Calculous prostatitis

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

The clinical manifestations of calculous prostatitis mostly 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 detected in the form of 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 necessary 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.

Treatment of calculous prostatitis

Calculous prostatitis is inflammation of the prostate, complicated by stone formation. This type of prostatitis is the result of long-term chronic inflammation of the prostate. The disease is accompanied by frequent urination, excruciating pain in the lower abdomen and perineum, erectile dysfunction and the presence of blood inclusions in the ejaculate.

Causes of this disease

Calculus is a form of chronic prostatitis characterized by the formation of stones. The disease is often a complication of a long-term inflammatory process in the prostate. Against the background of chronic inflammation under the influence of negative internal and external factors, the secretion stagnates, which over time crystallizes and turns into stones.

In addition to congestion and inflammation, urethro-prostatic reflux, characterized by the pathological reflux of a small amount of urine from the urethra into the prostate ducts during urination, plays a major role in the development of calculous prostatitis. Salts contained in urine gradually crystallize and over time turn into dense stones. Common causes of annual prostatic reflux:

• urethral injuries;
• atony of the prostate and seminal tubercle;
• previous surgical interventions and invasive procedures.

Other pathologies that increase the risk of prostate stone formation:

• varicose veins of the small pelvis;
• metabolic disorders due to systemic pathologies;

Factors that contribute to the development of calculous prostatitis:

• an inactive lifestyle that contributes to the development of stagnant processes in the pelvic organs;
• irregular sex life;
• alcohol abuse, smoking;
• uncontrolled use of certain groups of drugs;
• prostate damage during surgical procedures, long-term catheterization.

Types of stones in calculous prostatitis

According to the number of stones, single and multiple stones are distinguished. Depending on the underlying causes, prostate stones are:

• True. They arise directly in the acini and ducts of the gland.
• False. They migrate to the prostate from the upper urinary tract: kidney, bladder, urethra.

Stone formation in the prostate is identical in composition to stones in the bladder. In calculous prostatitis, the following types of stones are most often formed:

Symptoms of the disease

Symptoms of calculous prostatitis resemble the course of a chronic inflammatory process. The leading symptom in the clinical picture of the disease is pain, the nature of which can be painful and dull. Location of pain: sacrum or coccyx.

The painful attack worsens during defecation, sexual intercourse, physical activity, prolonged sitting on a hard surface and prolonged walking.

Other symptoms of pathology:

• frequent urination or complete retention of urine;
• hematuria and the presence of blood inclusions in the ejaculate;
• prostatorrhea – leakage of prostate secretions;
• decreased libido, erectile dysfunction, painful ejaculation;
• neurological disorders: irritability, increased fatigue, insomnia.

If you have any of the above symptoms, you should schedule an appointment with a urologist as soon as possible. The lack of adequate treatment and the long course of chronic calculous prostatitis is full of serious, sometimes life-threatening consequences:

• atrophy and sclerosis of glandular tissue;
• prostate abscess.

Diagnostics

For an accurate diagnosis, a consultation with a urologist-andrologist is necessary. During the initial examination, the specialist carefully listens to the patient's complaints, collects anamnesis and asks additional questions that will help determine the cause of prostatitis and risk factors.

Next, the doctor performs a rectal examination of the prostate, which involves palpating the gland through the rectum. The technique allows you to assess the size, shape, structure of the gland, detect stones, determine the inflammatory process by increasing the size and pain during pressure. To confirm the diagnosis, additional laboratory and instrumental methods are prescribed.

Laboratory diagnostics

A number of additional laboratory tests used to diagnose calculous prostatitis:

• Prostate secretion culture. An important informative method for identifying pathogenic microorganisms and diagnosing the inflammatory process in the prostate.
• Urine culture. It allows you to detect pathogenic infection in urine, as well as determine its type and concentration. A culture is performed to clarify the diagnosis if inflammation of the prostate is suspected.
• PCR scraping study. It allows you to detect sexually transmitted infections and identify pathogens.
• PSA analysis. It allows you to rule out prostate cancer, which often occurs against the background of prostatitis.
• General clinical analysis of blood and urine. It is prescribed to identify hidden inflammatory processes in the urinary tract and kidney disorders.
• Spermogram. Ejaculate analysis to rule out or confirm infertility.

