The diagnosis of prostatitis involves 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 inflammation of the prostate gland. The reason is that many urological diseases have a similar clinical picture, and only a comprehensive differential study eliminates the possibility of making a wrong diagnosis.
How to pass the inspection
Men are recommended to undergo prophylactic examination of the prostate by a urologist 1-2 times a year (prostatitis, adenoma and other pathologies of the prostate are asymptomatic in the initial stages). When symptoms of the disease appear, you should immediately consult a specialist. Such symptoms include pain in the lower abdomen and 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 the rectum in men). Finger examination allows the doctor to assess the following parameters:
- Prostate size.
- Surface (smooth or rough).
- Density of the gland (soft or stony).
- The presence or smoothness of the central groove.
- A man's tenderness (whether or not there is pain) during the examination of the prostate gland.
Analyzes
If the rectal examination and history taking indicate prostatitis, the urologist's next step is to send the patient for laboratory tests. According to clinical standards, the following types of examination are mandatory:
- clinical analysis of urine;
- general blood analysis;
- urine planting for flora;
- when an infection is detected, the sensitivity of pathogens to antibiotics is determined.
A complete blood test 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 strong decrease in the level of eosinophils. It is also possible to increase 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 for the content of PSA - prostate-specific antigen is performed. Its increased amount indicates the presence of tumors, but does not determine their nature (benign or malignant). To find this parameter, a biopsy of the prostate is performed with histological examination of the obtained material.
prostate gland
During the rectal examination of the prostate, the urologist pays attention to the secreted secretions. It is normally thick, odorless, and 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 disease. The consistency of the juice plays a role - if it comes out in the form of clots, then the man has diverticular prostatitis. A more detailed study of the material allows laboratory studies.
Microscopy and bacteriological examination of prostate secretion 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 secretion 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, sour pH, less than half of leukocytes, macrophages (more than 15), many amyloid bodies.
- Chronic non-bacterial prostatitis: red, 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 to detect prostatitis due to incorrect indicators. Blurred information will be in the presence of inflammation in other organs, body temperature is above 39 degrees. Contraindications for rectal massage (with this method, prostate juice is removed): it is impossible to take a sample of the material with hemorrhoids, anal fissures, exacerbation of prostate tuberculosis.
Urine
General and cytological analysis of urine does not require special preparation. A man should collect the material in a container before breakfast (it is better to buy a sterile plastic container at the pharmacy). A few hours before this, the patient is not recommended to empty the bladder, and the day before, drugs and alcohol should not be taken.
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 that precipitate are found in the studied material.
The study of a man's urine makes it possible to diagnose leukocyturia (an increase in the level of leukocytes that occurs with inflammation). Urine culture is performed to determine the type of pathogens. Symptoms of pathogens in the urine occur with complications such as infectious prostatitis or inflammation of the bladder and urethra or pyelonephritis.
tampons 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 when chronic pelvic pain syndrome, itching in the groin, rash on the penis, and difficulty urinating are observed. The study of the obtained material allows to make a 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 intercourse for 2 days before taking the material. Do not go to the toilet in a small way an hour before the procedure. If the patient is taking NSAIDs or antibiotics, then it is useless to take this analysis - the data will be wrong.
Spermogram
Spermogram - analysis of male ejaculation. With this method, in addition to prostatitis, diseases of the testes and testicles are also determined, and infertility can be detected. The material submitted by a man whose body temperature is not higher than 39 degrees, does not take antibiotics, and refrains from sexual intercourse for 2-3 days will be correct. Prostate massage is not recommended the day before sperm donation.
Spermogram includes three types of research. Macroscopic analysis includes the study of sperm volume, color, viscosity and liquefaction time. Microscopic examination reveals the quantity and quality of spermatozoa. Biochemical analysis determines the concentration in ejaculation of fructose, zinc, alpha-glucosidase, L-carnitine. Antisperm antibodies can be detected in bacterial prostatitis.
A spermogram with prostatitis can reveal a number of abnormalities. For example, decreased sperm volume (less than 1. 5 ml), low concentration of spermatozoa per 1 ml (less than 15 million), asthenozoospermia (more than 40% of immotile spermatozoa), achinospermia (more than 32% of immotile spermatozoa). ).
Prostate tissue
When examining an enlarged prostate, it is not always possible to understand the nature of seals and extensions with the help of rectal examination and urine and blood tests. This pathology can be benign (adenoma, prostatitis) or malignant (cancer). Accurate diagnosis helps the microscopic examination of prostate tissues obtained by biopsy.
The procedure is carried out 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. A microscopic part of the gland tissue is cut with a sharp tip and sent to the laboratory for study. The examination is carried out by comparing the parameters of the material with the norms from the Gleason table.
With congestive, viral or bacterial prostatitis, the size of gland cells decreases, 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 grow and gather in clusters, their abnormal changes are detected.
Ultrasound, MRI and other methods
Instrumental studies are carried out to confirm the diagnosis, as well as to determine the stage of development and characteristics of the course of the disease. The following examination methods are used for pathologies of the pelvic organs:
- traditional ultrasound;
- transrectal ultrasound;
- magnetic resonance imaging (MRI);
- CT scan.
These methods allow studying the shape, thickness, width, length, mass, structural uniformity, echogenicity, and vascularization of the prostate. These parameters are necessary to identify urological pathologies: ultrasound, CT and MRI show inflammatory, proliferative, oncological diseases of the prostate gland.
Classical ultrasound has the greatest inaccuracy, but it continues to be used because it is easy to use and affordable. Transrectal ultrasound is considered the "gold standard" in detecting prostatitis, but it is difficult to see prostate cancer this way (especially in the early stages). MRI and CT have the highest accuracy in identifying tumors, but these are complex and expensive procedures, so other research methods are performed when there is a high probability of oncology.
Examination at home
The prostate can be examined at home and identify the initial signs 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. However, the presence of alarming symptoms during an independent examination of the body is an important reason to immediately contact a urologist.
Similarly, it is not worth it without the need to self-diagnose. Instructions for home examination are:
- Urodynamics disorder (frequent urge to urinate).
- Weak flow, it is impossible to completely empty the bladder.
- Abdominal or groin discomfort (eg, painful urination).
- Decreased sexual desire, weakening of erection.
- Purulent impurities or turning the color of urine white or brown.
- Sperm or prostorrhea (discharge from the penis).
Examination at home is carried out according to the same scheme as in the doctor's office. First, a man should clean the intestines - take an enema or take laxatives after 10-12 hours. Take a bath immediately before the procedure. Then lie on your side, bend your knees, insert your index finger into the rectum (before you put it on the tip of your finger and rub vaseline on it).
A digital rectal examination is performed with probing of the back wall of the intestine and detection of 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 during probing.These symptoms indicate inflammation of the prostate gland or other pathological process. When they are identified, you should definitely consult a urologist, as a more accurate diagnosis and treatment plan is required.