test for PSA, a tumor marker that exceeds chronic prostatitis or prostate cancer.Norm- less than 4 ng / ml, after 50 years - 5, 53 ng / ml.
Urine
The urethra passes through the prostate (the prostate part of the urethra), so when the gland becomes inflamed, the urine changes color and consistency. Three types of analysis are used to diagnose prostatitis:
- General - determination of physical and chemical parameters. Signs of inflammation of the prostate: urine is cloudy, whitish, alkaline, there are proteins, leukocytes, purulent fibers, sometimes foam or blood. Phosphates are found in calculous prostatitis.
- Cytological - examination for the presence of pathologically altered cells. The presence of erythrocytes and epithelium may indicate a tumor process.
- Bacteriological - identification of traces of activity of pathogenic microorganisms. To do this, make a tank that sows sludge on a nutrient medium. If there are bacteria and fungi, after a while they begin to actively multiply. Escherichia coli often provokes prostatitis.
Before urinating, you should refrain from eating salty and spicy foods, do not consume alcohol and colorants (beets, coffee). The analysis is taken in the morning on an empty stomach.In prostatitis, the method with three glass tests is used:the patient urinates sequentially in each cup; the result is the first, middle and last part. This method allows you to identify the location of inflammation: the urethra, prostate, bladder. The four-glass method is more informative. The last portion of urine is collected after massaging the prostate to obtain its secretion.
Secret of the prostate and sperm
The juice produced by the prostate gland is a valuable diagnostic material. Prepare for his fence in the same way as for a rectal digital examination. For the volume of secrecy to be sufficient, you must abstain from sexual intercourse for three to five days.
Prostate secretion testing methods:
- Microscopy;
- Back seeding;
- PCR (polymerase chain reaction).
PCR is the most accurate method. Special enzymes are used to process the biomaterial, which multiply the number of DNA and RNA fragments of pathogens. The test requires a special device - an amflicator. Most accurate real-time PCR. The result is ready in an hour.
Inflammation of the prostate is indicated by the presence in its juice of amyloid bodies, staphylococci, streptococci, Pseudomonas aeruginosa, epithelial cells (more than three units in sight). The number of lipoid grains decreases and the number of leukocytes increases.
The spermogramfor prostatitis is an additional analysis. Against the background of inflammation of the prostate, the sperm become yellowish or brown, its viscosity increases (liquefies for a long time) and pathogenic microflora is present. In chronic prostatitis, epithelial cells of the gland, amyloid bodies and mucus are found.
Urethral tampon
Urethral swab (scraping) is a less informative method for diagnosing prostatitis than secretion analysis.Used in cases where it is impossible to get the latter due to hemorrhoids, exacerbation of inflammation, the presence of calcifications in the body of the prostate.
The procedure for taking the material is quick but inconvenient: the doctor dips a brush into the urethra, which captures part of the cells that cover it, along with microorganisms. The biomaterial is then examined by PCR, which allows you to determine the presence of pathogens in any quantity. The cause of prostatitis can be genital infections: chlamydia, Trichomonas, mycoplasma.
Before taking the test, you should refuse sexual intercourse for one day in the morning, perform only external hygiene procedures for the penis (do not pour anything into the urethra), do not urinate for two hours.
Instrumental methods
Instrumental diagnostic methods allow you to confirm and supplement the results of laboratory tests.
Ultrasound and TRUS
Ultrasound examination of the prostate makes it possible to visualize its structure, contours, the nature of tissue changes. In the case of prostatitis, transrectal ultrasound (TRUS) is considered the most informative: the doctor inserts the probe into the rectum. Prepare for the procedure in the same way as for palpation of the gland. Ultrasound of the abdomen (through the abdomen) is more comfortable for men, but the prostate is not fully visible due to the bladder.
In inflammation of the prostate gland, its structure is heterogeneous, the contours are blurred, foci of fibrosis (overgrown connective tissue), there may be scars. The prostate is enlarged, the furrow between her lobes is smoothed.
NMR, PET and CT
If the ultrasound gives reason to suspect the presence of a tumor process, the doctor prescribes CT (computed tomography) or MRI (magnetic resonance imaging) to clarify the picture. The latter type of research is more accurate, but also more expensive. The procedures are painless in terms of information content, they can replace a biopsy (pinching a piece of tissue).
CT and MRI show in detail the structure of the prostate: stones, cysts, tumors, inflammatory foci, structural abnormalities. For a clearer picture, a contrast agent is pre-injected into a vein (not used for men with kidney failure). An appropriate type of tomograph and rectal probe are used for the procedure.
