The more complete and competent the diagnosis of prostatitis, the more effective the later therapy will be. A formal physician approach can result in long-term and ineffective treatment of the patient. Its task is to recognize 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 to the patient, the doctor prescribes the necessary examinations: first a standard set (blood, urine, prostate secretions, rectal examination), and then, if indicated, more detailed and high-tech methods are used: CT, MRI, ultrasound.
Taking medical history
During the initial consultation, the doctor will ask the following questions:
- Duration of the relationship (if it has become shorter, under what circumstances);
- Presence of groin discomfort 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 jet, do you have to get up often to use the toilet at night);
- Quality of orgasm (still bright or cloudy, pain during ejaculation).
The more details a patient remembers, the more complete the doctor will be in the clinical picture.
Differential Diagnostics
The symptoms of prostatitis are similar to the symptoms 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 urine, problems with urination).
- Rectal pathologies: hemorrhoids, paraproctitis (inflammation), anal fissures, creptitis (ulcerative colitis).
Additional diagnostic methods and rationale for their use are shown in Table 1.
Table 1. Differential diagnosis of prostatitis
| Illness | Risk group | Analyzes |
|---|---|---|
| Hyperplasia | Men older than 45 years without a 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 had a fever, hypothermia, in whose history 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 experts identify the causes of pain associated with a violation of the structure of the spine, disruption of nerve endings.
Rectal palpation
Digital rectal examination is the most accessible and informative method for checking prostate condition. During the procedure, the doctor pays attention to the following parameters of his structure:
- Volume;
- Density;
- Surface roughness;
- Homogeneity (tissue homogeneity);
- Boundaries (clarity of outline);
- Preservation of the coating (longitudinal seam between the lobes).
In prostatitis, the gland is enlarged due to edema (asymmetry is possible), its consistency is elastic, the longitudinal groove (suture) is not palpable and when touched, the patient may feel pain.
For a clear picture of this type of diagnosisit is necessaryto prepare:
- Do not ejaculate the day before, do not drink alcohol, avoid strenuous physical exertion, 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).
- Make an enema (a micro enema can be used) to clean the rectal ampoule before visiting the doctor.
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 the side of the bent knees or stands in the knee-elbow position.
Laboratory methods
Laboratory methods for the diagnosis of prostatitis include the study of biomaterials for the presence of 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 for one hour before the procedure.
Significant indicators:
- Leukocytes (blood cells, the number of which increases with decreasing immunity in the background of inflammatory reactions). Usually from 4-9 × 10 ^ 9 units;
- ESR (erythrocyte sedimentation rate). The norm is about 5 units, an increase indicates inflammation or an oncological process;
- Lymphocytes. Usually, their percentage in the total volume of blood cells ranges from 18 to 40 units. Exceeding means infection.
Men over the age of 40 are prescribed the PSA test- a tumor marker whose value 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 prostatic part of the urethra), so when the gland becomes inflamed, the urine changes color and consistency. Three types of tests are used to diagnose prostatitis:
- General - determination of physical and chemical parameters. Signs of inflammation of the prostate: urine is cloudy, whitish, alkaline, has protein, leukocytes, purulent threads, sometimes foam or blood. Phosphates have been 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 - recognition of traces of activity of pathogenic microorganisms. To do this, make a container for sowing sediment on a nutrient medium. If there are bacteria and fungi, after a while they start to actively multiply. Escherichia coli often provokes prostatitis.
Before urinating, you should refrain from eating salty and spicy foods, do not consume alcohol and coloring products (beets, coffee). The analysis is taken in the morning on an empty stomach.For prostatitis, a three-glass test method is used:the patient urinates alternately in each glass; the result is the first, middle and final part. This method allows you to recognize the localization of inflammation: urethra, prostate, bladder. The four-cup method is more informative. The last part of the urine is collected after the prostate massage to get its secretion.
Secret of the prostate and sperm
The juice produced by the prostate is a valuable diagnostic material. Prepare for his fence in the same way as for a rectal digital examination. For the scope of the secret to be sufficient, you need to abstain from sexual intercourse for three to five days.
Prostate secretion test methods:
- Microscopy;
- Backseeding;
- PCR (polymerase chain reaction).
PCR is the most accurate method. Special enzymes that multiply the number of DNA and RNA fragments of the pathogen are used to process the biomaterial. A special device is needed for research - an amflicator. The most accurate real-time PCR. The result is ready in an hour.
Inflammation of the prostate is indicated by the presence of amyloid bodies, staphylococci, streptococci, Pseudomonas aeruginosa, epithelial cells (more than three units in the visual field) in its juice. The number of lipoid grains decreases and the number of leukocytes increases.Spermogramfor prostatitis is an additional analysis. Against the background of inflammation of the prostate, sperm become yellowish or brown, viscosity increases (liquefies for a long time) and pathogenic microflora is present. In chronic prostatitis, there are epithelial cells of the gland, amyloid bodies and mucus.
Urethral swab
Urethral swab (scraping) is a less informative method for diagnosing prostatitis than secretion analysis.It is used in cases when the latter is impossible to get due to hemorrhoids, worsening of inflammation, the presence of calcifications in the prostate body.
