Prostate secretion: sampling technique and laboratory characteristics

• November 15, 2018
• Prostatitis
• David Omarov

Not many people are familiar with how to prepare for the analysis of prostate secretions.

The prostate gland is a very important male reproductive organ. It produces a secretion, otherwise called prostate juice.

It contains enzymes that are required to reduce the viscosity of sperm. This ensures sperm motility. This function of the gland is far from the only one.

The analysis makes it possible to determine important indicators of a man’s health and the degree of effectiveness of treatment.

Preparation for the analysis of prostate secretions is important. If the meanings are correctly deciphered, it is possible to establish oncology, infertility and obtain all the necessary information about the condition of the main gland in the male reproductive system.

If the doctor directs you to undergo such a study, then you should not neglect this procedure or postpone it until later if you want to maintain the healthy condition of your intimate organs.

The doctor will tell you in detail what preparation is required for the analysis of prostate secretions.

Function of prostate secretion

In the male reproductive system, the prostate gland is one of the most important organs.

It is located in the pelvic area, directly behind the posterior surface of the bladder, and on the other side it is in contact with the rectum, separated by a thin septum. The average size of the gland is three centimeters.

It includes two lobes, each of them is covered with excretory ducts. They are all sent to the prostatic urethra.

In addition, prostate secretion has stabilizing properties for sperm, due to which sperm activity increases. The gland produces two milliliters of secretion per day. It makes up at least 30 percent of seminal fluid.

Nature, therefore, took care of eliminating obstacles to normal fertilization of the egg.

Not everyone knows why preparation is needed for the analysis of prostate secretions.

When is prostate juice examined?

As in any other organ, pathological processes can develop in the prostate. They are most often caused by infections that are sexually transmitted.

Such troubles most often occur to men at a young age, when they are sexually active. Infectious pathogens “settle” in the prostate and accumulate there throughout the entire period of male sexual life. If conditions arise that provoke the activation of infectious pathogens, the process of inflammation begins to develop. Such conditions may be:

• state of stress;
• hypothermia;
• pathologies of the pelvic organs;
• Unhealthy Lifestyle.

The process of inflammation in the prostate is called prostatitis. Its forms differ depending on the source of occurrence: chronic, acute, abacterial, bacterial. The study of prostate secretions makes it possible to determine the nature of the disease and the prognosis of its development.

Symptoms

Analysis is also carried out for the following symptoms:

• decreased sex drive;
• long-term difficulties with conceiving to rule out male infertility;
• erectile disfunction;
• systematic pain in the pelvic area.

There is another significant reason for studying the analysis of prostate secretions, that is, tracking the therapeutic dynamics of the patient's condition.

The biochemical content of the juice becomes an indicator of the ineffectiveness or effectiveness of prescribed medications.

The analysis is carried out to determine infectious pathogens and their sensitivity to drugs, mainly to antibiotics.

Signs of an unhealthy prostate

It is necessary to distinguish the initial signs that indicate disorders of the prostate gland, signaling an urgent visit to the urologist.

With timely detection of a developing disease, you can get rid of it and return to normal in a short time.

Any man who is attentive to his own well-being is able to conduct an initial self-diagnosis and determine that he is beginning to have genitourinary problems. For the prostate gland, the first signs of pathology development are:

• frequent urge to empty the bladder;
• feeling of incomplete urination;
• pain when urinating;
• potency defects.

Self-medication without determining the cause of deviations in a person’s health is pointless.

It is important to eliminate the cause

The use of herbal medicines and special urological exercises also contribute to recovery. However, without eliminating the cause of the disease, all these actions will only relieve symptoms. As soon as the training stops and the drug is discontinued, all the genitourinary problems will return again.

Algorithm for collecting prostate secretions

Often representatives of the strong, who are concerned about their health, ask the question of how to analyze prostate secretions in men? This is done only by massaging the gland. No other method has been found or invented at this time. Men do not like this procedure, but without it it is impossible to get an accurate picture of the condition of the prostate.

After preparing for the analysis of prostate juice, the doctor massages the gland on an outpatient basis. Before starting the procedure, the patient is advised to empty the bladder. The urologist, depending on the weight, build and other characteristics of the patient, chooses the most comfortable position for massage for the person. This is predominantly a knee-elbow position. However, it can be done with legs tucked in, lying on one's side.

After a rectal massage, a small volume of secretion is released from the urethra, which is collected on a previously prepared glass slide or in a test tube. The material is then packaged in a sterile container, formatted and described, and then sent for testing to the laboratory.

It happens that after a massage the juice is not released and goes into the urethra. In this case, the patient is asked to defecate and urine is collected. Subsequently, it is passed through a special centrifuge, due to which the liquid is divided into components.

Preparation for analysis of prostate secretions at a psychological level

For a man, the most unpleasant thing during a urological appointment when taking prostate secretions is emotional discomfort.

The volume of collected secretion can show congestion in the prostate (over two milliliters) or prostatitis (less than one milliliter). Normally - from 0.5 to 2 milliliters.

The procedure is contraindicated for acute types of prostate pathologies, so there will be no pain. It is important to find out in advance how to prepare for the analysis of prostate secretions.

That is why the main preparation of a man for the reception is overcoming his own shyness and emotional state. You need to understand that these unpleasant moments will become assistants in finding the most effective treatment method. Thus, one can hope for quick relief from genitourinary disorders.

