Differential diagnostic technique for chronic prostatitis

FIELD: medicine.

SUBSTANCE: patient's prostate secretion microscopy and microbiological analysis of sperm are conducted prior to and after three sessions of low-intensity infra-red laser therapy. Further, a final diagnosis of category II, category IIIA or category IIIB chronic prostatitis is stated.

EFFECT: higher differential diagnostic accuracy in chronic prostatitis forms which have essentially different pathogenesis and therapy and improved therapeutic results.

3 ex

 

The invention relates to medicine, namely to urology.

Close goal is to offer Kogan M.I. et al. "A method for the diagnosis of chronic bacteriologi prostatitis", 2004 Patent number RU (11) 2272294. The essence of the invention lies in the fact that in the serum to determine the activity of kallikrein and values from 18 to 39 IU/ml diagnose chronic bacterially prostate inflammatory forms, and when values of 39 IU/ml and above diagnosed with chronic abacterial prostatitis noninflammatory forms. The disadvantages of this method is the technical complexity of the method, the need for highly qualified laboratory and the difficulty of reproduction of this method.

Another similar invention is to offer Sarichev A.V. et al. The method of differential diagnosis of chronic bacteriologi prostatitis", 2006 Patent number RU (11) 2315318. The essence of the method: patients in serum to determine the activity of superoxide dismutase (SOD) and catalase (cat). When the decrease of SOD activity from 69 to 62 srvc. units/ml and the increase of catalase activity from 66 to 74 units/ml diagnose chronic abacterial prostatitis (HAP) inflammatory forms. When the activity of SOD from 62 srvc. units/ml and below and the increase of catalase activity from 60 to 66 units/ml - HAP non-inflammatory forms. The disadvantages of this ways is and is the technical complexity of the method, skilled laboratory and the difficulty of reproduction of this method.

Also close method proposed Changeeven A.V. et al., The method of differential diagnosis of chronic bacteriologi prostatitis", 2007 Patent number RU (11) 2359273. The essence of the method: in the blood of the subject determine the content of nitric oxide released macrophage NO-synthase. When the content produced NO faguoqitirute blood cells from 23 [n/M 2·105

cells]·10-3and above diagnosed with chronic abacterial prostatitis (HAP) inflammatory forms, and when the content of 16 [n/M 2·105cells]·10-3and lower - HAP non-inflammatory forms. The disadvantages of this method is the technical complexity of the method, the need for highly qualified laboratory and the difficulty of reproduction of this method.

As a prototype of the selected method of differential diagnosis of chronic bacteriologi prostatitis, which consists in determining the activity level of 2-macroglobulin, based on the values which are diagnosed chronic abacterial prostatitis noninflammatory and inflammatory forms EN 2276359 C1, published 10.05.2006. Our proposed method differs from the prototype in that conduct microscopy prostate secretion jelly is s and microbiological analysis of sperm before and after three sessions of low-intensity infrared laser therapy.

The aim of the proposed method is to improve the accuracy of differential diagnosis of prostatitis II, IIIA and IIIB categories of chronic prostatitis.

This goal is achieved by the fact that twice was performed microscopy of prostate secretion before and after three sessions of low-intensity infrared laser according to the described method. Simultaneously with the analysis of a secret of a prostate gland was carried out bacteriological analysis of sperm.

The technical result of the proposed method is to improve the accuracy of differential diagnosis of chronic prostatitis II, IIIA and IIIB, which have fundamentally different pathogenesis and treatment. This is achieved by conducting a three-day course of low-intensity infrared laser therapy with the subsequent study of prostate secretion and bacteriological analysis of sperm. This survey was conducted in men with chronic prostatitis category IIIB.

We used low-intensity infrared laser "ALT Mustang 2000" and "ALT Mustang 2000-2" with penetrating power of about 6-8 cm

The technique of laser therapy: the duration of exposure of 1 minute for each of the zones. Zone: above the fold - 600 Hz; lumbar region - 300 Hz; crotch - 80 Hz; the area of the femoral artery - 80 Hz (Semenov A.V. et al. Low-energy lacerater the Pius in the complex treatment of chronic prostatitis. // The Plenum of the Board of VNO: proc. Dokl. - Perm. - 1994. - S-153). After conducting a three-day course of therapy was conducted microbiological semen analysis and microscopy of prostate secretion by traditional methods and bacteriological analysis. It was estimated the same indicators as before laser therapy.

The study was conducted on the basis of the urological clinic of the GOU VPO Yugma University by G. Ivanov.

