Diagnostic Tests for Chronic nonbacterial prostatitis
Chronic nonbacterial prostatitis Tests: Book Excerpts
Home Diagnostic Testing
These home medical tests may be relevant to Chronic nonbacterial prostatitis:
- Bladder & Urinary Health: Home Testing:
- Prostate Health: Home Testing:
- Kidney Health: Home Testing:
Chronic nonbacterial prostatitis Diagnosis: Book Excerpts
Diagnostic Tests for Chronic nonbacterial prostatitis: Online Medical Books
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PELVIC PAIN:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
Routine studies include a CBC, sedimentation rate, pregnancy test, urinalysis, urine culture, chemistry panel, VDRL test, and Pap smear. A vaginal smear and culture should also be done routinely.
The next step would logically be a pelvic ultrasound, but it is wise to consult a gynecologist before ordering expensive tests. The gynecologist may proceed with laparoscopy, culdocentesis, and, ultimately, an exploratory laparotomy. A CT scan of the abdomen and pelvis may also be necessary.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Chronic Pelvic Pain:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A. The general condition of the patient should be noted. Does the patient look chronically ill, which may suggest a pelvic lesion or an inflammatory bowel disorder? Does the patient appear anxious, stressed, or inappropriate?
1. Can the patient point to the pain with one finger? If so, this can indicate that the pain may have a discrete source.
2. An examination of the lower back, sacral area, and coccyx, including a neuologic examination of the lower extremities, is necessary. Herniated disc, exaggerated lumbar lordosis, and spondylolisthesis can all cause pelvic pain.
3. Examine the abdomen, looking for surgical scars, distension, and palpable tenderness, particularly in the epigastrium, flank, back, or bladder.
B. A thorough pelvic examination is the most important part of the evaluation.
Testing (3)
If no obvious cause is apparent, it is reasonable to obtain a complete blood count, urine analysis, sedimentation rate, and serum chemistry profile. A pelvic ultrasound may be helpful when the pelvic examination is inconclusive. Laparoscopy is best used to diagnose a definite pelvic mass. Laparoscopy has been used extensively in the past but various studies have shown a 66% negative laparoscopy rate for patients with chronic pelvic pain. A multidisciplinary approach using medical, psychologic, environmental, and nutritional disciplines showed decreased pain after 1 year.
Diagnostic assessment
Chronic pelvic pain has a wide differential diagnosis (1). These complex problems can be assessed using a multisystems approach. Whereas gastrointestinal, gynecologic, musculoskeletal, and psychiatric conditions can cause chronic pelvic pain, a thorough gynecologic history and pelvic examination are the cornerstones of the diagnostic assessment. Few laboratory tests are helpful. A pelvic ultrasound is useful when the pelvic organs cannot be adequately assessed during the physical examination. A team approach, coordinated by a trusted family physician, can bring much relief to patients with this frustrating clinical problem.
References
1. Ryder RM. Chronic pelvic pain. Am Fam Physician 1996;54(7):2225–2232.
2. Stiege JF, Stout AL, Somkuti SG. Chronic pelvic pain in women: toward an integrative model. Obstet Gynecol Surv 1993;48:95–110.
3. Chan PD, Winkle CR, eds. Gynecology and obstetrics, 1999–2000. Laguna Hills, CA: Current Clinical Strategies Publishers; 1999:23–25.
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Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Prostate Abnormality:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
History helps in risk stratification: Men with a first degree relative with prostate cancer have a 2 to 3 fold increased incidence of prostate cancer. With 2 first degree relatives, this increases 5 to 8 fold.
The normal prostate is heart-shaped with a median raphe and a mass of 20 to 25 g. Carefully examine the posterior surfaces of the lateral lobes because this is where most prostate cancer originates. In screening for prostate cancer, digital rectal examination (DRE) looking for nodules, induration, or asymmetry may help to calibrate PSA values in the “gray zone” of 4 to 10. For example, a large gland may offer an explanation for a mildly elevated PSA, but a small gland or one with induration or asymmetry should heighten suspicion of prostate cancer. The positive predictive value for prostate cancer of an abnormal finding on DRE is 15% to 30%, increasing odds 1.5- to 2-fold. Because of low sensitivity, the value of a negative DRE to rule out prostate cancer is low. Men with an abnormality on DRE and a PSA ,4 still have a probability of prostate cancer of 12%, so biopsy is usually recommended. Examination followed by biopsy of any prostate nodule is the appropriate tactic because the clinical examination alone is not accurate enough in distinguishing benign causes from adenocarcinoma.
New suspicious findings on DRE in a patient with an initial negative baseline helps to select for aggressive tumors. Cancer found based on the first DRE has a 5 year prostate cancer mortality of 3% and 10 year mortality of 14%. Cancer found on a subsequent DRE has mortalities of 19% and 43% respectively.
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Source: Field Guide to Bedside Diagnosis, 2007
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