A few more recommendations

There are several more recommendations for preparing for the donation of prostate secretions:

• you need to abstain from intimate relationships 2-3 days before the analysis;
• It is prohibited to drink alcohol;
• do not load the prostate gland;
• do not engage in strength exercises, do not carry heavy objects or ride a bicycle;
• Overheating of the prostate area is prohibited, and therefore saunas, steam baths and hot baths are excluded.

The essence of bacterial sowing

The doctor will tell you in more detail about preparing for the analysis of prostate secretions at your appointment. What is this analysis?

By bacterial culture we mean a laboratory analysis of biomaterial, which allows us to identify pathogens and test their sensitivity to antibiotics. Such a study is in demand by gynecologists, urologists, dermatovenerologists, etc. The analysis has two stages:

• Growing bacteria. The biomaterial is placed in favorable conditions for their growth and provided with the necessary nutrient medium. Laboratory assistants observe this process and determine the rate (degree) of increase in the number of bacteria. It is calculated in CFU/ml.
• At the second stage, sensitivity to medications is determined. This is a very important study, since recently there is a serious disorder that significantly complicates all therapeutic methods. This is the resistance of bacteria and viruses to drugs. That is why it is so important to conduct an antibiogram, which allows you to choose an effective drug in a given situation.

The following pathogenic microorganisms grow especially often in prostate secretions:

• staphylococci;
• coli;
• enterococci.

You can also test prostate secretions for sexually transmitted infections. Venereal pathogens are often identified in this way:

• mycoplasma;
• gonococci;
• ureaplasma;
• candida;
• chlamydia, etc.

Where can I take the test?

Many men do not know where to get tested for culture of prostate secretions, as well as what the cost will be.

The duration of bacteriological analysis is from five to seven days. Its results allow us to develop treatment tactics for each case. Bacterial seeding is currently an accessible procedure. It is performed in all urological clinics and dermatovenerological clinics.

Decoding the analysis results

The study of prostate secretions includes two types of tests: bacteriological and microscopic.

In the first process, the structure of cells is studied. To do this, use two viewing glasses, with a drop of secretion placed between them. Bacteriological research is bacterial culture. There is another quite informative test for the so-called “fern symptom”.

It is carried out in this way: a drop of secretion and the same amount of saline solution are applied to the viewing glass. They are mixed and left to dry. During crystallization, a special pattern is formed. If it looks like a fern leaf, we can judge the absence of inflammation in the prostate.

Analysis of prostate secretion allows you to evaluate the following indicators: odor, color, density and collected amount. The absence or presence of pus in the blood is determined.

Native analysis of prostate secretion

In a laboratory setting, a native test is performed: the biomaterial is applied to glass slides, dried in the open air, and then stained with a Gram stain. After this, the laboratory doctor examines the native agent microscopically in all fields of view and counts the number of formed components of the secretion.

The volume of collected material can indicate symptoms of stagnation in the prostate (over two milliliters) or prostatitis (less than one milliliter). The norm is from 0.5 to 2 milliliters, an increase or decrease is a symptom of the inflammation process. Color – yellowish or transparent white.

Lecithin grains - ten million per milliliter of secretion. A decrease indicates the presence of disease. Density is 1.022, pH (acidity) is neutral, 0.7, in both directions it can deviate no more than 0.3. The number of leukocytes is a maximum of ten per field of view.

If there are more of them, inflammation can be judged. There should be no macrophages. Their presence indicates pathology. Red blood cells are also absent or found sporadically; their presence indicates disease. Fungi and bacteria are absent; if present, they speak of prostatitis.

Trichomonas, gonococcus, and Escherichia coli are absent.

Pyrogenal test

Sometimes bacterial culture of prostate secretions does not indicate an inflammatory process. However, there may be symptoms of the disease. In such an ambiguous situation, the patient is offered a test with pyrogenal.

When such an analysis does not show prostate symptoms, there are two options: narrowing of the excretory ducts and/or several inflammatory foci in the gland. To determine the condition, a biopsy or TRUS is prescribed.

Preparation of prostate secretion must be carried out correctly. Moreover, the collection can be done independently.

Features of self-collection of prostate secretion

Nowadays it is not difficult to carry out microscopic and bacteriological examination. Any large populated area has a laboratory that specializes in performing such tests. The study is paid, but the cost is affordable. To collect the secret yourself, you need:

• learn prostate massage techniques;
• prepare a hermetically sealed sterile container;
• bring the quickly collected secret to the clinic.

After receiving the result, you can visit a urologist. Typically, prostate secretion analysis does not take long.

Source: https://cureprostate.ru/421185a-sekret-prostatyi-podgotovka-k-analizu-algoritm-provedeniya-i-rasshifrovka-rezultatov

Analysis of prostate secretions

Assessing the composition of prostatic fluid helps the doctor in diagnosing prostatitis, male infertility, inflammatory and hyperplastic diseases of the prostate gland. This type of laboratory examination is necessary for a qualitative study of the functional characteristics of the prostate and in urological practice is an important part of the diagnostic process. By assessing the physical, chemical and biological properties of prostatic secretions, certain conclusions can be drawn about the functioning of the prostate gland and the male genitourinary system. Analysis of prostate secretion is carried out after preliminary preparation; interpretation of the results is based on physiological norms, which differ depending on the age of the man.

