What are the items in a prostate examination?

The prostate is the largest accessory gland in men. The prostate secreted by the prostate gland is one of the main components of male semen. When examining the prostate, attention should be paid to the size, shape, hardness, presence of stones, tenderness, fluctuation and other symptoms of the prostate. It can also be examined through B-ultrasound, X-ray examination and other examination methods.

1. Rectal examination

Prostate examination usually involves rectal examination. By palpating the prostate through the rectum, the size, texture, presence of nodules, and pain of the prostate can be understood. The function of the urethral sphincter can also be indirectly understood by feeling the tension of the anal sphincter. If nodules are felt on the surface of the prostate, the possibility of prostate cancer should be considered. Blood PSA should be checked (increased in cases of prostate cancer), and a prostate puncture biopsy should be performed to confirm the diagnosis if necessary.

1. Most patients take the knee-chest position or lithotomy position. If the patient is seriously ill or weak, the side-lying position can also be taken.

2. The doctor wears gloves or finger cots and applies vaseline or liquid wax on the fingertips.

3. In the knee-chest position, support the patient's left shoulder or buttocks with your left hand, and gently massage the anus with your right index finger.

Detect early prostate disease and make the patient adapt to avoid sudden tension of the anal sphincter. Then slowly insert the finger into the anus. When the finger tip enters the anus about 5 cm from the anus, the prostate can be touched. Pay attention to the shape and changes of the prostate.

4. When massaging the prostate, use the distal ends of your fingers to slowly massage inward and forward, about 4-5 times on each side. Then move your hands to the upper part of the gland and squeeze downward along the median groove. This will allow the prostate fluid to be discharged from the urethra and a sample can be collected for testing.

Second, B-ultrasound

(1) Transabdominal examination: The body position and preparation before the examination are the same as those for bladder examination. The probe is placed on the pubic symphysis, and the ultrasound beam is tilted downward toward the foot to perform transverse and longitudinal scans.

(2) Transrectal scanning: Same as bladder examination, the prostate gland appears larger in size.

(3) Transurethral examination: Same as bladder examination, with the same advantages as transrectal examination.

(4) Transperineal examination: in left-side lying position, lithotomy position, or standing beside the bed with the upper body prone on the bed, the probe is covered with a latex condom and placed on the front edge of the anus, and scanned forward and upward with pressure, and longitudinal and oblique coronal sections are performed. Alternatively, the probe can be placed on the dorsal side of the scrotum for a coronal section scan.

3. X-ray examination

It is of great value in the diagnosis of prostate diseases. For example, plain films can detect whether there is calcification or stone shadow in the prostate. Contrast imaging can help check whether there is prostate hyperplasia or prostate cancer. CT examination is even more important for the differential diagnosis of prostate diseases.

4. Organizational Inspection

It is very useful for clarifying the nature of prostate masses and is extremely helpful for clarifying the histological typing and cytological characteristics of prostate tumors. It can be performed by transrectal needle aspiration biopsy or perineal puncture biopsy. It is painful and traumatic, but it is necessary.

In addition, lower urinary tract urine motility examination is very helpful in diagnosing prostatic hyperplasia. Cystoscopy can directly observe the hyperplasia of the posterior urethra, spermatophore, and middle and lateral lobes of the prostate, which is also very important for diagnosing prostate diseases.

Prostate massage is used to collect prostate fluid. Normal prostate fluid is a thin milky white liquid. Microscopic examination shows that there are many lecithin bodies, less than 10 white blood cells per high-power field of view, and occasional sperm. In prostatitis, there are less than 10 white blood cells or pus cells per high-power field of view, some in piles, fewer lecithin bodies, and occasional trichomonas can be found. Prostate fluid can also be used for bacterial culture.

5. Urethral radiography

Bladder and urethra examination is a method of inserting a catheter into the bladder and injecting 100-200ml of 3%-6% sodium iodide solution to visualize the bladder. It is mainly used to diagnose bladder tumors, bladder diverticula, external pressure, such as prostate hypertrophy and other diseases.

Gas is good for showing bladder tumors, prostate hypertrophy, etc. Iodine and gas can also be used at the same time to form a double contrast. Inserting a catheter into the anterior urethra, or directly placing a syringe against the urethral opening, and injecting 12.5% ​​sodium iodide or 15%~25% diatrizoate can show the lesions of the male urethra. After the excretory urography is completed, urination urethrography can also be performed, which is excretory urethrography. This is even more necessary for patients with urethral stenosis who cannot pass the catheter.

The clinical manifestations of prostate hypertrophy or benign proliferative disease are mainly dysuria and incomplete urination, and increased urination frequency. Cystography can show arc-shaped pressure marks at the bottom of the bladder, or the shadow of the swelling protruding upward, with smooth and neat edges, or slightly leaf-shaped. The posterior urethra is deformed by pressure, showing elongation, narrowness, and enlargement of the normal curvature. In addition, bladder changes caused by chronic obstruction can be seen, such as conical bladder and irregular edges.

6. Ultrasound diagnosis

Ultrasound images are acoustic images of human organs and tissue structures. Such images are closely related to anatomical structures and pathological changes, and have certain regularity. However, current ultrasound images cannot reflect the characteristics of histology and cytopathology. Therefore, in the diagnosis work, ultrasound images must be combined with anatomical, pathological and clinical knowledge for analysis and judgment to make correct conclusions.

7. CT and MRI diagnosis

Both CT and MRI are suitable for diagnosing bladder and prostate diseases. However, MRI is better than CT in showing the invasion of lesions into the fat tissue adjacent to the organs, the internal tissue structure of the prostate, and the central and peripheral areas and transitional zones.

CT examination of the bladder requires proper swelling to distinguish the bladder wall from the inner cavity. Drinking plenty of water, saline, and not urinating to fill the bladder is a simple method, but not accurate enough. Inflation of the bladder by injecting a low-concentration iodine preparation, air, or CO2 through a urethral catheter can easily show lesions.

A transverse scan is routinely performed from the pubic symphysis to the upper edge of the pelvis, with a slice thickness of 1 cm. Coronal reconstruction is best used for tumors at the top or bottom of the bladder or prostate cancer invading the bottom of the bladder. Enhanced scanning can make the ureters visible and help identify enlarged lymph nodes, but the bladder should be scanned in the early stage of bladder filling with contrast agent, because if it is too late, the contrast agent in the bladder will be too concentrated and false images are likely to occur.

In addition to the transverse section, MRI should also include sagittal and/or coronal scans, especially for lesions in the trigone of the bladder. Multi-echo scanning helps to determine the tissue characteristics of the lesion and its infiltration into the adjacent areas.

8. Rectal examination of the prostate

The bladder is located in the front of the pelvic cavity, and its size and shape vary depending on the degree of fullness and the height of the layer. On CT, the bladder appears as a soft tissue density with uniform thickness. The prostate can be seen on the obturator plane, which is round in shape and has uniform soft tissue density. The small round low-density area in the center is the urethra. Behind the prostate is the anal sphincter, which has a soft tissue density. The boundary with the prostate is unclear, and the rectum can be seen on the upper layer, which is clearly separated from the prostate. On the dorsal side of the bladder base, the seminal vesicle connected to the prostate is a protrusion that protrudes symmetrically 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 low signal on T1WI and is relatively uniform. T2WI can show the central zone, transition zone and peripheral zone. The central zone has a slightly low signal, the peripheral zone has a strong signal due to the high water content of the gland, and the transition zone is very narrow and has a low signal.