The diagnosis of prostatitis relies on a careful history and physical examination by the health care practitioner.
The most important laboratory test is a urinalysis to help differentiate the types of prostatitis. The need for other blood tests or imaging studies such as ultrasound, X-ray, and computerized tomography (CT) will depend upon the clinical situation and presentation.
Acute bacterial prostatitis diagnosis
After taking a history, the health care practitioner will likely have a directed physical examination concentrating on the scrotum, looking for inflammation of the testicle(s) or epididymis, and the flank and mid-back, where the kidney is located. If a rectal examination is performed, the prostate may be swollen and boggy, consistent with acute inflammation.
Laboratory testing may include urinalysis, looking for white blood cells and bacteria, signifying infection. The urine may also be cultured to identify the bacteria that are responsible for the infection, but results will take up to seven days to return. The results will help confirm that the antibiotic chosen is correct and may help choose an alternate antibiotic should the illness progress.
Chronic bacterial prostatitis diagnosis
The diagnosis is made by finding an abnormal urinalysis. Sometimes, a urinalysis is collected after prostate examination. This may allow some prostatic fluid to be expressed into the urine and cultured.
A blood test called PSA (prostate surface antigen) may be elevated in this type of prostatitis. While PSA is used as a prostate cancer screening tool, it can also be elevated whenever the prostate is inflamed.
Chronic prostatitis without infection diagnosis
To make the diagnosis of chronic prostatitis without infection, symptoms should be present for at least three months. The cause of chronic prostatitis without infection (chronic pelvic pain syndrome) is not known.
This is a frustrating condition for the patient and the health care practitioner since there is controversy as to the aggressiveness of testing, and exactly what tests should be done. Often, this is a diagnosis of exclusion, meaning that blood tests, urine tests, X-rays and ultrasounds tend to be normal, yet the patient continues to suffer.
Asymptomatic inflammatory prostatitis diagnosis
There are no symptoms with this type of prostatitis; however, when routine lab tests are performed, white blood cells (a sign of inflammation) are found in the urine, but there are no associated bacteria or infection.
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