Chalcolithic prostatitis– a complication of chronic inflammation of the prostate gland, characterized by the formation of stones in the acini or excretory ducts of the gland. Chalcolithic prostatitis is accompanied by increased urination, dull, aching pain in the lower abdomen and perineum, erectile dysfunction, the presence of blood in the semen, and prostatorrhea. Chalcolithic prostatitis can be diagnosed using a digital prostate exam, a prostate ultrasound, a urography, and a laboratory test. Conservative therapy of chalcolithic prostatitis is carried out with the help of drugs, phytotherapy and physiotherapy; If these measures are ineffective, destruction of the stones with a low-intensity laser or surgical removal is indicated.
general informations
Chalcolithic prostatitis is a form of chronic prostatitis, accompanied by the formation of stones (prostatoliths). Chalcolithic prostatitis is the most common complication of a long-term inflammatory process in the prostate gland, 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 various ages. The first age peak in the incidence of stone prostatitis occurs between 30-39 years of age 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, stone prostatitis, as a rule, develops against the background of prostatic adenoma, and in patients over 60 years of age it is associated with a decline in sexual function.
Causes of chalcolithic 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 migrate into the prostate from the upper urinary tract (kidneys, bladder or urethra) if the patient suffers from urolithiasis.
The development of stone prostatitis is caused by congestive and inflammatory changes in the prostate gland. Impaired emptying of the prostate glands is caused by BPH, irregularity or lack of sexual activity, and a sedentary lifestyle. In this context, the addition of a slow infection of the genitourinary tract leads to obstruction of the prostatic ducts and a change in the nature of prostatic secretion. In turn, prostatic stones also favor the chronic inflammatory process and the stagnation of secretions in the prostate.
In addition to stagnation and inflammatory phenomena, urethroprostatic reflux plays an important role in the development of calculous prostatitis - the pathological reflux of a small amount of urine from the urethra into the prostatic ducts during urination. At the same time, the salts contained in the urine crystallize, thicken and, over time, transform into stones. The causes of urethro-prostatic reflux can be urethral strictures, trauma to the urethra, atony of the prostate and seminal tubercle, previous transurethral resection of the prostate, etc.
The morphological core of prostatic stones are amyloid bodies and desquamated epithelium, which are gradually "covered" with phosphate and calcareous salts. Prostatic stones are found in cystically dilated acini (lobules) or excretory ducts. Prostatoliths are yellowish in color, spherical in shape and variable in size (on average from 2. 5 to 4 mm); they can be single or multiple. In terms of chemical composition, prostate stones are identical to bladder stones. With chalcolithic prostatitis, oxalate, phosphate and urate stones are most often formed.
Symptoms of chalcolithic prostatitis
The clinical manifestations of chalcolithic prostatitis generally resemble the course of chronic inflammation of the prostate. The main symptom in the clinic of stone prostatitis is pain. The pain is dull, aching in nature; located in the perineum, scrotum, above the pubis, sacrum or coccyx. Exacerbation of painful attacks may be associated with defecation, sexual intercourse, physical activity, prolonged sitting on a hard surface, prolonged walking or driving on rough roads. Chalcolithic prostatitis is accompanied by frequent urination, sometimes by complete urinary retention; haematuria, prostatorrhea (loss of prostatic secretions), haemospermia. Characterized by decreased libido, weak erection, reduced ejaculation and painful ejaculation.
Endogenous prostatic stones can remain in the prostate gland for a long time without symptoms. However, a long course of chronic inflammation and associated calculous prostatitis can lead to the formation of a prostatic abscess, the development of vesiculitis, atrophy and sclerosis of the glandular tissue.
Diagnosis of calculous prostatitis
To establish a diagnosis of stone prostatitis, a consultation with a urologist (andrologist), an assessment of existing complaints, and a physical and instrumental examination of the patient are necessary. When performing a digital rectal examination of the prostate, palpation determines the lumpy surface of the stones and a sort of crepitus. Using transrectal ultrasound of the prostate, stones are detected as hyperechoic formations with a clear acoustic signature; their location, quantity, size and structure are clarified. Sometimes urography, CT and MRI of the prostate are used to detect prostatoliths. Exogenous stones are diagnosed by pyelography, cystography and urethrography.
The instrumental examination of a patient with calculous prostatitis is completed by laboratory diagnostics: examination of prostatic secretions, bacteriological culture of urethral secretions and urine, PCR examination of scrapings for sexually transmitted infections, biochemical analysis of blood and urine, determination of prostate level -specific antigen, sperm biochemistry, ejaculate culture, etc.
When carrying out an examination, stone prostatitis is differentiated from prostatic adenoma, tuberculosis and prostate cancer, chronic bacterial and abacterial prostatitis. In chalcolithic prostatitis not associated with prostatic adenoma, the volume of the prostate gland and the PSA level remain normal.
Treatment of chalcolithic prostatitis
Uncomplicated stones in combination with chronic inflammation of the prostate gland require conservative anti-inflammatory therapy. Treatment of chalcolithic prostatitis includes antibiotic therapy, non-steroidal anti-inflammatory drugs, herbal medicine, physiotherapeutic procedures (magnetic therapy, ultrasound therapy, electrophoresis). In recent years, low-intensity laser has been used successfully to noninvasively destroy prostate stones. Prostate massage for patients with stone prostatitis is strictly contraindicated.
Surgical treatment of stone prostatitis is usually required in the case of a complicated course of the disease, in combination with prostatic adenoma. When a prostate abscess is formed, the abscess is opened and, along with the outflow of pus, the passage of stones is also noted. Sometimes mobile exogenous stones can be instrumentally pushed into the bladder and subjected to lithotripsy. Removal of large fixed stones is carried out during the process of perineal or suprapubic section. When prostatitis stones are combined with BPH, the optimal method of surgical treatment is adenomectomy, TUR of the prostate, prostatectomy.
Prediction and prevention of calculous prostatitis
In most cases, the prognosis for conservative and surgical treatment of stone prostatitis is favorable. Long-term non-healing urinary fistulas may be a complication of perineal removal of prostate stones. In the absence of treatment, the outcome of calculous prostatitis is the formation of abscesses and sclerosis of the prostate gland, urinary incontinence, impotence and male infertility.
The most effective measure to prevent the formation of stones in the prostate gland is to contact a specialist when the first signs of prostatitis appear. 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 a urologist and timely treatment of urolithiasis will help avoid the development of stone prostatitis.