The diagnosis of prostatitis includes more than 5 mandatory and 4 additional procedures. Only a rectal examination of the prostate gland or an ultrasound cannot tell for sure whether men have inflammation of the prostate. The reason is that many urological diseases have a similar clinical picture and only a complete differential examination eliminates the possibility of a wrong diagnosis.
How to pass a review
Men are recommended to undergo a prophylactic examination of the prostate by a urologist 1-2 times a year (prostatitis, adenoma and other pathologies of the prostate in the first stages are asymptomatic). When signs of illness appear, you should immediately go to a specialist. Such symptoms are pain in the lower abdomen and groin, difficulty urinating and erection.
The doctor begins by collecting the patient's complaints and history, then conducts a general examination. The next step when prostatitis is suspected is a rectal examination (palpation of the prostate through a man's rectum). Examination of the fingers allows the doctor to assess the following parameters:
- Prostate size.
- Surface (smooth or uneven).
- The density of the gland (soft or stony).
- The presence or smoothness of the central furrow.
- The man's sensitivity when probing the prostate (whether or not he feels pain).
Analyzes
If a rectal examination and history suggest prostatitis, the next step for the urologist is to refer the patient for laboratory testing. According to clinical standards, the following types of research are mandatory:
- clinical urinalysis;
- general blood analysis;
- urine culture for flora;
- when an infection is detected, the sensitivity of pathogens to antibiotics is determined.
A complete blood count helps to confirm acute prostatitis - with this diagnosis, an increase in the number of neutrophils is observed with a shift of the leukocyte formula to the left and a strong decrease in the level of eosinophils. It is also possible to increase the ESR. Chronic inflammation is characterized by a low hemoglobin content (below 100 grams per liter of blood).
To rule out prostate cancer, a blood serum is made for the content of PSA - prostate specific antigen. Its increased amount indicates the presence of tumors, but does not determine their nature (benign or malignant). To establish this parameter, a biopsy of the prostate is performed with a histological examination of the obtained material.
prostate secretion
During a rectal examination of the prostate, the urologist pays attention to the discharge. It is usually thick, odorless, white in color. The maximum volume is 1-2 drops (3-5 ml). It should not contain impurities of pus or blood, as this is a sign of disease. The consistency of the juice plays a role - if it comes out in clots, then the man has diverticular prostatitis. A more detailed study of the material allows laboratory studies.
Microscopic and bacteriological examination of prostate secretion is based on the number of leukocytes, lecithin grains, amyloid bodies, macrophages, pathogenic and opportunistic microorganisms. Prostatitis is characterized by deviations:
- Acute prostatitis: the color of the discharge is yellowish, the smell is sweet, the pH is acidic, there are less than half of the leukocytes and up to ¼ of the epithelial cells.
- Chronic bacterial prostatitis: yellow or brown color, sour smell, acidic pH, less than half of leukocytes, macrophages (over 15), many amyloid bodies.
- Chronic non-bacterial prostatitis: the color is reddish, brown, odorless, leukocytes are normal, macrophages (10-20) are detected, there are many amyloid bodies.
In some cases, the examination of the secretion does not allow to detect prostatitis due to incorrect indicators. Blurred data will be in the presence of inflammation in other organs, body temperature above 39 degrees. Taking material is not possible with contraindications for rectal massage (prostatic juice is extracted by this method): with exacerbation of hemorrhoids, anal fissures, tuberculosis of the prostate.
Urine
General and cytological analysis of urine do not require special preparation. One should collect the material in the morning before breakfast in a container (it is better to buy a sterile plastic container in a pharmacy). A few hours before, the patient is not recommended to empty the bladder and should not take drugs and alcoholic beverages the day before.
In the catarrhal form of the disease, deviations from the norm may not be observed in the general analysis of urine. In the case of prostatitis in the last stages, purulent threads are found in the examined material, which settle.
Examining a man's urine allows you to diagnose leukocyturia (an increase in the level of leukocytes that occurs during inflammation). A urine culture is done to determine the type of pathogens. Signs of urinary pathogens appear in infectious prostatitis or complications such as inflammation of the bladder and urethra or pyelonephritis.
urethral swabs
A smear from the urethra is a type of research confirming inflammation caused by pathogens such as Trichomonas, gonococci, Candida. It is prescribed if there is a syndrome of chronic pelvic pain, itching in the groin, rash on the penis, difficulty urinating. Examination of the material taken allows for a differential diagnosis - to distinguish between prostatitis, urethritis or sexually transmitted diseases, often with similar symptoms or occurring at the same time.
