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, presence of blood in the seminal fluid and prostatorrhea. Calculous prostatitis can be diagnosed by digital examination of the prostate, ultrasound of the prostate gland, examination urography and laboratory tests. Conservative treatment of calculous prostatitis is carried out with the help of drugs, herbal medicine and physiotherapy; If these measures are ineffective, destruction of stones with a low-intensity laser or surgical removal is indicated.
Main information
Calculous prostatitis is a form of chronic prostatitis accompanied by the formation of stones (prostatoliths). Calculous prostatitis is the most common complication of a prolonged inflammatory process in the prostate gland, which specialists in the field of urology and andrology face. During a prophylactic ultrasound examination, stones in the prostate are found in 8. 4% of men of different ages. The first age peak in the incidence of calculous prostatitis occurs at 30-39 years old and is due to an increase in cases of chronic prostatitis caused by sexually transmitted diseases (chlamydia, trichomoniasis, gonorrhea, ureaplasmosis, mycoplasmosis, etc. ). In men aged 40-59 years, calculous prostatitis, as a rule, 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 formation, stones in the prostate 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 due to 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. Against this background, the addition of a slow infection of the genitourinary system leads to blockage of the prostatic ducts and a change in the nature of prostatic secretion. In turn, prostate stones also contribute to a chronic inflammatory process and 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 - the 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 the urine crystallize, thicken and turn into stones over time. The causes of urethro-prostatic reflux can be urethral strictures, trauma to the urethra, atony of the prostate and seminal tuberculosis, previous transurethral resection of the prostate gland, etc.
The morphological core of prostate concretions are amyloid bodies and desquamated epithelium, which gradually "overgrow" with phosphate and lime salts. Stones in the prostate are located in cystic enlarged acini (lobules) or in the excretory ducts. Prostatoliths are yellowish in color, spherical in shape and differentsizes (on average from 2. 5 to 4 mm); they can be single or multiple. In 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
The 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 can be associated with defecation, sexual intercourse, physical activity, prolonged sitting on a hard surface, prolonged walking or uneven driving. Calculous prostatitis is accompanied by frequent urination, sometimes by complete retention of urine; hematuria, prostatorrhea (prostatic discharge), hemospermia. It is characterized by reduced libido, weak erection, impaired ejaculation and painful ejaculation.
Endogenous prostate stones can remain in the prostate gland for a long time without symptoms. However, prolonged chronic inflammation and associated calculous prostatitis can lead to prostatic abscess formation, development of vesiculitis, atrophy and sclerosis of the glandular tissue.
Diagnosis of calculous prostatitis
To establish the diagnosis of calculous prostatitis, a consultation with a urologist (andrologist), an assessment of the existing complaints and a physical and instrumental examination of the patient is necessary. When performing a rectal digital examination of the prostate, a lumpy surface of the stones and a type of crepitus are determined by palpation. By transrectal ultrasound of the prostate gland, stones are detected as hyperechoic formations with a clear acoustic trace; their location, quantity, dimensions 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.
Instrumental examination of a patient with calculous prostatitis is supplemented by laboratory diagnostics: examination of prostate secretion, bacteriological culture of urethral secretion 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.
When conducting research, calculous prostatitis is differentiated from prostate adenoma, tuberculosis and prostate cancer, chronic bacterial and abacterial prostatitis. In calculous prostatitis that is not associated with a prostatic 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, nonsteroidal anti-inflammatory drugs, herbal medicine, physical therapy procedures (magnetic therapy, ultrasound therapy, electrophoresis). In recent years, the low-intensity laser has been used successfully for 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 is opened and along with the discharge of pus, the passage of stones is noted. Occasionally, mobile exogenous stones can be instrumentally pushed into the bladder and subjected to lithotripsy. Removal of fixed stones of large sizes 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.
Prognosis and prevention of calculous prostatitis
In most cases, the prognosis for conservative and surgical treatment of calculous prostatitis is favorable. Long-standing 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 an 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 at the first signs of prostatitis. An important role is played by the prevention of STIs, the elimination of predisposing factors (uretro-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.