Calculous prostatitis: causes, symptoms and treatment
Calculous prostatitis is one of the forms of chronic prostatitis, which is characterized by the formation of prostatolites and calculi in the excretory ducts and acini of the gland. The whole process proceeds against the background of increased and frequent urge to empty the bladder, with painful sensations of a dull and aching nature, with impaired erection 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 a prophylactic 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 diagnosed most often in the age range from 30 to 39 years, which is associated with chronic prostatitis, which forms against the background of genital infections. At the age of 40 to 60 years, the cause of calculous prostatitis is most often the adenoma of the prostate gland. At an older age, the disease is a consequence of the extinction of a man's sexual capabilities.
Content:
- Symptoms of calculous prostatitis
- Causes of calculous prostatitis
- Complications of calculous prostatitis
- Diagnosis of calculous prostatitis
- Treatment of calculous prostatitis
- Disease prognosis
Symptoms of calculous prostatitis
The 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. It can radiate to the pubis, coccyx, sacral region.
- The pain tends to intensify during bowel movement, during sexual activity, during physical exertion. In addition, painful sensations increase with a prolonged static position, especially if a man sits on a hard surface for a long time. Shaking, any prolonged vibration, for example, when driving a car, has a negative effect.
- Bladder emptying disorders. The urge to urinate becomes either more frequent or, on the contrary, is carried out with a delay. Complete urinary retention is possible.
- Hematuria. Impurities of blood in the urine with calculous prostatitis are not uncommon. This is due to trauma to the ducts of the gland by the sharp edges of the stones, as well as the very fact of the presence of inflammation.
- Prostatorrhea, in which the secretion of the prostate gland is secreted during the process of urination, during intense physical exertion, but can appear against the background of complete physical rest. In this case, a transparent stretching fluid 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 sign of the disease is a disorder of sexual function with a weak expression of sexual desire. In this case, erectile and ejaculation disorders are observed. Pain during ejaculation may occur.
It is possible that prostatolites will be hidden in the lobules and ducts of the organ for a long time, without provoking any symptoms, except for rare mild pain. However, as the disease progresses, the symptoms will become more acute.
Causes of calculous prostatitis
The stones that form in the prostate are divided into primary and secondary. The 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 prostatolites descend from the bladder, kidneys, or urethra and are caused by the presence of urolithiasis.
Andrologists and urologists identify the following main causes of calculous prostatitis:
- Congestion in the prostate gland. The prostate glands are not able 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 improper lifestyle in general become a provoking factor in the formation of calculi.
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Genitourinary 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, a man falls into a vicious circle, since the infection contributes to the creation of favorable conditions for the formation of prostatolites, and stones, in turn, support chronic inflammation and contribute to the stagnation of a secret in the organ.
- Another reason for the development of calculous prostatitis is urethro-prostatic reflux, characterized by the regular flow 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 the urine to crystallize, become denser, 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 caused by a number of reasons, including: trauma to the urethra, resection of the prostate gland, atony of the prostate, etc.
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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 "surrounded" with lime and phosphoric acid 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 in the range from 0.25 to 0.4 cm. During the ultrasound, both single and multiple formations are detected. Prostate stones and bladder stones have a similar chemical composition. If we consider just 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 in the following:
- Abscess of the prostate gland. At the same time, pus accumulates in the tissues of the organ, the body temperature rises, the intoxication of the body increases, the man is disturbed by severe pain, urination and defecation are disturbed. Even with timely treatment of an abscess, a man loses his ability to work for a certain time. If therapy is not carried out, then generalization of the infection occurs and urosepsis develops with a high probability of death.
- Acute or chronic vesiculitis. The process is accompanied by severe pain, sexual dysfunction. If at this stage no treatment is undertaken, then this threatens with epiema 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 organ dysfunction.
- Urinary incontinence.
- Impotence.
Diagnosis of calculous prostatitis
Diagnosis of calculous prostatitis is in the competence of a urologist or andrologist. In this case, 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, the number, structure and size of stones. In order to detect prostatoliths, it is possible to conduct MRI, CT, survey urography of the prostate. If there is a suspicion of the existence of stones outside the prostate, then urethrography, cystography, pyelography are performed.
Laboratory diagnostic methods:
- LHC culture of urine and urethral secretions;
- Study of the secretion of the prostate;
- Biochemistry of blood and urine;
- PCR diagnostics of scraping for the detection of STDs;
- Sperm biochemistry, etc.
It is important to distinguish calculous prostatitis from other organ diseases, 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 is aimed at achieving remission of the disease, preventing complications and normalizing the quality of life of a man.
It is imperative to carry out antibiotic therapy. It is based on the diagnostic data of the LHC culture of urethral secretions and urine. The choice of a specific drug remains with the doctor:
- Fluoroquinolones are the most effective treatments for prostatitis. They are prescribed only after prostate tuberculosis has been ruled out. This can be Levofloxacin (Eleflox, Tavanik), Ofloxacin (Zanocin, Ofloxin), Ciprofloxacin (Tsiprobai, Tsifran, Tsiprinol).
- Penicillins. It is most effective to use Amoxiclav, Augmentin, Flemoklav Solutab for the treatment of calculous prostatitis.
- Tetracyclines are used much less frequently to treat calculous prostatitis, since they are poorly tolerated. Nevertheless, it is possible to use Unidox solutab, which causes fewer side effects compared to other drugs of this series.
- Intramuscularly, it is possible to administer drugs from the cephalosporin group - these are Claforan, Suprax, Cefotaxime, etc.
- 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 using a low-intensity therapeutic laser has been gaining popularity. The procedure takes 15 minutes on average; 10 sessions are enough to destroy one prostatolite. In this case, the patient does not experience pain, he does not need the introduction of anesthesia. The probe is applied to the skin where the prostate is located. Under the action of a laser, stones are split into grains of sand and released naturally. In this case, the surrounding tissues remain intact.
It is worth remembering that massage of the prostate with stones is strictly prohibited.
As for the surgical intervention, it is necessary if the disease proceeds with complications, or there is a prostate adenoma. 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 lithotripsy procedure (crushing stones without surgery).
When prostatolites are of impressive size, a suprapubic or perineal section is shown for their extraction.
Prostatectomy, TURP or adenoectomy is performed when calculous prostatitis is complicated by prostate adenoma.
Disease prognosis
Calculous prostatitis, as a rule, can be successfully treated with conservative treatment. If it turns out to be ineffective, then they resort to surgical intervention, in which the prognosis also remains favorable. The most common complication of the operation is urinary fistulas that do not heal for a long time.
If there is no treatment, then this threatens the development of complications. The earlier the patient seeks qualified help, the more favorable the prognosis.
To avoid the disease will allow regular examinations at the urologist, the prevention of STIs, the elimination of other provoking factors.
Author of the article: Lebedev Andrey Sergeevich | Urologist
Education: Diploma in the specialty "Andrology" received after completing residency at the Department of Endoscopic Urology of the Russian Medical Academy of Postgraduate Education in the urological center of the Central Clinical Hospital No. 1 of JSC Russian Railways (2007). Postgraduate studies were completed here by 2010.