Instrumental diagnostics

Instrumental methods used to diagnose pathology:

Ultrasound of the prostate. It allows you to detect stones, clarify their location, quantity, size, structure. Ultrasound will also help distinguish prostate inflammation from other diseases accompanied by similar symptoms.

Inspection urography. X-ray method with contrast enhancement, which allows detection of prostate stones, their size and location.

CT or MRI of the prostate. It enables layer by layer scanning of the prostate and surrounding tissues. Using CT or MRI scans, the doctor can study the structure of the prostate in detail, detect pathological foci, assess their location, size and relationship with the surrounding tissues.

Treatment of calculous prostatitis

If the disease is uncomplicated and the general condition of the patient is satisfactory, the treatment of calculous prostatitis is carried out on an outpatient basis. If the disease is accompanied by complications, in combination with prostate adenoma, hospitalization of the patient is required.

Conservative treatment

The main goals of conservative therapy are the elimination of pathological symptoms. For this, the patient is prescribed a course of drug therapy, which includes the use of the following groups of drugs:

• Antibiotics. Destroy infection, stop inflammation. The type of drug, dose and duration of the course are determined individually for each patient.
• Nonsteroidal anti-inflammatory drugs. They stop the inflammatory process and help eliminate pathological symptoms: pain, swelling.
• Antispasmodics. It relieves muscle spasms and relieves pain.
• Alpha adrenergic blockers. Make the urination process easier.
• Vitamin-mineral complexes, immunomodulators. Strengthen the immune system and promote rapid recovery.

In addition to complex drug therapy, doctors often prescribe physiotherapeutic procedures that allow:

• eliminate stagnant processes;
• activate tissue regeneration.
• The most effective methods of physiotherapy for calculous prostatitis:
• ultrasound therapy, shock wave therapy.

Effective treatment of calculous prostatitis is ensured by lifestyle changes. In order to prevent relapses, it is recommended to include physical activity, especially if your job forces you to lead a sedentary lifestyle. Moderate physical activity improves blood circulation in the pelvic organs, removes congestion and strengthens local immunity.

Operation

Surgical treatment is carried out in the case of a complicated course of the disease and a combination with prostate hyperplasia. When an abscess forms, the surgeon opens the abscess. Together with the discharge of pus, the passage of stones is often observed. Large fixed stones are removed during a perineal or suprapubic incision. When calculous prostatitis is combined with benign prostatic hyperplasia, the optimal methods of surgical treatment are transurethral resection of the prostate.

Chronic calculous prostatitis

The term calculous prostatitis defines prostate pathology, in which stones are formed in its tubules. This disease is characterized by impaired erection of the penis and pain in the groin area.

Causes and mechanism of development of calculous prostatitis

A prolonged inflammatory process or congestion in the prostate tubules leads to the accumulation of secretions and mucus in them. Bacteria settle on these accumulations and calcium salts are deposited. Over time, the mucus thickens and turns into small sand-like stones. They stick together and form stones.

There are several predisposing factors for the development of calculous prostatitis:

• Chronic sexually transmitted infections (STIs)
• prolonged course of the infectious process with inflammation of the ducts and tissue of the prostate;
• congestion in the prostate, which is primarily associated with a man's irregular sex life;
• urethro-prostatic reflux - pathological return flow of a small amount of urine into the prostate;
• genetic predisposition – presence of relatives with calculous prostatitis.

Knowing the causes of stone formation in the prostate is necessary for quality and adequate etiological therapy, which helps prevent the re-development of calculous prostatitis.

Symptoms of calculous prostatitis

Symptoms of calculous prostatitis develop over a long period of time, and a man may not pay attention to them. The clinical picture of the disease may include symptoms such as dull pain in the lower abdomen and lower back, sacrum, perineum and pubis.

