Diagnosis of prostatitis includes more than 5 mandatory procedures and 4 additional procedures. Only a rectal examination of the prostate gland or an ultrasound cannot determine whether a man has inflammation of the prostate. The reason is that many urological diseases have the same clinical picture and only a comprehensive differential study eliminates the possibility of misdiagnosis.
How to pass the inspection
Men are recommended to undergo 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 first stage). When signs of the disease appear, you should immediately see a specialist. Such symptoms are pain in the lower abdomen and in the groin, difficulty urinating and erection.
The doctor begins by collecting the patient's complaints and anamnesis, 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:
- Prostate size.
- Surface (smooth or wavy).
- Density of the gland (soft or stony).
- The presence or smoothness of the central groove.
- A man's sensitivity when probing the prostate (whether he has pain).
Analyze
If the rectal examination and history taking suggest prostatitis, then 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 analysis of urine;
- general blood analysis;
- urine culture 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 low hemoglobin content (below 100 grams per liter of blood).
To rule out prostate cancer, a blood serum test is performed for the content of PSA - prostate-specific antigen. Its increased number indicates the presence of a tumor, but does not determine its nature (benign or malignant). To find out these parameters, 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 secreted secretions. Usually, 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 these are signs of 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 materials allows laboratory research.
Microscopy and bacteriological studies of prostate secretions are based on the count of leukocytes, lecithin grains, amyloid bodies, macrophages, pathogenic and opportunistic organisms. Prostatitis is characterized by deviations:
- Acute prostatitis: secretory color is yellowish, sweet smell, acidic pH, 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 of leukocytes, macrophages (more than 15), many amyloid bodies.
- Chronic non-bacterial prostatitis: reddish color, brown, odorless, leukocytes are normal, macrophages (10-20) are detected, there are many amyloid bodies.
In some cases, secret studies do not allow to detect prostatitis due to wrong indicators. Blurry data will be in front of inflammation in other organs, body temperature above 39 degrees. Material sampling is not possible with contraindications for rectal massage (prostate juice is extracted by this method): with aggravation of hemorrhoids, anal fissure, dry prostate.
Urine
General analysis and cytology of urine do not require special preparation. A man 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, the patient is not recommended to empty the bladder, and one should not take drugs and alcoholic beverages the day before.
In the form of catarrhal disease, deviations from the norm may not be observed in the general analysis of urine. With late-stage prostatitis, purulent threads are detected in the studied material, which settles.
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 pathogen. Signs of pathogens in the urine occur with infectious prostatitis or complications such as inflammation of the bladder and urethra or pyelonephritis.
a smear 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 the syndrome of chronic pelvic pain, itching in the groin, rash on the penis, difficulty urinating is observed. The study of the material taken allows differential diagnosis - to distinguish between prostatitis, urethritis or venereal disease, often having the same symptoms or occurring simultaneously.
The disease is diagnosed only with a properly collected smear. A man should abstain from sex for 2 days before taking the substance. An hour before the procedure, do not go to the toilet in a small way. If the patient takes NSAIDs or antibiotics, then there is no point in taking this analysis - the data will be incorrect.
Spermogram
Spermogram - analysis of male ejaculation. 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 higher than 39 degrees, who does not take antibiotics, and abstains from sexual intercourse for 2-3 days, is correct. The day before sperm donation, prostate massage is not recommended.
Spermogram includes three types of studies. Macroscopic analysis involves studying the volume, color, viscosity and dilution time of semen. Microscopic examination reveals the quantity and quality of spermatozoa. 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 several abnormalities. For example, a reduction in the amount of semen (less than 1. 5 ml), a low concentration of spermatozoa in 1 ml (less than 15 million), asthenozoospermia (more than 40% of spermatozoa do not move), akinospermia (more than 32% of spermatozoa do notmoving. ).
Prostate tissue
When examining an enlarged prostate, it is not always possible to understand the nature of the seal and connection with the help of a rectal examination and urine and blood tests. It can be a benign pathology (adenoma, prostatitis) or malignant (cancer). Accurate diagnosis helps microscopic examination of prostate tissue, obtained through 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 tip, a microscopic part of the gland tissue is cut and given to the laboratory for study. The examination is carried out according to the method of comparing material parameters with the norm from the Gleason table.
With congestive, viral or bacterial prostatitis, the cells of the gland seem to decrease in size, the amount of connective tissue in the intercellular space increases. Atypical cells with altered nuclei will not be observed. If a man has prostate cancer, then the cells of the gland become large and accumulate in clusters, their abnormal modifications are revealed.
Ultrasound, MRI and other methods
To confirm the diagnosis, as well as to determine the level of development and characteristics of the course of the disease, instrumental studies are carried out. For pathology of the pelvic organs, the following examination methods are used:
- traditional ultrasound;
- transrectal ultrasound;
- magnetic resonance imaging (MRI);
- CT scan.
This method allows 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 pathology: ultrasound, CT and MRI show inflammatory, proliferative, oncological diseases of the prostate gland.
Classic 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 the detection of prostatitis, but prostate cancer is difficult to see this way (especially in the 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.
Exam at home
The prostate can be examined at home and identify the main symptoms of urological pathology. Of course, this will not be a diagnosis of chronic prostatitis, because it is impossible to determine with certainty the cause of the enlarged gland. But the presence of alarming signs during an independent examination of a person's body is an important reason to immediately contact a urologist.
Just like that, without having to do self-diagnosis is not worth it. Indications to check at home are:
- Impaired urodynamics (frequent urge to urinate).
- Weak flow, inability to empty the bladder completely.
- Discomfort in the abdomen or groin (for example, painful urination).
- Reduces sexual desire, weakens erection.
- Purulent impurities or change in color of urine to 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, a man needs to clean the intestines - in 10-12 hours, conduct an enema or take a laxative. Take a shower immediately before the procedure. Then lie on your side, bend your knees, insert your index finger into the rectum (previously put it on the tip of the finger and apply Vaseline on top).
A digital rectal examination is performed by examining the posterior wall of the intestine and locating the adjacent prostate. This gland is easy to spot - it feels like a small walnut to the touch. Adverse symptoms: prostate enlargement, non-round shape, presence of tubercles, pain when probing.These signs indicate inflammation or other pathological processes of the prostate gland. When they are identified, you should definitely go to a urologist, because a more accurate diagnosis and treatment plan is needed.