Indications for analysis

The doctor resorts to examining the secretions of the prostate gland if indicated, in the case when there is a suspicion that malfunctions in the genitourinary system are associated with pathological changes in the tissues of the prostate.

Laboratory analysis of prostatic fluid is carried out in cases where a man complains of erectile dysfunction, problems with urination, as well as the possible development of infertility, inflammation, hyperplasia or dysfunctional disorder.

Indications for analysis:

1. Diagnosis of prostatitis. The appearance of purulent or bloody discharge from the urethral canal, the presence of pain, burning, and frequent urination are often clear symptoms of prostate inflammation. In the typical course of the disease, the study is of a clarifying nature, but in the latent form of prostatitis, this type of laboratory diagnosis is often the only option for detecting the disease. By identifying pathological microflora in prostatic secretions, the doctor not only receives confirmation of the existing inflammatory process, but also determines the sensitivity of the pathogen to antibacterial drugs.
2. Suspicion of hyperplasia. Decreased erection, weakened urine stream, and the appearance of pain in the area of ​​​​the projection of the bladder are typical for various forms of hyperplastic tumors of the prostate gland. In addition to instrumental types of examination, laboratory analysis of prostatic fluid helps in diagnosis. Atypical structures are found in the prostate secretion, the presence of which indicates increased cell activity and an increase in the production of specific enzymes. The study is carried out to differentiate between cancer and prostate adenoma, since pathological changes in benign and malignant tumors are of a different nature.
3. Determining the cause of erectile dysfunction. A man's potency is directly dependent on the functional state of the prostate. Diseases and pathological processes in the tissues of the prostate gland often lead to weakened erections and also cause problems with the emission of semen. The analysis helps to assess the degree of functional abnormalities and establish the nature of erectile dysfunction, after which the disorder is corrected using available methods of conservative or surgical medicine.
4. Infertility. When, despite an active sexual life in a couple and the woman being in full health, the family fails to conceive a child, the question arises about reproductive disorders on the part of the man. Prostate secretion is part of sperm, providing the correct habitat for sperm, increasing their activity and viability. If problems arise, the prostatic fluid loses its functional properties, and the quality of the semen decreases. By analyzing the data, the doctor can understand the cause of infertility and prescribe appropriate treatment to return the indicators to normal.

In urological practice, research is one of the most accessible, simple and informative diagnostic methods, allowing you to quickly find out the cause of the disorder, make a correct diagnosis or clarify the presumptive nature of the disease.

Contraindications

The procedure for taking a secretion for research is quite simple, but the specifics of the technique for performing the manipulation impose a number of restrictions.

There are contraindications in which the collection of prostatic fluid is difficult or may lead to unreliable data during interpretation.

Some restrictions are temporary, but sometimes you have to completely abandon laboratory diagnostics of this type.

Contraindications for analysis:

1. Cracks, damage to the skin and mucous membranes in the anus. The collection of biological material is carried out by massaging the prostate through the anus, therefore, in the presence of pathological changes, taking the secretion becomes a painful procedure and can lead to complications.
2. Acute inflammatory diseases with high fever. As a result of temperature deviations from the norm, the prostate secretion will have different characteristics, so it will not be possible to obtain reliable data.
3. Tuberculosis, prostate cancer with metastases. Since the procedure is associated with irritation of the prostate tissue, during manipulation there is a risk of damaging the organ and causing complications of the underlying pathology.

If it is impossible to conduct a laboratory analysis, which is a good diagnostic tool, you have to carefully draw up a research plan and choose more favorable methods.

Preparatory stage

Despite the fact that the study of prostatic secretions is a standard laboratory analysis and is not a complex type of diagnosis, preparation for the delivery of biological material takes from 3 to 5 days.

A doctor will help you properly prepare for the test, providing you with all the necessary information and giving you a leaflet with instructions.

Fulfilling the requirements of the preparatory stage is an important condition for obtaining reliable results.

List of recommendations during preparation for the study:

1. Refusal to take medications that may affect the composition of the secretion. During the preparation period, you should stop using antibiotics, hormonal and vascular drugs, as well as medications that affect blood composition. The physical indicators of the secretion may change under the influence of the active components of the medications; when deciphered, the doctor will receive incorrect results, so 5 days before the expected date of the study, he cancels the prescribed medications.
2. Refusal of thermal procedures and excessive temperature fluctuations. Visiting a sauna, solarium, swimming pool - all types of exposure associated with overheating or hypothermia can distort the results of the study.
3. Refusal of physiotherapeutic procedures. Radiation, magnetic fields, vibration effects, heat influence the composition of biological fluids and can stimulate or inhibit the production of prostate secretions. It is not recommended to take a test while undergoing physical treatment, since diagnostic data may be changed.
4. Reduced physical activity. Active exercise is useful, but during the period of preparation for the analysis, a man should limit the work of the abdominal muscles, pelvic floor and lower body. Active blood flow can lead to an increase in enzyme production, increasing testosterone levels, and the results obtained when deciphered will be incorrect.
5. Proper nutrition. Food is the main source of energy and a way to replenish resources spent by the body on the reproduction of new cellular structures. The method of passing the secretion involves limiting the consumption of smoked, salted, pickled foods, semi-finished products, sweets and alcoholic products for a period of 3 to 5 days.
6. Rejection of bad habits. Smoking and alcohol negatively affect the functioning of all body systems, and the prostate gland reacts sharply to the effects of poisonous substances and toxins. Before taking the test, you need to reduce the number of cigarettes you smoke and completely give up alcohol. On the day of collection of biological material, before the study, smoking is prohibited.
7. Cleansing enema. The method of donating prostate secretions involves performing a rectal examination and stimulating prostate tissue through the anus. A man needs to do a cleansing enema at home, which will ensure hygienic cleanliness and make the procedure more comfortable for all participants.
8. Sexual abstinence. During sexual intercourse, a large amount of prostatic fluid is released, which takes some time to replenish. 2-3 days before the test you should refrain from sexual intercourse, otherwise the volume of secretion secreted by the prostate will not be enough for analysis.

