What are prostatic concretions? – Balanced Platter

The medical-dictionary defines Prostatic Concretions or Calculus an abnormal concretion, usually composed of mineral salts, occurring within the body, chiefly in hollow organs or their passages. Also called a stone.

A more simple definition is Prostatic calcifications, usually referred to as prostate stones, are one cause of chronic prostatitis/chronic pelvic pain syndrome.

In men, these stones are pretty common however as many as 75% of middle-aged men have these prostatic calcifications. It’s not the stones that actually cause symptoms.  Symptoms may be related to enlarged prostate from a BPH (benign prostatic hyperplasia).  BPH is common with men who have prostate cancer.

Furthermore, prostatic calcifications can aggravate the lower urinary tract resulting in symptoms as well.  Many men don’t know that they have calcifications. This is usually discovered when their medical providers screen the patient for other reasons.   There is no difference in the numbers, size and locations of the stones in the prostate between men with urinary symptoms and without.

Symptoms of Prostatitis (Prostate Stones)

1. Frequent Pain and swelling of the prostate gland
2. Enlarged prostate (BPH)
3. Pain in the groin
4. Weak urine stream
5. Painful ejaculation
6. Grainy sand-like pebbles that may be discharged during urination or ejaculation
7. Symptoms disappear temporarily with prostate mediation or antibiotics, but the pain and symptoms eventually return
8. Elevated PSA score
9. Lower urinary tract infection

If prostatic stones are the source of recurring infection, then this can be a problem.  Taking antibiotics that kill associated bacteria does not remove the obstructive stones. Therefore the inflammation can continue. Chronic inflammation can lead to prostatitis symptoms.  Inflammation can wreak havoc on the body causing problems with the nervous system.   This can cause pain and in this case prostatitis.  Also, you have to be careful that bacteria does not still reside in the stones because they don’t show up when cultured because they are protected and sealed off by the stone or scar tissue.

No one knows why these stones form.

• Some experts say they are from prostatic secretions.
• Others say the stones tend to be made from ingredients found in urine. This kind would form from urine making its way into the prostatic ducts.
• Anecdotal evidence seems to suggest that taking magnesium and zinc helps to break up these stones and you may see “gravel” in your semen or urine if this occurs.
• Other doctors say that no dietary change or supplement will help with stones caused by prostatic secretions.
• If you have prostatic calcification talk to your doctor or consider natural alternatives to support the symptoms.

#1: Magnesium, Zinc, Astragalus, and Soybean extracts

Many doctors prescribe antibiotics along with magnesium and zinc supplements.  This helps clear infections.  The supplements (minerals) zinc and magnesium seem to help break up prostatic stones.  This helps them pass through the urine.

A recommendation of a combination of natural clinically-researched supplements that contain the following may be beneficial:

Curcumin: A recent meta-analysis examined dozens of studies on just one nutrient, curcumin, effects on blood levels of CRP, a key marker of inflammation that has been linked to health problems. The studies reflect an astonishing conclusion: Curcumin lowers levels of CRP.

Phytother Res. 2014 May; 28(5):633-42.

Vitamin C: Adequate dietary intake of the antioxidant vitamin, vitamin C, is also essential because free radicals have pro-inflammatory effects (45). A cross-sectional study of 3,258 men (aged 60-79 years) participating in the British Regional Heart Study found that both dietary intake and plasma levels of vitamin C were inversely related to CRP levels (47). Higher vitamin C levels were also associated with lower CRP levels in the NHANES III, which included data from 14,519 US adults.

