The diagnosis of prostatitis includes more than 5 mandatory procedures and 4 additional ones. A rectal exam of the prostate or an ultrasound alone cannot tell for sure if men have inflammation in the 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 disease 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 complaints and anamnesis from the patient, then conducts a general examination. The next step in suspected prostatitis is a rectal examination (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 irregular).
- 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 experiences pain).
Normally, the prostate should have 2 well palpable symmetrical lobes 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, smooth enough, but not loose. Any deviation from the listed characteristics means prostatitis, prostate adenoma, fibrosis, cancer or other pathologies of the genitourinary system.
Analysis
If a rectal examination 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 tests;
- sowing urine 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, 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 a low hemoglobin content (less than 100 grams per liter of blood).
To exclude prostate cancer, a blood serum test is performed to determine the content of PSA, a prostate-specific antigen. Their increased amount indicates the presence of tumors, but does not determine their nature (benign or malignant). To determine this parameter, a prostate biopsy is performed with a histological study of the material obtained.
prostate secret
During a rectal examination of the prostate, the urologist pays attention to the discharge 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 count 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 epithelial cells.
- Chronic bacterial prostatitis: yellow or brown color, sour odor, sour pH, less than half leukocytes, macrophages (more than 15), many 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. Sampling of material is not possible with contraindications to rectal massage (prostate juice is extracted by this method): with exacerbation of hemorrhoids, anal fissures, prostatic tuberculosis.
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 sterilized plastic container in a pharmacy). A couple of hours before this, the patient is not recommended to empty the bladder, and you should not take drugs or alcoholic beverages a 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 last 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). A urine culture is performed 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.
urethral swabs
A smear 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. The study of 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 correctly collected smear. A man should refrain from sexual intercourse 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 perform this analysis: the data will be incorrect.
spermogram
Spermogram - analysis of a man's ejaculation. In addition to prostatitis, diseases of the seminal vesicles, the testicles are diagnosed in this way, and infertility can be detected. The material presented by a man with a body temperature not higher than 39 degrees, who does not take antibiotics and abstains from sexual intercourse for 2-3 days, will be correct. One day before the sperm donation, prostate massage is not recommended.
The spermogram includes three types of studies. The macroscopic analysis implies the study of the volume, color, viscosity and liquefaction time of the semen. Microscopic examination reveals the quantity and quality of the sperm. Biochemical analysis determines the concentration in the ejaculate of fructose, zinc, alpha-glucosidase, L-carnitine. In bacterial prostatitis, antisperm antibodies can be detected.
With prostatitis, a spermogram can reveal a number of abnormalities. For example, reduced semen volume (less than 1. 5 ml), low sperm concentration in 1 ml (less than 15 million), asthenozoospermia (more than 40% immotile sperm), acinospermia (more than 32% immotile sperm ) ).
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 urine and blood tests. It can be a benign (adenoma, prostatitis) or malignant (cancer) pathology. Accurate diagnosis helps microscopic examination of prostate tissues, which are obtained by biopsy.
The procedure is performed as follows: the patient is inserted transrectally with an ultrasound machine 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 out and delivered 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 cells of the gland are reduced in size, the amount of connective tissue in the intercellular space increases. Atypical cells with altered nuclei will not be seen. If a man has prostate cancer, then the glandular cells enlarge and accumulate in groups, their abnormal modifications 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 examination methods are used:
- traditional ultrasound;
- transrectal ultrasound;
- nuclear magnetic resonance (NMR);
- computed tomography
These methods allow you to find out the shape, thickness, width, length of the prostate, its mass, structural uniformity, echogenicity, vascularity (vascular pattern). These parameters are necessary to determine urological pathologies: ultrasound, computed tomography and magnetic resonance imaging show inflammatory, proliferative and oncological diseases of the prostate gland.
Classic ultrasound has the highest inaccuracy, but this method is still used as it is easy to use and affordable. Transrectal ultrasound is considered the "gold standard" in detecting prostatitis, but prostate cancer is hard to see this way (especially in the early stages). Magnetic resonance imaging and computed tomography have the highest accuracy in determining tumors, but these are complex and expensive procedures, so they are performed when other research methods show a high probability of oncology.
exam at home
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, since it will not be possible to reliably determine the cause of the gland enlargement. But the presence of alarming signs during an independent examination of the body is an important reason to immediately contact a urologist.
Thus, without the need to carry out a self-diagnosis, it is not worth it. The indications to examine yourself at home are:
- Impaired urodynamics (frequent urge to urinate).
- Weak stream, inability to completely empty the bladder.
- Discomfort in the abdomen or groin (for example, pain when urinating).
- Decreased sexual desire, weakening of the erection.
- Purulent impurities or discoloration of urine to white, brown.
- Spermatorrhea or prostrorrhea (discharge from the penis).
At home, the examination is carried out according to the same scheme as in the doctor's office. First, a man needs to cleanse the intestines: in 10-12 hours, he perform 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 (previously put your fingertip on it and smear it with petroleum jelly on top).
A digital rectal examination is performed by palpating the posterior wall of the intestine and detecting the adjacent prostate. The gland is easily detected - it feels like a small nut to the touch. Bad symptoms: enlarged prostate, non-circular shape, presence of tubercles, pain on probing.These signs indicate inflammation or another pathological process of the prostate gland. When they are identified, you should definitely go to the urologist, as a more accurate diagnosis and treatment plan is required.