On the day of the examination, the man needs to take a hygienic shower, drink about half a liter of water and go to the office. Accurate preparation is the key to correct diagnosis, therefore the preparatory stage should be treated with a great deal of responsibility, and if necessary, be sure to ask clarifying questions to the attending physician.

Process

The technique for collecting secretions for analysis is similar to the procedure for rectal massage of the prostate. The man is asked to lie on his right side or take a knee-wrist position, the doctor puts on gloves, lubricates the anus with a special lubricant or regular Vaseline, and inserts a finger into the rectum to a depth of 3 to 5 cm. Next, the prostate tissue is stimulated, resulting in the urethra begins to secrete secretions. The liquid, collected in a sterile container or tube, is delivered to the laboratory.

Sometimes, after direct stimulation of the prostate, it is not possible to achieve secretion. In this case, the analysis will be done from the first portion of urine, which contains a small amount of prostatic fluid. This method is less reliable and when deciphering, the doctor must indicate the error.

Decoding the results

In laboratory conditions, the study takes place in several stages.

Physical, chemical, and biological indicators are assessed, special tests are made, and, if necessary, ultrasound and molecular tests are performed.

An employee of the laboratory research office deciphers the analysis data, and the finished results are transferred to the attending physician for comparison with the clinical picture and diagnostic information.

Normal results

When examining the secretion, a test called the “fern symptom” is performed.

In this analysis, part of the liquid is mixed with physiological solution, and after application to the glass, wait until it dries.

Normally, the result should be a pattern resembling a fern leaf; if the composition of the secretion is disrupted or in the presence of pathogenic flora, the structure of the crystals changes and the outlines become blurred.

For macroscopic indicators

The data should normally show the following values:

• volume of delivered material from 1.5 to 2 ml;
• milky color;
• the reaction is neutral or slightly acidic;
• the density indicator is 1.022 g/cm3;
• the smell is neutral.

The initial assessment is made on fresh material, and if the first portion of urine is delivered to the laboratory, it is first run through a centrifuge to isolate prostate secretions.

For microscopic indicators

The study of cellular structures is carried out in a counting chamber or under a microscope, depending on the technical equipment of the laboratory:

• there should be no red blood cells in the delivered sample, and the number of leukocytes should not exceed 10 in the field of view or 300 cells/μl when using a counting chamber;
• lecithin grains form the basis of the secretion and they should completely cover the field of view;
• epithelial cells in unit equivalent;
• macrophages, amyloid bodies and giant cells are normally absent;
• there should be no pathogenic microflora, fungi, bacteria and viruses.

Based on the calculation data of micro- and macroscopic indicators, the laboratory gives a conclusion, which is the basis for a doctor to make a diagnosis.

Reasons for deviations

As a result of evaluating the analysis data, the treating doctor receives valuable information for subsequent diagnosis. If there are deviations, additional research methods are required, since changes in the composition of the prostatic fluid may indicate a variety of pathologies. The presence of pathogenic microflora is the first sign of prostatitis, a decrease in the number of lecithin grains calls into question the reproductive abilities of a man, the appearance of red blood cells is often considered a symptom of hyperplasia or cancer, and the presence of giant cells and atypical structures often indicates an oncological disease.

The analysis is a simple and accessible method for early diagnosis of many diseases of the male genitourinary system. Despite the necessary preparation and discomfort of the procedure for collecting fluid for examination, it is recommended for preventive purposes to conduct an examination using this method at least once a year.

Doctor of the highest category, Candidate of Medical Sciences, Diploma in General Medicine, Russian State Medical University named after. N. I. Pirogova (2000) Experience 17 years

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Source: https://kisstyle.ru/predstatelnaya-zheleza/analiz-sekreta-prostaty/

What is prostate secretion - how to take it and interpretation of the test

To identify prostatitis, oncological processes and other diseases, it is recommended to study the secretion of the prostate gland.

What is prostate secretion? This is a biological fluid that is a component of sperm. Its composition affects the fertilizing ability of male germ cells.

Changes in the characteristics of the juice make it possible to diagnose organ disorders. Let's look at how prostate secretions are taken, what preparation is needed for the procedure?

Who needs to take a prostate secretion test?

Analysis of prostate secretion is carried out to identify diseases that are caused by a malfunction in the functionality of the reproductive system. Laboratory research has specific goals - to establish pathologies of the glandular organ, for example, prostatitis, cancer, etc.; definition of infertility in men. Another goal is to monitor the effectiveness of already prescribed drug therapy.

