Diagnosis of prostatitis includes more than 5 mandatory procedures and 4 additional procedures. A single rectal prostate exam or ultrasound cannot tell for sure if men have an inflamed prostate. The reason is that many urological diseases have a similar clinical picture, and only a comprehensive differential study eliminates the possibility of misdiagnosis.
How to pass an inspection
Men are recommended to have a preventive examination of the prostate by a urologist 1-2 times a year (prostatitis, adenoma and other pathologies of the prostate are asymptomatic in the early stages). When signs of illness appear, you should immediately consult a specialist. These symptoms are pain in the lower abdomen and groin, difficulty urinating and erection.
The doctor begins by collecting the patient's complaints and anamnesis, and then conducts a general examination. The next step if prostatitis is suspected is a rectal exam (palpation of the prostate through a man's rectum). Finger research allows the doctor to assess the following parameters:
- The size of the prostate.
- Surface (smooth or bumpy).
- The density of the gland (soft or stony).
- The presence or smoothness of the central groove.
- The sensitivity of a man when probing the prostate (if he feels pain).
Normally, the prostate should have 2 well palpable symmetrical lobules and a groove in the middle. The diameter of a healthy prostate is 2. 5-3. 5 cm, in the longitudinal direction - 2. 5-3 cm. The surface should be even, without pronounced tubercles, sufficiently soft, but not loose. Any deviation from the listed features means prostatitis, prostate adenoma, fibrosis, cancer or other pathologies of the genitourinary system.
Analyzes
If a rectal exam and history suggest prostatitis, the urologist's next action is to refer the patient for laboratory testing. According to clinical standards, the following types of examinations are mandatory:
- clinical urine analysis;
- general blood analysis;
- sow urine for flora;
- when an infection is detected, the susceptibility of pathogens to antibiotics is determined.
A complete blood count helps to confirm acute prostatitis - with this diagnosis there is an increase in the number of neutrophils with a shift in the leukocyte formula to the left and a sharp decrease in the level of eosinophils. It is also possible to increase the ESR. Chronic inflammation is characterized by low hemoglobin content (less than 100 grams per liter of blood).
To exclude prostate cancer, a blood serum test is performed for the content of PSA - a prostate-specific antigen. Its increased amount indicates the presence of tumors, but does not determine their nature (benign or malignant). To find out this parameter, a prostate biopsy is performed with a histological study of the material obtained.
prostate secret
During a digital rectal examination of the prostate, the urologist pays attention to the secretion secreted. Normally it is 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 a 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 research.
The microscopic and bacteriological study of the secret of the prostate is based on the counting of leukocytes, lecithin grains, amyloid bodies, macrophages, pathogenic and opportunistic organisms. Prostatitis is characterized by deviations:
- Acute prostatitis: the color of the secret is yellowish, the smell is sweetish, the pH is acidic, there are less than half of leukocytes and up to ¼ of epithelial cells.
- Chronic bacterial prostatitis: yellow or brown color, sour smell, sour pH, less than half leukocytes, macrophages (more than 15), lots of amyloid bodies.
- Chronic nonbacterial prostatitis: the color is reddish, brown, there is no smell, leukocytes are normal, macrophages (10–20) are detected, there are many amyloid bodies.
In some cases, the study of the secret does not allow to detect prostatitis due to incorrect indicators. Fuzzy data will be in the presence of inflammation in other organs, body temperature above 39 degrees. Removal of material is not possible with contraindications to 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 does not require special preparation. A man 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 this, the patient is not recommended to empty the bladder, and drugs and alcoholic beverages should not be taken the day before.
In the catarrhal form of the disease, deviations from the norm may not be observed in the general analysis of urine. With prostatitis of the later stages, purulent threads are detected in the material under study, which precipitate.
The study of a man's urine allows you to diagnose leukocyturia (an increase in the level of leukocytes, which occurs with inflammation). Urine culture is done to determine the type of pathogens. Signs of pathogens in the urine occur with infectious prostatitis or complications such as inflammation of the bladder and urethra or pyelonephritis.
swabs from the urethra
A smear from the urethra is a type of examination confirming inflammation caused by pathogens such as Trichomonas, gonococci, Candida. It is prescribed for chronic pelvic pain syndrome, itching in the groin, rash on the penis, difficulty urinating. The study of the removed material allows differential diagnosis - to distinguish between prostatitis, urethritis or sexually transmitted diseases, often having similar symptoms or occurring simultaneously.
