A. When the white blood cells increase in the routine examination of prostate fluid, do you necessarily have prostatitis?
Not necessarily.
1, prostate fluid may be contaminated
The actual fact is that you can find a lot of people who are not able to get a good deal on a lot of things. The actual fact is that you will be able to get a lot more than just a few drops of prostate massage fluid.
2, under normal circumstances, the white blood cells in the prostate fluid may also increase
If there are no infected prostate stones, healthy men after ejaculation, alcoholism, eating a lot of irritating food, local cold, long time cycling or sedentary can appear the increase of white blood cells in the prostate fluid. Therefore, these behaviors should be avoided before prostate massage and abstinence needs to be more than 48 hours.
3, laboratory errors
The prostate massage technique should not be too heavy, and a single examination should not be repeatedly massaged too much, because of damage to the prostate and affect the examination results. The prostate fluid in the white blood cells gathered into a heap, uneven distribution, and affect the results of the examination.
The actual fact is that you can find a lot of people who are not able to get a good deal on a lot of things.
However, a simple bacterial culture of prostate fluid is of little clinical significance.
The actual fact is that not all bacteria are “bad” bacteria, in the long term evolution of human beings, some bacteria reside in some parts of the human body, and live in harmony with human beings, and play an important physiological function, the medical term is normal flora. The normal human front urethra and urethral orifice also exist normal flora, can resist the invasion of pathogenic bacteria, but the normal flora if displaced to other parts, such as the prostate, bladder, will also cause infection. The actual fact is that the actual prostate fluid must flow through the urethra in order to be discharged out of the body, so in the process of being discharged out of the body will certainly be contaminated by these normal flora, if the patient has a bladder urethritis is more likely to be contaminated. This makes it difficult to determine the origin of the bacteria that are cultured from the prostate fluid alone. The actual fact is that you will not be able to obtain satisfactory results, but rather risk the adverse effects of misuse of antibiotics.
What are the methods of lower urinary tract bacterial localization culture? How is it performed?
The classic method for locating bacteria in the lower urinary tract is the four-cup method.
The specific steps are
1.No urination for 2~4 hours, holding urine until intention to urinate.
2.If the foreskin is long, turn up the foreskin to expose the external urethral opening and keep the foreskin turned up throughout the collection of the specimen.
3, using the first sterile tube to receive 10 ml of primary urine (initially dissolved urine, also known as VB1) as a urethral specimen.
4. after excreting 200 ml of urine, a second sterile tube is used to receive 10 ml of urine (mid-stage urine, also known as VB2) as a bladder specimen.
5. prostate massage, with a third sterile tube connected to prostatic fluid as a prostate specimen (also known as EPS).
6. Immediately after prostate massage, a fourth sterile tube was used to receive 10 ml of urine also as a prostate specimen (also known as VB3). The specimen was sent for bacterial culture immediately after collection.
Precautions for lower urinary tract bacterial localization culture.
1. No antibiotics have been used within the last 1 month.
2, no ejaculation within the last 2 days.
3, bladder is full and not dilated.
4. if there is urethritis and cystitis, furatantin 50mg, which does not easily enter the prostate, should be given 3 times daily to kill bladder bacteria before EPS testing is done.
5. Acute bacterial prostatitis should not be massaged to prevent the spread of infection.
The four-cup method is cumbersome and expensive. In recent years, the two-cup method is commonly used, i.e., only VB2 and VB3 specimens are collected, and the effect is similar to the four-cup method, but if urethritis is suspected, it is still necessary to perform the four-cup test.
How to see the results of the lower urinary tract localized bacterial culture?
If the bacterial count in the prostatic fluid (EPS) and post-prostate massage urine (VB3) is significantly higher than that in the primary urine (VB1) and the intermediate urine (VB2), then the patient has chronic bacterial prostatitis; if the bacterial count in the primary urine (VB1) is significantly higher, then the patient has urethritis; if the bacterial count in the intermediate urine (VB2) is significantly higher, then the patient has cystitis. The general criterion for diagnosing chronic bacterial prostatitis is a 10-fold or greater increase in the number of bacteria in EPS and VB3 compared to VB1 and VB2.
Although localized bacterial culture of the lower urinary tract offers the possibility of localization of bacteria, the practical application is still not ideal. On the one hand, false negative results may occur, i.e. bacteria are in fact present in the prostate but not cultured, because: (i) substances that inhibit bacterial growth are present in the prostatic fluid; (ii) the patient uses antibiotics prior to culture, which inhibit bacterial growth; (iii) prostatitis is not inflammation of the entire prostate, but local inflammation, and the collected prostatic fluid may not be from the focal site; (iv) many bacteria cannot be obtained in culture using conventional techniques. On the other hand, false-positive results may occur, where there are in fact no bacteria in the prostate, but a positive culture result is obtained due to contamination with urethral bacteria, and the contamination cannot be ruled out during the analysis of the results, and is mistaken for bacteria in the prostate. The clinical diagnosis of chronic bacterial prostatitis is made when the number of bacteria in the prostate fluid (EPS) and post-prostate massage urine (VB3) is significantly higher than in the primary urine (VB1) and the intermediate urine (VB2), but there is no uniform standard for how much of an increase is considered “significantly” higher, and clinical ambiguity is often encountered. The most important thing is that it is not a good idea to have an increase in the number of patients. As we have already discussed, chronic non-bacterial prostatitis can also be caused by bacteria, so some doctors believe that localized bacterial culture of the lower urinary tract is not very helpful for clinical use, i.e., antibiotics should be used regardless of whether it is bacterial or non-bacterial. For all these reasons, lower urinary tract locoregional bacterial culture is less used in clinical practice. However, it is undeniable that lower urinary tract locoregional bacterial culture helps in the proper selection of antibiotics and is extremely important clinically for chronic bacterial prostatitis that has been untreated for a long time.
