Calculous prostatitis– a complication of chronic inflammation of the prostate, characterized by the formation of stones in the acini or 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 fluid and prostatorrhea. Calculous prostatitis can be diagnosed by digital examination of the prostate, ultrasound of the prostate, examination urography and laboratory examination. Conservative therapy of calculous prostatitis is carried out with the help of drugs, herbal medicine and physiotherapy; If these measures are ineffective, destruction of the stone with a low-intensity laser or surgical removal is indicated.
General information
Calculous prostatitis is a form of chronic prostatitis, accompanied by stone formation (prostatolith). Calculous prostatitis is the most common complication of a long-term inflammatory process in the prostate that specialists in the field of urology and andrology face. Preventive ultrasound examination reveals stones in the prostate in 8. 4% of men of different ages. The first age peak in the incidence of calculous prostatitis occurs at the age of 30-39 years and is a consequence of the increase in cases of chronic prostatitis caused by sexually transmitted diseases (chlamydia, trichomoniasis, gonorrhea, ureaplasmosis, mycoplasmosis, etc. ). In men aged 40-59, calculous prostatitis usually develops on the background of prostate adenoma, and in patients over 60 years of age, it is associated with a decline in sexual function.
Causes of calculous prostatitis
Depending on the cause, prostate stones can be real (primary) or false (secondary). Primary stones are initially formed 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. Prostate emptying disorder is caused by BHP, irregularities or lack of sexual activity and a sedentary lifestyle. In view of this, the addition of a delayed infection of the genitourinary tract leads to obstruction of the prostate duct and a change in the nature of prostate secretions. In turn, the stone in the prostate also supports the chronic inflammatory process and the stagnation of secretions in the prostate.
In addition to stagnation and inflammatory phenomena, urethro-prostatic reflux plays an important role in the development of calculous prostatitis - 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 eventually 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 tubercle, previous transurethral resection of the prostate, etc.
The morphological core of prostate stones are amyloid bodies and desquamated epithelium, which gradually "overgrow" with phosphate and calcareous salts. Prostate stones lie in cystically enlarged acini (lobules) or in the excretory ducts. Prostatoliths are yellowish in color, spherical in shape and vary in size (on averagefrom 2. 5 to 4 mm); they can be single or multiple. According to their chemical composition, prostate stones are identical to bladder stones. In 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 leading symptom in the clinic of calculous prostatitis is pain. The pain is dull, painful in nature; localized 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 retention of urine; hematuria, prosatorrhoea (leakage of prostate secretions), hemospermia. It is characterized by reduced 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 prostate abscess, 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), an assessment of existing complaints, and a physical and instrumental examination of the patient is required. During a rectal digital examination of the prostate, a bumpy surface of the stones and some kind of crepitus are determined by palpation. Using transrectal ultrasound of the prostate, stones are revealed as hyperechoic formations with a clear acoustic trace; their location, quantity, size and structure are clarified. Sometimes survey urography, CT and MRI of the prostate are used to detect prostatolith. Exogenous stones are diagnosed by pyelography, cystography and urethrography.
Instrumental examination of patients with calculous prostatitis is completed with laboratory diagnostics: examination of prostate secretions, bacteriological culture of urethral secretions and urine, 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 differs from prostate adenoma, tuberculosis and prostate cancer, chronic bacterial and abacterial prostatitis. In calculous prostatitis not associated with prostate adenoma, prostate volume and PSA level remain normal.
Treatment of calculous prostatitis
Uncomplicated stones in combination with chronic inflammation of the prostate require conservative anti-inflammatory therapy. Treatment of calculous prostatitis includes antibiotic therapy, nonsteroidal anti-inflammatory drugs, herbal drugs, physiotherapeutic procedures (magnetotherapy, ultrasound therapy, electrophoresis). In recent years, a low-intensity laser has been successfully used for the non-invasive destruction of prostate stones. Prostate massage in patients with calculous prostatitis is strictly contraindicated.
Surgical treatment of calculous prostatitis is usually required in case of a complicated course of the disease, its combination with prostate adenoma. When an abscess of the prostate is formed, the abscess opens, and along with the discharge of pus, the passage of stones is noticed. Sometimes mobile exogenous stones can be instrumentally pushed into the bladder and subjected to lithotripsy. Removal of fixed stones of large sizes is performed 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.
Prognosis 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 can be a complication of perineal removal of prostate stones. In the absence of treatment, the outcome of calculous prostatitis is the formation of abscesses and sclerosis of the prostate, urinary incontinence, impotence and male infertility.
The most effective measure to prevent stone formation in the prostate is to consult a specialist when the first signs of prostatitis appear. Prevention of sexually transmitted diseases, elimination of predisposing factors (urethro-prostatic reflux, metabolic disorders), age-adjusted physical and sexual activity play an important role. Preventive visits to the urologist and timely treatment of urolithiasis will help to avoid the development of calculous prostatitis.