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 prostate inflammation. The reason is that many urological diseases have a similar clinical picture and only a comprehensive differential study eliminates the possibility of misdiagnoses.
How to pass an inspection
Men are recommended to undergo a preventive examination of the prostate by a urologist 1-2 times a year (prostatitis, adenoma and other prostate pathologies are asymptomatic in the early stages). When signs of the disease appear, you should immediately go to a specialist. Such symptoms are pain in the lower abdomen and groin, difficulty urinating and erections.
The doctor begins by collecting the patient's complaints and anamnesis, and then conducts a general examination. The next step in suspected prostatitis is a rectal exam (palpation of the prostate through a man's rectum). Finger research allows the doctor to evaluate 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.
- How sensitive a man is when he probes the prostate (if it feels pain).
Normally, the prostate gland should have 2 well palpable symmetrical lobules and a groove in the middle. The diameter of a healthy prostate is from 2. 5 to 3. 5 cm, in the longitudinal direction - 2. 5-3 cm. The surface should be smooth, without pronounced tubercles, soft enough, but not loose. Any deviation from the listed characteristics means prostatitis, prostate adenoma, fibrosis, cancer or other pathologies of the genitourinary system.
Analyses
If a rectal examination and history suggest prostatitis, the urologist's next action is to perform laboratory tests. According to clinical standards, the following types of examinations are mandatory:
- clinical analysis of urine;
- general blood test;
- sow 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 of 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 greater quantity 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 rectal examination of the prostate, the urologist pays attention to the secretion secreted. It is usually dense, odorless, white in color. The maximum volume is 1-2 drops (3-5 ml). It should not contain pus or blood impurities, as this is a sign of a disease. The consistency of the juice plays a role: if it comes out in lumps, then the man has diverticular prostatitis. A more detailed study of the material allows laboratory research.
Microscopy and bacteriological study of the prostate secret is based on the counting of leukocytes, lecithin granules, 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 the leukocytes and up to ¼ of the epithelial cells.
- Chronic bacterial prostatitis: yellow or brown color, acid odor, acid pH, less than half of leukocytes, macrophages (over 15), many amyloid bodies.
- Chronic non-bacterial 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 the material is not possible with contraindications for 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 needs to collect the material in the morning before breakfast in a container (it is better to buy a sterile plastic container at the pharmacy). A couple of hours before that, the patient is not recommended to empty the bladder, and the day before, medicines and alcoholic beverages should not be taken.
In the catarrhal form of the disease, deviations from the norm may not be observed in the general urine analysis. With prostatitis of the last stages, purulent threads are revealed in the material under study, which precipitate.
A 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 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.
swabs from the urethra
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 is observed. The study of the taken material allows for 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 will have to abstain from sex for 2 days before taking the material. An hour before the procedure, do not go to the toilet with little. If the patient is taking NSAIDs or antibiotics, this analysis is useless - the data will be erroneous.
Spermagram
Spermogram - analysis of a man's ejaculate. In addition to prostatitis, diseases of the seminal vesicles, testicles are diagnosed in this way, and infertility can be detected. The material presented by a man with a body temperature not exceeding 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. Macroscopic analysis involves the study of the volume, colour, viscosity and liquefaction time of the seed. Microscopic examination reveals the quantity and quality of sperm. Biochemical analysis determines the concentration in the ejaculate of fructose, zinc, alpha-glucosidase, L-carnitine. Antisperm antibodies can be detected in bacterial prostatitis.
With prostatitis, a spermogram can reveal a number of abnormalities. For example, low semen volume (less than 1. 5 mL), low sperm concentration in 1 mL (less than 15 million), asthenozoospermia (more than 40% of immotile sperm), acinospermia (more than 32% of immobile 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 tissue, 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 pistol with a biopsy needle. With a sharp tip, a microscopic portion 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 prostatitis, viral or bacterial, the cells of the gland appear small in size, the amount of connective tissue in the intercellular space increases. No atypical cells with altered nuclei will be observed. If a man has prostate cancer, the glandular cells become large and collected in groups, 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 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 gland.
Classical ultrasound has the greatest inaccuracy, but this method continues to be used, as it is easy to use and convenient. Transrectal ultrasound is considered the "gold standard" in prostatitis detection, but prostate cancer is difficult to see this way (especially in its early stages). MRI and CT 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.
Home exam
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 enlarged gland. But the presence of alarming signs during an independent examination of your own body is a significant reason to promptly contact a urologist.
That's right, without the need to conduct self-diagnosis is not worth it. Indications to examine at home are:
- Impaired urodynamics (frequent urge to urinate).
- Weak flow, inability to completely empty the bladder.
- Abdominal or groin discomfort (for example, painful urination).
- Decreased sexual desire, weakening of erection.
- Purulent impurities or urine discoloration in white, brown.
- Spermatorrhea or prostorrhoea (discharge from the penis).
At home, the examination takes place according to the same scheme as in the doctor's office. First, a man needs to cleanse his intestines: in 10-12 hours, do 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 and smear it with petroleum jelly).
A digital rectal exam is done by probing the posterior wall of the intestine and sensing the adjacent prostate. The gland is easily detectable: it feels like a small nut to the touch. Bad symptoms: enlarged prostate, non-circular shape, presence of tubercles, pain when probing.These signs signal inflammation or other pathological processes of the prostate gland. When they are identified, you should definitely go to the urologist, as a more accurate diagnosis and treatment plan are needed.