The disease is diagnosed only with a properly collected smear. A man will need to abstain from sex for 2 days before taking the material. An hour before the procedure, do not go to the toilet in a small way. If the patient is taking NSAIDs or antibiotics, there is no point in doing this analysis - the data will be incorrect.
Spermogram
Spermogram - analysis of a man's ejaculate. In addition to prostatitis, diseases of the seminal vesicles, the testicles are diagnosed in this way and infertility can be detected. Material submitted by a man whose body temperature does not exceed 39 degrees, who does not take antibiotics and abstains from sexual intercourse for 2-3 days, will be correct. One day before sperm donation, prostate massage is not recommended.
The spermogram includes three types of studies. The macroscopic analysis consists in studying the volume, the color, the viscosity and the time of liquefaction of the sperm. 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, anti-sperm antibodies can be detected.
With prostatitis, a 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% immobile sperm), akinospermia (more than 32% immobile sperm).
prostate tissue
When examining an enlarged prostate, it is not always possible to understand the nature of seals and extensions with the help of a digital rectal examination and urine and blood tests. It can be a benign pathology (adenoma, prostatitis) or malignant (cancer). Accurate diagnosis facilitates microscopic examination of prostate tissue, which is obtained by biopsy.
The procedure is as follows: the patient is transrectally inserted with an ultrasound device sensor, at the end of which there is a gun with a biopsy needle. With a sharp point, a microscopic part of the glandular tissue is cut off and given to the laboratory for study. The examination is carried out according to the method of comparing the parameters of the material with the norms of the Gleason table.
With congestive, viral or bacterial prostatitis, the size of the gland cells appears reduced, the amount of connective tissue in the intercellular space is increased. Atypical cells with altered nuclei will not be observed. If a man has prostate cancer, the glandular cells grow in size and gather in clusters, their abnormal changes are revealed.
Ultrasound, MRI and other methods
To confirm the diagnosis, as well as to determine the stage of development and features of the course of the disease, instrumental studies are carried out. For pathologies of the pelvic organs, the following methods of examination are used:
- traditional ultrasound;
- transrectal ultrasound;
- magnetic resonance imaging (MRI);
- CT.
These methods allow you to find out 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 and oncological diseases of the prostate.
Conventional 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 detecting prostatitis, but prostate cancer is difficult to see this way (especially in the early stages). MRI and CT scans have the highest accuracy in determining tumors, but they are complex and expensive procedures, so they are performed when other research methods show a high probability of oncology.
Home exam
The prostate can be examined at home and identify the main symptoms of urological pathologies. 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 his body is an important reason for promptly contacting a urologist.
Just like that, without the need for self-diagnosis, it's not worth it. The indications to be examined at home are:
- Urodynamic disorders (frequent urge to urinate).
- Weak flow, inability to completely empty the bladder.
- Discomfort in the abdomen or groin (eg, painful urination).
- Decreased sexual desire, weakened erection.
- Purulent impurities or discoloration of urine in white, brown.
- Spermatorrhea or prostorrhea (discharge from the penis).
At home, the examination takes place according to the same scheme as in the doctor's office. First of all, a man needs to cleanse the intestines - in 10-12 hours, perform an enema or take laxatives. Take a bath just before the procedure. Then lie on your side, bend your knees, insert your index finger into the rectum (previously put on the fingertip and smear it with Vaseline on top).
A digital rectal examination is performed by probing the posterior wall of the intestine and detecting the adjacent prostate. The gland is easily detected - it feels like a small walnut to the touch. Bad symptoms: enlarged prostate, non-circular shape, presence of tubercles, pain on probing.These signs signal inflammation or another pathological process in the prostate. When they are identified, you should definitely go to the urologist, because a more accurate diagnosis and treatment plan are needed.