The more complete and competent the diagnosis of prostatitis, the more effective the subsequent treatment. A formal approach from a doctor can lead to long-term and ineffective treatment for the patient. Its task is to identify the inflammation of the prostate and all the factors that provoke 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, prostatic secretions, rectal examination), then, if indicated, more detailed and high-tech methods are used: CT, MRI, ultrasound.
Take the anamnesis
During the initial consultation, the doctor will ask the following questions:
- Duration of sexual intercourse (if it has become shorter, under what circumstances);
- The presence of discomfort in the groin during a prolonged stay in a static position, as well as after drinking alcohol or hypothermia;
- Frequency and speed of urination (are there any difficulties, intermittent spray, do you have to get up often to go to the toilet at night);
- Quality of orgasm (always bright or blurry, painful ejaculation).
The more details the patient remembers, the more complete the clinical picture produced by the doctor will be.
Differential diagnostics
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, 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
| Disease | Risk group | Analyzes |
|---|---|---|
| Hyperplasia | Men over 45 without a history of urethritis, catheterization, trauma to the bladder and urethra (possible circumstances for pain, presence of blood in the urine) | Prostate ultrasound and digital exam |
| Prostatitis | Especially young men who 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 exam |
| Prostate cancer | Men over 45, no history of provoking factors | Prostate ultrasound, PSA scan, digital exam |
If necessary, other specialist 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 nerve endings.
Rectal palpation
The digital rectal exam 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:
- Volume;
- Density;
- Surface roughness;
- Homogeneity (tissue homogeneity);
- Borders (outline clarity);
- 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 the patient may feel pain when touching.
For a clear picture for this type of diagnosisit is necessaryprepare:
- Do not ejaculate the day before, do not drink alcohol, avoid intense physical exertion, hypothermia and overheating.
- Do not ride a bike for a day, do not use rowers (do not injure or massage the prostate in this way).
- Before seeing a doctor, do an enema (a micro enema can be used) to clean the bulb from the rectum.
You can feel the prostate 3 to 5 cm from the anus. The doctor performs the procedure in sterile gloves, lubricating the finger with gel. The patient lies on his or her side with the knees bent or stands in a knee-elbow position.
Laboratory methods
Laboratory methods for diagnosing prostate inflammation involve the study of biomaterials for the presence of pathogens.
Blood
Depending on the results of general and biochemical blood tests (hair sample from a finger), prostatitis may be suspected at an early stage. The analysis is carried out on an empty stomach in the morning. You must refrain from smoking one hour before the procedure.
Significant indicators:
- 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 whose value exceeds the value of chronic prostatitis or prostate cancer.Standard- 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. For the diagnosis of prostatitis, three types of analyzes are performed:
- 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, we find phosphates.
- Cytologic - examining 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 sowing sediment on a nutrient medium. If there are bacteria and fungi, after a while they begin to actively multiply. Escherichia coli often causes 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, the three-glass test method is used:the patient alternately urinates in each glass; the result is the first, middle and last part. This method allows you to identify the localization of inflammation: urethra, prostate, bladder. The four-glass method is more informative. The last urine sample is taken after the prostate massage to obtain its secretion.
Secret of prostate and semen
The juice produced by the prostate is a valuable diagnostic material. Prepare for his closing in the same way as for a digital rectal exam. In order for the volume of the secret to be sufficient, you should refrain from sexual intercourse for three to five days.
Methods of examining prostatic secretions:
- Microscopy;
- Backseeding;
- PCR (polymerase chain reaction).
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. Research requires a special device - an amphlicator. Specifically, 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 (liquefies for a long time), pathogenic microflora is present. In chronic prostatitis, there are gland epithelial cells, amyloid bodies and mucus.
Urethral swab
The urethral swab (scraping) is a less informative method of diagnosing prostatitis than the analysis of secretions.Used in cases where the latter cannot be obtained due to hemorrhoids, exacerbation of inflammation, the presence of calcifications in the body of the prostate.
The material collection procedure is quick, but uncomfortable: the doctor plunges a brush into the urethra, which captures part of the cells that cover it with the 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, mycoplasmas.
Before carrying out the analysis, you should refuse sexual intercourse in the daytime, 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
The ultrasound examination of the prostate allows to visualize its structure, its contours, the nature of the tissue modifications. In case of prostatitis, the 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 fully visible because of the bladder.
With inflammation of the prostate, 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 orders a CT (computed tomography) or MRI (magnetic resonance imaging) to clarify the picture. The latter type of research is more precise, but also more expensive. The procedures are painless, in terms of informational content, they can replace a biopsy (pinching of 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 image, a contrast agent is first injected into the vein (not used for men with kidney failure). For the procedure, an appropriate type of tomograph and rectal probe is used.
PET - positron emission CT. 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 the metabolic processes that take place in it.
Regarding the preparation:the rectum must be emptied. No food should be eaten for five hours before the procedure.
Features of the diagnosis of certain types of prostatitis
Acute bacterial prostatitis (infectious) is diagnosed on the basis of patient complaints, urinalysis, ultrasound, urethral smear. With active inflammation, the gland is sore, 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 desirable, 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 hardly manifests itself in any way, therefore, its detection requires a variety of laboratory, physical and instrumental methods. Determination of the patient's immune and neurological status may be necessary.
Palpation of the gland, urine and prostatic secretions is essential. 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, an analysis of genital infections is necessary.
With the bacterial nature of inflammation in urine and prostate juice, a large number of pathogens are found. An undeniable microbiological sign of chronic inflammation: the number of microbes (CFU) is greater than 104 per ml. Some of them are numbered in the tens, so their presence in an amount of 10-102 per ml may indicate prostatitis.
In abacterial (non-infectious) inflammation they are absent, but in such cases experts recommend carrying out a more thorough analysis: puncture of the prostate, through which pathogens living in passages are extractedprostatic closed. 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-mentioned methods, the doctor may prescribe uroflowmetry - measurement of urine flow using special sensors.
Typical comorbidities
For long-term chronic prostatitis with signs of colliculitis (inflammation of the seminal tubercle near the prostate), urethroscopyis used - a 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 openings of the excretory ducts of the prostate (mucus, pus, thickening) and the seminal tubercle.
Interpretation of the results (definition of the stages of prostatitis by the condition of the seminal tubercle):
- First: the seed tuber is red, edematous, bleeding. The same pattern is observed at the back of the urethra;
- Second: a periodic increase and decrease in redness and swelling are characteristic;
- Third: scar changes in the tissues of the tubercle and urethra occur, due to which the lumen of the ureter can narrow (stenosis).
Ureteroscopy irritates the receptors of the seminal tubercle, resulting in impaired microcirculation and motility of the prostate, so the procedure is not performed unnecessarily.
Cystitis is also a companion of chronic prostatitis. Inflammation of the walls of the bladder is detected by ultrasound andcystoscopy. In the course of research, pathological changes in the mucous membranes are determined, especially in the neck area. The condition of the bladder against the background of chronic prostatitis (sclerosis of the prostate):
- Scarring deformity of the bladder triangle.
- Dilated ureteral orifices.
- neck narrowing.
Cystoscopy is already prescribed 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 these patients, doctors first conduct research to rule out cystitis and neuropsychiatric pathologies.
How to diagnose prostatitis at home
A man may suspect acute prostatitis by the following signs:
- Severe pain in the lower abdomen and groin (between the testicles and the anus);
- Increase in 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 consumption. 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 the erection. These signs are the reason to contact a urologist.
Conclusion
The longer the inflammatory process in the prostate, the more difficult the treatment will be, so you should not delay the diagnosis. In government agencies, most follow-up procedures and treatments are free.