Niacin: This study provides evidence that niacin therapy may improve the vascular environment, and is compatible with previous studies evaluating the use of extended-release niacin in patients with coronary disease. This finding may also be interpreted as evidence showing that the anti-inflammatory effect of niacin therapy … https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4804877/

Stinging Nettle: May sound harsh in name but actually has been used for many years to soothe the urinary tract and help men with their prostate problems. Stinging nettle’s many anti-inflammatory properties are helpful to both men with CPPS and men with chronic bacterial prostatitis. https://prostate.net/health-centers/prostatitis/…prostatitis…/supplements-chronic-prostatitis…

Creatine: Has been proven that taking Creatine supplements can help the body with the overall reduction of inflammation. This is especially true during times of extreme stress. Creatine not only helps decrease the probability of inflammation but also helps deflect damage to the organs like the heart, cardiovascular system and all the major organs, including the prostate. There was a study conducted in the summer of 2008 which tested the effect of Creatine on the immune system of athletes before and during a triathlon. Published in the 2008 August issue of the titled “Amino Acids.”

L-Norvaline: is an arginase inhibitor which exhibits anti-inflammatory effects independently of inhibition of arginase in human endothelial cells. The anti-inflammatory properties of L-Norvaline are partially attributable to its ability to inhibit S6K1.

These natural herbs and plants help support the prostate, reduce inflammation, and promote blood flow. Each of these nutrients performed well in individual clinical trials and reduced symptoms in BPH patients.

When Combined They Create a Powerful Combination of Anti-Inflammatories for Prostate.

#2: Prostate massage

Some men find that a prostate massage, which increases healthy blood flow and oxygen to the prostate, helps flush away prostate calcification and helps men achieve a prostate orgasm, which clears blocked prostate ducts of toxic bacteria and buildup of prostatic fluid.

#3: Diet

A diet or a healthier lifestyle is recommended to eliminate processed sugars, saturated fats from red meat, sodium and dairy products.

#4: Exercise

Exercising a minimum of three times per week for a minimum of 30 minutes is recommended.

#5: Alternative Medicine or Ayurvedic medicine

The alternative therapies for reducing prostatitis symptoms may include acupuncture, Ayurvedic medicine, and reflexology.

Hope this helps!

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Clinical Significance of Prostatic Calculi: A Review

World J Mens Health. 2018 Jan; 36(1): 15–21.

Jae Seog Hyun

Department of Urology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea.

Department of Urology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea.

Corresponding author.Correspondence to: Jae Seog Hyun. Department of Urology, Gyeongsang National University College of Medicine, 15 Jinju-daero 816beon-gil, Jinju 52727, Korea. Tel: +82-55-750-8192, Fax: +82-55-757-4503, rk.ca.ung@sjnuyh

Received 2017 May 23; Accepted 2017 Jun 8.

Copyright © 2018 Korean Society for Sexual Medicine and AndrologyThis is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC.

Abstract

Prostatic calculi often occur in middle-aged and old men. Prostatic calculi are usually classified as primary/endogenous stones or secondary/extrinsic stones. Endogenous stones are commonly caused by obstruction of the prostatic ducts around the enlarged prostate by benign prostatic hyperplasia (BPH) or by chronic inflammation. Extrinsic stones occur mainly around the urethra, because they are caused by urine reflux. The exact prevalence of prostatic calculi is not known, and it has been reported to vary widely, from 7% to 70%. Most cases of prostatic calculi are not accompanied by symptoms. Therefore, most cases are found incidentally during the diagnosis of BPH using transrectal ultrasonography (TRUS). However, prostatic calculi associated with chronic prostatitis may be accompanied by chronic pelvic pain. Rare cases have been reported in which extrinsic prostatic calculi caused by urine reflux have led to voiding difficulty due to their size. More than 80% of prostatic calculi are composed of calcium phosphate. Prostatic calculi can be easily diagnosed using TRUS or computed tomography. Treatment is often unnecessary, but if an individual experiences difficulty in urination or chronic pain, prostatic calculi can be easily removed using a transurethral electroresection loop or holmium laser.

