prostate examination

The examination of prostate is mainly performed by digital rectal examination. Attention should be paid to the size, shape and hardness of the prostate, whether there are nodules, tenderness, fluctuations and the situation of the middle groove. If you suspect chronic prostatitis, you need to perform a prostate massage (massage of prostate) to obtain prostatic fluid for bacterial culture and laboratory tests. In addition, this procedure can also be applied as a treatment. Basic Information Specialist classification: male examination inspection classification: other inspection Applicable gender: whether the male is fasting: fasting Tips: CT examination of the bladder, need to properly fill, to distinguish between the bladder wall and the lumen. Normal value The prostate is like chestnut size, indicating regular, no induration and pliable areas. The PSA content in the serum of normal people at the time of blood PSA examination is 4 nanograms per milliliter. Clinical significance Abnormal results: When prostate cancer grows in the capsule, CT is difficult to diagnose, and it is only possible to diagnose when the invading capsule infiltrates into the surrounding adipose tissue. The performance of the prostate is irregular and the density is uneven. The anterior rectal wall and bladder wall can be infiltrated and the seminal vesicles disappear. CT can also detect lymph node metastasis and pelvic metastases. CT is helpful for the staging of prostate cancer. On MRI, the prostatic hyperplasia mainly occurs in the central region, so the T2WI shows an increase in the central region. Prostate cancer often occurs in the surrounding area, causing the surrounding area to have a low or slightly lower signal nodule on the T2WI. Therefore MRI is more diagnostic than CT. However, when the MRI findings of prostate cancer are not typical, the diagnosis is still difficult. People who need to be examined: middle-aged and old men often have difficulty urinating. Sometimes they feel that urinary tract can not be emptied. Because the bladder can not be emptied, frequent urination occurs, especially the number of nocturia increases, urinating effort, urine output is obviously reduced, and urinary flow is not smooth. Patient. Precautions Taboo before inspection: 1, CT examination of the bladder, need to properly full, to distinguish between the bladder wall and the lumen. Drink more water, do not urinate to inflate the bladder. 2, the prostate should be emptied before the examination. 3, when doing prostate fluid culture, prostatic fluid collection should be abstinence for more than 5 days. Otherwise it will affect the results of the inspection. 4, prostatic fluid culture specimens should be stopped before the collection of antibiotics. Because, after the antibiotic enters the body, it can reach various tissues and organs in the human body in a short period of time, so that the growth and reproduction of microorganisms such as bacteria in the specimen can be inhibited, resulting in false negative results, and some pathogens are missed. Therefore, if the patient is receiving antibiotic treatment at the time of treatment, whether it is for the treatment of prostatitis or for the treatment of other organ infections, the specimens such as urine and prostatic fluid should be collected after 3 days of withdrawal. And routine inspection, isolation and culture of pathogens. Of course, this may not be necessary in certain special circumstances, such as acute prostatitis or because of some other special reasons. 5. When the prostatic fluid is cultured, the foreskin is too long to cause false positives. Because of the presence of a variety of bacteria or other microorganisms in the urethra, urethral mucosa, and penile skin of normal male urethra or prostatitis patients, specimens such as collected prostatic fluid are often contaminated by microbes present on the surface of the external genitalia. . These contaminated specimens of microorganisms can cause false positive results of bacteria such as the original sterile prostatic fluid, which makes people mistakenly believe that the patient's prostate or other organs of the reproductive system are infected or even seriously infected. Therefore, you must pay attention to cleaning the vulva before collecting the specimen, check whether the foreskin is too long, and whether there is infection. 6. The external genitalia should be carefully cleaned before collecting the prostate fluid specimen. 7. PSA will be affected by local irritation or examination. Such as prostatitis, rectal prostate gland, bladder examination, transrectal ultrasound examination, catheter or catheter riding, may temporarily increase the PSA value, if you want to determine the PSA value, it is best to wait for three After five days of blood draw, the PSA value will be more accurate. 