Calcareous prostatitis– a complication of chronic inflammation of the prostate, characterized by the formation of stones in the acini or ducts of the gland. Calcareous prostatitis is accompanied by increased urination, dull pain in the lower abdomen and perineum, erectile dysfunction, blood in the semen, and prostatorrhea. Calcific prostatitis can be diagnosed using digital examination of the prostate, ultrasound of the prostate, survey urography and laboratory examination. Conservative therapy for calcareous prostatitis is carried out with the help of medications, herbal medicine and physiotherapy; If these measures are ineffective, stone destruction with a low-intensity laser or surgical removal is indicated.
General information
Calcific prostatitis is a form of chronic prostatitis that is associated with the formation of stones (prostatoliths). Calcific prostatitis is the most common complication of a long-term inflammatory process in the prostate, which specialists in the field of urology and andrology have to deal with. During preventive ultrasound examination, prostate stones are detected in 8. 4% of men of different ages. The first age peak in the incidence of calcareous prostatitis occurs between the ages of 30 and 39 and is due to an increase in cases of chronic prostatitis caused by sexually transmitted diseases (chlamydia, trichomoniasis, gonorrhea, ureaplasmosis, mycoplasmosis, etc. ). In men aged 40 to 59 years, calcareous prostatitis usually develops against the background of prostate adenoma and is associated with deterioration in sexual function in patients over 60 years old.
Causes of calcific prostatitis
Depending on the cause, prostate stones can be real (primary) or fake (secondary). Primary stones initially form directly in the acini and ducts of the gland, secondary stones migrate from the upper urinary tract (kidneys, bladder or urethra) into the prostate if the patient suffers from urolithiasis.
The development of calcareous prostatitis is caused by obstructed and inflammatory changes in the prostate gland. Impaired emptying of the prostate glands is caused by BPH, irregularities or lack of sexual activity and a sedentary lifestyle. Against this background, the addition of a sluggish infection of the genitourinary tract leads to obstruction of the prostate ducts and a change in the nature of prostate secretion. Prostate stones, in turn, also promote a chronic inflammatory process and a build-up of secretions in the prostate.
In addition to stagnation and inflammatory phenomena, urethro-prostatic reflux plays an important role in the development of calcareous prostatitis - the pathological reflux of a small amount of urine from the urethra into the prostate ducts during urination. At the same time, the salts contained in urine crystallize, thicken and turn into stones over time. The causes of urethro-prostatic reflux can be urethral strictures, trauma to the urethra, atony of the prostate and seminiferous tuberosity, previous transurethral resection of the prostate, etc.
The morphological core of prostate stones consists of amyloid bodies and desquamated epithelium, which gradually "overgrow" with phosphate and lime salts. Prostate stones lie in cystically dilated acini (lobules) or in the excretory ducts. Prostatoliths have a yellowish color, a spherical shape and vary inin size (average 2. 5 to 4 mm); can be single or multiple. In terms of chemical composition, prostate stones are identical to bladder stones. In calcareous prostatitis, oxalate, phosphate and urate stones are most commonly formed.
Symptoms of calcareous prostatitis
The clinical manifestations of calcific prostatitis are generally similar to the course of chronic inflammation of the prostate. The main symptom in the clinic for calcific prostatitis is pain. The pain is dull and aching; localized in the perineum, scrotum, over the pubic bone, sacrum or coccyx. Worsening of painful attacks may occur with bowel movements, sexual intercourse, physical activity, prolonged sitting on a hard surface, prolonged walking, or bumpy driving. Calcareous prostatitis is accompanied by frequent urination, sometimes with complete urinary retention; Hematuria, prostatorrhea (leakage of prostate secretion), hematospermia. Characterized by decreased libido, weak erection, impaired ejaculation and painful ejaculation.
Endogenous prostate stones can remain in the prostate for a long time without symptoms. However, a prolonged course of chronic inflammation and associated calcareous prostatitis can lead to the formation of a prostate abscess, the development of vesiculitis, atrophy and sclerosis of the glandular tissue.
Diagnosis of calcific prostatitis
To make the diagnosis of calcareous prostatitis, a conversation with a urologist (andrologist), an assessment of existing complaints, and a physical and instrumental examination of the patient are required. During the rectal digital examination of the prostate, palpation reveals the lumpy surface of the stones and a type of crepitus. Using transrectal ultrasound of the prostate, stones are detected as hyperechoic structures with a clear acoustic trace; their location, quantity, size and structure are clarified. Sometimes to detect prostatoliths, survey urography, CT and MRI of the prostate are used. Exogenous stones are diagnosed by pyelography, cystography and urethrography.
The instrumental examination of a patient with calcareous prostatitis is supplemented by laboratory diagnostics: examination of prostatic secretion, bacteriological culture of urethral discharge and urine, PCR examination of smears for sexually transmitted infections, biochemical analysis of blood and urine, determination of the level of prostate-specific antigen, biochemistry of theSperm, ejaculate culture, etc.
During the examination, a distinction is made between prostate adenoma, tuberculosis and prostate cancer as well as chronic bacterial and abacterial prostatitis. In calcific prostatitis not associated with prostate adenoma, the volume of the prostate and the PSA level remain normal.
Treatment of calcific prostatitis
Uncomplicated stones in combination with chronic inflammation of the prostate require conservative anti-inflammatory therapy. Treatment of calcareous prostatitis includes antibiotic therapy, non-steroidal anti-inflammatory drugs, herbal medicine and physiotherapeutic procedures (magnetotherapy, ultrasound therapy, electrophoresis). In recent years, low-intensity lasers have been used successfully to destroy prostate stones non-invasively. Prostate massage is strictly contraindicated in patients with calcareous prostatitis.
With a complicated course of the disease associated with prostate adenoma, surgical treatment of calcareous prostatitis is usually required. When a prostate abscess forms, the abscess is opened and, in addition to the discharge of pus, the discharge of stones is also noted. Sometimes mobile exogenous stones can be pressed instrumentally into the bladder and subjected to lithotripsy. Large, stuck stones are removed using the perineal or suprapubic incision. If calculous prostatitis is combined with BPH, the optimal method of surgical treatment is adenomectomy, TUR of the prostate, prostatectomy.
Prognosis and prevention of calcific prostatitis
In most cases, the prognosis for conservative and surgical treatment of calcific prostatitis is favorable. Urinary fistulas that do not heal in the long term can be a complication of perineal removal of prostate stones. Without treatment, calcareous prostatitis leads to abscess formation and sclerosis of the prostate, urinary incontinence, impotence and male infertility.
The most effective measure to prevent stone formation in the prostate is to see a specialist at the first signs of prostatitis. An important role is played by the prevention of sexually transmitted diseases, the elimination of predisposing factors (urethro-prostatic reflux, metabolic disorders) and age-appropriate physical and sexual activity. Preventive visits to the urologist and timely treatment of urolithiasis will help avoid the development of calcareous prostatitis.