The study is recommended by a urologist if the patient exhibits the following clinical manifestations:

• Pain syndrome in the perineum;
• Painful sensations and pain during urination;
• Frequent trips to the toilet, especially at night;
• Sluggish urine stream due to frequent urination;
• Specific discharge from the urethral canal.

Please note that the procedure has certain contraindications. These include prostate tuberculosis, acute inflammatory diseases accompanied by fever and increased body temperature, exacerbation of hemorrhoidal disease, and anal fissures.

Depending on the composition of prostate juice, the doctor can determine the presence of pathological processes and, accordingly, recommend certain treatment tactics.

Methods for analyzing prostate secretions

To determine pathological processes in the prostate, various laboratory diagnostic methods are used. The choice of one method or another is based on the doctor’s suspicions of some disease. To establish a diagnosis, a microscopy method can be used. seeding of secretion and method of crystallization.

Method of obtaining prostate secretion

The gland is located near the rectum. The juice secreted by the organ is discharged into the urethral canal. Many patients are interested in how to donate prostate secretions, how is biological fluid collected? Spontaneous release of secretion is observed only during ejaculation. But in order to obtain material for further study, the doctor performs a special massage through the rectum.

To take prostate secretions for analysis, the procedure is as follows:

1. The patient needs to free the lower part of the body from clothing.
2. Then the man lies on the couch on his side, with his legs slightly bent at the knees and his hands near his chest. In some cases, the doctor may recommend taking the knee-elbow position.
3. The medical specialist puts on disposable gloves and inserts the index finger into the anus to a depth of 35-40 millimeters. Next he makes stroking movements on both sides. Usually 11-17 movements are enough.
4. Afterwards, you need to press on the interlobar groove to release the juice that has accumulated in the glandular organ.

It is worth knowing: the release of biological fluid occurs through the urethral canal, then it is applied to a glass slide.

Sometimes the fluid is not released, in which case the test is different. After massaging the gland, the doctor suggests that the patient urinate into a test tube, which allows the necessary juice to be removed along with urine. The collected material is sent for laboratory testing.

Preparing for the test

Before conducting the study, you need to prepare. There is nothing complicated about this; all requirements are easily met. Ten hours before the expected test, you need to refuse food. Typically, massage to obtain material is done in the morning, so problems with this condition are not observed.

Before the procedure, a cleansing enema is performed. It is also necessary to empty the bladder before the procedure to prevent urine drops from mixing with prostatic secretions.

Other preparation rules:

• 3-5 days before the study, it is necessary to exclude sexual contacts;
• 24-48 hours before the analysis, exclude alcoholic drinks from the menu and visiting the bathhouse/sauna.

Many representatives of the stronger sex have an extremely negative attitude towards massaging the glandular organ. Sometimes the help of a psychologist is required, or the patient is first given a sedative.

Carrying out analyzes

As already noted, analyzes are carried out using different techniques. All of them are focused on identifying pathological processes in the prostate. The microscopy method involves identifying the following indicators:

1. Leukocyte count;
2. Concentration of lecithin grains;
3. Content of amyloid bodies;
4. Epithelial cells, etc.

Leukocytes play an important role in prostate secretions. If their concentration is above 10, then this indicates the development of an inflammatory process in the glandular organ, prostatitis is suspected. Sometimes the prostate juice is quite viscous and thick, which contributes to clogging of the organ’s excretory channels. With this picture, leukocytes are also elevated. But the problem is solved through a course of prostate massage.

Important: deviations from the norm in the number of leukocytes are not always due to the development of prostatitis in a man. This is often caused by an inflammatory process that occurs in the urethral canal.

Secret lecithin grains are a product of the production of prostate juice. If the quantity is small, they speak of a partial disruption of the functionality of the male organ.

Analysis of the nature of crystallization is an auxiliary test that is carried out to monitor the effectiveness of prescribed therapy for chronic prostatitis. Within the framework of this technique, the process of crystallization of sodium chloride, which is contained in low concentrations in the juice of the gland, is studied.

The chemical substance contained in the secretion of a healthy organ is characterized by a crystal lattice, which in its outline resembles a “fern”. If the structure of the lattice is disturbed, then they speak of a pathology of the glandular organ - this may be an inflammatory process or a hormonal imbalance.

Interpretation of results and norms

Prostatic discharge is subjected to various studies, on the basis of which a medical specialist from the laboratory issues a conclusion. The treating doctor must decipher the results; accordingly, after decoding, he prescribes further treatment, if required.

When the prostate secretion is studied, the norm and pathology are determined in accordance with certain criteria:

• Amount of juice. The minimum value is 0.5 ml, the maximum value is 2 ml. If a decrease in quantity is detected, then they speak of prostatitis; an increase indicates stagnation;
• Color. Normally, the color of the liquid should be white. Against the background of the inflammatory process, it changes, becomes bright white or has a yellowish tint. When blood is found, the color is red;
• Smell. Normally, there is a specific smell of semen. If the smell is different, then this indicates a pathological change in the composition of the liquid;
• The normal density is 1.022. Any deviation to a smaller or larger direction signals a pathological process;
• pH of prostate juice. Normally 7 is exactly, deviation up to 0.3 is acceptable. If a shift towards alkaline reactions is detected, then this is a chronic inflammatory process; to the acid side – prostatitis;
• Red blood cells should normally be absent or present in a single quantity in the visible area. Their high concentration indicates oncology or prostatitis;
• Epithelial cells. Normally, there are no more than two in sight. Epithelial cells line the canals of the glandular organ. When the content increases, inflammation occurs. If leukocytes in the prostate secretion and red blood cells are increased at the same time, then everything indicates a malignant neoplasm;
• There should be no more than ten leukocytes in the field of view at a magnification of 280 times, and no more than five if the magnification is 400 times. In any case, their high content means inflammation;
• Normally, macrophages should be absent or no more than three. Excessive content – ​​inflammation;
• Amyloid bodies are not normally detected. If they are present, benign prostatic hyperplasia, hypertrophy of the glandular organ, and congestion in the pelvis are suspected;
• Crystallization is normally maintained. Deviation – does not correspond to the picture;
• Fungi are not normally observed;
• Pathogenic microflora is normally present in low concentration. Excess indicates various infectious processes. It is necessary to establish the specific type of pathogen.

