Общеклиническое исследование секрета предстательной железы

Microscopic examination of expressed prostatic secretion (EPS) evaluates cellular elements and microorganisms in prostate fluid to support classification of prostatitis. This prostate fluid microscopy, often including a Gram-stained prostatic secretion smear, assists in distinguishing chronic bacterial prostatitis from chronic pelvic pain syndrome (nonbacterial) and from asymptomatic inflammatory prostatitis, and can guide empiric therapy while culture results are pending.

Expressed prostatic secretion is obtained after prostatic massage as a stand‑alone collection or as the third fraction in the Meares–Stamey four‑glass test. Light microscopy assesses leukocytes, erythrocytes, and epithelial cells and surveys for microorganisms; Gram staining may demonstrate bacteria including gram‑negative diplococci, and wet preparations can reveal Trichomonas, while fungal hyphae or pseudohyphae may be seen with yeast infections. Findings help categorize prostatitis into acute bacterial, chronic bacterial, chronic pelvic pain syndrome (nonbacterial), and asymptomatic inflammatory forms. In health, leukocytes do not exceed approximately 10 per high‑power field; counts above this threshold indicate inflammation. Prostatic fluid is normally sterile, but as it passes through the nonsterile urethra, scant organisms may reflect contamination; abundant bacteria favors bacterial prostatitis. Typical etiologies include gram‑negative rods such as Escherichia coli, Enterobacter, and Proteus species. In men younger than 35 years, Neisseria gonorrhoeae and Chlamydia trachomatis are common causes; numerous leukocytes with gram‑negative diplococci suggest gonorrhea, yet culture is required for definitive diagnosis, and microscopic or culture‑based identification of C. trachomatis is challenging, particularly in chronic infection. Detection of fungal elements or Trichomonas in prostatic fluid is always abnormal. Absence of microorganisms in a symptomatic patient supports chronic nonbacterial prostatitis, although final classification typically relies on culture. A few erythrocytes per field can be seen normally; increased numbers may occur with prostatitis and with prostate adenocarcinoma. Red cells arising from prostatic disease are usually morphologically intact, a finding that can also be observed in bladder and urethral disorders; this examination is not a screening test for prostate cancer. A comprehensive evaluation often includes urine or semen studies and, when indicated, PCR and culture, with interpretation integrated with clinical and imaging findings.