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UROLOGY
INVENTION
Patent of the Russian Federation RU2263915

METHOD OF LABORATORY DIAGNOSTICS OF CHRONIC PROSTATITIS

METHOD OF LABORATORY DIAGNOSTICS OF CHRONIC PROSTATITIS

The name of the inventor: Eseneev Sultan Magometovich (RU); Boriak Viktor Petrovich (RU)
The name of the patent owner: Eseneev Sultan Magometovich (RU); Boriak Viktor Petrovich (RU)
Address for correspondence: 357504, Stavropol Territory, Pyatigorsk, Gagarin's b., 2, S.M. Eseneev
Date of commencement of the patent: 2004.01.05

The invention relates to laboratory diagnostics of chronic prostatitis and can be used for differential diagnosis of inflammatory diseases of the prostate and urethra. Summary of the invention consists in determining the number of leukocytes in 10 ml of the premalange and 10 ml of the postmassage portion of morning urine, and with an increase in the number of leukocytes in the postmassage portion of urine for 2000-2500 in 1 ml, prostatodynia is diagnosed, 2,500-6,000 in 1 ml - stagnant Prostatitis, more than 6000 in 1 ml - infectious prostatitis, and an increase in the number of leukocytes in the premalignment of urine indicates the presence of urethritis. The technical result is the possibility of an objective topical diagnosis of the pathological process of the lower urinary tract.

DESCRIPTION OF THE INVENTION

The proposed method refers to medicine and can be used in urology for differential diagnosis of inflammatory diseases of the prostate and urethra.

Chronic nonspecific inflammations of the prostate and urethra are the most common diseases of men of reproductive age. According to various authors, chronic prostatitis occurs in 35-40% of men of working age [1-4]. This pathology can lead to violations of copulative function and fertility, and consequently, to personal and demographic problems, which leads to the treatment of this disease in a number of socially important tasks.

The therapeutic tactics and effectiveness of therapy for chronic prostatitis are largely determined by the diagnostic criteria that exist today. The main method of laboratory diagnosis of chronic prostatitis is still the study of the secretion of the prostate gland. The possibility of obtaining a secretion of the prostate gland depends largely on the technique of performing a massage of the prostate gland, but this does not guarantee obtaining a secret [5]. When studying the secret in the native preparation, the leading criterion is the ratio of the number of leukocytes and lecithin grains. Characteristic for chronic prostatitis is an increase in the number of leukocytes more than 10-15 in the field of vision and a decrease in the number of lecithin grains.

Determination of the number of leukocytes per unit volume of the secretion of the prostate gland using the camera Goriaeva dramatically increased the value of the study. The presence of pathology, according to the data of Yu.N. Kovalev (1973), RJPeperella and V.Hadson (1983), is confirmed when a secret of 300 ml leucocytes or more is found in 1 ml of secretion [6].

Due to the fact that the traditional technique of sampling the secretion of the prostate through its massage does not guarantee against infection from the urethra, various variants of washing the urethra with solutions of antiseptics have been proposed to increase the diagnostic value of the prostatic secretion analysis [7, 8]. However, for proper interpretation of the results, it is sufficient to urinate before the study [3, 5].

A fractional microscopic examination of the first (VB1), medium (VB2) portions of urine, secretion of the prostate (EPS) after its massage and the last portion of urine (VB3) proposed by TAStamey and EMMears (1968) is considered the "gold standard" in topical diagnosis of inflammation of the lower urinary tract. ) [9]. Some simplification of the method was proposed by OL Tiktinskii in a three-glass sample with the microscopy of the precipitate VB1, EPS and VB3 [5].

The lack of wide use of these samples is due to the fact that the results of the study are sharply reduced when a small amount of the secretion of the prostate gland is obtained or in its absence, with the duration of both the investigation and the expectation of its results [3, 10].

Selective method of bacteriological study of the material of the prostate gland according to McCullough-EMMeares-BD Ayinde presupposes the sowing of VB1, VB2, EPS, VB3. Belonging of the flora to the prostate is determined by logical comparisons with the elucidation of its possible participation in the pathogenesis of prostatitis. [7]. Bacteriological tests, giving information on the assortment of strains, require a lot of time and adequate equipment of the laboratory, which is not available in most medical institutions.

The disadvantages of these methods is the cumbersomeness of the studies and the lack of clear differential diagnostic criteria for various groups of patients with chronic prostatitis, noted in the literature, and this does not make it possible to widely use the proposed samples [5, 6, 11].

The closest in technical essence to the proposed method is the microscopic examination of the pre-massage portion of urine and secretion of the prostate (or urine) after its massage, proposed by JCNickel, which makes the method more informative, accessible and simple [12].