8, before the blood test PSA, it is best not to ride for three to five days. 9, blood PSA examination requires an empty stomach 12 hours after the blood test. Requirements for inspection: 1, the size of the prostate is estimated to be the actual size of the prostate is not necessarily its actual volume, such as the mid-lobe hyperplasia, the gland into the bladder, the prostate is not obvious when the rectal examination. If the prostate is increased in hardness during rectal examination, the surface is uneven, and there is suspicious induration. The hospital should be recommended for needle aspiration cytology to exclude prostate cancer, etc., and to check the contractile function of the anal sphincter, pay attention to the neurogenic bladder. Identification of urethral dysfunction. 2, the best position of the prostate for the examination of the knee chest position; but can also stand, the abdomen close to the side of the examination platform bent to be examined, elderly patients with frail or seriously ill can take supine or lateral position. 3. The collected prostate fluid should be collected in a sterile bottle. 4. Prostate fluid culture specimens should be sent for inspection in time. Routine examination of chronic prostatitis, such as urine and prostatic fluid examinations, should be sent to the laboratory as soon as possible after collection of specimens. Because the specimen stays in vitro for too long, it is highly probable that the number of pathogens in the specimen will increase or decrease due to the death or growth of certain bacteria and other microorganisms, resulting in the analysis of false negative results or results that are inconsistent with the existing conditions. For example, after a urine specimen is left at room temperature for a long time, the pH of the urine is lowered due to the acidity of the urine itself or due to the metabolism of some bacteria, which may cause a large number of deaths of acid-sensitive bacteria, mycoplasma and the like. Missed or misdiagnosed. Specimens such as prostatic fluid, due to their rich nutrients, are placed at room temperature for a long time, which is beneficial to the growth, reproduction and metabolism of certain bacteria or microorganisms, resulting in an increase in the number of certain microorganisms in the specimens, and other microorganisms. The number is reduced, resulting in misdiagnosis or missed diagnosis. 5. PSA values ​​are also affected by age factors, and the elderly are generally elevated. 6. You need to fill in your information and name, gender, date of birth, address, contact number, etc. on the checklist to know the results of the test and prevent the results of different patients from being confused. Inspection process 1, rectal examination (1) The patient may take more than the chest position or the lithotomy position. If the patient's condition is severe or weak, the lateral position may also be taken. (2) The physician wears gloves or finger cots and applies Vaseline or liquid paraffin to the end. (3) When taking the chest position, the left hand supports the patient's left shoulder or buttocks, and the right index finger first gently massages at the anal mouth to detect the early prostate lesions to adapt the patient to avoid sudden anal sphincter tension. Then slowly insert the finger into the anus. When the fingertip enters the anterior wall of the rectum about 5cm away from the anus, the prostate can be touched. Pay attention to the shape and change of the prostate. (4) When massaging the prostate, massage the inward and forward muscles with the end of the finger, about 4-5 times on each side, then move the hand to the upper part of the gland and squeeze it downwards, so that the prostatic fluid can be The urethra is discharged, and the specimen is taken for inspection. 2, B ultrasound (1) Transabdominal wall examination: The position and preparation before the examination are the same as the bladder examination. The probe is placed on the pubic symphysis, and the ultrasound beam is tilted downward to the foot side for cross-cutting and slitting scanning. (2) Transrectal scanning method: With the bladder examination method, the prostate shows a large range. (3) Transurethral examination: the same as the bladder examination method, the advantages of the same transrectal method. (4) The perineal examination method; the left lateral position, the stone removal position, or the bedside bed on the prone bed, the probe is placed on the front edge of the anus with a latex sleeve, and the upper and lower pressure are scanned for longitudinal and oblique crown. Section scan. Or placed on the dorsal side of the scrotum for a coronal section scan. Take prostatic fluid with prostate massage. The normal prostatic fluid is a thin milky white liquid. Microscopic examination: There are many lecithin bodies, and the number of white blood cells per high power field is less than 10, and occasionally sperm. In prostatitis, white blood cells or pus cells are 10 or less per high power field, and some piles, lecithin bodies are reduced, and trichomoniasis can be found. Prostatic fluid can also be cultured in bacteria. 