Calculous prostatitis– a complication of chronic inflammation of the prostate gland, characterized by the formation of stones in the acini or excretory ducts of the gland. Calculous prostatitis is accompanied by increased urination, dull pain in the lower abdomen and perineum, erectile dysfunction, the presence of blood in the seminal and prostate fluid. Calculous prostatitis can be diagnosed using a digital examination of the prostate, ultrasound of the prostate gland, urography and laboratory examination. Conservative therapy for calculous prostatitis is carried out with the help of medications, herbal medicine and physiotherapy; If these measures are ineffective, stone destruction with low-intensity laser or surgical removal is indicated.
General information
Calculous prostatitis is a form of chronic prostatitis, associated with the formation of stones (prostatolites). Calculous prostatitis is the most common complication of a long-term inflammatory process in the prostate gland, which specialists in the field of urology and andrology have to deal with. During preventive ultrasound examination, prostate stones are detected in 8. 4% of men of various ages. The first age peak in the incidence of calculous prostatitis occurs at the age of 30-39 years and is due to the increase in cases of chronic prostatitis caused by STDs (chlamydia, trichomoniasis, gonorrhea, ureaplasmosis, mycoplasmosis, etc. ). In men 40-59 years old, calculous prostatitis, as a rule, 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 formation, prostate stones can be true (primary) or false (secondary). Primary stones first form directly in the acini and ducts of the gland, secondary stones migrate to the prostate from the upper urinary tract (kidneys, bladder or urethra) if the patient has urolithiasis.
The development of calculous prostatitis is caused by congestive 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. Against this background, the addition of a slow infection of the genitourinary tract leads to blockage of the prostate ducts and a change in the nature of the prostate secretion. On the other hand, prostate stones also support a chronic inflammatory process and stagnation of secretions in the prostate.
In addition to stagnation and inflammatory phenomena, an important role in the development of calculous prostatitis is played by urethro-prostatic reflux - the pathological reflux of a small amount of urine from the urethra into the prostate ducts during urination. At the same time, the salts contained in the urine crystallize, thicken and over time turn into stones. The causes of urethro-prostatic reflux can be strictures of the urethra, trauma of the urethra, atony of the prostate and seminal tuberculosis, previous transurethral resection of the prostate gland, etc.
The morphological core for prostate stones are amyloid bodies and desquamated epithelium, which gradually "fill" with phosphate and lime salts. Prostate stones lie in cystically distended acini (lobules) or excretory ducts. Prostatoliths are yellow in color, spherical in shape and vary in size (on average from 2. 5 to 4 mm); can be single or multiple. In terms of their 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
Clinical manifestations of calculous prostatitis generally resemble the course of chronic inflammation of the prostate. The main symptom in the clinic of calculous prostatitis is pain. The pain is dull, aching in nature; located in the perineum, scrotum, on the pubis, sacrum or coccyx. Aggravation 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 with complete retention of urine; hematuria, prostatorrhea (flow of prostate secretions), hemospermia. It is characterized by decreased sexual desire, weak erection, impaired ejaculation and painful ejaculation.
Endogenous prostate stones can remain in the prostate gland 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 make 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. When performing a digital rectal examination of the prostate, the bumpy surface of the stones and a type of crepitus are determined by palpation. Using transrectal ultrasound of the prostate gland, stones are detected as hyperechoic formations with a clear acoustic trace; their location, quantity, size and structure are clarified. Sometimes urography, CT and MRI of the prostate are used to detect prostatitis. Exogenous stones are diagnosed by pyelography, cystography and urethrography.
Instrumental examination of a patient with calculous prostate is complemented by laboratory diagnostics: examination of prostate secretions, bacteriological culture of secretions and urine from the urethra, PCR examination of scrapings for sexually transmitted infections, biochemical analysis of blood and urine, determination of prostate level. -specific antigen, sperm biochemistry, ejaculate culture, etc.
During examination, calculous prostatitis is distinguished from prostate adenoma, tuberculosis and prostate cancer, chronic bacterial and bacterial 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 in combination with chronic inflammation of the prostate gland require conservative anti-inflammatory therapy. Treatment of calculous prostatitis includes antibiotic therapy, non-steroidal anti-inflammatory drugs, herbal medicine, physiotherapeutic procedures (magnetic therapy, ultrasound therapy, electrophoresis). In recent years, low-intensity lasers have been successfully used to noninvasively destroy prostate stones. Prostate massage for patients with calculous prostate is strictly contraindicated.
Surgical treatment of calculous prostatitis is usually required in the case of a complicated course of the disease, its combination with prostate adenoma. When an abscess of the prostate is created, the abscess opens and together with the discharge of pus, the passage of stones is also observed. Sometimes mobile exogenous stones can be instrumentally pushed into the bladder and subjected to lithotripsy. Removal of fixed stones of large size is carried out in the process of perineal or suprapubic section. When calculous prostatitis is combined with BPH, the optimal method of surgical treatment is adenomectomy, TUR of the prostate, 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 removal of prostate stones. In the absence of treatment, the result of calculous prostatitis is the formation of abscess and sclerosis of the prostate gland, urinary incontinence, impotence and male infertility.
The most effective measure to prevent the formation of stones in the prostate gland is to contact a specialist when the first signs of prostatitis appear. An important role is the prevention of STIs, the elimination of predisposing factors (urethro-prostatic reflux, metabolic disorders), age-appropriate physical and sexual activity. Preventive visits to a urologist and timely treatment of urolithiasis will help avoid the development of calculous prostatitis.