The more complete and competent the diagnosis of prostatitis, the more effective the subsequent therapy. A formal approach from a physician can result in lengthy and ineffective treatment for the patient. His 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 an andrologist. After speaking with the patient, the doctor prescribes the necessary tests: first, a standard set (blood, urine, prostate secretions, digital rectal examination), then, if indicated, more detailed and high-tech methods are used - CT, MRI, ultrasound.
Taking anamnesis
During the initial consultation, the doctor will ask the following questions:
- Duration of sexual intercourse (if shortened, then under what circumstances);
- The presence of discomfort in the groin during a long stay in a static position, as well as after drinking alcohol or hypothermia;
- Frequency and speed of urination (there is some difficulty, intermittent stream, you have to get up often to go to the bathroom at night);
- Quality of orgasm (still bright or fuzzy, pain when ejaculating).
The more details the patient remembers, the more complete the clinical picture prepared by the doctor will be.
Differential diagnosis
The symptoms of prostatitis are similar to those 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 urinating).
- 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 | Analysis |
|---|---|---|
| Hyperplasia | Men older than 45 years with no history of urethritis, catheterization, trauma to the bladder and urethra (circumstances that could explain the pain, appearance of blood in the urine) | Prostate ultrasound and digital exam |
| Prostatitis | Mostly young men who have recently suffered from 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 years old, with no history of provoking factors | Prostate ultrasound, PSA test, digital exam |
If necessary, other specialized doctors participate 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.
Rectal palpation
The digital rectal exam is the most accessible and informative method to check the status of the prostate. During the procedure, the doctor pays attention to the following parameters of its structure:
- Volume;
- Density;
- Surface roughness;
- Homogeneity (tissue homogeneity);
- Edges (outline clarity);
- Preservation of the isthmus (longitudinal suture between the lobes).
In prostatitis, the gland is enlarged due to edema (asymmetry possible), its consistency is elastic, the longitudinal groove (suture) is not palpable, and when touched, the patient may feel pain.
To have a clear idea 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 hurt or massage the prostate in this way).
- Before visiting a doctor, do an enema (a microenema can be used) to clean the blister from the rectum.
You can feel the prostate at a depth of 3-5 cm from the anus. The doctor performs the procedure wearing sterile gloves, lubricating the finger with gel. The patient lies on his side with his knees bent or stands in a knee and elbow position.
Laboratory methods
Laboratory methods for diagnosing inflammation of the prostate involve the study of biomaterials to detect the presence of pathogens.
Blood
Based on the results of general and biochemical blood tests (take a finger capillary), prostatitis may be suspected at an early stageThe analysis is performed on an empty stomach in the morning. You should 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). Usually 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, its percentage of the total volume of blood cells ranges between 18 and 40 units. Excess means infection.
Men over 40 are prescribed a PSA test, a tumor marker, the value of which exceeds the meaning of 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 prostate part of the urethra), so when the gland becomes inflamed, the urine changes color and consistency. For the diagnosis of prostatitis, three types of tests are taken:
- General - determination of physical and chemical parameters. Signs of inflammation of the prostate: the urine is cloudy, whitish, alkaline, there are proteins, leukocytes, purulent strands, sometimes foam or blood. With calculous prostatitis, phosphates are found.
- Cytological: examination to detect the presence of pathologically altered cells. The presence of erythrocytes and epithelium may indicate a tumor process.
- Bacteriological: identification of traces of the activity of pathogenic microorganisms. To do this, make a tank by sowing sediment in a nutrient medium. If there are bacteria and fungi, after a while they begin to multiply actively. 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 carried out in the morning on an empty stomach.For prostatitis, the three-vessel test method is used:the patient urinates alternately in each vessel; the result is the first, middle and last part. This method allows you to identify the location of inflammation: urethra, prostate, bladder. The four-cup method is more informative. The last portion of urine is collected after prostate massage to obtain its secretion.
Prostate and sperm secret
The juice produced by the prostate gland is a valuable diagnostic material. Prepare for your fence in the same way as for a digital rectal exam. In order for the volume of the secret to be sufficient, you need to refrain from sexual intercourse for three to five days.
Methods for examining prostate secretions:
- Microscopy;
- Backseeding;
- 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. The investigation requires a special device: an amplicator. 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 field of vision). The number of lipoid grains decreases and the number of leukocytes increases.
