Diagnosis of prostatitis. Methods of identifying diseases and the necessary research.
In order to make a diagnosis of prostatitis, it is necessary to conduct microscopic examination of prostate secretion and topical diagnosis of inflammation of the lower urinary tract. The two main type of diagnosis. Other methods of examination is performed to confirm the diagnosis and identify complications of the main disease.
Diagnostic methods are divided into 3 groups:
- diagnosis is possible.
Examination of patients with chronic prostatitis
For men with chronic type of the disease also conduct medical history and physical examination and localisation test.
To the recommended types of diagnosis in this case include the identification of symptoms or the index of symptoms, cytological examination of urine, uroflowmetry and determination of rest urine.
For possible diagnostic use methods such as examination of the ejaculate, taking a smear from the urethra to determine the bacteria causing urethritis. Also conducting a study pressure-flow urodynamic study transrectal ultrasonography and PSA.
Types of diagnostics
Diagnosis includes several stages: collection of anamnesis, ultrasound and various blood tests.
Thoroughly collected history of the disease is considered the main component of all diagnostic.
The doctor must find out the following information:
- the duration of the disease;
- the development of the symptoms and the causes that led to this;
- the time of relapse and the factors causing them;
- the presence of sexually transmitted diseases and infections;
- information about sexual life;
- examination and treatment, which was conducted early, its effectiveness and duration;
- treatment of sexual partners;
- diseases and operations that was previously.
Evaluation of symptoms of chronic prostatitis
The national Institute of health, USA developed a questionnaire to determine the index of the symptoms of this variety of the disease (NIH-CPSI).
The patient's condition can be adequately assessed through registration of symptoms of pain, voiding. This questionnaire gives you the opportunity to obtain the necessary information and quickly assess the situation, but it will not replace a thorough medical history of the disease.
Smear from the urethra
At the time of diagnosis in the urethra introduce a tampon applicator and turn it off. Study take material from the tip and stem of the applicator.
About the urethritis will testify to the identification of four or more polymorphonuclear leukocytes. Also in the diagnosis determine the presence of microflora. In order to detect the infection which is transmitted sexually, by means of a probe, take a scraping from a mucous membraneurethra.
It is worth noting that the most common methods for the determination of pathogens (RIF, PCR) do not have 100% sensitivity.
Therefore, in order to verify the results and to exclude false-positive and false-negative results infections that are sexually transmitted, it is necessary to determine by means of two different methods.
The study of secret
The study of prostate secretion under the microscope was performed to confirm inflammation in the prostate gland and to determine its functional state.
Microscopy secret of the prostate reveals:
- lecithin granules;
- the microbial community.
The secret is in the norm in the following ratios:
- leukocytes are less than ten;
- a lot of lecithin granules;
- microflora there.
Before the examination the patient should partially empty the bladder. After that do massage of the prostate gland. If you can't get the secret prostate, and then study carried out on urine sediment that is obtained within five minutes after the massage.
The negative results of a single study of prostate secretion can not accurately indicate the absence of inflammation in the prostate. If you conduct research only prostate secretion, it will be impossible to detect inflammation in 50%.
The main indicator of urinalysis is considered a protein and leukocytes, bacteria.
In normal urine protein is not. Healthy men in the urine is up to five leukocytes. If there are more, then we can talk about inflammatory processes in the urogenital tract.
Identification of bacteria in General, the analysis of urine has significant diagnostic value. More can tell the presence of microbes per unit volume or urine culture.
Cytological examination of urine
Examination of the urine sediment will help to detect two types of epithelial cells.
Some are dark, elongated, scattered in different directions. Other great, which accumulate in one place. These cytograms often just say present or absent cells of malignant tumors.
Bacteriological examination of urine
If viewed under a microscope one or more bacterial cells, this suggests the presence of 105 organisms in 1 ml of urine. The presence of one or more of leukocytes indicates infection. In a smear of the urine of a healthy person can be only a few bacterial cells and white blood cells.
Urine for bacteriological examination are taken after the washing of the genitals of 0.5%a solution of manganese-sour potassium.
Allowed flushing with boiled water with soap. Urine is allocated a sterile container with a lid. Research necessary to spend within two hours after sampling. It can also be stored in the refrigerator at +4°C, but not longer than 18 hours.
The study of ejaculate
In the study of the ejaculate is carried out differential diagnosis of inflammatory and noninflammatory chronic pain syndrome in the pelvic region.
The study also allows to identify the organs of the reproductive system that have undergone an inflammatory process, and to determine the quality of semen.
Uroflowmetry is the most affordable study through which urination occurs video graphic registration of the dynamics of the flow rate of urine. Results urologom allow you to see the overall contractility of the detrusor and patency of the urethra and bladder neck as reveals.
If the maximum speed of urine flow greater than 15 ml/s, this tells about the normal functioning of the bladder and the patency of the urethra. Dysfunction of the detrusor may cause reduced speed of the flow of urine.
Uroflowmetry is used for examination of patients with disorders of urination, but can not identify the exact location of the dysfunction.
Invasive urodynamic examination prescribed for:
- obstructive urinating;
- lowering the flow velocity of urine;
- increased residual urine volume.
Cystoscopy is considered an additional method of diagnosis, which is used on the strict condition:
- injury of the urogenital tract and perineum;
- obstructive urinating;
- before surgery;
- when suprapubic pain.
Imaging techniques of the prostate
Ultrasound imaging of the prostate is considered to be inexpensive and informative method for the diagnosis of prostatitis.
Ultrasound of the prostate using a rectal sensor, is prescribed for:
- acute bacterial type of the disease, to exclude abscess if the antibiotic therapy is not observed positive changes.
- pathological changes in the prostate.
- suspected cancer results from a digital rectal examination.
- painful ejaculation to exclude obstruction of the ejaculatory duct or cystic duct.
- bacterial cystitis to exclude the relationship of bacterial persistence, with the stones of the prostate.
If you suspect abscess or prostate cancer used a CT scan and MRI.