Calculous prostatitis- a complication of chronic inflammation of the prostate gland, characterized by the formation of stones in the gland's acini or secretion channels. Calculous prostatitis is accompanied by increased urination, dull aching pain in the lower abdomen and perineum, erectile dysfunction, presence of blood in the seminal fluid and prostatitis. Calculous prostatitis can be diagnosed by digital examination of the prostate, ultrasound of the prostate, survey urography and laboratory testing. Conservative therapy of calculous prostatitis is carried out with the help of drugs, herbs and physiotherapy; If these measures are ineffective, stone destruction with a low-intensity laser or surgical removal is recommended.
general information
Calculous prostatitis is a form of chronic prostatitis accompanied by the formation of stones (prostatoliths). Calculous prostatitis is the most common complication of the long-term inflammatory process of the prostate, which specialists working in the fields of urology and andrology have to deal with. Prostate stones are detected in 8. 4% of men of various ages during the preventive ultrasound examination. The first age peak in the incidence of calculous prostatitis occurs at the age of 30-39 and is due to the increase in the number of chronic prostatitis caused by STDs (chlamydia, trichomoniasis, gonorrhea, ureaplasmosis, mycoplasmosis, etc. ). In men aged 40-59, calculous prostatitis usually develops against the background of prostate adenoma, and in patients over 60 years of age, it is associated with a decrease 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 are initially formed directly in the acini and ducts of the gland, secondary stones migrate from the upper urinary tract (kidneys, bladder or urethra) to the prostate if the patient suffers from urolithiasis.
The development of calculous prostatitis is caused by stagnant and inflammatory changes in the prostate gland. Impaired emptying of the prostate glands is caused by BPH, irregular or lack of sexual activity, and a sedentary lifestyle. In light of this, a sluggish infection of the urinary tract leads to blockage of the prostate ducts and a change in the nature of the prostate secretion. Prostate stones, on the other hand, support the chronic inflammatory process and the stagnation of secretions in the prostate.
In addition to stagnation and inflammatory phenomena, urethro-prostatic reflux also plays an important role in the development of calculous prostatitis - this is the pathological reflux of a small amount of urine from the urethra into the prostate channels during urination. At the same time, the salts in the urine crystallize, thicken and turn into stones over time. Causes of urethro-prostatic reflux can be urethral strictures, urethral trauma, prostate and seminal tubercle atony, previous transurethral resection of the prostate gland, etc.
The morphological core of the prostate stone is the amyloid bodies and the epithelial layer, which gradually "grow in" with phosphate and lime salts. Prostate stones lie in cystically expanded acini (lobes) or in the excretory ducts. Prostatoliths are yellowish in color, spherical in shape and variable in size (average-4 mm); can be single or multiple. In terms of their chemical composition, prostate stones are the same as bladder stones. In case of calculous prostatitis, oxalate, phosphate and urate stones are most often formed.
Symptoms of calculous prostatitis
The clinical manifestations of calculous prostatitis usually resemble chronic inflammation of the prostate. The leading symptom of calculous prostatitis is pain. The pain is dull, aching in nature; it can be located in the perineum, scrotum, above the pubic bone, sacrum or coccyx. Exacerbation of painful attacks may be associated with bowel movements, 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; hematoma, prostate cancer (leakage of prostate secretion), hemospermia. It is characterized by reduced libido, weak erection, impaired ejaculation and painful ejaculation.
Endogenous prostate stones can remain in the prostate without symptoms for a long time. However, long-lasting chronic inflammation and the accompanying calculous prostatitis can lead to the formation of prostate abscess, cystitis, atrophy and sclerosis of the glandular tissue.
Diagnosis of calculous prostatitis
In order to establish a diagnosis of calculous prostatitis, a consultation with a urologist (andrologist), an assessment of existing complaints, and a physical and instrumental examination of the patient is required. During the rectal digital examination of the prostate, the nodular surface of the stones and a kind of crepitus are determined by palpation. With transrectal ultrasound of the prostate gland, stones are detected as hyperechoic formations with a clear acoustic trajectory; their location, quantity, size and structure are clarified. Sometimes, survey urography, CT, and prostate MRI are used to detect prostatoliths. Exogenous stones are diagnosed by pyelography, cystography and urethrography.
The instrumental examination of a patient suffering from calculous prostatitis is complemented by laboratory diagnostics: examination of prostate discharge, bacteriological culture of urethral discharge and urine, PCR examination of scrapings for sexually transmitted infections, biochemical analysis of blood and urine, determination of prostate level. -specific antigen, sperm biochemistry, culture of ejaculate, etc.
During the examination, calculous prostatitis is distinguished from prostate adenoma, tuberculosis and prostate cancer, chronic bacterial and abacterial prostatitis. In calculous prostatitis not associated with prostate adenoma, the volume of the prostate gland and the PSA level remain normal.
Treatment of calculous prostatitis
Uncomplicated stones combined with chronic inflammation of the prostate require conservative anti-inflammatory therapy. Treatment of calculous prostatitis includes antibiotic therapy, non-steroidal anti-inflammatory drugs, medicinal herbs, and physiotherapy procedures (magnet therapy, ultrasound therapy, electrophoresis). In recent years, low-intensity lasers have been successfully used to destroy prostate stones non-invasively. Prostate massage is strictly contraindicated in patients with calculous prostatitis.
Surgical treatment of calculous prostatitis is usually necessary in the case of a complicated course of the disease, in combination with a prostate adenoma. When a prostatic abscess is formed, the abscess is opened, and along with the outflow of pus, the passage of stones is also observed. Sometimes mobile exogenous stones can be mechanically pushed into the bladder and subjected to lithotripsy. Large fixed stones are removed in the perineal or suprapubic section. When calculous prostatitis is combined with BPH, the optimal surgical treatment is adenomectomy, prostatic TUR, and prostatectomy.
Prediction and prevention of calculous prostatitis
In most cases, the prognosis of conservative and surgical treatment of calculous prostatitis is favorable. Long-lasting, non-healing urinary tract fistulas can be a complication of perineal removal of prostate stones. In the absence of treatment, calculous prostatitis results in abscess formation and sclerosis of the prostate gland, urinary incontinence, impotence and male infertility.
The most effective measure to prevent prostate stone formation is to see a specialist at the first signs of prostatitis. The prevention of STIs, the elimination of predisposing factors (urethro-prostatic reflux, metabolic disorders), age-appropriate physical and sexual activity play an important role. Preventive visits to the urologist and timely treatment of urolithiasis help to avoid the development of calculous prostatitis.