Post Date April, 15 2023
Prostatitis is a common and frequently occurring disease in middle-aged and young men, often caused by urethritis, seminal vesiculitis, or epididymitis. There are acute and chronic clinical manifestations, bacterial infectivity and non infectivity, specificity and non specificity. Belonging to the categories of traditional Chinese medicine such as "suspended carbuncle, white turbidity, Lao Lin, Gao Lin, and Jing turbid". It can be completely asymptomatic and can also cause persistent or recurrent urinary and reproductive system infections.
It is not difficult to make general diagnosis of chronic prostatitis according to the history, symptoms, rectal digital diagnosis, prostatic fluid examination, etc., but those with complex symptoms and atypical signs should be differentiated from the following diseases.
1. Prostate tuberculosis: the symptoms are similar to those of chronic prostatitis, but there is often a history of urinary tuberculosis or tuberculosis in other parts of the body. The prostate is irregular and nodular, the epididymis is swollen and hard, the vas deferens has beaded induration, and tuberculosis is detected in prostatic fluid by direct smear or pcr.
2. Prostate stones: refer to stones that occur within the acini and ducts of the prostate gland. It is related to chronic inflammation of prostate, retention of prostatic fluid, stricture of glandular duct, metabolic disorder and other factors. Inorganic salts such as calcium oxalate, calcium phosphate, magnesium phosphate, etc. deposited in the amyloid in the prostatic acinus, epithelial cells and inflammatory exudate formed stones. The patient may show various symptoms of chronic prostatitis, but the prostate can be palpated by rectal digital examination with a sense of stone friction. The pelvis X-ray has a positive stone shadow on one side of the pubic symphysis area, and the ultrasonic examination can show a strong light band and sound shadow on the part of the prostate stone.
3. Prostate cancer: In the late stage, symptoms such as frequent urination, painful urination, and difficulty urinating can occur. However, patients often have obvious systemic symptoms such as weight loss, fatigue, anemia, and loss of appetite. On rectal digital examination, the prostate has a hard, stone like mass with uneven surface, and an increase in serum prostate specific antigen and prostate 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 examination shows asymmetric prostate morphology. If the tumor infiltrates outside the capsule, the tissue gap between the seminal vesicle and the posterior wall of the bladder can be seen disappearing. CT can determine the degree of invasion of prostate cancer.
4. Osteitis pubis: clinically, it often presents the symptoms of chronic prostatitis, but the anal diagnosis and prostatic fluid examination are normal. The main feature is that there is obvious tenderness at the pubic symphysis. Pelvic X-ray shows that the space of the pubic symphysis is widened by more than 10 mm, the horizontal difference between the bilateral superior pubic branches is more than 2 mm, the pubic symphysis is irregular, and there is erosion and reactive osteosclerosis.
5. Prostate pain: These patients exhibit persistent frequent urination, painful urination, difficulty urinating, pain and discomfort in areas such as the perineum, lower abdomen, and lumbosacral region, and worsen after prolonged sitting or cycling. Digital rectal examination showed obvious tenderness of levator ani muscles on both sides, and palpation of prostate was normal without tenderness. In the past, this disease was known as piriformis levator ani syndrome. The microscopic examination of prostatic fluid was normal, and bacterial culture did not grow.
6. Prostate abscess: most of them are complications of acute bacterial prostatitis, mostly occurring in the age of 50-60. Half of the patients have acute urinary retention, frequency of urination, dysuria, rectal discomfort, purulent urethra, and some are accompanied by epididymitis. The rectal digital examination shows that the diseased side of the prostate is enlarged, soft to touch, and has a sense of wave motion. Occasionally, prostate abscesses can naturally rupture towards the urethra or rectum, mistaken for perirectal abscesses.