Keywords: Calculi, Prostate, Prostatic hyperplasia, Prostatitis

INTRODUCTION

Transrectal ultrasonography (TRUS) is used to diagnose benign prostatic hyperplasia in an increasing number of patients. As TRUS has become more common, benign prostatic hyperplasia has often been found to be accompanied by prostatic calculi. However, few studies have been conducted on prostatic calculi. In 1586, Donatus reported them for the first time in an autopsy. The first clinical report of urinary symptoms associated with stones was published in the late 19th century [1]. To date, it has been accepted that prostatic calculi occur in proportion to age without causing any specific symptoms [2]. Recently, as the implementation of TRUS has increased, more research on prostatic calculi has been conducted, and there have been some reports on the shape and composition of the stones. However, the incidence of stones, the mechanism of their formation, their relationship to benign or malignant findings in the prostate, and the clinical significance of stones are not yet known.

PROSTATE ANATOMY AND PROSTATIC CALCULI

The prostate is a male reproductive organ composed of glandular tissue and the fibrous tissue surrounding it. The average prostate weight of a normal adult is about 20 g. The length of the long axis is 4 cm, the width is 2 cm, and the length is 2 cm. The prostate completely surrounds the prostatic urethra, and there are 15 to 30 conduits opening from the prostate urethra. The entire prostate is surrounded by a connective tissue layer rich in plexus and elastic fibers, and the hull is surrounded by prostatic interstitial tissue. The prostate is attached to the bladder neck on the back on the upper side, is fixed to the anterior labral prostate ligament, and is fixed by the urogenital septum on the lower side. Behind the prostate is the Denonvilliers fascia, which separates this region from the rectum. The anterior and lateral segments are attached to the pelvic floor and wrapped in the endopelvic fascia. The prostatic urethra and verumontanum are in the prostate, and 2 posterior ejaculatory ducts enter the prostate urethra [2]. In 1912, Lowsley divided the prostate into 5 lobes, comprising 2 lateral lobes, 1 anterior lobe, 1 middle lobe, and 1 posterior lobe. However, this concept of a lobular structure has evolved into a zonal concept, as articulated by McNeal in 1968. The prostate gland tissue is divided into 5 zones: the central zone, the peripheral zone, the transitional zone, the anterior fibromuscular stroma, and the preprostatic sphincter, according to the location of the urethra, distribution of pathologic lesions, and patterns of development () [3]. Each site can be investigated by TRUS; this classification is consistent with the anatomical structure of the prostate, and is also recognized as clinically useful in that it is consistent with differences in the sites of the major diseases that occur in the prostate. The inferior oblique ganglion passes through the entire prostatic sphincter just beneath the lateral and posterior sides and normally occupies 5% to 10% of the tissue of the prostate gland. The fibrous band separates the transition zone from the surrounding glandular tissue, and this muscle band can also be observed using TRUS. Benign prostatic hyperplasia occurs most often in the transitional zone, and 20% of prostate cancers occur at this site.

Zonal classification of the prostate and prostatic calculi. AFS: anterior fibromuscular stroma, TZ: transitional zone, CZ: central zone, PZ: peripheral zone.

The tube system of the central zone occurs around the ejaculatory duct of the prostate and accounts for 25% of the tissue of the gland; 1% to 5% of prostate cancer cases occur at this site. The peripheral zone accounts for almost 70% of the tissue of the prostate gland in the posterior and lateral regions. Seventy percent of cases of prostate cancer occur in this area, and it is also the site where chronic prostatitis occurs. Fibromuscular stroma predominates in up to 33% of prostates, and invasion of this tissue by cancer is rare. Prostatic fluid is discharged through the tube system to the urethra. The prostate tube system is an independent functional unit of the prostate, and the secreted fluid is discharged to the urethra through the respective draining tube. The tube system is arranged concentrically around the urethra, and when viewed from the urethral opening, appears to extend like tree branches. The human prostate has more than 30 tubular structures and is open to the prostate urethra. Prostatic calculi can occur all over the prostate in the case of multiple prostatic calculi. However, benign prostatic hyperplasia is often caused by blockage of the glandular tissue around the capsules of hypertrophic prostate adenomas due to the presence of benign prostatic hyperplasia in the transition zone [4]. Therefore, in patients with benign prostatic hyperplasia, the resection margin or extent of transurethral resection of the prostate (TURP) may be restricted to the site where the prostate calculi are visible ().

