Diagnosis of prostatitis includes more than 5 mandatory and 4 additional procedures. A prostate rectal exam or ultrasound alone cannot tell for sure whether 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 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 stages). When signs of illness 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 the patient's complaints and anamnesis, then performs a general examination. The next step in suspected prostatitis is a rectal exam (palpation of the prostate through a man's rectum). Finger survey allows the physician to evaluate the following parameters:
- The size of the prostate.
- Surface (smooth or uneven).
- The density of the gland (soft or stony).
- The presence or softness of the central sulcus.
- A man's sensitivity to probing the prostate (if he feels 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, lengthwise - 2. 5-3 cm. The surface should be even, without pronounced tubercles, rather soft, but not loose. Any deviation from the listed characteristics means prostatitis, prostate adenoma, fibrosis, cancer or other pathologies of the genitourinary system.
analyzes
If a rectal examination and history suggest prostatitis, the urologist's next course of action is to refer the patient for laboratory tests. According to clinical standards, the following types of examinations are mandatory:
- clinical analysis of urine;
- general blood analysis;
- sow urine for flora;
- when an infection is detected, the sensitivity of the pathogens to antibiotics is determined.
A complete blood count helps to confirm acute prostatitis - with this diagnosis, an increase in the number of neutrophils occurs 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 a low hemoglobin content (below 100 grams per liter of blood).
To exclude prostate cancer, a blood serum test is done 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 know this parameter, a prostate biopsy is performed with histological study of the material obtained.
prostate secret
During the rectal exam of the prostate, the urologist is attentive to the secreted secretion. Usually it is thick, 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 illness. The consistency of the juice plays a role - if it comes out in clots, the man has diverticular prostatitis. A more detailed study of the material allows laboratory research.
The microscopic and bacteriological study of the prostate secret is based on the leukocyte count, 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 of white blood cells, macrophages (more than 15), many amyloid bodies.
- Chronic non-bacterial prostatitis: the color is reddish, brown, there is no smell, leukocytes are normal, macrophages are detected (10–20), there are many amyloid bodies.
In some cases, the study of the secret does not allow to detect prostatitis due to incorrect indicators. Blurred data will be in the presence of inflammation in other organs, body temperature above 39 degrees. Sampling material is not possible with contraindications for 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. The 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 that, it is not recommended for the patient to empty the bladder, and you should not take medicines and alcoholic beverages 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 last stages, purulent threads are detected in the material under study, which precipitate.
Studying a man's urine makes it possible to diagnose leukocyturia (increased 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.
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 collected material allows the differential diagnosis - to distinguish between prostatitis, urethritis or sexually transmitted diseases, many times with similar symptoms or occurring simultaneously.
The disease is diagnosed only with a correctly collected smear. A man will have to abstain from sex for 2 days before getting the stuff. An hour before the procedure, he does not go to the toilet in a small way. If the patient is taking NSAIDs or antibiotics, it is useless to do this analysis - the data will be incorrect.
spermogram
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 submitted by a man with a body temperature of not more than 39 degrees, who does not take antibiotics and refrains from sexual intercourse for 2-3 days, will be correct. The day before sperm donation, prostate massage is not recommended.
The spermogram includes three types of studies. Macroscopic analysis involves the study of semen volume, color, viscosity and liquefaction time. 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. Ex. ).
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 pathology (adenoma, prostatitis) or malignant (cancer). Accurate diagnosis helps microscopic examination of prostate tissues, which are obtained by biopsy.
The procedure is done 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 piece of gland tissue is cut 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 cells of the gland appear reduced in size, 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 become large and clump together in groups, revealing their abnormal changes.
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 Organs pelvic organs, the following examination methods are used:
- traditional ultrasound;
- transrectal ultrasound;
- magnetic resonance imaging (MRI);
- computed tomography.
These methods make it possible 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.
Classical ultrasound has the most 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). Magnetic resonance imaging and computed tomography 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, as 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 a significant reason to immediately contact a urologist.
Just like that, without the need to carry out self-diagnosis is not worth it. The indications to be examined at home are:
- Impaired urodynamics (frequent urge to urinate).
- Weak flow, inability to completely empty the bladder.
- Discomfort in the abdomen or groin (for example, painful urination).
- Decreased sexual desire, weakening of the erection.
- Purulent impurities or discoloration 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 cleanse the intestines - in 10-12 hours, do an enema or take laxatives. Take a shower immediately before the procedure. Then lie on your side, bend your knees, insert your index finger into your rectum (pre-insert your fingertip and spread Vaseline on top).
A digital rectal exam is performed by probing the back wall of the bowel 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 of the prostate. When they are identified, you should definitely go to the urologist, as a more accurate diagnosis and treatment plan is needed.