Note: Diagnosis is not made based on a single test. For example, in some cases, increased viscosity of prostatic juice can distort the results obtained, so the analysis is repeated at least twice. Between two examinations it is required to massage the prostate gland.

Analysis of prostatic juice is an informative diagnostic method that helps diagnose prostatitis of any form, benign prostatic hyperplasia, and oncological process. In the laboratory it is possible to determine not only the disease, but also the stage of its development.

Source: https://ManExpert.ru/prostata/diagnostika/chto-takoe-sekret-prostaty.html

Laboratory methods for examining the prostate gland

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Of great importance in the diagnosis of prostate is laboratory research methods, including a general blood test, serological methods and PCR diagnostics to exclude atypical intracellular infection ; general urine analysis, culture of the middle portion of urine, microscopic examination of pancreatic secretion, bacteriological examination (culture) of three portions of urine and pancreatic secretion (Meaxes-Stamey test), as well as bacterioscopy of urethral smears to detect gonococci. The most important indicators of a general urine test are protein, leukocytes, and bacteria. Normal urine does not contain protein. In the urine of a healthy person, 1-2 (up to 5) leukocytes are detected in the field of view of the microscope. Leukocyturia and pyuria (>60-100 leukocytes in the field of view) indicate an inflammatory process in the organs of the genitourinary system.

Bacteriuria in a general urine test does not have significant diagnostic value. More informative are the calculation of the number of microbial bodies per unit volume (degree of bacteriuria) and bacteriological examination of urine.

Normally, human urine obtained non-invasively can be contaminated with microflora from the distal urinary tract and perineal skin. The detection of one or more bacterial cells in the field of view of the microscope indicates the presence of 105 microorganisms or more in 1 ml of urine. Determination of one or more leukocytes in the field of view of the microscope is an indicator of infection. In a urine smear of a healthy person, the presence of only a few bacterial cells and leukocytes is allowed. Urine collection for bacteriological examination is carried out after a thorough toilet of the external genitalia with a 0.5% solution of potassium permanganate or boiled water and soap. Urine is collected in an amount of 10-15 ml in a sterile container with a lid. Samples are delivered to the laboratory within 2 hours after collection or stored in a refrigerator at a temperature of +4 ° C until delivery to the laboratory (no more than 18 hours). To detect hidden leukocyturia, erythrocyturia and cylindruria (with single leukocytes, erythrocytes and cylinders in the field of view), a urine test is performed according to Nechiporenko, in which their content in 1 ml of urine is calculated (normally 4000, 1000 and 500, respectively). Urine analysis in three portions with examination of prostate secretions (Fig. 1-5) (three-glass sample, Meares-Stamey test, four-glass sample) is a key laboratory method for diagnosing and determining the category of prostatitis.

Figure 1-5. Meares-Stamey sample

Before the study, the patient is recommended not to have sexual intercourse for 2-3 days and immediately before taking samples for analysis not to urinate for several hours (the patient’s bladder should be well filled). After toileting the external genitalia and retracting the foreskin, the patient begins to urinate (10-15 ml) into the first container (urethral test), then 100-200 ml into the toilet, and then, without interrupting the flow, 20-30 ml of urine is collected into the second container (bubble test); after this, the patient should stop urinating. To obtain prostate secretions, massage the right and then the left lobe of the prostate gland from the periphery to the center for one minute. The whitish-yellow fluid released from the urethra is collected on a glass slide or in a Lippendorff tube for analysis. If it is not possible to obtain prostate secretion, then examine the urine sediment obtained immediately after prostate massage (no later than 5 minutes). Then the very first urine (10-15 ml) excreted by the patient after massage of the prostate gland is collected into the third container (prostatic sample). The resulting three portions of urine and/or prostate secretion in its pure form are subjected to microscopy and cultural examination.

Laboratory signs of prostatitis under microscopy are an increase in the number of leukocytes (more than 10-15 in the field of view of the microscope), a decrease in the number of lecithin grains and the presence of macrophages containing fat (oval fat bodies) in the secretion of the prostate gland or in the third portion of urine.

In case of bacterial prostatitis, bacteriological examination reveals uropathogenic flora in the secretion of the prostate gland or in the third portion of urine: most often Escherichia coli, less often Klebsiella, Proteus, Enterobacter, Staphylococcus and Pseudomonas aeruginosa.

It should be borne in mind that negative results of a single study of prostate secretion do not mean the absence of an inflammatory process in the prostate gland.

At the same time, examination of prostate secretion alone does not reveal inflammation in almost 50% of patients with inflammatory syndrome of chronic pelvic pain.