The disease is diagnosed only with a correctly taken Pap smear. The man will have to abstain from sex for 2 days before taking the material. One hour before the procedure, do not go to the toilet in a small way. If the patient takes NSAIDs or antibiotics, then it is useless to take this analysis - the data will be incorrect.
spermogram
Spermogram - analysis of a man's ejaculate. In addition to prostatitis, diseases of the seminal vesicles, testicles, and infertility can be diagnosed in this way. The material submitted by a man with a body temperature not higher than 39 degrees, who does not take antibiotics and refrains from sexual intercourse for 2-3 days will be correct. Prostate massage is not recommended one day before sperm donation.
The spermogram includes three types of research. Macroscopic analysis includes examination of the volume, color, viscosity and liquefaction time of the semen. Microscopic examination reveals the quantity and quality of sperm. Biochemical analysis determines the concentration in the ejaculate of fructose, zinc, alpha-glucosidase, L-carnitine. In bacterial prostatitis, antisperm antibodies can be detected.
In prostatitis, the spermogram can reveal a number of abnormalities. For example, reduced sperm volume (less than 1. 5 ml), low concentration of sperm in 1 ml (less than 15 million), asthenozoospermia (more than 40% of immotile sperm), achinospermia (more than 32%of the immotile spermatozoa).
Prostate tissue
When examining an enlarged prostate, it is not always possible to understand the nature of the seals and enlargements with the help of a rectal examination and urine and blood tests. It can be a benign pathology (adenoma, prostatitis) or malignant (cancer). Accurate diagnosis helps with microscopic examination of prostate tissue, which is obtained by biopsy.
The procedure is carried out as follows: a transrectal sensor for an ultrasound machine, at the end of which there is a gun with a biopsy needle, is introduced to the patient. With a sharp tip, a microscopic part of the gland tissue is cut and sent to the laboratory for examination. The examination is carried out by the method of comparing the parameters of the material with the norms of the Gleason table.
In congestive, viral or bacterial prostatitis, the cells of the gland appear reduced in size, the amount of connective tissue in the intercellular space increases. Atypical cells with altered nuclei will not be observed. If a person has prostate cancer, then the cells of the glands become large and gather in clusters, their unusual modifications are revealed.
Ultrasound, MRI and other methods
To confirm the diagnosis, as well as to determine the stage of development and the characteristics of the course of the disease, instrumental studies are carried out. For pathologies of the pelvic organs, the following research methods are used:
- traditional ultrasound;
- transrectal ultrasound;
- magnetic resonance imaging (MRI);
- CT.
These methods allow you to understand the shape, thickness, width, length of the prostate, its mass, structural uniformity, echogenicity, vascularization (vascular pattern). These parameters are necessary to determine urological pathologies: ultrasound, CT and MRI show inflammatory, proliferative, oncological diseases of the prostate gland.
The classic ultrasound has the greatest inaccuracy, but this method continues to be used because it is easy to use and affordable. Transrectal ultrasound is considered the "gold standard" in the detection of prostatitis, but prostate cancer is difficult to see this way (especially in the early stages). MRI and CT have the highest accuracy in determining tumors, but these are complicatedand expensive procedures, so they are performed when other research methods show a high probability of oncology.
View at home
The prostate can be examined at home and the main symptoms of urological pathologies can be identified. Of course, this will not be a diagnosis of chronic prostatitis, since it will not be possible to reliably determine the cause of the enlarged gland. But the presence of alarming signs during an independent examination of the body is an important reason for immediate contact with a urologist.
Just like that, without the need to conduct self-diagnosis, it is not worth it. Indications for home examination are:
- Disturbed urodynamics (frequent urges to urinate).
- Weak stream, inability to completely empty the bladder.
- Abdominal or groin discomfort (for example, painful urination).
- Decreased sexual desire, weakening of erection.
- Purulent impurities or change in the color of urine to white, brown.
- Spermatorrhea or prostorrhea (discharge from the penis).
At home, the examination follows the same scheme as in the doctor's office. First, the man must clean the intestines - after 10-12 hours, make an enema or take laxatives. Take a bath immediately before the procedure. Then lie on your side, bend your knees, insert your index finger into the rectum (pre-insert the tip of your finger and smear it with petroleum jelly on top).
Digital rectal examination is performed by probing the posterior wall of the intestine and detecting the adjacent prostate. The gland is easy to find - it feels like a small walnut to the touch. Bad symptoms: enlarged prostate, irregular shape, presence of tubercles, pain on probing.These signs signal an inflammation or other pathological process of the prostate gland. When they are identified, you should definitely go to a urologist, as a more accurate diagnosis and treatment plan is needed.