The process of taking the material is quick but inconvenient: the doctor immerses the brush in the urethra which affects the part of the cells that cover it together with the 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 analysis for one day, you should refuse sexual intercourse, in the morning perform only external hygienic procedures of the penis (do not pour anything into the urethra), do not urinate for two hours.
Instrumental methods
Instrumental diagnostic methods enable confirmation and supplementation of laboratory test results.
Ultrasound and TRUS
Ultrasound examination of the prostate makes it possible to visualize its structure, contours, the nature of changes in the tissues. In the case of prostatitis, transrectal ultrasound (TRUS) is considered the most informative: the doctor inserts a 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 a man, but the prostate is not fully visible due to the bladder.
In inflammation of the prostate, its structure is heterogeneous, the contours are blurred, there may be foci of fibrosis (overgrown connective tissue), scars. The prostate is enlarged, the groove between her 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 MRI (magnetic resonance imaging) to clarify the picture. This second type of research is more precise, but also more expensive. The procedures are painless, in terms of informative content they can replace a biopsy (pinching a fragment of tissue).
CT and MRI show in detail the structure of the prostate: stones, cysts, tumors, inflammatory foci, structural abnormalities. For a clearer picture, the contrast agent is previously injected into a vein (it is not used for men with renal insufficiency). The appropriate type of tomograph and rectal probe is used for the procedure.
PET - CT positron emission. It allows you to analyze the condition of the prostate at the cellular and molecular level. It not only determines the presence and size of the tumor, but also the speed and quality of metabolic processes that take place in it.
Regarding preparation:the rectum should be emptied. Do not eat for five hours before the procedure.
Diagnostic characteristics of certain types of prostatitis
Acute bacterial (infectious) prostatitis is diagnosed based on patient complaints, urine analysis, ultrasound, urethral swab. With active inflammation, the gland is painful, transrectal interventions are not allowed, in extreme cases careful examination of the finger.
Laboratory data for the diagnosis of acute prostatitis are not particularly informative. Urine culture may be recommended but not required. With active inflammation there is no time to wait for results. To alleviate the symptoms, antibacterial therapy with broad-spectrum drugs is performed.
Chronic prostatitis is practically not manifested in any way, so its detection requires a number of laboratory, physical, instrumental methods. It may be necessary to determine the patient's immune and neurological status.
Palpation of the gland, urine and prostate secretions are of the utmost importance. The presence of more than 10 leukocytes in the visual field indicates inflammation. If the bacterial culture does not give the growth of infectious microflora in the background of the increased number of leukocytes, then the analysis of genital infections is necessary.
In addition to the bacterial nature of inflammation, a large number of pathogens are found in urine and prostate juice. An undeniable microbiological sign of chronic inflammation: the number of microbes (CFU) is more than 104 per ml. Some of them number in the tens, so their presence in the amount of 10 to 102 per ml may indicate prostatitis.
In abacterial (non-infectious) inflammation, those absent, but experts in such cases recommend conducting a deeper analysis: a puncture of the prostate, which removes pathogens that live in closed prostate passages. At the same time, the bacterial culture is sterile, but in the end the pathogen is still found. It is most often one of the varieties of E. coli.
Ultrasound does not always show chronic inflammation. In addition to the above methods, your 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 vesicles near the prostate), urethroscopy is used- visual examination of the canal using an endoscopic device. It helps to identify narrowing of the urethra, violation of its structure, the condition of the opening of the excretory ducts of the prostate (mucus, pus, thickening) and seminal tubercles.
Interpretation of results (definition of the stage of prostatitis according to the condition of seminal tuberculosis):
- First: tubercle semen is red, edematous, bleeding. The same pattern is observed on the back of the urethra;
- Second: periodic increase and decrease of redness and swelling are characteristic;
- Third: cicatricial changes occur in the tissues of the tubercle and urethra, due to which the lumen of the ureter may narrow (stricture).
Ureteroscopy irritates the receptors of seminal tuberculosis, which leads to damage to the microcirculation and motility of the prostate, so the procedure is not performed unnecessarily.
Cystitis is also a companion of chronic prostatitis. Inflammation of the bladder walls is detected by ultrasound andcystoscopy. During the examination, pathological changes are found on the mucous membranes, especially in the neck area. Bladder condition on the background of chronic prostatitis (prostate sclerosis):
- Ugly deformation of the bladder triangle.
- Dilated ureter openings.
- Narrowing the neck.
Cystoscopy is prescribed already in the final phase of the examination in the presence of pain in the lower abdomen and frequent urination.
Chronic abacterial prostatitis with pelvic pain of undetermined origin is the most difficult to diagnose. In such patients, physicians primarily conduct research to rule out cystitis and neuropsychiatric pathologies.
How to diagnose prostatitis at home
A man may suspect acute prostatitis according to the following signs:
- Severe pain in the lower abdomen and groin (between testicles and anus);
- Increased body temperature;
- Pain when urinating (like cystitis);
- Early and painful ejaculation.
The same symptoms appear during the worsening 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, worsening of the erection. Such signs are a 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 institutions, most procedures and follow-up treatment are free.