Calculous prostatitis

Calculous prostatitis is accompanied by increased urination, dull aching pains in the lower abdomen and perineum, erectile dysfunction, blood in the seminal fluid, and prostatorrhea. Calculous prostatitis can be diagnosed using digital examination of the prostate, ultrasound of the prostate gland, questionnaire urography and laboratory examination. Conservative therapy for calculous prostatitis is carried out with the help of drugs, herbal medicines 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 the formation of stones (prostatoliths). Calculous prostatitis is the most common complication of the long-term inflammatory process in the prostate gland, which specialists in the field of urology and andrology deal with. Stones in the prostate gland are detected in 8. 4% of men of different ages during preventive ultrasound examination. The first age peak of the incidence of calculous prostatitis occurs at 30-39 years of age and is associated with an increase in cases of chronic prostatitis caused by STDs (chlamydia, trichomonosis, gonorrhea, ureaplasmosis, mycoplasmosis, etc. ). Calculous prostatitis in 40-59-year-old men, 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, prostate stones can be true (primary) or false (secondary). Primary stones initially form directly in the acini and ducts of the gland, while secondary stones pass from the upper urinary tract (kidneys, bladder or urethra) to the prostate if the patient has urolithiasis.

The development of calculous prostatitis occurs as a result of congestive and inflammatory changes in the prostate gland. BPH, irregular or lack of sexual activity, and sedentary lifestyle are the causes of prostatic discharge disorder. Against this background, the addition of a slow infection of the genitourinary tract leads to blockage of the prostate ducts and changes in the nature of prostate secretion. In turn, stones in the prostate gland also support the chronic inflammatory process and stagnation of secretions in the prostate.

In addition to stagnation and inflammation, urethro-prostatic reflux, pathological reflux of a small amount of urine from the urethra to the prostate ducts during urination - plays an important role in the development of calculus prostatitis. At the same time, the salts in the urine crystallize, thicken and turn into stones over time. The causes of urethro-prostatic reflux are narrowing of the urethra, injury to the urethra, atony of the prostate gland and seminal tubercle, previous transurethral resection of the prostate gland, etc. can be.

The morphological core of prostate stones is amyloid bodies and desquamated epithelium, which gradually "grew" with phosphate and lime salts. In the prostate gland, stones are located in cystically swollen acini (lobules) or excretory ducts. Prostatoliths are yellowish in color, spherical in shape, different in size (on average 2. 5-4 mm); can be single or multiple. Prostate stones are chemically similar to bladder stones. Most oxalate, phosphate and urate stones are formed with calculous prostatitis.

Symptoms of calculous prostatitis

Clinical manifestations of calculous prostatitis are generally similar to the course of chronic inflammation of the prostate. The leading symptom in the clinic of calculous prostatitis is pain. The pain is dull, aching in nature; localized on the perineum, scrotum, 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 often accompanied by urinary incontinence, sometimes complete retention of urine; hematuria, prostatorrhea (leakage of prostate secretion), hemospermia. It is characterized by decreased libido, weak erection, ejaculation disorder and painful ejaculation.

Endogenous prostate stones can remain in the prostate gland for a long time without symptoms. However, a long course of chronic inflammation and stone prostatitis associated with it can lead to the formation of prostate abscess, development of vesiculitis, atrophy and sclerosis of glandular tissue.

Diagnosis of calculous prostatitis

To determine the diagnosis of calculous prostatitis, consultation with a urologist (andrologist), evaluation of existing complaints, physical and instrumental examination of the patient is required. When performing a rectal digital examination of the prostate, a lumpy surface of stones and a kind of crepitus are determined by palpation. Using transrectal ultrasound of the prostate gland, stones are detected as hyperechoic formations with a clear acoustic trace; their location, quantity, size 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 completed with laboratory diagnostics: examination of prostate secretion, bacteriological culture of urethral discharge and urine, PCR examination of scraps for sexually transmitted infections, biochemical analysis of blood and urine, determination of the level of the prostate gland. -specific antigen, sperm biochemistry, ejaculate culture, etc.

During examination, calculous prostatitis is differentiated from prostate adenoma, tuberculosis and prostate cancer, chronic bacterial and bacterial prostatitis. In calculous prostatitis not associated with prostate adenoma, prostate volume and PSA level remain normal.

