The more complete and competent the diagnosis of prostatitis, the more effective the subsequent therapy. A formal approach by a physician can result in lengthy and ineffective treatment for the patient. Its task is to identify the inflammation of the prostate and all the factors that cause it.
How doctors diagnose prostatitis
Prostatitis is diagnosed by a urologist or andrologist. After talking with the patient, the doctor prescribes the necessary examinations: first, a standard set (blood, urine, prostate secretions, rectal examination), then, if indicated, more detailed and high-tech methods are used: CT, magnetic resonance, ultrasound.
Taking the anamnesis
During the initial consultation, the doctor will ask the following questions:
- Duration of the relationship (if it has become shorter, 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 (there are difficulties, intermittent jet, you have to get up often to go to the toilet at night);
- Quality of orgasm (still bright or fuzzy, pain on ejaculation).
The more details the patient remembers, the more complete the clinical picture filled in by the doctor.
The symptoms of prostatitis are similar to those of a number of other diseases:
- Cystitis (cramps when urinating, pain in the lower abdomen).
- Adenoma (difficulty urinating, feeling of heaviness in the groin).
- Prostate cancer (blood in the urine, problems with urination).
- Rectal disorders: hemorrhoids, paraproctitis (inflammation), anal fissures, creptitis (ulcerative colitis).
Further diagnostic methods and the reasons for their use are shown in Table 1.
Table 1. Differential diagnosis of prostatitis
|Hyperplasia||Men over 45 years of age with no history of urethritis, catheterization, bladder and urethral trauma (circumstances that could explain pain, blood in urine)||Prostate ultrasound and digital examination|
|Prostatitis||Mostly young men who have recently suffered fever, hypothermia, in whose history there are no provoking factors (identical to hyperplasia)||ultrasound, complete blood count (CBC), digital prostate exam|
|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, violation of nerve endings.
Digital rectal examination is the most accessible and informative method to check the condition of the prostate. During the procedure, the doctor pays attention to the following parameters of its structure:
- Surface roughness;
- Homogeneity (homogeneity of the tissue);
- Edges (clarity of the outline);
- Preservation of the isthmus (longitudinal suture between the lobes).
In prostatitis, the gland is enlarged due to edema (asymmetry is possible), its consistency is elastic, the longitudinal sulcus (suture) is not palpable, and the patient may feel pain when touched.
For a clear picture for this type of diagnosisit is necessaryto prepare:
- Do not ejaculate the day before, do not drink alcohol, avoid heavy physical exertion, hypothermia and overheating.
- Do not ride a bike for a day, do not use rowing machines (do not injure or massage the prostate in this way).
- Before visiting a doctor, do an enema (a micro enema can be used) to clean the rectal vial.
You can feel the prostate at a depth of 3-5 cm from the anus. The doctor carries out the procedure in sterile gloves, lubricating the finger with gel. The patient lies on his side with his knees bent or is in the knee-elbow position.
The laboratory methods for the diagnosis of inflammation of the prostate involve the study of biomaterials for the presence of pathogens.
Based on the results of general and biochemical blood tests (taking capillaries from a finger), prostatitis can be suspected at an early stage. The analysis is performed on an empty stomach in the morning. One should refrain from smoking one hour before the procedure.
- Leukocytes (blood cells, the number of which increases with a decrease in immunity against the background of inflammatory reactions). Normally 4-9 × 10 ^ 9 units;
- ESR (erythrocyte sedimentation rate). The norm is about 5 units, an increase indicates inflammation or an oncological process;
- Lymphocytes. Normally, their percentage of the total volume of blood cells varies from 18 to 40 units. Excess means infection.
Men over 40 are prescribed a PSA test- a tumor marker, the higher value of which means chronic prostatitis or prostate cancer.Norm- less than 4 ng / ml, after 50 years - 5. 53 ng / ml.
The urethra passes through the prostate (the prostatic part of the urethra), so when the gland becomes inflamed, the urine changes color and texture. For the diagnosis of prostatitis, three types of analyzes are taken:
- General - determination of physical and chemical parameters. Signs of inflammation of the prostate: urine is cloudy, whitish, alkaline, there are proteins, leukocytes, purulent threads, sometimes foam or blood. With calcareous prostatitis, phosphates are found.
- Cytological - examination for the presence of pathologically altered cells. The presence of erythrocytes and epithelium can indicate a tumor process.
- Bacteriological: identification of traces of the activity of pathogenic microorganisms. To do this, create a reservoir that sows sediment on a nutrient medium. If there are bacteria and fungi, then after a while they begin to actively multiply. Escherichia coli often causes prostatitis.
Before urinating, refrain from eating salty and spicy foods, do not consume alcohol and coloring products (beets, coffee). The analysis is carried out in the morning on an empty stomach.For prostatitis, the three-glass test method is used:the patient urinates alternately in each glass; the result is the first, the central and the final part. This method allows you to identify the localization of inflammation: urethra, prostate, bladder. The four cup method is more informative. The last urine sample is collected after the prostate massage to obtain its secretion.
Prostate secret and sperm
The juice produced by the prostate gland is a valuable diagnostic material. Prepare for her enclosure as for a digital rectal exam. In order for the volume of the secret to be sufficient, it is necessary to refrain from sexual intercourse for 3-5 days.
Methods for examining prostatic secretions:
- PCR (polymerase chain reaction).
PCR is the most accurate method. To process the biomaterial, special enzymes are used that multiply the number of DNA and RNA fragments of pathogens. Research requires a special device - an amphlicator. More precisely, 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 the visual field). The number of lipoid grains decreases and the number of leukocytes increases.
