Calculous prostatitis

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 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 prostate 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. Using transrectal ultrasound of the prostate gland, stones are detected in the form of 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.

Treatment of calculous prostatitis

Calculous prostatitis is an inflammation of the prostate gland, complicated by the formation of stones. This type of prostatitis is a consequence of prolonged chronic inflammation of the prostate. The disease is accompanied by frequent urination, nagging pain in the lower abdomen and perineum, erectile dysfunction and the presence of blood impurities in the ejaculate.

Causes of this disease

Calculous prostatitis is a form of chronic prostatitis characterized by stone formation. 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 inflammatory phenomena, urethro-prostatic reflux, characterized by 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 calculous prostatitis. The salts contained in the urine gradually crystallize and over time turn into solid stones. Common causes of ureteroprostatic reflux:

• urethral injuries;
• atony of the prostate gland and seminal tuberculosis;
• 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 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 certain groups of drugs;
• damage to the prostate during surgical procedures, prolonged catheterization.

Types of stones in calculous prostatitis

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

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

Stone formation in the prostate gland is identical in composition to bladder stones. 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. Pain location: sacrum or coccyx.

The pain 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 prostatic secretion;
• decreased libido, erectile dysfunction, painful ejaculation;
• neurological disorders: irritability, increased fatigue, insomnia.

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

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

Diagnosis

To establish 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 history and asks additional questions that will help determine the causes of prostatitis and risk factors.

The doctor then 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:

• Culture of prostate secretion. An important informative method for identifying pathogenic microorganisms and diagnosing the inflammatory process in the prostate gland.
• Urine culture. It allows you to detect a pathogenic infection in the urine, as well as determine its type and concentration. Culture is performed to clarify the diagnosis if inflammation of the prostate gland is suspected.
• PCR examination of scrapings. It allows you 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 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 find stones, clarify their location, quantity, size, structure. Ultrasound will also help distinguish inflammation of the prostate from other diseases accompanied by similar symptoms.

Survey urography. X-ray method with contrast enhancement, which makes it possible to detect stones in the prostate, their size and location.

CT or MRI of the prostate. Allows layer-by-layer scanning of the prostate gland and surrounding tissue. With the help of 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 combined with prostate adenoma, hospitalization of the patient is necessary.

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

As a supplement to complex drug therapy, doctors often prescribe physical therapy procedures that allow:

• elimination of stagnant processes;
• activates tissue regeneration.
• The most effective methods of physiotherapy 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 include physical activity, especially if your 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 case of a complicated course of the disease and a combination with prostatic hyperplasia. When an abscess forms, the surgeon opens the abscess. Along with 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 prostatic hyperplasia, the optimal method of surgical treatment is transurethral resection of the prostate.

Chronic calculous prostatitis

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

Causes and mechanisms of development of calculous prostatitis

Prolonged inflammatory process or congestion in the prostate tubules leads to the accumulation of secretions and mucus in them. Bacteria settle on these deposits and calcium salts are precipitated. Over time, the mucus thickens and turns into small sand 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 tissues of the prostate gland;
• congestion in the prostate, which is primarily associated with a man's irregular sex life;
• urethro-prostatic reflux - pathological backflow of a small volume of urine into the prostate;
• genetic predisposition - presence of relatives with calculous prostatitis.

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

Symptoms of calculous prostatitis

The symptoms of calculous prostatitis develop for a long time and a person 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 noted - frequent urges to go to the toilet, painful or difficult urination, burning in the urethra and lower abdomen, sometimes urinary retention occurs due to blockages in the form of stones.

Patients experience prostatorrhea - involuntary discharge of secretions from the prostate gland during 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 prolonged inflammation with stone formation, sexual dysfunctions develop - weakened erection, premature ejaculation, decreased libido.

The main signs of calculous prostatitis include:

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

Such symptoms lead to a decrease in sexual desire.

Often men attribute this to the age factor, mistakenly believing that such sexual dysfunctions will not go away. Sometimes they begin to self-medicate, using various drugs to stimulate erection (PDE-5 inhibitors).

This approach is very dangerous, as 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 gland of a man. In most cases, it is caused by an infection, which gradually leads to a chronic, prolonged course of the disease and the development of complications.

The treatment of calculous prostatitis is complex

• antibiotics,
• anti-inflammatory drugs,
• enzymes
• immune drugs
• phytotherapy,
• physiotherapy 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. This 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 a culture study of the prostate secretion and determining the sensitivity of the microbial pathogen to drugs. Antibiotics are sometimes prescribed empirically based on scientifically proven antimicrobial effectiveness of the drugs. The choice of antibiotics, the determination of the dose and the duration of their use can be carried out exclusively by the attending physician, since their uncontrolled use can lead to serious complications and worsen the course of the underlying disease.

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

To stimulate the immune defense of the bodyand its resistance to infections, immunomodulatory drugs are prescribed - Immunomax, Panavir, Interferon and its derivatives. To improve the antimicrobial effect of etiotropic drugs, together with them, enzyme agents are prescribed - longidase, hemotrypsin. They facilitate the delivery of active antibiotic substances to the affected tissues, have an indirect analgesic effect, have an anti-inflammatory and regenerative effect.

The pain syndrome is relieved withuse of nonsteroidal anti-inflammatory drugs. Along with antibiotic therapy, probiotics are prescribed to prevent the development of intestinal dysbiosis. To protect the liver parenchyma from the toxic effects of antibacterial drugs and to improve its functional state, hepatoprotectors are prescribed. After the acute inflammatory phenomena have subsided, physiotherapeutic procedures are prescribed - laser treatment, magnetotherapy, mud therapy, galvanization, medicinal electrophoresis, reflexogenic therapy, apparatus treatment, etc.

This improves metabolic processes, microcirculation, lymphatic drainage and trophicity 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 the stones. It breaks up the stones and allows the small stones to pass out of the tubules. In case of complications in the form of an adenoma or an abscess of the prostate (a limited cavity filled with pus), surgical intervention is performed.

It involves removing part of the prostate gland (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.