Diagnosis of prostatitis includes more than 5 mandatory and 4 additional procedures. Just one rectal examination of the prostate gland or ultrasound cannot say for sure whether 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 first stages). When signs of illness appear, you should go to a specialist immediately. Such symptoms are pain in the lower abdomen and in the groin, difficulty with urination and erection.
The doctor begins by collecting complaints and anamnesis of the patient, then conducts a general examination. The next step in suspected prostatitis is a rectal examination (palpation of the prostate through the rectum of a man). 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.
- The sensitivity of a man when probing the prostate (whether he experiences pain).
Normally, the prostate gland should have well-palpable 2 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 uniform, 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.
Analyzes
If a rectal examination and history taking suggest prostatitis, then the next action of the urologist 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;
- sowing urine for flora;
- when an infection is detected, the sensitivity of pathogens to antibiotics is determined.
A complete blood count helps 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 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 find out this parameter, a biopsy of the prostate is done 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. 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.
Microscopy 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 of epithelial cells.
- Chronic bacterial prostatitis: yellow or brown color, sour smell, sour pH, less than half of leukocytes, macrophages (over 15), a lot of 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. Blurred data will be in the presence of inflammation in other organs, body temperature above 39 degrees. The sampling of material is not possible with contraindications for rectal massage (prostatic juice is extracted by this method): with exacerbation of hemorrhoids, anal fissures, prostate tuberculosis.
Urine
General and cytological analysis of urine does 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 a pharmacy). A couple of hours before this, the patient is not recommended to empty the bladder, and one should not take medicines and 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 the urine of a man allows you to diagnose leukocyturia (an increase in the 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.
swabs from the urethra
A smear from the urethra is a type of examination confirming 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 taken material allows for differential diagnosis - to distinguish between prostatitis, urethritis or sexually transmitted diseases, often having similar symptoms or occurring simultaneously.
The disease is diagnosed only with a correctly collected smear. A man will have to refrain from sex 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 take 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 that is submitted by a man with a body temperature not higher than 39 degrees, who does not take antibiotics, and refrains from sexual intercourse for 2-3 days, will be correct. A day before sperm donation, prostate massage is not recommended.
Spermogram includes three types of studies. Macroscopic analysis involves the study of the volume, color, viscosity and liquefaction time of the 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 may be detected.
With prostatitis, a spermogram can reveal a number of abnormalities. For example, a reduced volume of semen (less than 1. 5 ml), a low concentration of spermatozoa in 1 ml (less than 15 million), asthenozoospermia (more than 40% of immobile spermatozoa), akinospermia (more than 32% of immobile spermatozoa).
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 transrectally inserted 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 off 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 from the Gleason table.
With congestive, viral or bacterial prostatitis, the gland cells look 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, then the glandular cells become large and collected in clusters, 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;
- magnetic resonance imaging (MRI);
- CT scan.
These methods allow you to find out the shape, thickness, width, length of the prostate, its mass, structural uniformity, echogenicity, vascularization (vascular pattern). These parameters are needed to determine urological pathologies: ultrasound, CT and MRI show inflammatory, proliferative, oncological diseases of the prostate gland.
Classical ultrasound has the biggest inaccuracy, but this method continues to be used, as 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 in 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.
Examination 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 enlarged gland. But the presence of alarming signs during an independent examination of one's body is a significant reason for promptly contacting a urologist.
Just like that, without the need to conduct self-diagnosis is not worth it. Indications to be examined 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, painful urination).
- Decreased sexual desire, weakening of 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, carry out 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 on a fingertip and smear it with Vaseline on top).
A digital rectal examination is performed by probing the posterior wall of the intestine 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, the presence of tubercles, pain when probing.These signs signal inflammation or other pathological process of the prostate gland. When they are identified, you should definitely go to the urologist, as more accurate diagnosis and treatment plan are required.