The detection of more than 15 leukocytes when examining the sediment of the first portion of urine confirms the diagnosis of urethritis.

When examining urine sediment for any histological form of a tumor, two types of epithelial cells are found: some are dark, degeneratively changed, often elongated, scattered, others are large, located in complexes or in the form of papillary structures. Nuclei with coarse chromatin, some with nucleoli. Both types of cells can be found in the same patient in different portions of urine. As a rule, the background of the drug consists of detritus, elements of inflammation, and erythrocytes. In most cases, such cytograms can only be used to judge the presence or absence of malignant neoplasm cells. A tampon with a narrow applicator is inserted into the urethra to a depth of 3-4 cm, carefully turned and removed. For the study, material obtained from both the tip and the rod of the tampon applicator is used. To collect material for the purpose of microbiological research, it is also possible to use a sterile bacteriological loop.

A reliable sign of urethritis is four polymorphonuclear leukocytes (or more) in one field of view of the microscope (oil immersion system). In addition to determining the number of leukocytes, microscopy of a smear from the urethra determines the presence of microflora (including gonococci, trichomonas, fungi).

Scraping from the mucous membrane of the urethra to determine sexually transmitted infections is done using a probe to take material from the urethra.

Clinically significant pathogens - Chlamydia trachomatis, Ureaplasma wealyticum, Mycoplasma hominis, Mycoplasma genitalium, Herpes simplex, Cytomegalovirus, Trichomonas vaginalis, Gardnerella vaginalis, Neisseria gonorrhoeae, Candida spp.

It should be noted that the most widely used methods for detecting pathogens ( immunofluorescence reaction - RIF , polymerase chain reaction - PCR ) do not have 100% sensitivity and specificity.

Therefore, to increase the reliability of the research results, as well as to exclude false-positive and false-negative results, it is desirable to determine sexually transmitted infections using two different methods.

Urine testing for tumor markers is a relatively new diagnostic method, used for early detection of bladder cancer (Bard-BTA stat and NMP22 tests) and prostate cancer (PCA3 test - urine is examined after prostate massage).

The main indication for the study of ejaculate is the inability of a patient who has been sexually active for a year and has not used protection to conceive a child. Material for research is usually collected through masturbation. On the eve of donating the ejaculate, the patient is advised to abstain from intimate life, alcohol and taking hot baths for 3-4 days. It is considered optimal to conduct the study within an hour from the moment of receiving the ejaculate, since when the sample stands for a long time, its physicochemical properties change, which affects the activity of sperm and, accordingly, the results of the analysis.

The scope of laboratory research includes the study of microscopic characteristics of sperm (spermogram), as well as a number of physical and biochemical indicators of the ejaculate. The ejaculate is assessed in accordance with the standards of the World Health Organization ( WHO) (Table 1-4).

Table 1-4. Evaluation of ejaculate according to WHO standards

The study of ejaculate allows, in some cases, to carry out a differential diagnosis with inflammatory and non-inflammatory chronic pelvic pain syndrome, to identify the involvement of the reproductive system organs in the inflammatory process and to determine the quality of the seminal fluid.

The most frequently detected abnormalities in semen analysis are oligospermia (For leukocytospermia (the number of leukocytes in seminal fluid >1.0x106/ml), a microbiological examination of the ejaculate is recommended.

The concentration of pathogenic bacteria in the ejaculate >103 CFU/ml is clinically significant bacteriospermia. Since the 90s

Since the last century, the determination of a tumor marker in the blood serum - prostate specific antigen (PSA) - . PSA is a serine protease produced almost exclusively by the prostate epithelium.

This marker is organ-specific, since its increase can be caused not only by cancer, but also by hyperplasia, prostatitis and other causes (digital rectal examination, prostate massage, bladder catheterization, ejaculation).

However, PSA is superior in diagnostic value to digital rectal examination and transrectal ultrasound ( US) . The study is carried out for suspected prostate cancer, as well as for all men over 45 years old, once a year for its early detection. The normal level of prostate specific antigen is 0-4 ng/ml.

However, there is currently a trend towards a decrease in the upper limit of normal PSA from 4 to 2.5 ng/ml, since some studies have found that in this range of values ​​the risk of detecting prostate cancer is more than 20%, which leads to the diagnosis of clinically insignificant tumors which could lead to death. Thus, according to various authors, the probability of developing prostate cancer within 7 years is: with prostate-specific antigen 3-6 ng/ml - 34%; 6-10 ng/ml - 44%; >10 ng/ml – 71%. A false increase in PSA lasting about 10 days can occur after a digital rectal examination or prostate massage performed the day before, after ejaculation, rectal ultrasound examination, and in patients suffering from constipation. It is also known that the PSA level directly correlates with the volume of the prostate gland and the degree of activity of the inflammatory process, and therefore PSA can be increased with a large prostate size and with an active inflammatory process.

To optimize the diagnostic value of prostate-specific antigen, clinical algorithms have been developed, including a number of indicators:

• PSA density (PSA D);
• PSA density in the transition zone (PSA TZ);
• age-specific PSA norms;
• free PSA (PSA F);
• PSA growth rate (PSA V);
• PSA doubling time.