STONE FORMATION AND COMPOSITION OF PROSTATIC CALCULI

Prostatic calculi can be divided into primary/endogenous stones (occurring within the acini of the prostate) () or secondary/extrinsic (caused by reflux of urine into the prostate) () [5]. However, the term ‘prostatic calculus,’ strictly speaking, means only a primary/endogenous prostatic calculus. Klimas et al [1] suggested that prostatic secretions, corpora amylacea, or inflammation of the prostate can block the secretory tube, leading to thickening () and calcification of the stones. Stones exist in the form of several small stones, ranging from 0.5 to 5.0 mm in size. Stones are a pathophysiologic phenomenon occurring during the aging process, mainly after age 50 years. Moore [6] and Kirby et al [7], as part of their proposed hypothesis regarding extrinsic stones, concluded that prostatic hypertrophy causes chronic prostate inflammation, which affects the formation of calculi.

(A) Primary/endogenous prostatic calculi. (B) Secondary/exogenous prostatic calculi. Arrows indicate prostatic calculi.

The solidified dark secretion of the prostate can be seen during holmium laser enucleation of the prostate (arrow).

Endogenous prostatic calculi are mainly found in the head (front) part of the posterior lobe and in the large tube and acini of the lateral lobe of the prostate. The calculi in the acini are fine, whereas those inside the tube are large and easily visible. Because extrinsic prostatic calculi are mainly caused by urinary reflux into the prostate, they are fewer in number than endogenous prostate calculi, but are often larger. The age of onset of extrinsic prostatic calculi varies, and they are often secondary to neurogenic bladder or chronic urinary tract infection rather than age. In severe cases, prostate enlargement has been reported to cause urethral closure [8]. However, despite this hypothesis, the precise mechanism of development of prostatic calculi is still unclear.

There are few studies and therefore insufficient data on the components of prostatic calculi. Recently, studies analyzing the components of prostatic calculi were published by Sfanos et al [9] and Dessombz et al [10]. Sfanos et al [9] showed that calcium phosphate accounted for 82.6% (19 of 23) of prostatic calculi. Calcium carbonate phosphate accounted for 8.7% (2 of 23), calcium oxalate monohydrate accounted for 4.4% (1 of 23), and calcium phosphate and calcium oxalate monohydrate-mixed calculi accounted for 4.4% (). Dessombz et al [10] reported that a combination of calcium phosphate, calcium phosphate, and calcium carbonate phosphate was the most abundant composition found in 23 prostatic calculi.

Table 1

The main composition of prostatic calculi

Deposition	Prostatic calculi		Corpora amylacea
	No. of sample	Percent	No. of sample	Percent
Calcium phosphate (hydroxyapatite)	19/23	82.6	1/4	25.0
Calcium phosphate (hydroxyapatite) Co-deposited with calcium oxalate monohydrate (granular whewellite)	1/23	4.4	1/4	25. 0
Calcium carbonate phosphate (carbonate apatite)	2/23	8.7	0/4	0
Calcium oxalate monohydrate (whewellite)	1/23	4.4	0/4	0

PREVALENCE AND SYMPTOMS OF PROSTATIC CALCULI

Prostatic calculi are a very common finding, but it is difficult to know the exact frequency of this finding, and the prevalence varies across reports () [11,12,13,14,15,16]. Harada et al [17] reported that calculi were observed in 68. 8% of patients with benign prostatic hyperplasia, and Kim et al [18] reported that calculi were observed in 70% of elderly patients with benign prostatic hyperplasia. Lee et al [19] reported that calculi were observed in 40.7% of patients when an ultrasonographic examination was performed, regardless of age. Shoskes et al [15] reported that 46.8% of patients with chronic pelvic pain had prostatic calculi, excluding calculi less than 3 mm in diameter, and Geramoutsos et al [16] reported a prevalence of 7.4%. Therefore, the prevalence of prostatic calculi in patients with benign prostatic hyperplasia or prostatitis is greater than in those with a normal prostate.

