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Calculous prostatitis is one of the forms of chronic prostatitis, which is characterized by the formation of prostoliths and stones in the excretory ducts and acini of the gland. The whole process takes place against the background of increased and frequent urge to empty the bladder, with painful sensations of a dull and aching nature, with erectile dysfunction and other symptoms of inflammation of the prostate gland.
It is calculous prostatitis that is the most common complication of untreated sluggish chronic prostatitis. When conducting preventive ultrasound of the prostate gland, stones in the prostate are found in 8,4% of men of all ages. For the first time, calculous prostatitis is most often diagnosed in the age range from 30 to 39 years, which is associated with chronic prostatitis that develops against the background of genital infections. At the age of 40 to 60 years, the cause of calculous prostatitis is most often prostate adenoma. At an older age, the disease is a consequence of the extinction of the sexual capabilities of a man.
Symptoms of calculous prostatitis
Symptoms of calculous prostatitis resemble the clinical picture characteristic of chronic inflammation of the prostate gland and are expressed as follows:
Painful sensations. The nature of the pain is aching and dull, it occurs mainly in the perineum and in the scrotum. May irradiate to the pubis, coccyx, sacrum.
Pain tends to increase during bowel movements, during sexual activity, during physical exertion. In addition, pain increases with a long static position, especially if a man sits on a hard surface for a long time. Shaking, any prolonged vibrations, for example, when driving a car, negatively affects.
Bladder emptying disorders. The urge to urinate becomes either more frequent, or, on the contrary, is carried out with a delay. Complete retention of urine is possible.
Hematuria. Blood impurities in the urine with calculous prostatitis are not uncommon. This is due to injury to the ducts of the gland with sharp edges of stones, as well as the very fact of the presence of inflammation.
Prostatorrhea, in which the secret of the prostate gland is released during the process of urination, during increased physical exertion, but may appear against the background of complete physical rest. At the same time, a transparent lingering liquid leaves the urethra. The process itself may be accompanied by a burning sensation, but more often it causes psychological discomfort.
Hemospermia in calculous prostatitis is characterized by the appearance of blood impurities in the semen.
A characteristic symptom of the disease is a disorder of sexual function with a weak expression of sexual desire. At the same time erection disorders, ejaculation are observed. There may be pain during ejaculation.
It is possible that prostoliths will remain hidden in the lobules and ducts of the organ for a long time, without provoking any symptoms, except for rare mild pains. However, as the disease progresses, the symptoms will become more acute.
Causes of calculous prostatitis
Stones that form in the prostate are divided into primary and secondary. Causes of calculous prostatitis directly affect their nature. So, primary stones are formed immediately directly in the ducts and acini of the organ, and secondary prostoliths descend from the bladder, kidneys, or urethra and are caused by the presence of urolithiasis.
Andrology and urologists identify the following main causes of calculous prostatitis:
Stagnation in the prostate gland. The prostate glands do not have the ability to empty normally if a man lives an irregular sexual life, or completely abstains from it. In addition, benign prostatic hyperplasia (prostate adenoma), physical inactivity, dietary patterns, bad habits, and an unhealthy lifestyle in general become a provoking factor in the formation of calculi.
Urinary tract infections. Against the background of their prolonged presence, obstruction of the ducts of the gland occurs, the secret produced by the prostate changes, it becomes thicker and more viscous. STDs such as trichomoniasis, gonorrhea, chlamydia, mycoplasmosis, ureaplasmosis, etc. are capable of provoking the development of the disease. As a result, the man falls into a vicious circle, since the infection contributes to the creation of favorable conditions for the formation of prostoliths, and the stones, in turn, support chronic inflammation and contribute to the stagnation of the secret in the body.
Another reason for the development of calculous prostatitis is urethro-prostatic reflux, characterized by regular reflux of a small portion of urine from the urethra into the ducts of the gland. This pathological process occurs on a regular basis with each emptying of the bladder. Over time, reflux causes the salts in your urine to crystallize, become thicker, and turn into stones. In this case, it will not be possible to get rid of calculous prostatitis until urethro-prostatic reflux is treated, which can be due to a number of reasons, among them: trauma to the urethra, resection of the prostate gland, prostate atony, etc.
Also, men have morphological prerequisites for the formation of stones and the development of calculous prostatitis. In this case, we are talking about the amyloid bodies themselves and the desquamated epithelium. With age, they are “enclosed” with lime and phosphate layers. In this case, the stones will be located in the stretched lobules of the prostate, or in the ducts themselves.
The stones have a rounded spherical shape, the color is close to yellow. Their size varies from 0,25 to 0,4 cm. During ultrasound, both single and multiple formations are detected. Prostate stones and bladder stones have a similar chemical composition. If we consider calculous prostatitis, then the appearance of urate, oxalate and phosphate stones is more characteristic of it.