3, bladder and urethra photo Bladder and urethra examination is a method of inserting a catheter into the bladder and injecting 100-200 ml of 3% to 6% sodium iodide solution to develop the bladder. Mainly used for the diagnosis of bladder tumors, bladder diverticulum, external compression, such as prostatic hypertrophy and other diseases. Gas has a good effect on showing bladder tumors, prostatic hypertrophy and the like. It is also possible to use both iodine and gas to form a double contrast. The catheter is inserted into the anterior urethra, or the syringe is directly placed against the urethral opening, and 12.5% ​​sodium iodide or 15% to 25% diatrizoate is injected to show the lesion of the male urethra. At the end of the excretory urography, urinary urinary tract photography during urination can also be performed for excretion of urethral angiography. For patients with urethral stricture, the catheter cannot pass. The clinical manifestations of hypertrophyofprostate or hyperplasia of prostate are mainly dysuria and urinary incontinence, and increased urinary output. Cyst angiography shows that there is a curved impression on the bottom of the bladder, or that the shadow of the tumor protrudes upwards, and the edges are often smooth and tidy, and may also become slightly leafy. The posterior urethra is deformed by compression, which is characterized by elongation, stenosis and an increase in normal curvature. In addition, bladder changes caused by chronic obstruction, such as a conical bladder and irregular edges, can be seen. 4, ultrasound diagnosis Ultrasound images are acoustic images of human organs and tissue structures. These images are closely related to anatomical structures and pathological changes, and have certain regularity. However, current ultrasound images do not reflect histological and cytopathological features. Therefore, in the diagnosis work, the ultrasound image must be combined with anatomy, pathology and clinical knowledge to analyze and judge, in order to make a correct conclusion. 5, nuclear magnetic resonance CT and MRI diagnosis Both CT and MRI are suitable for the diagnosis of bladder and prostate diseases. However, for the indication of the invasion of the lesion to the adjacent adipose tissue of the organ, MRI is superior to CT for displaying the intrinsic tissue structure of the prostate, showing the central zone and the surrounding zone as well as the transition zone. The CT examination of the bladder requires proper inflation to distinguish the bladder wall from the lumen. Drinking more water, not urinating to inflate the bladder, the method is simple, but not accurate enough. Intravenous infusion of low concentration iodine preparation, saline, air or CO2 gas into the bladder is easy to show lesions. Conventional cross-sectional scan, from the pubic symphysis up to the upper edge of the pelvis, layer thickness 1cm. Tumor or prostate cancer at the top or bottom of the bladder invades the bottom of the bladder and is preferably reconstructed with a crown. Enhanced scanning can visualize the ureter and help identify enlarged lymph nodes, but scanning the bladder is early in the bladder filling contrast agent, because too late, the contrast agent in the bladder is too thick, prone to artifacts. In addition to the cross-section, MRI should be treated as a sagittal or (and) coronal scan, especially in the trigone of the bladder. Multi-echo scans help to determine the characteristics of the diseased tissue and infiltration into the vicinity. The bladder is in the front of the pelvis, and the size and shape vary depending on the degree of filling and the level of the layer. The bladder on the CT showed soft tissue density and uniform thickness. The prostate is visible in the obturator plane, which is round and has a uniform soft tissue density. The central small circular low density area is the urethra. There is an external anal sphincter behind the prostate, which is soft tissue density. The boundary with the prostate is unclear, and the rectum is visible on the upper level, and the boundary with the prostate is clear. On the dorsal side of the bladder bottom, the seminal vesicles connected to the prostate are prominent protrusions on both sides. The gap between the seminal vesicle and the posterior wall of the bladder is the seminal vesicle angle The normal prostate has a lower signal on T1WI, which is more uniform. The central region, transition and surrounding area can be displayed on T2WI. The signal in the central area is slightly lower. The surrounding area has a larger water content due to the gland, the signal is stronger, the transition area is narrower, and the signal is low. 6, the method of taking prostatic fluid: The method of obtaining prostate fluid by prostate massage method: the patient takes a standing position to bend or chest and knee after urinating. The examiner's right index finger is worn by the index finger. After applying the lubricant, put it into the anus. Press the side of the prostate on the sides of the prostate from the outside to the bottom 2 to 3 times, then press the center groove again and 2 to 3 times to the anus. Press the perineal urethra, both milky white prostatic fluid outflow, and use glass or sterile tubes for examination. Due to the different lesions of the prostate, the speed of the prostatic fluid is also different. For example, the prostatic prostatitis is sensitive to the prostate, and the prostatic fluid can be obtained by a little massage. Not suitable for the crowd Patients with severe damage to the anus and urethra. Adverse reactions and risks Generally no complications.

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