Table 2

The prevalence and location of prostatic calculi

Reference	Prevalence	Location or type of stone
Dell’Atti et al (2016) [11]	25. 3% (168 of 664 patients) undergoing TRUS and prostate biopsy	50.6% in TZ, 20.2% in CZ, and 29.2% in PZ
Park and Choo (2017) [12]	76.6% (464 of 606) at a HPC
Hong et al (2012) [13]	41.5% (199 of 479), with 36.1% (97 of 268) at a HPC and 48.3% (102 of 211) at a urology outpatient department	66.3% (132 of 199) in CZ and 33.7% (67 of 199) in PZ
Kim et al (2011) [14]	51.1% (799 of 1,563) at a HPC	Small calculi (type A) in 39. 4% (615 of 1,563) and large calculi (type B) in 11.8% (184 of 1,563)
Shoskes et al (2007) [15]	46.8% (22 of 47 patients) with CPPS
Geramoutsos et al (2004) [16]	7.4% (101 of 1,374) in young adults	Type A in 71.3% and type B in 28.7%

Prostatic calculi associated with simple benign prostatic hyperplasia are often asymptomatic. Prostatic calculi associated with chronic prostatitis may be closely related to lower urinary tract symptoms. Leader and Queen [20] pointed out that small prostatic calculi are clinically meaningless and occur physiologically in the process of aging. Søndergaard et al [21] also reported that prostatic calculi are part of the normal aging process and have little clinical significance. In that report, prostatic calculi were not described as causing clinical symptoms, and, even if they did, the authors suggested that prostatic calculi can be thought of as a symptom of underlying disease, such as benign prostatic hyperplasia. However, chronic prostate inflammatory conditions other than simple benign prostatic hyperplasia may be the source of persistent inflammation in patients with pelvic pain. In such patients, prostatic calculi not only serve as a site for infectious bacteria to colonize, but also promote the closure of the secretory tubes of the prostate, which may cause resistance to antibiotics and other medications. These conclusions are supported by the findings of Shoskes et al [15] that prostatic calculi in patients with chronic pelvic pain syndrome were associated with inflammation, bacterial colonization, and symptom duration. Geramoutsos et al [16] reported that small prostatic calculi were normal as subjects grow older, but that larger calculi were associated with chronic prostate inflammation and lower urinary tract symptoms. Geramoutsos et al [16] classified calculi into a group around the center/ urethra and a group at the periphery of the urethra. Kim et al [18] did not observe any differences in the storage and urination symptoms of the International Prostate Symptom Score according to the type and location of prostatic calculi and the presence of lower urinary tract symptoms. However, Cha et al [22] reported that when prostate calculi were present in the periurethral prostate transit zone, they may have caused lower urinary tract symptoms to worsen, and a case of urinary retention due to a massive prostatic calculus has also been reported.

DIAGNOSIS AND TREATMENT OF PROSTATIC CALCULI

Prostatic calculi are mainly found using TRUS () in the process of diagnosing lower urinary tract symptoms. Harada et al [17] divided patients into 2 groups according to the echo patterns of prostatic calculi: (1) type A: discrete, multiple small echoes, usually diffusely distributed throughout the gland and (2) type B: a large mass of multiple, coarser echoes. In addition to TRUS, a computed tomography (CT) scan () or a kidney, ureter, and bladder x-ray may find prostatic calculi incidentally, but in most cases, finding prostate calculi is not the goal; thus, even if they are diagnosed, they are mostly clinically meaningless. and are TRUS and CT images, respectively, of the same patient.