The routine urine examination before prostate massage helps in the diagnosis of urinary tract infection. The actual prostatitis type I (acute bacterial prostatitis) is usually not suitable for prostate massage to avoid the spread of inflammation, and routine urine examination can provide diagnostic clues. Since prostatitis type I has a large number of bacteria discharged into the posterior urethra, the causative organism of acute prostatitis can be initially identified based on the results of urine culture. Prostatitis type II (chronic bacterial prostatitis) can cause recurrent urinary tract infections. A routine urine examination will often reveal white blood cells, and multiple urine bacterial cultures may reveal the same bacterial growth. However, in most cases, urinalysis will not reveal abnormal findings.
When prostate fluid is not available, urine after prostate massage may indirectly reflect inflammation within the prostate. If the sphincter does not relax during prostate massage, or if there is a delay in emptying the prostatic ducts in the area of inflammation, or if the ducts without inflammation empty first and those with inflammation or obstruction empty later, then the prostatic fluid obtained will not reflect the true inflammation in the prostate, and a routine examination of the post-prostate massage urine and bacterial culture will instead The diagnosis can be confirmed by routine examination of the urine after prostate massage and bacterial culture. The amount of urine retained will directly affect the test results.
The normal value of urine leukocytes after prostate massage is not yet unified, generally speaking, urine leukocytes after prostate massage ≥ 5 / high magnification field of view highly suggests the presence of inflammation in the prostate, ≥ 10 / high magnification field of view is clear that the prostate exists inflammation.
What is the significance of semen examination when diagnosing chronic prostatitis?
In the seminal plasma, seminal vesicle fluid accounts for about 60% and prostate fluid accounts for about 30%. Therefore, semen examination can provide information about changes in prostate fluid and is one of the indicators recommended by the National Institutes of Health (NIH) to diagnose the presence of inflammation in the prostate. Clinical studies have confirmed that semen examination can sometimes detect inflammation of the prostate that is not detected by prostatic fluid and urinalysis after prostate massage, and is an important addition to the diagnosis of the presence of inflammation in the prostate, especially when prostatic fluid is not available.
Prostate fluid is the main component that makes up semen and is less affected by non-prostate fluid substances compared to post-prostate massage urine. The seminal fluid is complex and contains substances other than prostatic fluid, and there are many tissues and organs through which the seminal fluid is produced and discharged. In addition, the morphology of immature spermatozoa in semen is similar to that of leukocytes, so direct smear microscopy cannot distinguish between the two, and special staining is required to differentiate them, but this special staining technique is not yet routinely carried out in clinical practice.
The normal value of semen leukocytes is not yet unified. In general, a semen leukocyte count of ≥5/high magnification field is highly suggestive of inflammation of the prostate, and ≥10/high magnification field is definite for the presence of inflammation of the prostate. The unit volume semen leukocyte count is more accurate, ≥106 WBC/ml can clearly indicate the presence of inflammation in the prostate.
What is the significance of B-ultrasound in diagnosing chronic prostatitis?
The B ultrasound can detect pathological changes in chronic prostatitis, which helps in the diagnosis of chronic prostatitis, and can detect prostate cysts, abscesses, stones, etc., which can be used as an auxiliary diagnosis of chronic prostatitis. The prostate ultrasound can be done through the rectum or abdomen. Due to the anatomical location of the prostate, the abdomen ultrasound is blocked by the pubic bone and the distance between the ultrasound probe and the prostate is far, so the accuracy is not as good as the transrectal ultrasound. In mild cases of chronic prostatitis with light pathological changes, the ultrasound cannot detect the lesions, i.e. there may be false negative results. In addition, the ultrasound changes are similar in all types of prostatitis, so the types cannot be distinguished.
The rectal examination of the prostate can provide diagnostic clues to the size, shape, texture, nodules, pain, and shallowness of the central groove of the prostate. The prostate gland may not be abnormal in chronic prostatitis or may appear slightly hard, harder, less regular, full, distended, unevenly soft and hard, with small nodules (harder nodules with stones or calcification), and the sensation of tenderness varies from person to person. 5% of cases have a smaller, slightly harder prostate than normal. The significance of anal finger examination is to exclude other diseases, especially prostate cancer.
One of the main clinical manifestations of chronic prostatitis is abnormal urination. The urodynamic examination has recently confirmed that patients with prostatitis have a reduced maximum urinary flow rate, increased resistance in the lower urinary tract, hyperreflexia of the forced urinary muscles, bladder outlet obstruction and dysfunction of the forced urinary muscle-external sphincter synergy, which leads to reflux of urine and pathogens into the prostate, resulting in chemical prostatitis. Urodynamic examination of patients with chronic prostatitis can help in the diagnosis of functional lower urinary tract obstruction and provide a basis for further treatment.
However, the study of urodynamics in chronic prostatitis is not yet mature, and further research is needed on how to integrate the results of urodynamic examination with clinical diagnosis and treatment, to observe the effects of drugs and treatment protocols, and to add an objective basis for clinical work. In addition, urodynamic examination is influenced by various aspects such as general condition, psychological factors, and neuromuscular factors, and its changes only play a part in the etiology and pathophysiological changes of chronic prostatitis. Therefore, urodynamic examination is not a mandatory test for patients with chronic prostatitis.
However, the uroflow rate test is relatively simple. 30% of patients with chronic prostatitis have a decreased uroflow rate, so some experts recommend that it should be used as a routine test with a view to obtaining information about abnormal urination, especially when there are obstructive voiding symptoms. Further urodynamic studies should be performed if the urine flow rate suggests obstruction. Urodynamic testing suggests bladder neck pathology, with the option of a televised voiding examination.