1. Urodynamic examination
The main manifestations include a decrease in urinary flow rate, incomplete relaxation of the bladder neck-urethral sphincter muscle, and an abnormal increase in the maximum urethral closure pressure.
2. Digital rectal examination
The prostate is plump, enlarged, soft, and slightly tender. "If the disease lasts a long time, the prostate gland will become smaller, harder, uneven in texture, and have small nodules.". At the same time, the method of prostate massage is used to obtain prostate fluid for a routine examination.
3. Prostate fluid examination
Prostatitis can be diagnosed by having more than 10 white blood cells in the prostatic fluid and a decrease in lecithin bodies in the high magnification field of the microscope. If bacterial culture is conducted simultaneously, a clear diagnosis and classification of chronic prostatitis can be made. If the bacterial culture result of prostatitis fluid is positive, chronic bacterial prostatitis is diagnosed; On the contrary, it is chronic non bacterial prostatitis.
4. B-ultrasound examination
It shows that the boundary of prostate tissue structure is unclear and disordered, which can indicate prostatitis.
What diseases should prostatitis be differentiated from?
1. Differential diagnosis of acute bacterial prostatitis
(1) Acute pyelonephritis: It also manifests as acute chills, fever, and frequent, urgent, and painful urination. Usually, it also manifests as low back pain and soreness on the affected side; "Instead of suprapubic and perineal pain, there is no difficulty urinating.". The rectal digital examination showed no tenderness of the prostate, and the prostate fluid examination was normal.
(2) Purulent kidney: It also manifests as acute chills, fever, and frequent, urgent, and painful urination. Also manifested as significant low back pain on the affected side; There was no pain in the pubic and perineal regions, no difficulty urinating, and no tenderness of the prostate during digital rectal examination. The prostate fluid test is normal.
(3) Prostate abscess: It also manifests as acute chills and fever. Accompanying frequent urination, urgency, and pain in urination is the result of the development of acute prostatitis. Transrectal B-ultrasound and CT examination showed a fluid occupying lesion in the prostate. Puncture and aspiration of pus can provide a clear diagnosis.
2. Differential diagnosis of chronic bacterial prostatitis
(1) Prostate cancer: Late stage also manifests as discomfort in urination, which can include frequent urination, urgency, and difficulty urinating. Digital examination of the rectum revealed a hard prostate with nodules; Serum PSA is significantly elevated. Transrectal B-ultrasound shows heterogeneous light masses in the prostate, and prostate biopsy can confirm the diagnosis.
(2) Prostate tuberculosis: It also manifests as frequent urination, urgency, pain in urination, accompanied by urethral drip, and pain in the lower abdomen and perineum. Usually there is a history of tuberculosis in the urogenital system. Digital rectal examination can find irregular nodules in the prostate, and acid fast bacteria can be found in the prostatic fluid.
(3) Chronic aseptic prostatitis: also characterized by frequent urination with urethral drip, and pain in the lower abdomen and perineum. The two are mainly identified based on the bacterial cultures of VB1, EPS, and VB3. The bacterial cultures of VB1, EPS, and VB3 in aseptic prostatitis are all negative.
(4) Prostatic hyperplasia: It also manifests as frequent urination with poor urination. It occurs mostly in elderly men and is characterized by poor urination. Digital rectal examination shows that the prostate gland is significantly enlarged, while the prostate fluid generally has no white blood cells.
(5) Seminal vesiculitis: It also manifests as frequent urination, urgency, pain in urination, accompanied by urethral drip, and pain in the lower abdomen and perineum. There is often blood sperm, and examination of seminal vesicle fluid shows red and white cells.
(6) Chronic cystitis: It also manifests as frequent urination, urgency, and pain in urination accompanied by pain in the lower abdomen and perineum. Both VBl and VB3 showed white blood cells and bacterial growth in culture, but the EPS test was normal.
3. Differential diagnosis of non bacterial prostatitis
Chronic cystitis: It also manifests as frequent urination, urgency, and pain in urination with pain in the lower abdomen and perineum. However, the bacterial cultures of VB1 and VB3 in chronic cystitis were positive, while no bacterial growth was observed in EPS.
Chronic urethritis: also manifested as frequent urination, urgency, and pain in urination. The bacterial culture of VB1 was positive, while the bacterial culture of VB3 and EPS showed no bacterial growth.
4. Differential Diagnosis of Prostate Pain Currently, the diagnosis of prostate pain is mainly exclusive.
"That is, the patient has similar symptoms of prostatitis, but there are no inflammatory cells in the prostate fluid test, and there is no bacterial growth in the prostate fluid culture. In addition, the patient has no symptoms of urinary tract infections such as frequent urination, urgency, or pain in urination, which can be diagnosed as prostate pain.".
(Intern Editor: Cai Junyi)