1. How to diagnose and classify chronic prostatitis?
Diagnosis and classification are made mainly based on symptoms, leukocyte microscopy of prostate fluid, semen or urine after prostate massage, and localized culture of bacteria in the lower urinary tract (see table).
Diagnosis of prostatitis type II.
① with symptoms related to prostatitis;
② Leukocytes in prostatic fluid ≥ 10/ high magnification field, or leukocytes in urine (VB3) after prostate massage ≥ 10/ high magnification field, or leukocytes in semen ≥ 10/ high magnification field or ≥ 106 WBC/ml;
③Bacterial count in prostatic fluid (EPS) and post-prostate massage urine (VB3) was 10 times or more increased than that in primary urine (VB1) and intermediate urine (VB2);
④ Lecithin vesicles ≤++ and pH ≥8 were only used as reference.
Diagnosis of prostatitis type IIIa.
①Symptoms related to prostatitis;
② Leukocytes ≥ 10/high magnification field in prostate fluid, or leukocytes ≥ 10/high magnification field in urine (VB3) after prostate massage, or leukocytes ≥ 10/high magnification field or ≥ 106 WBC/ml in semen;
③Prostate fluid culture was sterile;
④Lecithin vesicles ≤++ and pH<8 were only used as reference.
Diagnosis of prostatitis type IIIb.
① with symptoms related to prostatitis;
② Leukocytes in prostatic fluid, urine after prostate massage (VB3) leukocytes and semen leukocytes are not increased;
③Prostate fluid culture was sterile;
④Lecithin vesicles ≥+++ only as a reference.
Diagnosis of prostatitis type IV.
①No symptoms related to prostatitis;
② leukocytes ≥10/high magnification field in prostate fluid, or leukocytes ≥10/high magnification field in urine (VB3) after prostate massage, or leukocytes ≥10/high magnification field or ≥106 WBC/ml in semen, or prostatitis found by pathological biopsy of prostate puncture.
Table: Differentiation of chronic prostatitis
———- ———- ———- ———
Prostatitis Symptoms Prostate fluid, semen, or prostate Is bacteria localized to the prostate
White blood cells in urine after massage
———- ———- ———- ———
Type II Yes Increased Yes
Type IIIa Yes Increased No
Type IIIb Yes Normal No
Type IV No Increased Yes or No
———- ———- ———- ———
2.How do I get prostate fluid?
Prostate fluid is obtained through prostate massage. The prostate gland is located in front of the rectum. The prostate gland can be touched on the anterior wall of the rectum after the fingers are extended into the rectum, which is about the size of a chestnut in normal people. By pressing on the prostate gland (see figure), the doctor can make the prostate fluid pass through the prostate gland. The prostate gland can be used as a place to get rid of prostate fluid through the prostate ducts. The actual prostate massage technique should not be too heavy, a single examination can not be repeatedly massaged too much, with violence barely obtain the prostate fluid will affect the examination results due to damage to the prostate. The actual fact is that you will be able to get a lot more than just a few of the most popular and most popular products. The actual fact is that there are many different kinds of prostate gland and the amount of prostate fluid secreted by the same patient at different times fluctuates, so there is a difference in the amount of prostate fluid obtained during prostate massage and the amount. Some patients can get more prostate fluid with a little massage of the prostate, while about 10% of patients clinically cannot get prostate fluid even after many attempts. The actual prostate massage will be uncomfortable for the patient, mainly the anal and perineal areas have a short period of swelling and pain or discomfort, at most in 1 to 3 days can disappear, do not worry too much. A few patients are very sensitive to prostate massage and will have strong discomfort, which can be replaced with urine or semen examination after prostate massage.
3. Is there an alternative when prostate massage cannot obtain prostate fluid?
The most important thing is that you can’t get the prostate fluid from the prostate. The answer is no. If prostate fluid cannot be obtained by prostate massage, it can be replaced by urine or semen examination after prostate massage, as urine or semen after prostate massage contains prostate fluid and can provide information about prostate fluid. If the sphincter cannot relax during prostate massage, or if the prostatic ducts in the inflamed area are delayed in emptying, or if the ducts without inflammation empty first and the ducts with inflammation or obstruction empty later, the prostatic fluid obtained at this time will cause errors in the test, and it can be seen that prostatic fluid sometimes does not reflect the real situation of prostate inflammation, and post-prostate massage urine or semen examination is a necessary supplement to prostatic fluid examination.