The study involved men who applied for chronic prostatitis, the examination of which were diagnosed: chronic prostatitis category IIIB. The diagnosis of chronic prostatitis was also confirmed by the data of the transrectal us of the prostate gland, bacteriological examination of prostate secretion of growth of microorganisms have been identified, a blood test for PSA was within the age norm. All patients received laser therapy according to the described method, then re-performed microscopy secret of the prostate gland. The proposed method allows to obtain objective criteria for antibacterial therapy. The basis of diagnosis was the classification proposed in 1995 by the national Institute of health, USA (J.N. Krieger, L. Nyberg, Jr., Nickel J.C. NIH consensus definition and classification of prostatitis // J.A.M.A. - 1999 - Vol.282. - P.236-237). Category II - chronic bacterial prostatitis condition is yavlyaetsya upon detection of pathogenic bacteria 10 3and more microbiological research of a secret of a prostate, a third portion of urine after prostate massage or ejaculate.

Category IIIA - inflammatory chronic pelvic pain syndrome more than 3 months, the presence of more than 10 leukocytes per field of view in the prostate secretion or urine after prostate massage; no or less than 103pathogenic bacteria in samples of prostate secretion, the third portion of urine after prostate massage or ejaculate.

Category IIIB - noninflammatory chronic pelvic pain syndrome more than 3 months, less than 10 leukocytes per field of view in the prostate secretion or urine after prostate massage; no or less than 103pathogenic bacteria in samples of prostate secretion, the third portion of urine after prostate massage or ejaculate.

Initially, all patients fit the criteria for chronic prostatitis category IIIB, which is shown as one of the treatments of low-intensity infrared laser therapy. After three sessions of low-intensity infrared laser therapy they have been re-examination and according to the examples in part of the patients were identified criteria matching the other categories, and accordingly the newly established category of chronic prostatitis them was changed treatment.

The laser therapy popisannoe technique in healthy volunteers inflammatory changes in the analysis of a secret of a prostate gland is not provoked.

Thus, this technique helps to solve the issues of further tactics of examination, treatment, prognosis.

The proposed method allows to obtain objective criteria for antibacterial therapy. The basis of diagnosis was the classification proposed in 1995 by the national Institute of health, USA (J.N. Krieger, L. Nyberg, Jr., Nickel J.C. NIH consensus definition and classification of prostatitis // J.A.M.A. - 1999 - Vol.282. - P.236-237).

Clinical example 1

Patient, 30 years. Went to the clinic with complaints of pain in the perineum, radiating to the lower abdomen, testicles, increasing during intercourse, nocturia 1-2 times per night, increased urination. According to the transrectal us: diffuse heterogeneous echostructure of the prostate contour fuzzy. In the analysis of a secret of a prostate: leukocytes 8-10 in the field of view, the epithelium +; lecithin grain +++; flora is not revealed. In the bacteriological examination of sperm Staphylococcus epidermidis growth of the cumulative environment.

Held laser according to the described method three times. Comparative analysis of a secret of a prostate: leukocytes 15-20-25; epithelium +; lecithin grain ++; flora +. Control bacteriological semen analysis: E. coli in the titer of 5 x 105CFU/ml

Thus, a patient diagnosed with chronic prostatitis category II, assigned to the anti-inflammatory and antibacterial therapy.

Clinical example 2

Ill "L", 49 years old. Went to the clinic with complaints of increased urination, low-intensity pain in the perineum, radiating to the testicles. According to the transrectal us: diffuse heterogeneous echostructure of the prostate gland, calcium, fuzzy contour. In the analysis of a secret of a prostate: leukocytes 2-6 in the field of view, the epithelium ++; lecithin grain +; flora is not revealed. In the bacteriological examination of sperm growth of microflora was not detected.

Held laser according to the described method three times. Comparative analysis of a secret of a prostate: leukocytes 18-24-28, in clusters of up to 40; the epithelium +; lecithin grain +++; flora is not revealed. Control bacteriological semen analysis: Staphylococcus saprophyticus in titer of 1*102CFU/ml

Thus, a patient diagnosed with chronic prostatitis category IIIA assigned to anti-inflammatory and antibacterial therapy.

Clinical example 3

The patient "M", 34 years. Went to the clinic complaining of intense pain in the perineum, radiating to the lower abdomen, testicles, sacral region. According to the transrectal us: diffuse heterogeneous echostructure of the prostate gland due to alternating areas of high and normal ahopelto, fuzzy contour. In the analysis of a secret of a prostate: leukocytes 1-2 in sight, the epithelium +; lecithin grain +++; flora not Yavlena. In the bacteriological examination of sperm growth of microflora is not revealed. A blood test for PSA - 0.02 ng/ml.

Held laser according to the described method three times. Comparative analysis of a secret of a prostate: leukocytes 1-2; epithelium +; lecithin grain ++; flora is not revealed. Control bacteriological semen analysis: the growth of microorganisms are not detected.

Thus, a patient diagnosed with chronic prostatitis category IIIB, antibacterial therapy is not shown.

The method of differential diagnosis of chronic prostatitis, including laboratory studies, characterized in that for confirmation of the diagnosis patients perform microscopy of prostate secretion and microbiological analysis of sperm before and after three sessions of low-intensity infrared laser therapy, and then finally establish the diagnosis of chronic prostatitis category II, category IIIA or category IIIB.



 

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