The disadvantage of this method is the need for microscopic examination of the material, which reduces the objectivity of the study. In addition, it is well known that not in all cases after the massage of the prostate gland it is possible to get its secret.

The technical result of the proposed method of laboratory diagnosis of prostatitis is the objectification of the results of the study of patients with chronic prostatitis, there are available diagnostic criteria that allow conducting a topical diagnosis of the pathological process of the lower urinary tract.

This technical result is achieved by examining 10 ml of the first portion of morning urine and 10 ml of urine after a massage of the prostate gland. The material is taken into graduated test tubes. Counting of the formed elements of the urine sediment after centrifugation is performed in the counting chamber of Goryaev according to the method of counting leukocytes. In 100 large squares of the Goryaev camera grid, counting of white blood cells, erythrocytes, counting of lecithin grains is possible. An increase in the number of leukocytes indicates the presence of inflammation, and an increase in the number of red blood cells indicates an increased vascular permeability, which is characteristic of pronounced stagnant phenomena in the prostate gland.

Conversion is carried out according to the following formula:

X = A × 4000 × 10 3/1600 × 10 = A × 250

X is the number of elements in 1 ml,

A is the number of shaped elements in 100 large squares of the Goryaev camera grid,

4000 is the conversion factor of the volume of one small square into a volume equal to 1 μl,

1600 - the number of small squares of 100 large,

10 is the ratio of the volume of centrifuged urine to the volume of the supernatant together with the precipitate,

10 3 - the number of microliths in 1 ml [13, 14] (the norm of taking the number of leukocytes to 2000 in 1 ml).

Determination of the number of shaped elements per unit volume makes it possible to objectively assess the level of lesions of the lower urinary tract, allows us to work out tactics for additional examination and treatment, and prescribe antibacterial therapy strictly according to indications.

Example №1

The patient Mr. VA, 43 years old, turned to the reception 4-5 days after sexual contact with complaints of unstable moderate rez when urinating, there are no discharges. When analyzing the secretion of the prostate gland of leukocytes 10-12 in the field of view, lecithin grains - a small amount, coccal flora - in a small amount, gN, Tr is not found. When examining the material in our proposed method of leukocytes in the premalm portion of 15000 / ml, erythrocytes - 500 / ml. In the postmassage portion of leukocytes 2500 / ml, erythrocytes 500 / ml. The results of this study clearly indicated the presence of urethritis. After the additional study (PCR diagnostics) Tr. Target antibiotic therapy with a positive result was carried out.

Example №2

The patient Ya-in AA, 31, turned to the reception with complaints of a feeling of heaviness in the perineum of a periodic nature, accompanied by frequent urge to urinate. When examined in other medical institutions in the analysis of the secretion of the prostate gland, the number of leukocytes did not exceed 9-11 in the field of view, there were no lecithin grains. The analysis of the secretion of the prostate gland, carried out in our country, revealed leukocytes 4-6 in the field of view, mucus - in a moderate amount, cocco flora moderately, gN, Tr was not detected. In our proposed procedure, in the premalignment of urine leucocytes 2500 / ml, erythrocytes 500 / ml, in the postmassage portion of urine leukocytes 21000 / ml, erythrocytes 1500 / ml, indicating the benefit of infectious prostatitis. With IFA blood, antibodies to chlamydia were detected, antibody titer 1: 160. Appropriate antibiotic therapy was performed against the background of traditional therapy of prostatitis, control tests - without pathology.

"Standard" or "traditional" therapy of prostatitis in this context are synonymous and in the conditions of the resort they prescribe prostate massage and mud rectal tampons.

The increase in the number of leukocytes in the postmassage portion of urine for 2000-6000 in 1 ml is more indicative of prostatodynia or congestive chronic prostatitis. With an increase in leukocytes by more than 6,000 in 1 ml, one can think of the presence of an infectious prostatitis. The high content of leukocytes in the premalignment of urine speaks in favor of inflammatory changes in the urethra.

The statistical criteria proposed to evaluate the results of the study, of course, have a certain degree of relativity and must always be correlated with the objective status of the patient, and the diagnosis is the prerogative of the clinician. This also has to do with the situation when the boundary results of the study are obtained. Unfortunately, it is not possible to offer specific digital data that is acceptable for any clinical situation. In order to establish the correct diagnosis, it is necessary to take into account both patient complaints, anamnesis, objective status, and the results of additional research methods to the extent determined by the doctor and necessary in this particular situation. Unfortunately, it is impossible to offer specific digital criteria for differential diagnosis of prostatodynia and congestive prostatitis, as there is no clear definition of these two nosological forms. The diagnosis of "prostatodynia" is made by the patient who makes complaints characteristic of prostatitis, but they do not have significant changes from the prostate gland and increase the number of leukocytes.

