The diagnosis of prostatitis includes more than 5 mandatory and 4 additional procedures. Only a rectal examination of the prostate or an ultrasound cannot tell for sure whether men have prostatitis. The reason is that many urological diseases have a similar clinical picture and only a comprehensive differential study eliminates the possibility of a wrong diagnosis.
How to pass an inspection
Men are recommended to have a preventive prostate examination by a urologist 1-2 times a year (prostatitis, adenoma and other prostate pathologies are asymptomatic in the first stages). When signs of the disease appear, contact a specialist immediately. 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, and then performs a general examination. The next step in suspected prostatitis is a rectal examination (palpation of the prostate through the man's rectum). Examination of the fingers allows the doctor to assess the following parameters:
- Prostate size.
- Surface (smooth or bumpy).
- Density of the gland (soft or stone).
- The presence or smoothness of the central groove.
- Sensitivity of a man when probing the prostate (does he feel pain).
Analysis
If the rectal examination and history taking indicate prostatitis, the urologist's next action is to refer the patient to laboratory tests. According to clinical standards, the following types of examinations are mandatory:
- clinical urinalysis;
- general blood analysis;
- urine screening for flora;
- when an infection is detected, the sensitivity of the pathogen 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 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).
In order to rule out prostate cancer, a blood serum test is performed 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). In order to find out this parameter, a biopsy of the prostate is performed with a histological examination of the obtained material.
prostate secret
During the rectal examination of the prostate, the urologist pays attention to the secreted secretion. It is usually thick, odorless, and white in color. The maximum volume is 1-2 drops (3-5 ml). It must 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 is made possible by laboratory research.
Microscopic and bacteriological examination of the secret of the prostate is based on the number 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 sweet, 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, acidic pH, less than half of leukocytes, macrophages (over 15), lots of 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 study of the secret does not allow detection of prostatitis due to incorrect indicators. Cloudy data will be in the presence of inflammation in other organs, body temperature above 39 degrees. Taking the material is not possible with contraindications for rectal massage (prostate juice is extracted with this method): in case of exacerbation of hemorrhoids, anal fissures, prostate tuberculosis.
Urine
General and cytological analysis of urine does not require special preparation. One must collect the material in the morning before breakfast in a container (it is better to buy a sterile plastic container at the pharmacy). A few hours before that, the patient is not recommended to empty his bladder, and the day before, he should not take medicines and alcoholic beverages.
In the catarrhal form of the disease, deviations from the norm cannot be observed in the general analysis of urine. In prostatitis of the last stages, purulent threads are detected in the examined material, which are deposited.
Studying urine in a man 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 pathogen. Signs of pathogens in the urine occur in infectious prostatitis or complications such as inflammation of the urinary bladder and urethra or pyelonephritis.
swabs from the urethra
A swab from the urethra is a type of examination that confirms inflammation caused by pathogens such as trichomonas, gonococci, Candida. It is prescribed if chronic pelvic pain syndrome, itching in the groin, rash on the penis, difficulty urinating are observed. Studying the material taken allows differential diagnosis - to distinguish between prostatitis, urethritis or sexually transmitted diseases, which often have similar symptoms or occur simultaneously.
The disease is diagnosed only with a properly collected smear. The man will have 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, then it is useless to take this analysis - the data will be incorrect.
Spermogram
Spermogram - analysis of male ejaculate. In addition to prostatitis, diseases of the seminal vesicles and testicles can also be diagnosed in this way, and infertility can also be detected. The correct material will be tolerated by a man with a body temperature not higher than 39 degrees, who does not take antibiotics, and abstains from sexual relations for 2-3 days. Prostate massage is not recommended the day before sperm donation.
Spermogram includes three types of studies. Macroscopic analysis includes the study of volume, color, viscosity and liquefaction time of sperm. Microscopic examination reveals the quantity and quality of spermatozoa. Biochemical analysis determines the concentration of fructose, zinc, alpha-glucosidase, L-carnitine in the ejaculate. In bacterial prostatitis, antisperm antibodies can be detected.
In prostatitis, the spermogram can reveal numerous 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 immobile spermatozoa), akinospermia (more than 32% of immobile spermatozoa).
Prostate tissue
When examining an enlarged prostate, it is not always possible to understand the nature of the seals and extensions with the help of a rectal examination and analysis of urine and blood. It can be a benign pathology (adenoma, prostatitis) or malignant (cancer). Accurate diagnosis helps microscopic examination of prostate tissue, which is obtained by biopsy.
The operation is performed in the following way: the sensor of the ultrasound machine is transrectally introduced to the patient, at the end of which there is a gun with a needle for biopsy. A microscopic part of the gland tissue is cut off with a sharp tip and sent to the laboratory for study. The test is carried out by the method of comparing material parameters with the norms from the Gleason table.
In congestive, viral or bacterial prostatitis, gland cells appear 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, then the cells of the gland become large and gathered in clusters, their abnormal modifications are revealed.
Ultrasound, MRI and other methods
In order to confirm the diagnosis, as well as to determine the stage of development and characteristics of the course of the disease, instrumental studies are carried out. The following examination methods are used for pathologies of the pelvic organs:
- traditional ultrasound;
- transrectal ultrasound;
- magnetic resonance imaging (MRI);
- CT scanner.
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, oncological diseases of the prostate.
Classic ultrasound has the greatest inaccuracy, but this method is still 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 detect this way (especially in the early stages). MRI and CT have the highest accuracy in determining the tumor, but they are complex and expensive procedures, so they are performed whenother research methods show a high probability of oncology.
Home inspection
The prostate can be examined at home and identify the primary symptoms of urological pathologies. Of course, this will not be a diagnosis of chronic prostatitis, because 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 one's body is a significant reason to quickly contact a urologist.
Just like that, without the need for self-diagnosis, it's not worth it. Indications for home examination are:
- Urodynamic disorder (frequent urge 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 a change in the color of urine to white, brown.
- Spermatorrhea or spacetorrhea (discharge from the penis).
At home, the examination takes place according to the same scheme as in the doctor's office. First, a person should clean the intestines - in 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 (first place the tip of your finger and smear it with Vaseline from above).
A digital rectal examination is performed by probing the back wall of the intestine and revealing the adjacent prostate. The gland is easy to detect - 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 other pathological process of the prostate. When they are identified, you should definitely go to a urologist, because a more precise diagnosis and treatment plan is needed.