PET - CT for positron emission. Allows you to analyze the condition of the prostate at the cellular and molecular level. It determines not only the presence and size of the tumor, but also the speed and quality of metabolic processes occurring in it.
On preparation:the rectum should be emptied. Do not eat five hours before the procedure.
Characteristics of the diagnosis of some types of prostatitis
Acute bacterial (infectious) prostatitis is diagnosed based on the patient's complaints, urine analysis, ultrasound, urethral smear. In active inflammation, the gland is painful, tranrectal interventions are not allowed, in extreme cases, careful examination of the fingers.
Laboratory data for the diagnosis of acute prostatitis are not very informative. Urine culture may be recommended but not required. With active inflammation, there is no time to wait for results. Antibacterial therapy with broad-spectrum drugs is performed to relieve symptoms.
Chronic prostatitis does not manifest itself in any way, which is why its detection requires a whole range of laboratory, physical, instrumental methods. The patient's immune and neurological status may need to be determined.
Palpation of the gland, urine and prostate secretions are paramount. The presence of more than 10 leukocytes in the visual field indicates inflammation. If the bacterial culture does not give growth of infectious microflora against the background of increased number of leukocytes, then analysis for genital infections is necessary.
With the bacterial nature of the inflammation, a large number of pathogens are found in urine and prostate juice. An indisputable microbiological sign of chronic inflammation: the number of microbes (CFU) is more than 104 per ml. Some of them are listed in the tens, so their presence in an amount of 10 to 102 per ml may indicate prostatitis.
In abacterial (non-infectious) inflammation, they are absent, but experts recommend in such cases to make a more in-depth analysis: a puncture of the prostate, which is used to extract pathogens living in closed prostate passages. At the same time, the bacterial culture is sterile, but the pathogen is eventually detected. Most often it is one of the varieties of E. coli.
Ultrasound does not always show chronic inflammation. In addition to the above methods, the doctor may prescribe uroflowmetry - measuring the flow rate of urine using special sensors.
Typical comorbidities
In long-term chronic prostatitis with signs of coliculitis (inflammation of the seminal tubercle to the prostate)urethroscopy is used - a visual examination of the canal using an endoscopic device. Helps to identify narrowing of the urethra, disorders of its structure, the condition of the openings of the secretory ducts of the prostate (mucus, pus, thickening) and seminal tubercle.
Interpretation of results (determination of the stages of prostatitis according to the condition of the seminal tubercle):
- First: the seminal tubercle is red, swollen, bleeding. The same pattern is observed in the back of the urethra;
- Second: periodic increase and decrease of redness and swelling is characteristic;
- Third: scar tissue occurs in the tissues of the tubercle and urethra, due to which the lumen of the ureter may narrow (stricture).
Ureteroscopy irritates the receptors of the seminal tubercle, which leads to impaired microcirculation and prostate motility, so the procedure is not performed unnecessarily.
Cystitis is also a companion to chronic prostatitis. Inflammation of the bladder wall is detected by ultrasound andcystoscopy. During the examination, pathological changes in the mucous membranes are determined, especially in the area of the cervix. The condition of the bladder against the background of chronic prostatitis (sclerosis of the prostate):
- Cicatricial deformity of the bladder triangle.
- Dilated urethral openings.
- Narrowing of the neck.
Cystoscopy is prescribed at the last stage of the examination in the presence of pain in the lower abdomen and frequent urination.
The most difficult to diagnose is chronic abacterial prostatitis with pelvic pain of unknown origin. In such patients, doctors primarily conduct studies to rule out cystitis and neuropsychiatric pathologies.
How to diagnose prostatitis at home
The man may suspect acute prostatitis on the following grounds:
- Severe pain in the lower abdomen and groin (between the testicles and anus);
- Fever;
- Pain when urinating (such as cystitis);
- Early and painful ejaculation.
The same symptoms occur during exacerbations of chronic prostatitis provoked by hypothermia or alcohol intake. The development of this form of pathology can be evidenced by the periodic appearance of blood in the urine, dull pain in the perineum (especially in a static position), difficulty urinating, deterioration of erection. Such signs are the reason to contact a urologist.
Conclusion
The longer the inflammatory process in the prostate lasts, the more difficult the treatment will be, so you should not delay the diagnosis. In government agencies, most procedures and follow-up treatment are free.