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 a digital examination of the prostate, an ultrasound of the prostate, a study urogram, and a 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 assessment 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 in the form of 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.

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, persistent pain in the lower abdomen and perineum, erectile dysfunction and the presence of blood inclusions in the ejaculate.

Causes of this disease.

Calculosa is a form of chronic prostatitis characterized by stone formation. The disease is usually a complication of a prolonged 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, urethroprostatic reflux, characterized by the pathological reflux of a small amount of urine from the urethra into the prostate ducts during urination, plays an important 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 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 that contribute to the development of calculous prostatitis:

• a sedentary lifestyle that contributes to the development of stagnant processes in the pelvic organs;
• irregular sexual 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

Depending on the number of stones, there are single and multiple ones. Depending on the underlying causes, prostate stones are:

• TRUE. They form directly in the acini and ducts of the gland.
• FAKE. They migrate to the prostate from the upper urinary tract: kidneys, bladder, urethra.

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

Symptoms of the disease

The symptoms of calculous prostatitis resemble the course of a chronic inflammatory process. The main symptom in the clinical picture of the disease is pain, the nature of which can be aching and dull. Location 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 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 experience 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 are fraught with serious, sometimes life-threatening consequences:

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

Diagnosis

To establish an accurate diagnosis, consultation with a urologist-andrologist is necessary. During the initial examination, the specialist carefully listens to the patient's complaints, collects a history 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 feeling the gland through the rectum. The technique allows you to evaluate the size, shape, structure of the gland, detect stones, determine the inflammatory process by increasing the size and pain when pressing. To confirm the diagnosis, additional instrumental and laboratory methods are prescribed.

Laboratory diagnosis

Several additional laboratory tests are 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 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 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 blood and urine tests. It is prescribed to identify hidden inflammatory processes in the urinary tract and kidney disorders.
• Spermogram. Analysis of ejaculate to exclude or confirm infertility.

Instrumental diagnosis

Instrumental methods used to diagnose pathology:

prostate ultrasound. 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. A contrast-enhanced X-ray method that detects prostate stones, their size and location.

CT or MRI of the prostate. It allows the prostate gland and surrounding tissues to be scanned layer by layer. Using computed tomography or magnetic resonance imaging, 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 not complicated and the patient's general condition 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 required.

Conservative treatment

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

• Antibiotics. Destroys infection, stops inflammation. The type of drug, dosage and duration of treatment for each patient are determined individually.
• Non-steroidal anti-inflammatory drugs. They stop the inflammatory process and help eliminate pathological symptoms: pain, swelling.
• Antispasmodics. Relieves muscle spasms and relieves pain.
• Alpha adrenergic blockers. Facilitate the urination process.
• Vitamin and mineral complexes, immunomodulators. Strengthens the immune system and promotes a speedy recovery.

As a complement to complex drug therapy, doctors usually prescribe physiotherapeutic procedures that allow:

• 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 ensured by lifestyle changes. To prevent relapses, it is recommended to include physical activity, especially if work requires 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 it. 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 penile erection problems and pain in the groin.

Causes and mechanism of development of calculous prostatitis.

A prolonged inflammatory process or congestion in the prostate tubules causes the accumulation of secretions and mucus in them. Bacteria settle in these accumulations and precipitate calcium salts. The mucus becomes thicker 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;
• congestion in the prostate, which is mainly associated with a man's irregular sexual life;
• urethroprostatic reflux: pathological reflux 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 is necessary for adequate and high-quality etiological therapy, which helps prevent the recurrence of calculous prostatitis.

Symptoms of calculous prostatitis.

The symptoms of calculous prostatitis develop over a long period of time and the 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 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 need to go to the toilet, pain or difficulty urinating, burning in the urethra and lower abdomen, and sometimes urinary retention occurs due to obstructions in the form of stones.

Patients experience prostatorrhea: involuntary discharge from the prostate gland during rest or during physical exertion, straining during defecation or urination. There may be blood in urine and semen.

Almost always, against the background of persistent 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 prostate tubules from the sharp edges of the stones;
• Premature and painful ejaculation.

These symptoms cause a decrease in sexual desire.

Men often attribute this to the age factor, mistakenly believing that such sexual dysfunctions will not go away. Sometimes they begin to self-medicate with various erection-stimulating 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 infection, which gradually leads to a chronic and prolonged course of the disease and the development of complications.

The treatment of calculous prostatitis is complex.

• antibiotics,
• anti-inflammatory medications,
• enzymes
• immune drugs
• Phytotherapy,
• Physiotherapeutic procedures.

Antibacterial agentsprescribed as part of etiotropic treatment. Its intake is necessary to suppress the activity of the causative agent of the infectious-inflammatory process. It 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 can 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 efficacy of the drugs. The selection of antibiotics, determination of the dosage 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 prostate tissues are parasitized by a polyassociated microbial flora (bacteria, 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 defense.and its resistance to infections, immunomodulatory drugs are prescribed: Immunomax, Panavir, Interferon and its derivatives. To enhance the antimicrobial effect of etiotropic drugs, enzymatic agents are prescribed together with them: longidase, chymotrypsin. 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.

Pain syndrome is relieved withusing non-steroidal 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 improve its functional state, hepaprotectors are prescribed. After the acute inflammatory phenomena disappear, 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 the prostate tissue, stimulates the restoration of its functional state and helps resolve inflammatory processes. A low frequency laser is used to destroy the stones. It crushes stones and allows small stones to come out of the tubules. In case of complications in the form of prostate adenoma or abscess (a limited cavity filled with pus), surgical intervention is performed.

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