CHRONIC PROSTATITIS – DIAGNOSIS
A combination of real world experience and specialised training is essential to a correct diagnosis and evaluation of chronic prostatitis.
The key tools for a successful diagnosis
Complete medical history: First of all, a careful assessment of a patient’s full medical history is required. This not only helps to bring context to the patient’s complaints, but also allows the doctor to detect issues or symptoms that the patient may not be aware of due to having grown used to them.
Digital rectal examination of the prostate: The digital rectal examination (DRΕ) of the prostate is vital since it provides crucial information on the texture of the glandular tissue, the corresponding susceptibility at inflammatory sites, and the size of the gland. It also enables the secretion of prostatic fluid for further specialised examinations.
Uroflowmetry: The uroflowmetric control provides important information on the quality of urination such as strength, quantity and duration.
Ultrasound: An ultrasound examination of the kidneys and bladder provides insight into any possible complications. In many cases, stone concretions and kidney stones are typically formed as a result of poor quality of urination caused by problems in the prostate.
Testicular ultrasound: Testicular ultrasonography in both testicles checks for any spread of the infection, also providing information on the epididymides and scrotal sac.
Transrectal ultrasonography: A transrectal ultrasonography of the prostate provides the fullest possible picture on any changes in the prostate. It measures both the echogenicity of the parenchyma and the vasculature at the damaged areas, as well as highlighting possible calcifications. The examination is also used to estimate the size of the gland, track the presence of inflammation in the seminal vesicles, spot possible dilatation of the utricle cyst, and find calculi of the ejaculatory ducts.
Semen and prostate fluid tests: Microbiological tests of sperm and prostatic fluid (post-prostate massage) complement any examination but do not constitute sufficient evidence in their own right for the existence of either inflammation or the microbes responsible. In 20% – 30% of cases, these tests will not reveal the microbes responsible for the inflammation at all. In a small number of cases (3%-5%), these tests will also fail to discover indications such as pus cells that would point to the presence of inflammation / prostatitis.
Urethral Cystoscopy: In cases of urethral complications where there are clear problems in urination, this specialised endoscopic process allows the doctor to look for the possible existence of intraluminal urethral stricture or obstructions at the bladder neck.
Penile arteries triplex: Usually performed at the initial diagnosis in cases of erectile dysfunction, especially if there are also other special conditions e.g. hypertension, diabetes mellitus, hypercholesterolemia etc.
Spermiogram and hormonal examination: In cases of infertility, a complete semen analysis and targeted hormonal examination are often necessary for a complete diagnosis.
Dynamic transrectal ultrasonography of urination: In cases of suspected active or passive intraprostatic reflux of urine, a transrectal ultrasonography is the test of choice for recording urination.