For a more specific diagnosis, especially when prostate-specific antigen levels are in the “gray zone” (from 2.5 to 10 ng/ml), the ratio of free (unbound) and total PSA is determined (0.75 ng/ml per year - for non-benign changes in the prostate). All of the above indicators are designed to distinguish cancer from benign processes, especially with an intermediate PSA level (2.5-10 ng/ml). There is no consensus yet on their combined use. SOUTH. Alyaev

Published by Konstantin Mokanov

Source: https://medbe.ru/materials/predstatelnaya-zheleza/laboratornye-metody-issledovaniya-predstatelnoy-zhelezy/

Laboratory examination of prostate secretion

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The secretion of the prostate gland (another name is prostate juice) is a functionally important biological fluid.

A balanced composition of prostate secretion is necessary for the normal functioning of the male reproductive system. To diagnose prostate pathology, an analysis of its juice is used.

Changes in the composition of secretions detected during laboratory tests may indicate the development of chronic prostatitis.

What is prostate secretion and what is it for?

Secretion of prostate juice occurs during sexual intercourse. During ejaculation, it combines with the secretion of the seminal vesicles and sperm produced in the testicles. The result is sperm, about a third of the volume of which comes from prostate juice.

Externally, the juice is a liquid with a whitish tint. The main part of the secretion is water (more than 90% of the volume). In addition to it, the secretion includes a whole range of substances:

• organic and inorganic salts;
• organic acids;
• specific enzymes (phosphatase, hyalorunidase, fibrokinase, fibrinolysin);
• Sahara;
• spermine;
• secretory immunoglobulins - antibodies.

Maintaining the optimal composition of the secretion is necessary for normal sperm motility, which is extremely important for fertilization. In addition, the juice contains protective factors (antibodies) that provide local immunity to the urethral mucosa.

Indications for laboratory tests

An analysis of the prostate secretion product is carried out to diagnose chronic prostatitis. It is possible to microscopically examine the secretion and conduct a culture for flora and sensitivity to antibiotics (bacteriological culture).

Microscopy of the smear may reveal inflammatory changes in the secretion. Culture of prostate juice is carried out to determine the causative agent of prostatitis and select an effective antibiotic. This analysis takes at least 3-5 working days.

Identification of the causative agent of prostatitis can be carried out using a modern laboratory diagnostic method - polymerase chain reaction (PCR). This method detects microorganism DNA even in minimal concentrations. For this reason, there is no need to wait a long time for the growth of microorganisms on a nutrient medium, as with tank sowing.

It is worth submitting a secret for analysis if you have the following complaints:

• chronic pain in the groin area, perineum;
• discharge from the urethra;
• discomfort when urinating;
• with difficulties during urination (urination in drops, the need to strain, a feeling of incomplete emptying of the bladder, frequent urge to urinate);
• male infertility.

No special preparation for analysis is required. When inoculating secretions for sterility, you must avoid taking antibacterial drugs for several days. Their use will distort the test results.

Since in order to collect material for analysis it is necessary to have a freely passable rectum, on the recommendation of a doctor, a cleansing enema is performed on the eve of the study. It is necessary to empty the bladder immediately before collecting material for analysis.

The study is contraindicated in case of acute inflammatory phenomena in the prostate gland, since during this period it is forbidden to massage the prostate.

Method of fluid collection

To obtain juice from the prostate, it is necessary to perform a special massage of the organ. During the procedure, the patient lies on his side, knees bent and brought to the stomach (fetal position) or stands in a knee-elbow position.

The doctor, with an index finger inserted into the rectum, finds the prostate gland and begins to massage it.

First, the right and left lobes of the prostate are massaged from the periphery to the center, squeezing out the secretion from the lobes of the gland in this way. Then, when pressing on the interlobar groove of the gland, the juice enters the urethral canal.

The reason for the lack of juice secretion after a massage may be its retrograde entry into the bladder. Therefore, sometimes, instead of prostate secretions, urine is collected after a massage of the glands. After centrifugation, the juice can be collected. However, the material still contains an admixture of urine, so such a study is less informative.

Decoding the results

Normal indicators for analyzing prostate secretions are shown in the table:

Index	Value is normal
Quantity	500 µl-2 ml
Color	Almost transparent with a slight whitish tint
Density	1022 g/l
pH	7
Lipoid bodies (lecithin grains)	Fully in sight
Leukocytes	0-10 in field of view at microscope magnification 280/ 0-5 in field of view. at 400x magnification
Red blood cells	None
Epithelium of the excretory ducts of the prostate gland	0-2 in sight
Giant cells	None
Böttcher crystals	Have no diagnostic value
Pathogenic microbes	None
Opportunistic microbes	Determined in single quantities
Mushrooms	None

In the presence of a chronic inflammatory process in the prostate tissue, the following changes are possible in the analyses:

• reduction in the amount of secretion;
• pH deviation towards acidosis (acid secretion);
• color change (appearance of a yellow tint, creamy appearance);
• reduction in the number of lecithin grains;
• increase in the number of leukocytes;
• the appearance of red blood cells (sometimes indicating a malignant neoplasm of the prostate);
• giant cells are present;
• microorganisms.

Depending on which microbe became the causative agent of prostatitis, pathogenic bacteria (gonococci, etc.) and fungi that are absent normally can be identified. It is possible to increase the content of opportunistic bacteria, which are present in small quantities in a healthy gland.

Source: http://manmedicine.ru/crotch/prostate/sekret-prostaty.html