Calculous prostatitis

Calculous prostatitis is accompanied by increased urination, dull aching pain in the lower abdomen and perineum, erectile dysfunction, the presence of blood in the seminal fluid, and prostatorrhea. Calculous prostatitis can be diagnosed using a digital examination of the prostate, ultrasound of the prostate gland, survey 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, stone destruction 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 a long-term inflammatory process in the prostate gland, 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 an increase in cases of chronic prostatitis caused by STDs (chlamydia, trichomoniasis, gonorrhea, ureaplasmosis, mycoplasmosis, etc. ). In men 40-59 years old, calculous prostatitis, as a rule, develops against the background of prostate adenoma, and in patients over 60 years old 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 into 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 prostatic glands is caused by BPH, irregularity or lack of sexual activity, and a sedentary lifestyle. Against this background, the addition of a sluggish infection of the genitourinary tract leads to obstruction of the prostate ducts and a change in the nature of the 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, 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 prostate 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 for prostate calculi is amyloid bodies and desquamated epithelium, which are gradually "overgrown" with phosphate and calcareous salts. Prostate stones lie in cystically distended acini (lobules) or in the excretory ducts. Prostatoliths are yellowish in color, spherical in shape, and vary in size (on average from 2. 5 to 4 mm); may be single or multiple. In terms of their chemical composition, prostate stones are identical to bladder stones. With calculous prostatitis, oxalate, phosphate and urate stones are most often formed.

Symptoms of calculous prostatitis

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, aching 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 by 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 gland for a long time without symptoms. However, a long course of chronic inflammation and associated calculous prostatitis can lead to the formation of a prostate 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 assessment of existing complaints, and a physical and instrumental examination of the patient are required. When performing a rectal digital examination of the prostate, the lumpy surface of the stones and a kind 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 track; their location, quantity, size and structure are clarified. Sometimes survey urography, CT and MRI of the prostate are used to detect prostatoliths. Exogenous stones are diagnosed by pyelography, cystography and urethrography.

An instrumental examination of a patient with calculous prostatitis is complemented by laboratory diagnostics: examination of prostate secretions, bacteriological culture of urethral discharge and urine, PCR examination of scrapings for sexually transmitted infections, biochemical analysis of blood and urine, determination of the level of prostate-specific antigen, biochemistry of sperm, culture of ejaculate, 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, the volume of the prostate gland and 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, non-steroidal anti-inflammatory drugs, herbal medicine, physiotherapeutic procedures (magnetic therapy, ultrasound therapy, electrophoresis). In recent years, low-intensity 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 is opened, and along with the outflow of pus, the passage of stones is also noted. Sometimes 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 long-term chronic inflammation of the prostate. The disease is accompanied by frequent urination, nagging aching pain in the lower abdomen and perineum, erectile dysfunction, and the presence of blood inclusions in the ejaculate.

Causes of this disease

Calculous 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, secretion stagnates, which over time crystallizes and turns into stones.

In addition to congestion and inflammatory phenomena, urethro-prostatic reflux, 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 calculous prostatitis. The salts contained in the urine gradually crystallize and over time turn into dense stones. Common causes of urteroprostatic reflux:

• urethral injuries;
• 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:

• 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 medications;
• damage to the prostate during surgical procedures, long-term catheterization.

Types of stones in calculous prostatitis

According to the number of stones, there 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.

The formation of stones in the prostate gland is identical in composition to bladder stones. With calculous prostatitis, the following types of stones most often form:

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 aching and dull. Localization of pain: sacrum or coccyx.

A 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 urinary retention;
• 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 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.

Diagnostics

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 anamnesis, and asks additional questions that will help determine the causes 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 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 secretions. An important informative method for identifying pathogenic microorganisms and diagnosing the inflammatory process in the prostate gland.
• Urine culture. Allows you to detect a pathogenic infection in the urine, as well as determine its type and concentration. Culture is carried out to clarify the diagnosis if inflammation of the prostate gland is suspected.
• PCR study of scrapings. Allows you to detect sexually transmitted infections and identify the pathogen.
• PSA analysis. Allows you to exclude 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 of the kidneys.
• Spermogram. Analysis of ejaculate to exclude or confirm infertility.

Instrumental diagnostics

Instrumental methods used to diagnose pathology:

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

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

CT or MRI of the prostate. Allows layer-by-layer scanning of the prostate gland and surrounding tissues. Using CT or MRI images, the doctor can study in detail the structure of the prostate, detect pathological foci, evaluate their location, size, and relationship with surrounding tissues.

Treatment of calculous prostatitis

If the disease is uncomplicated and the patient’s general condition is satisfactory, 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 required.

Conservative treatment

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

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

As a complement 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. To prevent relapses, it is recommended to include physical activity, especially if work forces you to lead a sedentary lifestyle. Moderate physical activity improves blood circulation in the pelvic organs, eliminates congestion, and strengthens local immunity.

Surgery

Surgical treatment is carried out in case of complicated course of the disease and combination with prostate hyperplasia. When an abscess forms, the surgeon opens the abscess. Along with the outflow 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 methods of surgical treatment are 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 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 precipitate. The 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)
• 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.

Knowledge of the causes of the development of stones in the prostate gland is necessary for high-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 aching pain in the lower abdomen and lower back, sacrum, perineum, and pubis.

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

Patients experience prostatorrhea - involuntary secretion of 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 persistent inflammation with the formation of stones, 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 prostate tubules by 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 disappear. Sometimes they begin to self-medicate using various erection stimulant drugs (PDE-5 inhibitors).

This approach is very dangerous, as it can aggravate 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, 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. This can be both nonspecific microbial flora (streptococci, staphylococci, enterococci, Escherichia coli, Proteus), and specific pathogens of urogenital infections - gonococci, chlamydia, ureaplasma, trichomonas, etc.

The choice of antibiotics may be based on the results of a culture study of prostate secretions and determination of the sensitivity of the microbial pathogen to drugs. Sometimes antibiotics are prescribed empirically based on scientifically proven antimicrobial effectiveness of the drugs. The selection of antibiotics, determination of the dose and duration of their use can be carried out exclusively by the attending physician, since their uncontrolled use can lead to serious complications and aggravate the course of the underlying disease.

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

To stimulate the body's immune defenseand its 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 affected tissues, have an indirect analgesic effect, and have an anti-inflammatory and regenerative effect.

Pain syndrome is relieved withusing 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 effects of antibacterial drugs and improve its functional state, hepaprotectors are prescribed. After the acute inflammatory phenomena subside, physiotherapeutic procedures are prescribed - laser treatment, magnetic therapy, mud therapy, galvanization, medicinal electrophoresis, reflexogenic therapy, hardware treatment, etc.

This improves metabolic processes, microcirculation, lymphatic drainage and trophism of prostate tissue, stimulates the restoration of its functional state and helps resolve inflammatory processes. To destroy the stones, a low-frequency laser is used. It crushes the stones and allows small stones to come out of the tubules. In case of complications in the form of adenoma or prostate abscess (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 need to consult a doctor. Self-medication or ignoring the problem always leads to the subsequent development of complications.