Calculous prostatitis

Calculous prostatitis is accompanied by frequent urination, dull aching pain in the lower abdomen and perineum, erectile dysfunction, presence of blood in seminal fluid and prostatorrhea. Calculous prostatitis can be diagnosed by digital examination of the prostate, ultrasound of the prostate gland, investigative urography and laboratory examination. Conservative therapy of calculous prostatitis is carried out with the help of medicines, 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 the formation of stones (prostatoliths). Calculous prostatitis is the most frequent complication of the long-term inflammatory process in the prostate gland, which specialists in the field of urology and andrology have to deal with. Prostate stones are detected in 8. 4% of men of different ages during preventive ultrasound examination. The first age peak of the frequency of calculous prostatitis occurs at the age of 30-39 years and is due to the increase in cases of chronic prostatitis caused by STDs (chlamydia, trichomoniasis, gonorrhea, ureaplasmosis, mycoplasmosis, etc. ). In men aged 40-59, calculous prostatitis usually develops against the background of prostate adenoma, and in patients over 60 years of age, it is associated with decreased 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 are transferred 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. Disorders of prostate gland emptying are caused by BPH, impaired or lack of sexual activity and a sedentary lifestyle. Against this background, the addition of a sluggish infection of the genitourinary system leads to obstruction of the prostate ducts and a change in the nature of the prostate secretion. On the other hand, prostate stones also contribute to the chronic inflammatory process and stagnation of prostate secretion.

In addition to stagnation and inflammatory events, urethro-prostatic reflux plays an important role in the development of calculous prostatitis - pathological reflux of small amounts of urine during urination into the prostate duct. At the same time, the salts in the urine crystallize, thicken and turn into stones over time. The causes of urethro-prostatic reflux can be urethral strictures, urethral trauma, prostate and testicular atony, previous urethral resection of the prostate gland, etc. Sh.

The morphological core of prostate stones is amyloid bodies and desquamated epithelium, which are gradually "enlarged" by phosphate and calcareous salts. Prostate stones are located in cystic acne (lobules) or excretory ducts. Prostatolites are yellowish in color, spherical in shape and vary in size (on average 2. up to 4 mm); can be single or multiple. In chemical composition, prostate stones are identical to bladder stones. Oxalate, phosphate and urate stones are most often formed during calculous prostatitis.

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; It is localized in the perineum, scrotum, above the pubis, sacrum or coccyx. Exacerbations 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, prostatorrhea (leakage of prostate secretion), hemospermia. It is characterized by decreased libido, weak erection, decreased ejaculation and painful ejaculation.

Endogenous prostate stones can remain in the prostate gland for a long time without symptoms. However, the long-term 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 determine the diagnosis of calculous prostatitis, it is necessary to consult a urologist (andrologist), evaluate the existing complaints, and perform a physical and instrumental examination of the patient. During a rectal digital examination of the prostate, a rough surface of the 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 path; Their location, number, size and structure are specified. Urography, prostate CT and MRI are sometimes used to detect the prostate. 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 secretion, bacteriological culture of urethral discharge and urine, PCR examination of scraping of sexually transmitted infections, biochemical analysis of blood and urine, determination of prostate level. - specific antigen, sperm biochemistry, ejaculate culture, etc. Sh.

During examination, calculous prostatitis is differentiated from prostate adenoma, tuberculosis and prostate cancer, chronic bacterial and bacterial prostatitis. In calculous prostatitis, which is not associated with prostate adenoma, the volume of the prostate gland and the 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, nonsteroidal anti-inflammatory drugs, herbal medicine, physical therapy procedures (magnetic therapy, ultrasound therapy, electrophoresis). In recent years, a low-intensity laser has been successfully used for the non-invasive destruction of prostate stones. Prostate massage is strictly contraindicated for patients with calculous prostatitis.

Surgical treatment of calculous prostatitis is usually required in the complicated course of the disease, its combination with prostate adenoma. During the formation of a prostate abscess, the abscess is opened and along with the outflow of pus, stones are also passed out. Sometimes mobile exogenous stones can be instrumentally entered into the bladder and subjected to lithotripsy. Removal of large fixed stones is performed in the process of perineal or suprapubic incision. 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 the result of long-term chronic inflammation of the prostate. The disease is accompanied by frequent urination, painful 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 inflammatory process of 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 swelling and inflammatory events, urethro-prostatic reflux, which is characterized by pathological reflux of a small amount of urine during urination in the ducts of the prostate gland, plays a major role in the development of calculous prostatitis. The salts in the urine gradually crystallize and turn into dense stones over time. Common causes of uroprostatic reflux:

• Urethral injuries;
• atony of the prostate gland and testicles;
• Previous surgical interventions and invasive procedures.

Other pathologies that increase the risk of stones in the prostate:

• Small pelvic varicose veins;
• metabolic disorders due to systemic pathologies;

Factors contributing to the development of calculous prostatitis:

• An inactive lifestyle, which contributes to the development of stagnation processes in the pelvic organs;
• Irregular sex life;
• alcohol abuse, smoking;
• uncontrolled use of certain group of medicines;
• Prostate damage during surgical procedures, long-term catheterization.

Types of stones in calculous prostatitis

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

• trueThey are formed 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 gland is identical in composition to bladder stones. The following types of stones are most often formed during calculous prostatitis:

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 localization: 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 retention of urine;
• Hematuria and the presence of blood inclusions in the ejaculate;
• Prostatorrhea - leakage of prostate secretion;
• decreased libido, erectile dysfunction, painful ejaculation;
• Neurological disorders: irritability, increased fatigue, insomnia.