The actual fact that urine or semen after prostate massage is not a complete substitute for prostate fluid examination is because urine after prostate massage dilutes prostate fluid, semen also contains substances other than prostate fluid, and immature sperm morphologically resembles white blood cells, which can interfere with the examination. Some experts have compared the results of the three specimens, and the results are shown in the figure, that is, the results of the three specimens overlap, and some of the results can be confirmed with the results of the examination with other specimens, but some of the results are different from the results of the examination with other specimens, and the three complement each other. The National Institutes of Health (NIH) recommends the use of these three specimens, and as long as one of the results is positive, it indicates the presence of inflammation in the prostate. 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 of the most popular and popular items.
The actual fact is that you should be abstinent for more than 48 hours before the prostate massage, because after ejaculation there will be an increase of white blood cells in the prostate fluid;
The actual fact is that you should not be able to get a lot of money from the prostate. Therefore, these behaviors should be avoided before the prostate massage.
The actual prostate massage is a great way to get the most out of your prostate;
The actual Urethritis is a very easy way to contaminate the prostate fluid, so you should treat the Urethritis first and then check;
The first thing you need to do is to clean your glans beforehand;
The actual prostate fluid should be discharged from the urethral sphincter due to the spasm of the urethral sphincter.
The prostate fluid should be sent for examination immediately to avoid the prostate from drying out and affecting the examination.
5. How to see the results of routine prostate fluid examination?
The routine examination of prostate fluid generally includes the number of white blood cells or pus cells, lecithin vesicles, and some laboratories also check the acidity of prostate fluid, i.e. pH. Normal prostate fluid has <10 leukocytes/high magnification view, lecithin vesicles ≥+++/high magnification view, no pus cells, pH 6.4~6.7.
Although the defined value of normal and abnormal prostatic fluid leukocytes is set at 10 cells/high magnification field, i.e. it is considered that the presence of inflammation in the prostate gland with ≥10 leukocytes/high magnification field can be considered, but in fact there are also leukocytes in normal prostatic fluid, which fluctuate in a wide range, sometimes >10 cells/high magnification field, therefore, some people also set the defined value at 15 or 20 leukocytes/high magnification field.
Lecithin vesicles are nutrients for spermatozoa. In normal prostate fluid, lecithin vesicles cover almost the entire field of view. In inflammation, lecithin vesicles are phagocytosed by inflammatory cells and are reduced. So the more lecithin vesicles the better, but its quantity is also influenced by many factors.
It is only used as a reference for diagnosis and its diagnostic value is weaker than that of leukocytes.
The pH of the prostate fluid increases in patients with bacterial prostatitis. When the pH is ≥ 8.0, it strongly suggests that the prostatitis is bacterial and can guide the clinical application of antibiotics. However, in healthy people, the pH of the prostate fluid also increases with age and gradually becomes alkaline, so the age factor needs to be taken into account when looking at pH.
In conclusion, the prostate fluid leukocyte examination is the most important and is the main reference content of the examination results and is the standard for the classification of prostatitis. The pH test is relatively simple and can be used to initially speculate whether the prostatitis is bacterial or non-bacterial.
The first thing you need to do is to get a good idea of what you’re looking for. It is possible.
The first thing you need to do is to have a normal routine prostate fluid test. Some people think that this is because the lesions of this type of prostatitis are not in the prostate at all, but in its surrounding tissues.
② There are inflammatory changes in the prostatic fluid, but prostate massage cannot obtain these inflammatory changes in the prostatic fluid, giving false results of no inflammation (false negative). This is due to the fact that prostatitis is not inflammation of the entire prostate, but local inflammation. The prostatic ducts that have inflammation during prostate massage may not be squeezed, and the prostatic fluid collected will not be from the focal site. The site of the onset of prostatitis is in the peripheral part of the prostate, and it is easier to obtain prostate fluid from the central part of the prostate because of the anatomy of the ducts, while it is difficult to obtain prostate fluid from the peripheral part. The prostate gland is blocked by inflammatory tissues and stones, and the inflammatory prostate fluid cannot be discharged, which can also lead to false negative results.
③Laboratory errors. If the prostate fluid obtained is too little, or if the white cells in the prostate fluid gather in piles and are not evenly distributed, a false negative result can occur.
The actual fact that a single prostate fluid examination is normal sometimes makes it difficult to explain the problem and should be examined several times to improve the accuracy of the examination.