Treatment of calculous prostatitis

Uncomplicated stones with chronic inflammation of the prostate gland require conservative anti-inflammatory therapy. Treatment of calculous prostatitis includes antibiotic therapy, non-steroidal anti-inflammatory drugs, herbal medicines, physiotherapeutic procedures (magnetic therapy, ultrasound therapy, electrophoresis). In recent years, low-intensity lasers have been successfully used to destroy prostate stones non-invasively. Prostate massage is strictly contraindicated for patients with calculous prostatitis.

Surgical treatment of calculous prostatitis is usually required in the case of a complex course of the disease, combined with prostate adenoma. When an abscess of the prostate gland is formed, the abscess is opened and the passage of stones is noted along with the discharge of pus. Sometimes mobile exogenous stones can be instrumentally pushed into the bladder and subjected to lithotripsy. Removal of large fixed stones is performed in the process of perineal or suprapubic division. When calculous prostatitis is combined with BPH, the optimal surgical treatment method is adenomectomy, TUR of the prostate, prostatectomy.

Treatment of calculous prostatitis

Calculous prostatitis is an inflammation of the prostate gland, complicated by the formation of stones. This type of prostatitis is the result of long-term chronic inflammation of the prostate. The disease is often accompanied by urinary incontinence, painful pain in the lower abdomen and perineum, erectile dysfunction, and the presence of blood in the stool.

The 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 gland. Against the background of chronic inflammation under the influence of negative internal and external factors, the secretion stagnates, crystallizes over time and turns into stones.

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

• damage to the urethra;
• atony of the prostate gland and seminal tubercle;
• previous surgical interventions and invasive procedures.

Other pathologies that increase the risk of stone formation in the prostate gland:

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

Factors contributing 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 a certain group of drugs;
• damage to the prostate during surgical operations, long-term catheterization.

Types of stones in calculous prostatitis

Depending on the number of stones, they are single and multiple. Depending on the main causes, prostate stones are:

• True. They are formed directly in the glands and ducts of the gland.
• A lie. They migrate from the upper urinary tract to the prostate: kidneys, bladder, urethra.

The formation of stones in the prostate gland is similar in composition to bladder stones. The following types of stones are most often formed with calculous prostatitis:

Symptoms of the disease

The symptoms of calculous prostatitis are similar to the course of the chronic inflammatory process. The leading symptom in the clinical picture of the disease is pain, which can be painful and dull in nature. Pain localization: sacrum or coccyx.

A painful attack worsens during defecation, sexual intercourse, physical activity, sitting for a long time on a hard surface and walking for a long time.

Other symptoms of pathology:

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

If you have any of the above symptoms, you should see a urologist as soon as possible. Lack of adequate treatment and a long course of chronic calculous prostatitis are fraught with serious, sometimes life-threatening consequences:

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

Diagnostics

To make 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 an anamnesis and asks additional questions that will help determine the causes and risk factors of prostatitis.

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

Laboratory diagnostics

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

• Culture of prostate secretion. It is an important informative method for identifying pathogenic microorganisms and diagnosing the inflammatory process in the prostate gland.
• Urine culture. It allows to detect a pathogenic infection in the urine, as well as to determine its type and concentration. If inflammation of the prostate gland is suspected, a culture is performed to clarify the diagnosis.
• PCR analysis of fragments. It allows to detect sexually transmitted infections and identify the pathogen.
• 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 disorders in the work of the kidneys.
• Spermogram. Ejaculation analysis to rule out or confirm infertility.

Instrumental diagnostics

Instrumental methods used for pathological diagnosis:

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

Survey urography. Contrast-enhanced X-ray method that allows you to detect stones in the prostate gland, their size and location.

CT or MRI of the prostate. It allows layer-by-layer scanning of the prostate gland and surrounding tissues. Using CT or MRI images, the doctor can study the structure of the prostate in detail, detect pathological foci, evaluate 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 associated with prostate adenoma, hospitalization of the patient is required.

Conservative treatment

The main goals of conservative therapy are to eliminate pathological symptoms. For this, the patient is prescribed a course of drug treatment that involves the use of the following groups of drugs:

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

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

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

Effective treatment of calculous prostatitis is provided by lifestyle changes. To prevent relapses, it is recommended to engage in physical activity, especially if work forces you to lead a sedentary lifestyle. Moderate physical activity improves blood circulation in the pelvic organs, removes congestion and strengthens local immunity.

