Post Date December, 03 2023
The diagnosis of chronic prostatitis is not difficult according to the medical history, symptoms, digital rectal examination, prostate fluid examination, etc., but those with complex symptoms and atypical physical signs should be distinguished from the following diseases.
1. Prostate pain: These patients are characterized by continuous frequent urination, pain in urination, difficulty in urination, pain and discomfort in perineum, lower abdomen, lumbosacral and other parts, and aggravation after long sitting and cycling. The rectal digital examination showed obvious tenderness of the levator ani muscles on both sides, and the palpation of the prostate was normal without tenderness. In the past, this disease was called piriformis levator ani syndrome. Prostate fluid was normal by microscopic examination, and bacterial culture did not grow.
2. Prostate abscess: most of them are complications of acute bacterial prostatitis, mostly occurring in the age of 50-60. Half of the patients have acute urinary retention, frequency of urination, dysuria, rectal discomfort, purulent urethra, and some are accompanied by epididymitis. The diseased side of the prostate is enlarged by digital examination of the rectum, and it feels soft and wavy. Occasionally, prostatic abscess can naturally rupture to the urethra or rectum, which is mistaken for perirectal abscess.
3. Prostate calculus: refers to the calculus occurring in the prostatic acini and ducts. It is related to chronic inflammation of prostate, prostatic fluid retention, glandular duct stenosis, metabolic disorder and other factors. Inorganic salts such as calcium oxalate, calcium phosphate, magnesium phosphate, etc. are deposited on the amyloid in the prostatic acinus, epithelial cells and inflammatory exudates to form stones. The patients can show various symptoms of chronic prostatitis, but the rectal digital examination can touch the prostate with a sense of stone friction, the pelvic X-ray has a positive stone shadow on the side of the pubic symphysis area, and the ultrasonic examination can show a strong light band and sound shadow on the prostate stone site.
4. Prostate tuberculosis: the symptoms are similar to those of chronic prostatitis, but there is often a history of urinary tuberculosis or tuberculosis lesions in other parts of the body. The prostate is irregular and nodular in digital rectal examination, the epididymis is swollen and hard, the vas deferens has beaded induration, and tuberculous bacteria are detected in the prostatic fluid by direct smear or PCR.
5. Prostate cancer: symptoms such as frequent urination, pain in urination and difficulty in urination can occur in the late stage, but patients often have obvious systemic symptoms such as emaciation, fatigue, anemia, anorexia, etc. The rectal digital examination shows that the prostate has a hard stone mass with uneven surface, and the serum prostate specific antigen and prostate acid phosphatase are increased. Cancer cells can be found in prostate puncture biopsy. Ultrasonic examination shows that the gland is enlarged, the boundary echo is irregular or defective, the internal light spot is uneven, and there are brighter light spots or light masses at the cancer site. CT examination showed that the prostatic morphology was asymmetric. If the tumor infiltrated outside the capsule, the tissue gap between the seminal vesicle and the posterior wall of the bladder disappeared. CT can determine the extent of invasion of prostate cancer.
6. Pubic osteitis: clinically, it is often manifested as chronic prostatitis, but the anal examination and prostatic fluid examination are normal. The main features are obvious tenderness at the pubic symphysis. The pelvic X-ray film shows that the width of the pubic symphysis space is greater than 10 mm, the horizontal difference between the bilateral superior pubic branches is greater than 2 mm, and the pubic symphysis edge is irregular, with erosion and reactive osteosclerosis.