The pain may begin or intensify after defecation, sexual intercourse, intense physical activity and other provoking factors. Dysuric disorders are observed - frequent urges to go to the toilet, painful or difficult urination, burning in the ureter and lower abdomen, and sometimes urinary retention occurs due to obstructions in the form of stones.

Patients experience prostatoa - involuntary secretion of the prostate at rest or during physical exertion, straining during bowel movements or urination. There may be blood in the urine and semen.

Almost always, on the background of permanent inflammation with the formation of stones, sexual dysfunctions develop - weakened erection, premature ejaculation, reduced libido.

The main signs of calculous prostatitis include:

• erectile dysfunction;
• pain in the groin area, which can be spasmodic and paroxysmal;
• during ejaculation - indicates damage to blood vessels of prostate tubules by sharp edges of stones;
• premature and painful ejaculation.

Such symptoms lead to a decrease in sexual desire.

Men often attribute this to the age factor, mistakenly believing that such sexual dysfunctions will not disappear. Sometimes they start to self-medicate using different drugs to stimulate erection (PDE-5 inhibitors).

This approach is very dangerous, because it can worsen the course of the pathological process and lead to the development of complications.

Prostatitis is an inflammatory pathological process in the prostate in men. In most cases, it is caused by an infection, which gradually leads to a chronic, long-term course of the disease and the development of complications.

Treatment of calculous prostatitis is complex

• antibiotics,
• anti-inflammatory drugs,
• enzymes
• immune drugs
• phytotherapy,
• physiotherapeutic procedures.

Antibacterial agentsprescribed as part of etiotropic treatment. Their intake is necessary to suppress the activity of the causative agent of the infectious-inflammatory process. It can be both non-specific microbial flora (streptococci, staphylococci, enterococci, Escherichia coli, Proteus), and specific pathogens of urogenital infections - gonococci, chlamydia, ureaplasma, trichomonas, etc.

The choice of antibiotics can be based on the results of the prostate secretion culture and determining the sensitivity of the microbial pathogen to the drugs. Sometimes antibiotics are prescribed empirically based on the scientifically proven antimicrobial efficacy of the drugs. Selection of antibiotics, determining the dose and duration of their use can only be done by a doctor, because their uncontrolled use can lead to serious complications and worsen the course of the underlying disease.

If prostate tissues are parasitized by poly-associated microbial flora (bacterial, viral microorganisms, protozoa), the regimen of etiotropic therapy will consist of a complex of different drugs that act in a certain antimicrobial spectrum.

To stimulate the body's immune defensesand its resistance to infections, immunomodulatory drugs are prescribed - Imunomax, Panavir, Interferon and its derivatives. In order to improve the antimicrobial effect of etiotropic drugs, together with them, enzymatic agents are prescribed - longidase, chemotrypsin. They facilitate the delivery of active antibiotic substances to the affected tissues, have an indirect analgesic effect, and have an anti-inflammatory and regenerative effect.

The pain syndrome is alleviated withuse of non-steroidal anti-inflammatory drugs. Along with antibiotic therapy, probiotics are prescribed to prevent the development of intestinal dysbiosis. In order to protect the liver parenchyma from the toxic effect of antibacterial drugs and improve its functional state, hepaprotectors are prescribed. After the acute inflammation subsides, physiotherapeutic procedures are prescribed - laser treatment, magnetotherapy, mud therapy, galvanization, medical electrophoresis, reflexogenic therapy, hardware treatment, etc.

This improves metabolic processes, microcirculation, lymphatic drainage and prostate tissue trophism, stimulates the restoration of its functional state and helps to resolve inflammatory processes. A low-frequency laser is used to destroy stones. It crushes stones and allows small stones to pass out of the tubules. In case of complications in the form of prostate adenoma or abscess (limited cavity filled with pus), surgical intervention is performed.

It involves removing part of the prostate (resection). To avoid this, at the first signs of pathology, which are expressed in erectile dysfunction, you should consult a doctor. Self-medication or ignoring the problem always leads to the subsequent development of complications.