The more complete and competent the diagnosis of prostatitis is, the more effective the subsequent therapy will be. A formal approach of a doctor can result in long and ineffective treatment for the patient. Its task is to identify inflammation of the prostate and all the factors provoking 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, MRI, ultrasound.
During the initial consultation, the doctor will ask the following questions:
- Duration of intercourse (if it became 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 jet, do you often have to get up to use the toilet at night);
- Orgasm quality (still bright or blurry, pain on ejaculation).
The more details the patient remembers, the more complete the clinical picture compiled by the doctor will be.
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 urine, problems with urination).
- 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
|Hyperplasia||Men over 45 years old with no history of urethritis, catheterization, trauma to the bladder and urethra (circumstances that could explain pain, appearance of blood in the urine)||Prostate ultrasound and digital examination|
|Prostatitis||Mostly young men who have recently undergone 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 years old, 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, infringement of nerve endings.
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:
- Surface roughness;
- Homogeneity (tissue homogeneity);
- Borders (clarity of 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 groove (suture) is not palpable, and when touched, the patient may feel soreness.
For a clear picture for this type of diagnosisit is necessaryprepare:
- 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, make an enema (micro enema can be used) to clean the ampoule of the rectum.
You can feel the prostate at a depth of 3-5 cm from the anus. The doctor carries out the procedure with sterile gloves, lubricating the finger with gel. The patient lies on his side with tucked knees or stands in a knee-elbow position.
Laboratory methods for diagnosing inflammation of the prostate involve the study of biomaterials for the presence of pathogens.
Based on the results of general and biochemical blood tests (take 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.
- Leukocytes (blood cells, the number of which increases with a decrease in immunity against the background of inflammatory reactions). Normally from 4-9 × 10 ^ 9 units;
- ESR (erythrocyte sedimentation rate). The norm is around 5 units, an increase indicates inflammation or an oncological process;
- Lymphocytes. Normally, their percentage of the total volume of blood cells ranges from 18 to 40 units. Exceeding means infection.
Men over 40 are prescribed a PSA test- a tumor marker, exceeding the 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 its color and consistency. For the diagnosis of prostatitis, three types of analysis are taken:
- General - determination of physical and chemical parameters. Signs of inflammation of the prostate: the urine is cloudy, whitish, alkaline, there is protein, leukocytes, purulent threads, sometimes foam or blood. With calculous prostatitis, phosphates are found.
- Cytological - examination for the presence of pathologically altered cells. The presence of erythrocytes and epithelium may indicate a tumor process.
- Bacteriological - identifying traces of the activity of pathogenic microorganisms. To do this, make a tank sowing sediment on a nutrient medium. If there are bacteria and fungi, then after a while they begin to actively multiply. Escherichia coli often provokes prostatitis.
Before passing urine, 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, the three-glass test method is used:the patient urinates alternately into each glass; the result is the first, middle and final portion. This method allows you to identify the localization of inflammation: urethra, prostate, bladder. The four-glass method is more informative. The last portion of urine is collected after prostate massage to obtain its secretion.
Prostate secret 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. In order for the volume of the secret to be sufficient, you should refrain from sexual intercourse for three to five days.
Methods for examining prostate secretions:
- PCR (polymerase chain reaction).
PCR is the most accurate method. For the processing of biomaterials, special enzymes are used that multiply the number of DNA and RNA fragments of pathogens. For research, a special device is required - an amphlicator. Most 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 per field of view). 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, the sperm becomes 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 for diagnosing prostatitis than secretion analysis.Used in cases where it is impossible to get the latter because of hemorrhoids, exacerbation of inflammation, the presence of calcifications in the body of the prostate.
The procedure for taking the material is quick, but uncomfortable: the doctor immerses a brush into the urethra, which captures part of the cells covering it along with microorganisms. Then the biomaterial is 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 a day, you should refuse sexual intercourse, in the morning, carry out only external hygienic 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 makes it possible 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 for palpation of the gland. An abdominal ultrasound (through the abdomen) is more comfortable for a man, but the prostate is not completely 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 (overgrown connective tissue), scars. The prostate is enlarged, the groove between its lobes is smoothed.
MRI, PET and CT
If 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 off a tissue fragment).
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 preliminarily injected into the vein (not used for men with renal failure). For the procedure, an appropriate type of tomograph and rectal probe are used.
PET - Positron Emission CT. 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 preparation:the rectum should be emptied. No food should be eaten for five hours before the procedure.
Features of the diagnosis of certain types of prostatitis
Acute bacterial (infectious) prostatitis is diagnosed on the basis of patient complaints, urinalysis, ultrasound, urethral smear. With active inflammation, the gland is painful, transrectal interventions are not allowed, in extreme cases, a careful finger examination.
Laboratory data for the diagnosis of acute prostatitis are not particularly informative. A urine culture may be advisable, but not required. 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, to identify it, a whole range of laboratory, physical, instrumental methods is required. Determination of the patient's immune and neurological status may be required.
Palpation of the gland, urine and prostatic secretions are of prime importance. The presence of more than 10 leukocytes in the field of view indicates inflammation. If the bacterial culture does not give the growth of infectious microflora against the background of an increased number of leukocytes, then an analysis for genital infections is necessary.
With the bacterial nature of inflammation, a large number of pathogens are found in the 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 are numbered in dozens, so their presence in an amount from 10 to 102 per ml may indicate prostatitis.
In abacterial (non-infectious) inflammation, they are absent, but experts recommend in such cases to conduct a more in-depth 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 still found in the end. Most often it is one of the varieties of E. coli.
Ultrasound does not always show chronic inflammation. In addition to the aforementioned methods, the doctor may prescribe uroflowmetry - measuring the flow rate of urine using special sensors.
For long-term chronic prostatitis with signs of colliculitis (inflammation of the seminal tubercle next to the prostate),urethroscopy is used - visual examination of the canal using an endoscopic device. 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 seminal tubercle.
Interpretation of results (determination of stages of prostatitis by the state of the seminal tubercle):
- First: the seed tubercle is red, edematous, bleeding. The same pattern is observed at the back of the urethra;
- Second: periodic increase and decrease in redness and swelling is characteristic;
- Third: cicatricial changes in the tissues of the tubercle and urethra occur, 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 unnecessarily performed.
Cystitis is also a companion of chronic prostatitis. Inflammation of the bladder walls is detected by ultrasound andcystoscopy. During the research, pathological changes in the mucous membranes are determined, especially in the neck area. The state of the bladder against the background of chronic prostatitis (prostate sclerosis):
- Cicatricial deformity of the bladder triangle.
- Dilated ureteral orifices.
- Neck narrowing.
Cystoscopy is prescribed already at the final stage of the examination in the presence of lower abdominal pain and frequent urination.
The most difficult to diagnose is chronic abacterial prostatitis with pelvic pain of undetermined origin. In such patients, doctors first of all conduct research to exclude cystitis and neuropsychiatric pathologies.
How to diagnose prostatitis at home
A man can suspect acute prostatitis by the following signs:
- Severe pain in the lower abdomen and groin (between the testicles and anus);
- Increased body temperature;
- Pain when urinating (like cystitis);
- Early and painful ejaculation.
The same symptoms appear during exacerbations of chronic prostatitis, provoked by hypothermia or alcohol intake. The development of this form of pathology may be indicated 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 procedures and follow-up treatment are free of charge.