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, exploratory urography, and laboratory examination. Conservative therapy for calculous prostatitis is carried out with the help of medications, phytotherapy and physiotherapy; If these measures are not effective, destruction of the stones with a low-level laser or surgical removal is indicated.
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 a prolonged inflammatory process in the prostate gland, with which specialists in the field of urology and andrology have to deal. During preventive ultrasound examination, prostate stones are detected in 8. 4% of men of different ages. The first age peak in the incidence of calculous prostatitis occurs between 30 and 39 years and is due to an increase in cases of chronic prostatitis caused by STDs (chlamydia, trichomoniasis, gonorrhea, ureaplasmosis, mycoplasmosis, etc. ). In men aged 40 to 59 years, calculous prostatitis usually develops against the background of prostate adenoma, and in patients over 60 years old 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 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 prostatic ducts and a change in the nature of prostatic secretion. In turn, prostate stones also promote 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 prostatic 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 urethral strictures, trauma to the urethra, atony of the prostate and seminal tubercle, previous transurethral resection of the prostate gland, etc.
The morphological core of prostatic stones is amyloid bodies and desquamated epithelium, which gradually become "covered" with phosphate and calcareous salts. Prostatic stones are found in cystically distended acini (lobes) or excretory ducts. The prostatoliths are yellowish in color, spherical in shape and vary in size (on average from 2. 5 to 4 mm); Can be unique or multiple. In terms of their chemical composition, prostate stones are identical to bladder stones. With calculous prostatitis, oxalate, phosphate and urate stones form more frequently.
Symptoms of calculous prostatitis.
The 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, painful 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 sitting on a hard surface, prolonged walking or bumpy driving. Calculous prostatitis is accompanied by frequent urination, sometimes complete urinary retention; hematuria, prostatorrhea (leakage of prostatic secretions), hemospermia. It is characterized by decreased libido, weak erection, impaired ejaculation and painful ejaculation.
Endogenous prostate stones can remain in the prostate gland for a long time without symptoms. However, a prolonged 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 the glandular tissue.
Diagnosis of calculous prostatitis.
To establish a diagnosis of calculous prostatitis, a consultation with a urologist (andrologist), an evaluation of existing complaints and a physical and instrumental examination of the patient is required. When performing a digital rectal examination of the prostate, palpation determines the lumpy surface of the stones and a kind of crepitus. Using transrectal ultrasound of the prostate, stones are detected as hyperechoic formations with a clear acoustic track; Its location, quantity, size and structure are clarified. Sometimes, screening 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 complemented by laboratory diagnostics: examination of prostate secretions, bacteriological culture of urethral secretion and urine, PCR examination of scrapings for sexually transmitted infections, biochemical analysis of blood and urine, determination of the level prostate. -specific antigen, sperm biochemistry, ejaculate culture, etc.
Upon 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, the 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, non-steroidal anti-inflammatory drugs, phytotherapy, physiotherapy procedures (magnetic therapy, ultrasound therapy, electrophoresis). In recent years, low-level laser has been successfully used to non-invasively destroy prostate stones. Prostate massage for patients with calculous prostatitis 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 a prostate abscess forms, the abscess opens and along with the outflow of pus, the passage of stones is also observed. Sometimes mobile exogenous stones can be instrumentally pushed into the bladder and subjected to lithotripsy. The removal of large fixed stones is performed by perineal or suprapubic section. When calculous prostatitis is combined with BPH, the optimal method of surgical treatment is adenomectomy, prostate TUR, and 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 may be a complication of perineal removal of prostatic stones. 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 the formation of stones in the prostate is to contact a specialist when the first signs of prostatitis appear. An important role belongs to the prevention of STIs, the 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.