calculus prostatitis– Complication of chronic inflammation of the prostate, characterized by the formation of stones in the acini or excretory ducts of the gland. Calculous prostatitis is associated with increased urination, dull pain in the lower abdomen and perineum, erectile dysfunction, blood in semen, and prostate leakage. Calculous prostatitis can be diagnosed by digital prostate examination, prostate ultrasound, urography, and laboratory tests. Conservative treatment of calculus prostatitis is carried out with the help of drugs, herbs and physical therapy; if these measures are ineffective, low-intensity laser destruction of the stones or surgical removal is required.
General information
Calculous prostatitis is a form of chronic prostatitis associated with the formation of stones (prostatic stones). Calculous prostatitis is the most common complication of a long-term inflammatory process of the prostate, which must be managed by specialists in the fields of urology and andrology. Prostate stones were detected in 8. 4% of men of all ages during preventive ultrasound examinations. The first age peak of the incidence of calculus prostatitis occurs between the ages of 30 and 39. This is due to the increase in chronic prostatitis cases caused by sexually transmitted diseases (chlamydia, trichomonas, gonorrhea, ureaplasmosis, mycoplasmosis, etc. ). In men aged 40-59 years, calculus prostatitis usually occurs in the context of prostate adenomas, whereas in patients older than 60 years, calculus prostatitis is associated with decreased sexual function.
Causes of calculus prostatitis
Depending on the cause of formation, prostate stones can be true (primary) or pseudo (secondary). Primary stones initially form directly in the acini and ducts, and if the patient has urolithiasis, secondary stones may migrate from the upper urinary tract (kidney, bladder, or urethra) to the prostate.The occurrence of calculus prostatitis is caused by congestion and inflammatory changes in the prostate. Impaired prostate emptying is caused by benign prostatic hyperplasia, irregular or lack of sexual activity, and a sedentary lifestyle. In this context, slow infection of the genitourinary tract leads to obstruction of the prostatic ducts and changes in the secretory properties of the prostate. Prostate stones, in turn, support chronic inflammatory processes and stagnation of prostate secretions.In addition to stagnation and inflammatory phenomena, urethroprostatic reflux plays an important role in the development of calculus prostatitis - the pathological reflux of small amounts of urine from the urethra into the prostatic duct during urination. At the same time, the salt in the urine crystallizes, thickens, and over time, turns into stones. The causes of urethroprostatic reflux may be urethral stricture, urethral trauma, prostate and seminal nodule weakness, previous transurethral resection of the prostate, etc.The morphological core of prostate stones are amyloid bodies and exfoliated epithelium, which are gradually "overgrown" by phosphate and calcium salts. Prostatic stones are located in cystically dilated acini (lobules) or excretory ducts. Prostatic stones are light yellow, spherical, and vary in size (average 2. 5 to 4 mm); they can be single or multiple. Chemically, prostate stones are identical to bladder stones. Calculous prostatitis most commonly forms oxalate, phosphate, and urate stones.
Symptoms of calculus prostatitis
The clinical manifestations of calculus prostatitis often resemble the course of chronic inflammation of the prostate. The main clinical symptom of calculus prostatitis is pain. The pain is dull, aching in nature; located above the perineum, scrotum, pubic bone, sacrum, or coccyx. Increased pain attacks may be associated with bowel movements, sexual intercourse, physical activity, prolonged sitting on hard surfaces, prolonged walking, or bumpy driving. Calculous prostatitis is accompanied by frequent urination and sometimes complete urinary retention; hematuria, prostatic leakage (leakage of prostate secretions), and hematospermia. It is characterized by decreased libido, weak erections, ejaculation disorders, and painful ejaculation. Endogenous prostate stones can remain in the prostate for long periods of time without any symptoms. However, long-term chronic inflammation and associated calculus prostatitis can lead to the formation of prostatic abscesses, development of seminal vesiculitis, atrophy and sclerosis of glandular tissue.
Diagnosis of calculus prostatitis
To confirm the diagnosis of calculus prostatitis, a consultation with a urologist (andrologist) is required, the existing symptoms are evaluated, and the patient is examined physically and instrumentally. When performing a digital rectal examination of the prostate, identify bumps and crepitus on the surface of the stone by palpation. Using transrectal prostate ultrasonography, stones are detected as hyperechoic structures with clear acoustic traces; their location, number, size, and structure are clarified. Prostatic urography, CT, and MRI are sometimes used to detect prostate stones. Extrinsic stones are diagnosed by pyelography, cystography, and urethrography.Instrumental examination in patients with calculus prostatitis is supplemented by laboratory diagnosis: examination of prostate secretions, bacterial culture of urethral secretions and urine, PCR examination of sexually transmitted infection scrapings, biochemical analysis of blood and urine, determination of prostate levels - specificAntigens, sperm biochemistry, semen culture, etc.During examination, calculus prostatitis needs to be differentiated from prostate adenoma, tuberculous prostate cancer, chronic bacterial and non-bacterial prostatitis. In calculus prostatitis not associated with prostatic adenoma, prostate volume and PSA levels remain normal.
Treatment of calculus prostatitis
Simple stones combined with chronic inflammation of the prostate require conservative anti-inflammatory treatment. Treatment of calculus prostatitis includes antibiotic therapy, non-steroidal anti-inflammatory drugs, herbal medicine, physical therapy procedures (magnetic therapy, ultrasound therapy, electrophoresis). In recent years, low-intensity lasers have been successfully used to non-invasively destroy prostate stones. Patients with calculus prostatitis are strictly prohibited from prostate massage.If the course of calculus prostatitis is complicated and associated with prostate adenoma, surgical treatment is usually required. When a prostate abscess forms, the abscess is opened and the stones pass as the pus drains out. Sometimes an instrument can be used to push a displaced exogenous stone into the bladder and perform lithotripsy. Removal of large fixed stones is performed in the perineal or suprapubic part of the procedure. When calculus prostatitis is complicated by BPH, the best surgical treatment is adenoma resection, prostate TUR, or prostatectomy.
Prediction and prevention of calculus prostatitis
In most cases, the prognosis for conservative and surgical treatment of calculus prostatitis is good. Prolonged non-healing urinary fistula may be a complication of perineal removal of prostatoliths. If left untreated, consequences of calculus prostatitis are prostate abscess formation and hardening, urinary incontinence, impotence, and male infertility.The most effective measure to prevent prostate stone formation is to contact a specialist at the first signs of prostatitis. An important role is the prevention of sexually transmitted infections, elimination of triggering factors (urethroprostatic reflux, metabolic disorders), age-appropriate physical and sexual activity. Preventive visits to your urologist and prompt treatment of urolithiasis will help avoid the development of calculus prostatitis.
