Calculous prostatitis– a complication of chronic inflammation of the prostate, characterized by the formation of stones in the acini or excretory ducts of the gland. Calculous prostatitis is accompanied by increased urination, dull aching pain in the lower abdomen and perineum, erectile dysfunction, the presence of blood in the seminal fluid and prostatorrhea. Calculous prostatitis can be diagnosed using a digital prostate exam, prostate ultrasound, investigative urography, and laboratory examination. Conservative treatment of calculous prostatitis is carried out using drugs, medicinal plants and physiotherapy; If these measures are ineffective, destruction of the stones with a low-intensity laser or surgical removal is indicated.
general informations
Calculous prostatitis is a form of chronic prostatitis, accompanied by the formation of stones (prostatoliths). Calculous prostatitis is the most common complication of a long-term inflammatory process in the prostate, which must be faced by specialists in the field of urology and andrology. During a preventive ultrasound, prostate stones are detected in 8. 4% of men of different ages. The first age peak in the incidence of calculous prostatitis occurs between 30 and 39 years of age and is due to an increase in cases of chronic prostatitis caused by STDs (chlamydia, trichomoniasis, gonorrhea, ureaplasmosis, mycoplasmosis, etc. ). In men aged 40 to 59 years, calculous prostatitis usually develops against the background of prostate adenoma, and in patients over 60 years old, it is associated with a decline in sexual function.
Causes of calculous prostatitis
Depending on the cause of their formation, prostate stones can be true (primary) or false (secondary). Primary stones initially form directly in the acini and ducts of the gland, secondary stones migrate into the prostate from the upper urinary tract (kidneys, bladder or urethra) if the patient suffers from urolithiasis.
The development of calculous prostatitis is caused by congestive and inflammatory changes in the prostate. Impaired emptying of the prostate glands is caused by BPH, irregularity or lack of sexual activity, and a sedentary lifestyle. In this context, the addition of a slow infection of the genitourinary tract leads to obstruction of the prostatic ducts and a change in the nature of prostatic secretion. In turn, prostate stones also promote a chronic inflammatory process and stagnation of secretions in the prostate.
In addition to stagnation and inflammatory phenomena, urethroprostatic reflux plays an important role in the development of calculous prostatitis - pathological reflux of a small amount of urine from the urethra into the prostatic ducts during urination. At the same time, the salts contained in urine crystallize, thicken and, over time, turn into stones. The causes of urethroprostatic reflux can be urethral strictures, trauma to the urethra, atony of the prostate and seminal tubercle, previous transurethral resection of the prostate, etc.
The morphological core of prostate stones is made up of amyloid bodies and desquamated epithelium, which are gradually "invaded" by phosphate and calcareous salts. Prostatic stones are found in cystically distended acini (lobules) or in the excretory ducts. The prostatoliths are yellowish in color, spherical in shape and variable in size (on average 2. 5 to 4 mm); can be single or multiple. In terms of chemical composition, prostate stones are identical to bladder stones. With calculous prostatitis, oxalate, phosphate and urate stones are most often formed.
Symptoms of calculous prostatitis
The clinical manifestations of calculous prostatitis generally resemble the development of chronic inflammation of the prostate. The main clinical symptom of calculous prostatitis is pain. The pain is dull, aching in nature; located in the perineum, scrotum, above the pubis, sacrum or coccyx. Exacerbation of painful attacks may be associated with defecation, sexual intercourse, physical activity, prolonged sitting on a hard surface, prolonged walking or bumpy driving. Calculous prostatitis is accompanied by frequent urination, sometimes complete urinary retention; hematuria, prostatorrhea (leakage of prostatic secretions), hemospermia. Characterized by decreased libido, weak erection, impaired ejaculation and painful ejaculation.
Endogenous prostate stones can remain in the prostate for a long time without symptoms. However, a long course of chronic inflammation and associated calculous prostatitis can lead to the formation of a prostate abscess, the development of vesiculitis, atrophy and sclerosis of the glandular tissue.
Diagnosis of calculous prostatitis
To establish a diagnosis of calculous prostatitis, a consultation with a urologist (andrologist), assessment of existing complaints and physical and instrumental examination of the patient are necessary. During a digital rectal examination of the prostate, the lumpy surface of the stones and a kind of crackling sound are determined by palpation. Using transrectal ultrasound of the prostate, stones are detected as hyperechoic formations with a clear acoustic track; their location, quantity, size and structure are clarified. Sometimes examination urography, CT and MRI of the prostate are used to detect prostatoliths. Exogenous stones are diagnosed by pyelography, cystography and urethrography.
The instrumental examination of a patient with calculous prostatitis is supplemented by laboratory diagnosis: examination of prostatic secretions, bacteriological culture of urethral discharge and urine, PCR examination of scrapings for sexually transmitted infections, biochemical analysis of blood and urine, determination of the prostate level. -specific antigen, sperm biochemistry, ejaculate culture, etc.
During examination, calculous prostatitis is differentiated from prostate adenoma, tuberculosis and prostate cancer, chronic bacterial and abacterial prostatitis. In calculous prostatitis not associated with a prostate adenoma, the volume of the prostate and the PSA level remain normal.
Treatment of calculous prostatitis
Uncomplicated stones associated with chronic inflammation of the prostate require conservative anti-inflammatory treatment. Treatment of calculous prostatitis includes antibiotic therapy, nonsteroidal anti-inflammatory drugs, herbal medicine and physiotherapeutic procedures (magnetotherapy, ultrasound therapy, electrophoresis). In recent years, low-level laser has been used successfully to non-invasively destroy prostate stones. Prostate massage for patients with calculous prostatitis is strictly contraindicated.
Surgical treatment of calculous prostatitis is usually necessary in cases of complicated course of the disease, associated with prostate adenoma. When a prostate abscess forms, the abscess is opened and, along with the outflow of pus, the passage of stones is also noted. Sometimes mobile exogenous stones can be pushed instrumentally into the bladder and subjected to lithotripsy. The elimination of large fixed stones is carried out during a perineal or suprapubic section. When calculous prostatitis is associated with BPH, the optimal method of surgical treatment is adenomectomy, prostate TUR, prostatectomy.
Prediction and prevention of calculous prostatitis
In most cases, the prognosis for conservative and surgical treatment of calculous prostatitis is favorable. Long-term non-healing urinary fistulas may be a complication of perineal prostate stone removal. If left untreated, calculous prostatitis leads to abscess formation and sclerosis of the prostate, urinary incontinence, impotence and male infertility.
The most effective measure to prevent the formation of stones in the prostate is to contact a specialist when the first signs of prostatitis appear. An important role belongs to the prevention of STIs, elimination of predisposing factors (urethral-prostatic reflux, metabolic disorders) and age-appropriate physical and sexual activity. Preventive visits to a urologist and timely treatment of urolithiasis will help avoid the development of calculous prostatitis.