The spermogramfor prostatitis is an additional test. Against the background of inflammation of the prostate, the sperm turns yellowish or brown, its viscosity increases (it liquefies for a long time), and there are pathogenic microflora. In chronic prostatitis, epithelial cells of the gland, amyloid bodies, and mucus are found.
Urethral swab
Urethral swab (scraping) is a less informative method of diagnosing prostatitis than discharge analysis.It is used in cases where it is impossible to contract the latter due to hemorrhoids, exacerbation of inflammation, presence of calcifications in the body of the prostate.
The procedure to take the material is quick, but uncomfortable: the doctor immerses a brush in the urethra, which captures a part of the cells that cover it together with the microorganisms. The biomaterial is then examined using PCR, allowing 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 need to refuse sexual intercourse, in the morning, perform only external penile hygiene procedures (do not pour anything into the urethra), do not urinate for two hours.
Instrumental methods
Instrumental diagnostic methods allow you to confirm and complement laboratory test results.
Ultrasound and TRUS
Ultrasound examination of the prostate allows 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 fully visible due to the bladder.
With inflammation of the prostate gland, its structure is heterogeneous, the contours are blurred, foci of fibrosis (too large connective tissue), scars may be present. The prostate enlarges, the groove between its lobes is smoothed.
MRI, PET and CT
If the ultrasound gives reason to suspect the presence of a tumor process, then, to clarify the image, the doctor prescribes CT (computed tomography) or MRI (magnetic resonance imaging). 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 abnormalities. For a clearer image, a contrast agent is preliminarily injected into the vein (not used for men with kidney failure). An appropriate type of CT scanner and rectal probe are used for the procedure.
PET - positron emission CT. It allows you to analyze the state 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 that occur in it.
Regarding the 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 on the basis of patient complaints, urinalysis, ultrasound, urethral swab. With active inflammation, the gland is painful, transrectal interventions are not allowed, in extreme cases - a 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 required. With active inflammation, there is no time to wait for results. To alleviate symptoms, antibacterial therapy with broad-spectrum drugs is performed.
Chronic prostatitis is practically not manifested in any way, therefore its detection requires a wide range of laboratory, physical and instrumental methods. The immunological and neurological status of the patient may need to be determined.
Palpation of the gland, urine, and prostate secretions are of utmost importance. The presence of more than 10 leukocytes in the field of vision indicates inflammation. If the bacterial culture does not produce 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 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 the dozens, so their presence in an amount of 10 to 102 per ml may indicate prostatitis.
In abacterial (non-infectious) inflammation, they are absent, but experts recommend in such cases to carry out a more in-depth analysis - prostatic puncture, through which pathogens living in closed prostate passages are removed. At the same time, the bacterial culture is sterile, but the pathogen is still at the end. Most of the time it is one of the E. coli varieties.
Ultrasound does not always show chronic inflammation. In addition to the methods mentioned above, the doctor may prescribe urinary flowmetry - measurement of urine flow using special sensors.
Typical comorbidities
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 with an endoscopic device. It helps to identify the narrowing of the urethra, violations of its structure, the state of the orifices of the excretory ducts of the prostate (mucus, pus, bulge) and the seminal tubercle.
Interpretation of the results (determination of the stages of prostatitis by the state of the seminal tubercle):
- First: the seed tuber is red, edematous, bleeding. The same pattern is seen in the back of the urethra;
- Second: periodic increase and decrease in redness and swelling is characteristic;
- Third: scarring changes occur in the tissues of the tubercle and urethra, so that the lumen of the ureter can narrow (stenosis).
Ureteroscopy irritates the receptors of the seminal tubercle, which leads to disturbances of the microcirculation and motility of the prostate, so the procedure is not performed unnecessarily.
Cystitis also accompanies chronic prostatitis. Inflammation of the bladder wall is detected by ultrasound andcystoscopy. During the investigation, pathological changes in the mucous membranes are determined, especially in the neck area. The state of the bladder in the context of chronic prostatitis (prostatic sclerosis):
- Scarring deformity of the bladder triangle.
- Dilated ureteral orifices.
- Neck narrowing.
Cystoscopy is already prescribed in 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 may suspect acute prostatitis from the following signs:
- Severe pain in the lower abdomen and groin (between the testicles and the anus);
- Increase in body temperature;
- Painful urination (like 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, impaired erection. Such signs are the reason to contact a urologist.
Conclusion
The longer the inflammatory process lasts in the prostate, 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.