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

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

diagnosis

To determine the exact diagnosis, it is necessary to consult a urologist-andrologist. 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.

The doctor then conducts a rectal examination of the prostate, which involves palpating the gland through the rectum. The technique allows you to evaluate the size, shape, structure of the gland, identify stones, determine the inflammatory process by increasing the size and increasing 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:

• Prostate secretion culture. An important informative method for identifying pathogenic microorganisms and diagnosing the inflammatory process in the prostate gland.
• Urine culture. Allows you to detect pathogenic infection in urine, as well as determine its type and concentration. If inflammation of the prostate gland is suspected, a culture is performed to clarify the diagnosis.
• Scraping PCR study. Allows you to identify sexually transmitted infections and identify the pathogen.
• PSA analysis. 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 detect hidden inflammatory processes in the urinary tract and kidney disorders.
• spermogram. Ejaculate analysis to rule out or confirm infertility.

Instrumental diagnostics

Instrumental methods of pathology diagnosis:

Ultrasound of the prostate. Allows you to identify stones, specify their location, number, size, structure. Ultrasound will also help to differentiate 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 prostate stones, their size and location.

Prostate CT or MRI. Allows layer-by-layer scanning of the prostate gland and surrounding tissues. Using a CT or MRI image, the doctor can study the structure of the prostate in detail, detect pathological foci, evaluate their location, size and relationship with 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, along with prostate adenoma, the patient needs to be hospitalized.

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 group of drugs:

• Antibiotics. Destroy the infection, stop the inflammation. For each patient, the type of medicine, dose and duration of the course are determined individually.
• Nonsteroidal anti-inflammatory drugs. They stop the inflammatory process and help eliminate pathological symptoms: pain, swelling.
• Antispasmodics. Relieves muscle spasm and relieves pain.
• Alpha adrenergic blockers. Facilitates urination.
• Vitamin-mineral complexes, immunomodulators. Strengthens the immune system and promotes rapid recovery.

As an addition to complex drug therapy, doctors often prescribe physical therapy procedures that allow:

• eliminate stagnant processes;
• Activation of 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. In order to prevent relapses, it is recommended to engage in physical activity, especially if your work forces you to lead a sedentary lifestyle. Moderate physical activity improves blood circulation in pelvic organs, eliminates swelling and strengthens local immunity.

surgery

Surgical treatment is performed when the disease is complicated and combined with prostate hyperplasia. When an abscess forms, the surgeon drains the abscess. Along with the flow of pus, stones are often passed out. Large fixed stones are removed during a perineal or suprapubic incision. When calculous prostatitis is combined with benign prostatic hyperplasia, the optimal surgical treatment methods are transurethral resection of the prostate.

Chronic calculous prostatitis

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

Causes and mechanism of development of calculous prostatitis

Prolonged inflammatory process or swelling in the prostate ducts causes accumulation of secretions and mucus in them. Bacteria settle on this accumulation and calcium salts accumulate. The mucus thickens 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)
• Prolongation of the infectious process with inflammation of the ducts and tissues of the prostate gland;
• prostate swelling, which is primarily associated with men's irregular sex life;
• Urethro-prostatic reflux - pathological return of a small volume of urine to the prostate;
• Genetic predisposition - presence of relatives with calculous prostatitis.

Knowledge of 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 re-development of calculous prostatitis.

Symptoms of calculous prostatitis

Symptoms of calculous prostatitis develop for a long 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 may begin or intensify after defecation, sexual intercourse, intense physical activity and other provoking factors. There are dysuric disorders - frequent desire to go to the toilet, painful or difficult urination, burning in the urethra and lower abdomen, sometimes urine is retained due to obstruction in the form of stones.

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

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

The main signs of calculous prostatitis are:

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

Such symptoms cause 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 stimulants (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 male prostate gland. 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,
• Physiotherapy procedures.

antibacterial agentsIt is prescribed as part of etiotropic treatment. Their reception is necessary to suppress the activity causing the infectious-inflammatory process. It can be non-specific microbial flora (streptococci, staphylococci, enterococci, Escherichia coli, Proteus), as well as specific pathogens of urogenital infections - gonococci, chlamydia, ureaplasma, trichomonas, etc. Sh.

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

If the prostate tissues are parasitized by poly-associated microbial flora (bacterial, viral microorganisms, protozoa), the etiotropic therapy regimen consists of a complex of various drugs that act 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, together with them, enzymatic agents are prescribed - longidase, chymotrypsin. They contribute to the delivery of active antibiotics to the affected tissues, have an indirect analgesic effect and have an anti-inflammatory and regenerative effect.

The pain syndrome is resolvedUsing non-steroidal anti-inflammatory drugs. Along with antibiotic therapy, probiotics are prescribed to prevent the development of intestinal dysbiosis. Hepaprotectors are prescribed to protect the liver parenchyma from the toxic effects of antibacterial drugs and to improve its functional state. After acute inflammatory events subside, physiotherapeutic procedures are prescribed - laser treatment, magnetotherapy, mud therapy, galvanization, therapeutic electrophoresis, reflexogenic therapy, hardware treatment, etc. Sh.

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 breaks up the stones and allows smaller stones to pass out of the tubes. In case of complications in the form of adenoma or prostate abscess (limited cavity filled with pus), surgical intervention is performed.

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