What are the Criteria for the Correct Diagnosis of Prostatitis?

Increasing numbers of men find themselves grappling with the effects of prostatitis, a condition that takes a toll on both physical and mental well-being. Urology experts emphasize that the cornerstone of prostatitis diagnosis rests on its symptoms. This ailment falls into two categories: acute and chronic prostatitis. Let's delve into the specifics.

Though immune factors play a role, prostatitis typically results from infection. The culprits encompass bacteria, fungi, mycoplasma, chlamydia, and viruses, with bacterial infection prevailing. Vigorous bacteria can swiftly proliferate in the prostate, leading to acute prostatitis.

In contrast, less virulent bacteria can establish a prolonged presence, creating a microbial community. Under ordinary circumstances, these bacteria are dormant, but when the immune system weakens, they multiply and trigger symptomatic chronic prostatitis or even acute episodes.

Criteria for Diagnosing Chronic prostatitis:

Multiple diagnostic avenues exist for chronic prostatitis, detailed as follows:

Symptoms:
Divided into two categories – lower urinary tract irritative symptoms and inflammatory or reflex pain symptoms – these manifest as varying degrees of urinary frequency, urgency, incomplete bladder emptying, urethral burning sensation, discomfort or pain in the perineal area, external genitalia, lower abdomen, pubic region, waist, and around the anus.

Prostate Examination:
The gland's texture may feel full, unevenly firm, or soft, accompanied by inflammatory nodules or a tougher texture. Localized tenderness may be present, and the gland's size can be enlarged, normal, or reduced.

Prostate Fluid (EPS) Microscopic Examination:
Leukocyte count (BC) exceeding 10 per high-power field (HPF), with decreased or absent phosphatidylcholine bodies.

Semen Analysis:
When prostate fluid isn't obtainable, semen analysis through Wright-Giemsa staining microscopy is an alternative, with a white blood cell count >1x10^6/mL deemed abnormal.

EPS Bacterial Culture:
Positive bacterial culture, coupled with a history of urinary tract infection and repeated cultures confirming the same pathogen, indicates bacterial prostatitis. Negative cultures suggest non-bacterial prostatitis.

Stamey Four-Glass Test:
Administered to hospitalized patients, this test diagnoses and differentiates between bacterial and non-bacterial chronic prostatitis. By comparing samples from the first voided bladder urine (VB1) and midstream urine (VB2), a difference of at least one logarithm confirms prostatitis. A higher bacterial count in VB1 may indicate anterior urethral infection. When both VB1 and VB3 show low bacterial counts, EPS results determine the diagnosis. In cases where EPS is unattainable, multiplying the bacterial count in VB3 by 100 yields the EPS value.

Ultrasonography:
Prominent ultrasound irregularities include normal or reduced-sized prostate with variable internal echogenicity, enhanced spots and nodular echoes, and enhanced, thickened capsule echoes. Mild ultrasound irregularities indicate normal or slightly enlarged prostate with slightly stronger or weaker internal echogenicity and unclear capsule echo.

Criteria for Diagnosing Acute Prostatitis:

Accurate diagnosis is pivotal for effectively treating acute prostatitis; however, this diagnosis shouldn't be hasty. It demands meticulous scientific assessment to establish definitive conclusions. What are the criteria?

Diagnosing acute prostatitis entails a gradual approach, with physicians methodically grasping the patient's status. Inquiries about the patient's medical history are essential, including systemic infections, localized infections like skin abscesses or upper respiratory tract infections, and a history of acute urethritis or urethral instrumentation.

Symptoms further shape the preliminary assessment. Given the abrupt onset, systemic indicators like high fever, chills, anorexia, and fatigue often emerge, alongside local manifestations such as frequent urination, urgency, urinary pain, and rectal irritation.

Scientific examinations serve as the ultimate diagnostic foundation for acute prostatitis. Various laboratory tests yield a comprehensive understanding. Digital rectal examination (DRE) is pivotal, revealing substantial inflammation through enlargement, firmness, heightened tension, and prostate tenderness. Gentle pressure may unveil soft areas and purulent discharge. Follicular inflammation could present small hard nodules or overall glandular enlargement with a soft, elastic texture and tenderness.

Once prostate inflammation is confirmed, prompt treatment is imperative. Antibiotic therapy, particularly with detected bacterial infection, is the preferred approach for acute prostatitis. Quinolone antibiotics are often employed and can prove efficacious.

For chronic prostatitis, especially the non-bacterial form, conventional antibacterial drugs might falter. Patients might contemplate herbal treatment like the Diuretic and Anti-inflammatory Pill, which possesses diuretic and anti-inflammatory properties.