Example №3

Patient IV, BP, 42 years old, was treated with complaints of intermittent difficulty in the beginning of urination, lethargy of the jet with urination, a feeling of incomplete emptying of the bladder, heaviness above the bosom, perineum. At repeated survey on a residence of a pathogenic microflora it is not revealed. When rectal examination and ultrasound of the prostate gland changes in linear dimensions, the structure of the gland is not revealed. In the analysis of the secretion of the prostate gland in the conditions of our sanatorium, it was revealed: leukocytes 4-6 in the field of vision, in places of congestion up to 5, mucus in a moderate amount, coccal flora - moderately, gN, Tr was not detected. When examined in our modification in the premalignment of urine leucocytes 2000 / ml, erythrocytes 750 / ml, in the post-massage portion of urine leucocytes 2500 / ml, erythrocytes 750 / ml, indicating the absence of infectious prostatitis. With IFA blood, no antibodies to STI were detected. With the diagnosis of prostatodynia, traditional prostatitis therapy was performed using mud rectal tampons, prostate massage, office phytotherapeutic drugs. With improvement, he was discharged under the supervision of a urologist at his place of residence.

In a similar clinical situation, when identifying structural changes in the prostate gland, one can speak of a stagnant prostatitis.

The terminology used is based on the classification of GWDrach, EMMears, WRFair and TAStamey [15].

Interpretation of the results of studies with regard to the classification of prostatitis by the National Institutes of Health of the United States (NIH), which is now considered the most adequate [16], will be as follows (see the table):

A distinctive feature of the proposed method of differential diagnosis of inflammation of the lower urinary tract is the possibility of an objective evaluation of the results of laboratory diagnostics. It does not require additional technical equipment for the laboratory, it is simple and is available at any stage of treatment with prostatitis. Counting the number of shaped elements per unit of volume allows you to standardize the data obtained, it becomes possible to monitor treatment using a single diagnostic criteria.

INFORMATION SOURCES

1. DVKan Chronic non-specific prostatitis. / Materials of the 3rd All-Union Congress of Urology. Minsk. 1984. P.180-184.

2. Guide to andrology. Ed. OL Tiktinsky. L .: "Medicine." 1990.

3. A guide to urology in 3 volumes. / Ed. Acad. RAMP N.Lopatkina. M .: Medicine. 1998. T.1. C.400-430.

4. IF Yonda. Prostatitis. Kiev: "Health". 1987.

5. OL Tiktinsky, Inflammatory nonspecific diseases of the urino-genital organs. L .: "Medicine." 1984. P.257.

6. VNTkachuk AG Gorbachev, LI Agulyansky. Chronic prostatitis. L .: "Medicine." 1989. P.108-109.

7. EK Arnoldi. Prostatitis: experience, problems, prospects. Kharkiv. 1997. P.33-34.

8. APHitchens, CPBrown. The bacteriology of chronic prostatitis. // Am.J.Public.Health. 1913. Vol.3. P.884-91.

9. EMMears, T.Stamey. Bacteriologic localization patterns in bacterial prostatitis and urethritis.// Invest. Urol. 1968. Vol.5. P.492-518.

10. JCNickel. Prostatitis: myths and realities.// Urology. 1998. Mar. 51 (3). P.362-6.

11. DAShoskes. Use antibiotics in chronic prostatitis syndromes.// Can. J. Urol. 2001; 8 (Suppl). P.24-28.

12. J. S. Nickel. The Pre- and Post-Massage Test (PPMT): a simple screen for prostatitis.// Tech. Urol. 1997. Vol. P.38-43.

13. VS Ronin, GM Starobinets, NL Utevsky. Guide to practical exercises on methods of clinical laboratory research. M .: Medicine. 1982. P.53-54.

14. Handbook of clinical laboratory methods of research. Ed. E.A.Kost. M .: Medicine. 1975. P.234-235.

15. GWDrach, EMMears, WRFair and TAStamey. Classification of benign disease associated with prostatic pain: prostatitis or prostatodynia? (Letter to the editor) // J.Urol. 1978. 120. P.266.

16. Prostatitis. / Ed. Prof. P.A. Shcheplev. M .: Medpraktika. 2005. 222 p.

CLAIM

A method for differential diagnosis of diseases of the prostate and urethra, including the determination of the number of leukocytes per unit volume in the study of 10 ml of the premal and 10 ml of postmassage portions of morning urine, and with an increase in the number of leukocytes in the postmassage portion of urine at 2000-2500 in 1 ml, prostatodynia is diagnosed, -6000 in 1 ml - congestive prostatitis, more than 6000 in 1 ml - infectious prostatitis, and an increase in the number of leukocytes in the premalignment of urine testifies to the presence of urethritis.

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Date of publication 06.01.2007gg