Transrectal ultrasonography. (A) Transverse view. (B) Sagittal view. Arrows indicate prostatic calculi.

Pelvic computed tomography. Arrows indicate prostatic calculi.

Prostatic calculi are mostly asymptomatic, but in some cases, a large prostatic calculus protruding into the urethra causes severe lower urinary tract symptoms such as urinary obstruction. In such cases, the prostatic calculi can be removed with a transurethral endoscope. Prostatic calculi associated with benign prostatic hyperplasia tend to occur in adjacent areas of the glomeruli, as the compressed prostate ducts surrounding the glandular mass are occluded. Prostatic calculi observed on the border of enlarged prostate tissue during TURP also act as a boundary for prostate capsules during TURP, and can be easily removed by endoscopic resection. In a study of 183 patients with benign prostatic hyperplasia who underwent TURP, Jeon et al [23] reported that the group with prostatic calculi showed a greater improvement in lower urinary tract symptoms after TURP than the group without prostatic calculi. For calculi around the urethra (between the periurethral prostatic gland and the urethra) and around the adenoma (between the adenoma and the prostate tissue), it was shown that the greater the number of prostate calculi removed, the more significant was the change in lower urinary tract symptoms. However, calculi were not associated with any difference in patients with diffuse scattering in the central or peripheral region. Multiple calculi in the peripheral zone can be difficult to remove entirely with these surgical treatments.

Prostatic calculi, which are usually symptomless, generally require no special treatment. However, the most problematic cases of prostatic calculi are associated with chronic prostate inflammation. In this case, treatment with antibiotics combined with the treatment of prostatitis may cause the symptoms to disappear. However, because prostate calculi contaminated with bacteria are a source of persistent inflammation, the thorough elimination of prostate calculi is the preferred treatment method for chronic bacterial prostate inflammation. Lee and Kim [24] analyzed the efficacy of oral antibiotics in 64 patients with chronic bacterial prostatitis and reported that the healing rate using pharmacotherapy was 63.6% in patients without calculi and 35.7% in those with calculi; they emphasized the usefulness of TURP for the treatment of chronic bacterial prostate inflammation rather than relying on medical treatment.

CONCLUSIONS

As the use of TRUS in patients with benign prostatic hyperplasia is increasing, prostatic calculi are more commonly found. However, little is known about the incidence of calculi in the prostate, their mechanism of formation, their associations with benign or malignant prostate findings, and the clinical significance of the calculi.

The results of the present study suggest that prostatic calculi may be caused by the obstruction of prostate secretions around enlarged tissues or occlusion by chronic inflammation via benign prostatic hyperplasia. The incidence of prostatic calculi has been reported to vary widely (from 7% to 70%) across reports. Prostatic calculi are rarely accompanied by symptoms; hence, they are often found incidentally during the diagnosis of benign prostatic hyperplasia using transurethral ultrasonography. However, prostatic calculi associated with chronic prostate inflammation may be accompanied by chronic pelvic pain and, in the case of extrinsic prostatic calculi, have been reported to cause voiding dysfunction due to their large size in some rare cases. More than 80% of prostatic calculi are composed of calcium phosphate. Prostatic calculi can be easily diagnosed using TRUS and CT. Treatment is not usually necessary, but prostatic calculi can be easily removed with a transurethral electroresection loop or holmium laser if they cause difficulty in urination or chronic pain.

Footnotes

Disclosure: The author has no potential conflicts of interest to disclose.

Contributed by

Author Contribution: Research conception & design: Hyun JS. Data acquisition: Hyun JS. Data analysis and interpretation: Hyun JS. Drafting of the manuscript: Hyun JS. Critical revision of the manuscript: Hyun JS. Approval of final manuscript: Hyun JS.

References

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How Dangerous Is Having an Enlarged Prostate?

