Post Date December, 02 2023
"The diagnosis of chronic prostatitis is not difficult based on medical history, symptoms, digital rectal examination, and prostate fluid examination. However, those with complex symptoms and atypical physical signs should be distinguished 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 lesions in other parts of the body. The prostate is irregular and nodular in digital rectal examination, the epididymis is swollen and hard, the vas deferens has beaded induration, and tuberculous bacteria are detected in the prostatic fluid by direct smear or pcr.
2. Prostate calculus: Refers to stones that occur within the acini and ducts of the prostate. It is related to chronic inflammation of prostate, prostatic fluid retention, glandular duct stenosis, metabolic disorder and other factors. Inorganic salts such as calcium oxalate, calcium phosphate, and magnesium phosphate are deposited on the amyloid, epithelial cells, and inflammatory exudates within the prostate acini to form stones. Patients can exhibit various symptoms of chronic prostatitis, but digital rectal examination can detect a sensation of stone friction in the prostate. Pelvic X-ray shows positive stone shadows on the side of the pubic symphysis area. Ultrasonic examination can show strong light bands and sound shadows at the prostate stone site.
3. Prostate cancer: In the advanced stage, symptoms such as frequent urination, painful urination, and difficulty urinating can occur, but patients often have significant systemic symptoms such as weight loss, fatigue, anemia, and loss of appetite. On digital rectal examination, the prostate has a hard, stone like mass with uneven surface, and elevated 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 scan showed asymmetric prostate morphology. If the tumor infiltrates outside the capsule, the interstitial space between the seminal vesicle and the posterior wall of the bladder can be seen disappearing. CT can determine the extent of invasion of prostate cancer.
4. Pubic osteitis: Clinically, it is often manifested as a symptom of chronic prostatitis, but anal examination and prostate fluid examination are normal. The main feature is significant tenderness at the pubic symphysis, and pelvic radiographs show widening of the pubic symphysis space> 10mm, horizontal difference between bilateral superior pubic branches> 2mm, irregular pubic symphysis margin, erosion, and reactive bone sclerosis.
5. Prostate pain: These patients exhibit persistent frequent urination, pain in urination, difficulty urinating, pain and discomfort in the perineum, lower abdomen, lumbosacral region, and other areas, which worsen after prolonged sitting and cycling. The rectal digital examination showed significant tenderness in the levator ani muscles on both sides, and the palpation of the prostate was normal without tenderness. Previously, this condition was known as piriformis levator muscle syndrome. Microscopic examination of prostate fluid showed normal results, and bacterial culture showed no growth.
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. On digital rectal examination, the diseased side of the prostate is enlarged, soft to touch, and has a wavelike sensation. Occasionally, prostate abscesses can naturally rupture into the urethra or rectum, and are mistaken for perirectal abscesses.
