Post Date December, 02 2023
The treatment of chronic prostatitis can be diagnosed based on the patient's medical history, symptoms, digital rectal examination, and prostatitis examination. It is not very difficult, but the symptoms and signs of prostatitis are complex and atypical. During treatment, it should be distinguished from the following diseases:
Diagnostic differentiation
"Prostate pain: These patients exhibit persistent frequent urination, pain in urination, difficulty urinating, pain and discomfort in the perineum, lower abdomen, lumbosacral region, and other areas, which worsen after prolonged sitting and cycling.". The rectal digital examination showed significant tenderness in the levator ani muscles on both sides, and the palpation of the prostate was normal without tenderness. Previously, this condition was known as piriformis levator muscle syndrome. Microscopic examination of prostate fluid showed normal results, and bacterial culture showed no growth.
2. Prostate abscess: most of them are complications of acute bacterial prostatitis, which mostly occur in 50~60 years old. Half of the patients have acute urinary retention, frequency of urination, dysuria, rectal discomfort, purulent urethra, and some are accompanied by epididymitis. On digital rectal examination, the diseased side of the prostate is enlarged, soft to touch, and has a wavelike sensation. Occasionally, prostate abscesses can naturally rupture into the urethra or rectum, and are mistaken for perirectal abscesses.
3. Prostate calculus: refers to stones that occur within the acini and ducts of the prostate. 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, and magnesium phosphate are deposited on the amyloid, epithelial cells, and inflammatory exudates within the prostate acini to form stones. Patients can exhibit various symptoms of chronic prostatitis, but digital rectal examination can detect a sensation of stone friction in the prostate. Pelvic X-ray shows positive stone shadows on the side of the pubic symphysis area. Ultrasonic examination can show strong light bands and sound shadows at the prostate stone site.
4. Prostate tuberculosis: the symptoms are similar to chronic prostatitis, but there is often a history of urinary tuberculosis or tuberculosis lesions in other parts of the body. The prostate is irregular nodules, the epididymis is swollen and hard, the vas deferens has beaded nodules, and tuberculous bacteria are detected in the prostatic fluid by direct smear or pcr.
"Prostate cancer: In the advanced stage, symptoms such as frequent urination, painful urination, and difficulty urinating can occur, but patients often have significant systemic symptoms such as weight loss, fatigue, anemia, and loss of appetite. On digital rectal examination, the prostate has a hard, stone like mass with uneven surface, and elevated serum prostate specific antigen and preadenotid acid phosphatase.". "Prostate biopsy can reveal cancer cells. Ultrasound examination shows enlargement of the gland, irregular or defective boundary echoes, uneven internal light spots, and brighter light spots or light masses at the cancer site.". CT scan showed asymmetric prostate morphology. If the tumor infiltrates outside the capsule, the interstitial space between the seminal vesicle and the posterior wall of the bladder can be seen disappearing. CT can determine the extent of invasion of prostate cancer.
"Pubic osteitis: Clinically, it is often manifested as a symptom of chronic prostatitis, but anal examination and prostate fluid examination are normal.". The main features are significant tenderness at the pubic symphysis, pelvic radiographs showing a widening of the pubic symphysis space of>10mm, a horizontal difference of>2mm between the bilateral superior pubic branches, irregular edges of the pubic symphysis, erosion, and reactive osteosclerosis.
7. Acute pyelonephritis: Acute pyelonephritis is most commonly seen in women, and rarely seen in men. The low back pain caused by acute pyelonephritis is mostly in one renal region, with significant percussion pain. The low back pain caused by acute prostatitis is mostly in the center of the lumbosacral region, with no percussion pain in the renal region. A large number of pus cells can be seen in the prostatic fluid of acute prostatitis, and acute pyelonephritis is mainly characterized by changes in the nature of urine.