About half of men older than 50 have an enlarged prostate. Here are some of the basic facts you need to know about this common condition.

As men age, many experience prostate gland enlargement. This condition is known as benign prostatic hyperplasia (BPH).

The prostate gland surrounds the urethra, the hollow tube that carries urine out of the body. When the prostate gets bigger, it can squeeze or partially block the urethra, which leads to problems urinating.

BPH is quite common in older men. In fact, the condition impacts about 50% of men between the ages of 51 and 60. For men 80 and older, the prevalence of BPH is approximately 90%, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

While BPH can have serious complications, it is not a cancer and is generally linked to a man’s aging process. Although the causes of BPH are not entirely understood, some researchers have investigated whether hormonal changes and cell growth as men age could be related to the development of the condition. If left untreated, BPH can lead to bladder, urinary tract or kidney problems.

Signs and symptoms

Although many men with BPH have no symptoms, others show signs, known as lower urinary tract symptoms. They can range from mild and barely noticeable to serious, but the amount of prostate enlargement is not directly related to the severity of the symptoms.

“Men usually see a urologist because they’re annoyed that they have to wake up, or their partner will encourage them to come see the urologist, because they’re getting woken up in the middle of the night, when he goes to urinate,” explains Leo R. Doumanian, MD, associate professor of clinical urology at the Keck School of Medicine, who also practices at USC Urology of Keck Medicine of USC. “Or, he’ll be at his desk job and realize he’s got to go every 15 or 20 minutes to the bathroom.

“It’s a quality of life parameter, and that’s what usually brings the patient here. As you age, you have more susceptibility to an enlarged prostate, and then you seek treatment options, if indeed it affects your quality of life enough.”

Some symptoms may get worse because of cold weather or as a result of physical or emotional stress. Some over-the-counter medicines also can make BPH worse, such as diphenhydramine (e.g., Benadryl), pseudoephedrine (e.g., Sudafed) and oxymetazoline spray (e.g., Afrin). A number of prescription medications also can negatively impact BPH, such as antidepressants, water pills, testosterone and pain medicine.

Some of the most common symptoms of BPH are:

• Difficulty starting a urine stream (hesitancy and straining)
• Decreased strength of the urine stream, also known as weak flow
• Dribbling after urination
• Feeling that the bladder is not completely empty
• Having the urge to urinate again, soon after finishing
• Feeling pain during urination
• Waking at night to urinate
• Frequent urination
• A sudden, uncontrollable urge to urinate

A person experiencing symptoms of BPH should contact his doctor immediately, if:

• He is completely unable to urinate.
• Urination is painful, and he has a fever of more than 100.4 degrees Fahrenheit (38 degrees Celsius), chills or body aches.
• He feels pain in his lower back, just below the rib cage, that is not related to an injury or physical effort.
• There is blood or pus in his urine or semen.

Diagnosis

A physician can diagnose BPH, by asking questions about the symptoms and by doing a physical exam. A urine test and a digital rectal exam also may be necessary.

In some cases, a prostate-specific antigen test is done to help rule out prostate cancer. Although prostate cancer and BPH are not related, they can have some of the same symptoms.

If symptoms are mild to moderate and aren’t too bothersome, home treatment may be all that is needed to keep them under control. A doctor may need to be consulted regularly to check on symptoms and make sure other related problems haven’t come up.

Treatments

Because BPH cannot be cured, the treatment focuses on reducing the symptoms. The treatment is based on how severe the symptoms are, how much they bother the patient and whether there are complications. The more irritating the symptoms are, the more aggressive treatment should be.

Complications, such as ongoing inability to urinate, urinary tract infections, bladder stones, kidney damage or ongoing blood in the urine, should be treated with surgery. Surgery may also be needed, if symptoms have not been helped with other treatments.

by Ramin Zahed

If you have issues related to an enlarged prostate, make an appointment with one of the urology specialists at Keck Medicine. If you are in the Los Angeles area, schedule an appointment, by calling (800) USC-CARE (800-872-2273) or by visiting urology.keckmedicine.org/patient-information/request-an-appointment.