Thespermogram for prostatitis is an add-on analysis. Against the background of inflammation of the prostate, the sperm turns yellowish or brown, its viscosity increases (it liquefies for a long time), pathogenic microflora is present. In chronic prostatitis, epithelial cells of the gland, amyloid bodies and mucus are found.
Urethral swab (scraping) is a less informative method of diagnosing prostatitis than analysis of secretion.Used in cases where it is impossible to obtain the latter due to hemorrhoids, exacerbation of inflammation, presence of calcifications in the body of the prostate.
The procedure for withdrawing the material is quick, but inconvenient: the doctor dips a toothbrush into the urethra, which captures part of the cells that cover it together with the microorganisms. Then the biomaterial is examined by PCR, which makes it possible to determine the presence of pathogens in any quantity. The cause of prostatitis can be genital infections: chlamydia, Trichomonas, mycoplasma.
Before taking the analysis for a day, you should refuse sexual intercourse, in the morning, perform only external hygiene procedures of the penis (do not pour anything into the urethra), do not urinate for two hours.
Instrumental diagnostic methods allow you to confirm and supplement the results of laboratory tests.
Ultrasound and TRUS
Ultrasound examination of the prostate allows you to visualize its structure, contours, the nature of tissue changes. In 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 with palpation of the gland. An abdominal ultrasound (through the abdomen) is more comfortable for a man, but the prostate is not fully visible due to the bladder.
With inflammation of the prostate gland, its structure is heterogeneous, the contours are blurred, there may be foci of fibrosis (invaded connective tissue), scars. The prostate is enlarged, the groove between its lobes is smoothed.
MRI, PET and CT
If the ultrasound gives reason to suspect the presence of a tumor process, the doctor prescribes CT (computed tomography) or 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 anomalies. For a clearer picture, a contrast agent is preliminarily 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 with positron emission. It 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 the metabolic processes occurring in it.
Regarding the preparation:the rectum should be emptied. Do not eat for five hours before the procedure.
Features of the diagnosis of certain types of prostatitis
Acute (infectious) bacterial prostatitis is diagnosed based on patient complaints, urinalysis, ultrasound, urethral smear. With active inflammation, the gland is painful, transrectal interventions are not allowed, in extreme cases, careful examination of the fingers.
Laboratory data for the diagnosis of acute prostatitis are not particularly informative. A urine culture may be advisable, but not necessary. With active inflammation, there is no time to wait for results. To relieve symptoms, antibacterial therapy with broad-spectrum drugs is performed.
Chronic prostatitis practically does not manifest itself in any way, therefore its detection requires a whole series of laboratory, physical and instrumental methods. Determination of the patient's immune and neurological status may be necessary.
Palpation of the glands, urine and prostatic secretions are of primary importance. The presence of more than 10 leukocytes in the visual field indicates inflammation. If the bacterial culture does not provide the growth of infectious microflora against the background of an increased number of leukocytes, then an analysis for genital infections is required.
Given the bacterial nature of inflammation, a large number of pathogens are found in the urine and juice of the prostate. An undeniable microbiological sign of chronic inflammation: the number of microbes (CFU) is more than 104 per ml. Some of them are numbered in the dozen, so their presence in an amount of 10 to 102 per ml may indicate prostatitis.
In bacterial (non-infectious) inflammation they are absent, but experts advise in such cases to conduct a more thorough analysis - a puncture of the prostate, through which pathogens living in closed prostatic passages are extracted. 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 methods mentioned above, the doctor can prescribe uroflowmetry - measurement of the flow rate of urine using special sensors.
For long-term chronic prostatitis with signs of colliculitis (inflammation of the seminal tubercle near the prostate), urethroscopy, a visual examination of the canal using an endoscopic device, is used. Helps to identify the narrowing of the urethra, violations of its structure, the condition of the orifices of the excretory ducts of the prostate (mucus, pus, thickening) and the seminal tubercle.
Interpretation of results (determination of the stages of prostatitis based on the state of the seminal tubercle):
- First: the tubercle seed is red, edematous, bleeding. The same pattern is observed in the posterior part of the urethra;
- Second: periodic increase and decrease of redness and swelling are characteristic;
- Third: Scar changes occur in the tissues of the tubercle and urethra, as a result of which the lumen of the ureter can narrow (stricture).
Ureteroscopy irritates the receptors of the seminal tubercle, which leads to impaired microcirculation and prostatic motility, so the procedure is not done unnecessarily.
Cystitis is also a companion of chronic prostatitis. Inflammation of the bladder wall is detected by ultrasound andcystoscopy. During the research, pathological changes in the mucous membranes are determined, especially in the cervical region. The state of the bladder against the background of chronic prostatitis (prostatic sclerosis):
- Cicatricial deformity of the bladder triangle.
- Dilated ureteral orifices.
- Narrowing of the neck.
Cystoscopy is prescribed already in the final stage of the examination in the presence of lower abdominal pain and frequent urination.
The most difficult to diagnose is chronic bacterial prostatitis with pelvic pain of indeterminate origin. In such patients, doctors first of all conduct studies to exclude cystitis and neuropsychiatric pathologies.
How to diagnose prostatitis at home
A man may suspect acute prostatitis from the following signs:
- Severe pain in the lower abdomen and groin (between the testicles and the anus);
- Increased body temperature;
- Pain when urinating (such as cystitis);
- Premature and painful ejaculation.
The same symptoms appear during exacerbations of chronic prostatitis, caused 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 for contacting a urologist.
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 institutions, most follow-up procedures and treatments are free.