Calculated prostatitis– a complication of chronic inflammation of the prostate, characterized by the formation of stones in the acini or excretory ducts of the gland. Calculus 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. Calculus prostatitis can be diagnosed using digital prostate examination, prostate ultrasound, research 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, destruction of the stone with a low-intensity laser or surgical removal is indicated.
General information
Calculus prostatitis is a form of chronic prostatitis, accompanied by the formation of stones (prostatoliths). Calculus prostatitis is the most common complication of a long-term inflammatory process in the prostate, 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 30-39 years of age and is due to the increase in cases of chronic prostatitis caused by STDs (chlamydia, trichomoniasis, gonorrhea, ureaplasmosis, mycoplasmosis, etc. ). In men aged 40 to 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 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 initially 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, 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 prostate ducts and a change in the nature of prostate secretion. In turn, prostate stones also support 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 - 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 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 are amyloid bodies and desquamated epithelium, which are gradually "covered" with phosphate and calcareous salts. Prostate stones are located in distended cystic acini (lobules) or excretory ducts. Prostatoliths are yellowish 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 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 often resemble the course of chronic prostate inflammation. The main symptom in the clinic 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 standing on a hard surface, prolonged walking or bumpy driving. Calculus prostatitis is accompanied by frequent urination, sometimes complete urinary retention; hematuria, prostatorrhea (leakage of prostate 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 prostatic abscess, the development of vesiculitis, atrophy and sclerosis of glandular tissue.
Diagnosis of calculous prostatitis
To establish the diagnosis of calculous prostatitis, a consultation with a urologist (andrologist), an assessment of existing complaints and a physical and instrumental examination of the patient are necessary. When performing a digital rectal examination of the prostate, the protruding surface of the stones and a kind of crepitus are determined by palpation. Using transrectal ultrasound of the prostate, stones are detected as hyperechoic formations with a clear acoustic trace; their location, quantity, size and structure are clarified. Sometimes examination urography, computed tomography and magnetic resonance imaging 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 complemented by 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.
When conducting an examination, calculous prostatitis is differentiated 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 prostate inflammation 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 laser has been used successfully to destroy prostate stones non-invasively. Prostate massage for patients with calculous prostatitis is strictly contraindicated.
Surgical treatment of calculous prostatitis is usually necessary in case of a complicated course of the disease, its combination with prostate adenoma. When an abscess forms in the prostate, the abscess is opened and along with the exit of pus, the passage of stones is also noticed. Sometimes mobile exogenous stones can be pushed instrumentally into the bladder and subjected to lithotripsy. Removal of large-sized fixed stones 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, prostate TURP, 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. In the absence of treatment, the result 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 prostate stone formation is to consult a specialist when the first signs of prostatitis occur. An important role belongs to the prevention of STIs, elimination of predisposing factors (urethroprostatic 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.