Surgery

Surgical treatment is performed in the case of a complex course of the disease and a combination with prostatic hyperplasia. When an abscess forms, the surgeon opens the abscess. In addition to the discharge of pus, the passage of stones is often observed. Large fixed stones are removed during a perineal or suprapubic section. When calculous prostatitis is combined with benign hyperplasia of the prostate gland, the optimal methods of surgical treatment are transurethral resection of the prostate.

Chronic calculous prostatitis

The term calculous prostatitis defines the pathology of the prostate gland, stones are formed in its tubes. This disease is characterized by erectile dysfunction of the penis and pain in the groin area.

Causes and development mechanism of calculous prostatitis

Prolonged inflammatory process or blockage in the prostate ducts causes secretion and accumulation of mucus in them. Bacteria settle in these accumulations and calcium salts precipitate. Mucus becomes denser over time and turns into small sand-like stones. They stick together and form pebbles.

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

• Chronic sexually transmitted infections (STDs)
• long-term course of the infectious process with inflammation of the ducts and tissues of the prostate gland;
• Prostate congestion, which is primarily associated with a man's irregular sex life;
• urethro-prostatic reflux - pathological return of a small amount of urine to the prostate;
• genetic predisposition - the presence of relatives with calculous prostatitis.

Knowing the causes of the formation of stones in the prostate gland is necessary for high-quality and adequate etiological therapy, which helps to prevent the recurrence of stone prostatitis.

Symptoms of calculous prostatitis

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

Pain can begin or intensify after defecation, sexual intercourse, intense physical activity and other provoking factors. Dysuric disorders are noted - frequent desire to go to the toilet, painful or difficult urination, burning in the urethra and lower abdomen, sometimes urinary retention occurs due to obstructions in the form of stones.

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

Almost always, against the background of persistent inflammation with the formation of stones, sexual dysfunctions develop - weakened erection, premature ejaculation, decreased libido.

The main symptoms of calculous prostatitis include:

• erectile dysfunction;
• pain in the groin can be spasmodic and paroxysmal in nature;
• during ejaculation - indicates damage to the vessels of the prostate ducts with the sharp edges of the stones;
• premature and painful ejaculation.

Such symptoms cause a decrease in sexual desire.

Often, men associate it with the age factor, mistakenly believing that such sexual dysfunctions will not go away. Sometimes they begin to self-medicate using various erectile dysfunction drugs (PDE-5 inhibitors).

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

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

Treatment of calculous prostatitis is complicated

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

Antibacterial substancesprescribed as part of etiotropic treatment. Their reception is necessary to suppress the activity of the causative agent of the infectious-inflammatory process. This includes both non-specific microbial flora (streptococci, staphylococci, enterococci, Escherichia coli, Proteus) and specific pathogens of genitourinary infections - gonococci, chlamydia, ureaplasma, trichomonas, etc.

The choice of antibiotics can be based on the results of a culture study of prostate secretions and determining the sensitivity of the microbial pathogen to drugs. Sometimes antibiotics are prescribed empirically, based on the scientifically proven antimicrobial effectiveness of drugs. The selection of antibiotics, determination of their dosage and duration of use can be carried out only by the attending physician, because their uncontrolled use can cause serious complications and aggravate the course of the main disease.

If the tissues of the prostate gland are parasitized by polyassociated microbial flora (bacterial, viral microorganisms, protozoa), the etiotropic therapy regimen will consist of a complex of various drugs acting in a certain antimicrobial spectrum.

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

Relieves pain syndromeuse of non-steroidal anti-inflammatory drugs. In addition to antibiotic therapy, probiotics are prescribed to prevent the development of intestinal dysbiosis. Hepaprotectors are prescribed to protect the liver parenchyma from the toxic effect of antibacterial drugs and to improve its functional state. After acute inflammatory phenomena subside, physiotherapeutic procedures are prescribed - laser treatment, magnetic therapy, mud treatment, galvanization, medicinal electrophoresis, reflexogenic therapy, hardware treatment, etc.

It improves metabolic processes, microcirculation, lymphatic drainage and trophism of the prostate tissue, 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 come out of the pipes. In case of complications in the form of adenoma or prostate abscess (limited cavity filled with pus), surgical intervention is performed.

This involves the removal (resection) of part of the prostate gland. To prevent this, it is necessary to consult a doctor at the first signs of pathology expressed by erectile dysfunction. Self-medication or ignoring the problem always leads to the further development of complications.