Complications of calculous prostatitis
The longer a man has inflammation, the longer competent and adequate treatment is not carried out, the higher the risks of developing complications of calculous prostatitis. They can be expressed as follows:
Abscess of the prostate. At the same time, pus accumulates in the tissues of the organ, the body temperature rises, intoxication of the body increases, the man is worried about severe pain, urination and defecation are disturbed. Even with timely treatment of an abscess for a certain time, a man loses his ability to work. If therapy is not carried out, then infection generalizes and urosepsis develops with a high probability of death.
Acute or chronic vesiculitis. The process is accompanied by severe pain, impaired sexual function. If at this stage no treatment is undertaken, then this threatens with epidemy of the seminal vesicles, the development of chronic epididymitis, which later becomes the cause of infertility.
Atrophy and sclerosis of the prostate with the replacement of normal tissue with scar tissue, which leads to dysfunction of the organ.
Urinary incontinence.
Impotence.
Diagnosis of calculous prostatitis
Diagnosis of calculous prostatitis is within the competence of a urologist or andrologist. At the same time, the doctor listens to the patient’s complaints, performs a physical and instrumental examination. Rectal digital examination reveals bumps on the surface of the prostate, as well as characteristic crepitus.
Transrectal ultrasound allows you to visualize calculi, clarify their location, number, structure and size of stones. In order to detect prostoliths, it is possible to perform MRI, CT, and survey urography of the prostate. If there is a suspicion of the existence of stones outside the prostate, then urethrography, cystography, pyelography are performed.
Methods of laboratory diagnostics:
LHC culture of urine and urethral secretion;
The study of the secret of the prostate;
Biochemistry of blood and urine;
PCR diagnostics of scrapings for the detection of STDs;
Biochemistry of sperm, etc.
It is important to distinguish calculous prostatitis from other diseases of the organ, in particular, from prostate adenoma, prostate cancer, bacterial prostatitis, etc.
Treatment of calculous prostatitis
Treatment of calculous prostatitis takes from 1 to 3 months and aims to achieve remission of the disease, prevent complications and normalize the quality of life of a man.
It is mandatory to carry out antibiotic therapy. It is based on the diagnostic data of the urethral secretion and urine culture performed by the BAC. The choice of a specific drug remains with the doctor:
Fluoroquinolones are the most effective drugs for the treatment of prostatitis. They are prescribed only after prostate tuberculosis has been ruled out.
Penicillins.
Tetracyclines are used to treat calculous prostatitis much less frequently, as they are rather poorly tolerated.
Intramuscular injection of drugs from the group of cephalosporins is possible.
Macrolides for the treatment of prostatitis are rarely used, since there is no data on their effectiveness in relation to the disease.
In addition to antibiotics, a man is shown taking NSAIDs (Diclofenac, Nimisulide, Ibuprofen, etc.), vitamins, drugs aimed at normalizing blood circulation.
Physiotherapeutic procedures are effective against calculous prostatitis – ultrasound therapy, magnetotherapy, electrophoresis. In recent years, the procedure for crushing prostate stones with a low-intensity therapeutic laser is gaining popularity. The procedure takes an average of 15 minutes, 10 sessions are enough to destroy one prostolith. In this case, the patient does not experience pain, he does not require the introduction of anesthesia. The sensor is applied to the skin in the place where the prostate is located. Under the action of a laser, the stones are split into grains of sand and come out naturally. At the same time, the surrounding tissues remain intact.
It is worth remembering that prostate massage in the presence of stones in it is strictly prohibited.
As for surgical intervention, it is necessary if the disease proceeds with complications, or there is an adenoma of the prostate. When a formed organ abscess is diagnosed, the abscess is urgently opened, and stones come out with exudate. In some cases, stones that are mobile can be pushed into the bladder. There they are subjected to the procedure of lithotripsy (crushing of stones without surgery).
When the prostoliths are of impressive size, a suprapubic or perineal section is shown to extract them.
Prostatectomy, TURP, or adenectomy is performed when calculous prostatitis is complicated by prostate adenoma.
Prognosis of the disease
Calculous prostatitis usually responds well to conservative treatment. If it turns out to be ineffective, then they resort to surgical intervention, in which the prognosis also remains favorable. Urinary fistulas, which do not heal for a long time, are most often a complication of the operation.
If there is no treatment, then this threatens the development of complications. The earlier the patient seeks qualified help, the better the prognosis.
Regular examinations by a urologist, prevention of STIs, elimination of other provoking factors will help to avoid the disease.