Enlarged prostate: MedlinePlus Medical Encyclopedia

The treatment you choose will be based on how bad your symptoms are and how much they bother you. Your provider will also take into account other medical problems you may have.

Treatment options include “watchful waiting,” lifestyle changes, medicines, or surgery.

If you are over 60, you are more likely to have symptoms. But many men with an enlarged prostate have only minor symptoms. Self-care steps are often enough to make you feel better.

If you have BPH, you should have a yearly exam to monitor your symptoms and see if you need changes in treatment.

SELF-CARE

For mild symptoms:

• Urinate when you first get the urge. Also, go to the bathroom on a timed schedule, even if you don’t feel a need to urinate.
• Avoid alcohol and caffeine, especially after dinner.
• DO NOT drink a lot of fluid all at once. Spread out fluids during the day. Avoid drinking fluids within 2 hours of bedtime.
• Try NOT to take over-the-counter cold and sinus medicines that contain decongestants or antihistamines. These drugs can increase BPH symptoms.
• Keep warm and exercise regularly. Cold weather and lack of physical activity may worsen symptoms.
• Reduce stress. Nervousness and tension can lead to more frequent urination.

MEDICINES

Alpha-1 blockers are a class of drugs that are also used to treat high blood pressure. These medicines relax the muscles of the bladder neck and prostate. This allows easier urination. Most people who take alpha-1 blockers notice improvement in their symptoms, usually within 3 to 7 days after starting the medicine.

Finasteride and dutasteride lower levels of hormones produced by the prostate. These drugs also reduce the size of the gland, increase urine flow rate, and decrease symptoms of BPH. You may need to take these medicines for 3 to 6 months before you notice symptoms getting better. Possible side effects include decreased sex drive and impotence.

Antibiotics may be prescribed to treat chronic prostatitis (inflammation of the prostate), which may occur with BPH. BPH symptoms improve in some men after a course of antibiotics.

Watch out for drugs that may make your symptoms worse:

SAW PALMETTO

Many herbs have been tried for treating an enlarged prostate. Many men use saw palmetto to ease symptoms. Some studies have shown that it may help with symptoms, but results are mixed, and more research is needed. If you use saw palmetto and think it works, ask your doctor if you should still take it.

SURGERY

Prostate surgery may be recommended if you have:

The choice of which surgical procedure is recommended is most often based on the severity of your symptoms and the size and shape of your prostate gland. Most men who have prostate surgery have improvement in urine flow rates and symptoms.

Transurethral resection of the prostate (TURP): This is the most common and most proven surgical treatment for BPH. TURP is performed by inserting a scope through the penis and removing the prostate piece by piece.

Simple prostatectomy: It is a procedure to remove the inside part of the prostate gland. It is done through a surgical cut in your lower belly. This treatment is most often done on men who have very large prostate glands.

Other less-invasive procedures use heat or a laser to destroy prostate tissue. Another less-invasive procedure works by “tacking” the prostate open without removing or destroying tissues. None have been proven to be better than TURP. People who receive these procedures are more likely to need surgery again after 5 or 10 years. However, these procedures may be a choice for:

• Younger men (many of the less-invasive procedures carry a lower risk for impotence and incontinence than TURP, although the risk with TURP is not very high)
• Older people
• People with severe medical conditions, including uncontrolled diabetes, cirrhosis, alcoholism, psychosis, and serious lung, kidney, or heart disease
• Men who are taking blood-thinning drugs
• Men who are otherwise at an increased surgical risk

What Is It & What Causes It?

You can do a lot to take care of yourself and give your body what it needs. Still, as you get older, your body changes in ways you can’t always control. For most men, one of those changes is that the prostate gets bigger.

It’s a natural part of aging, but at some point, it can lead to a condition called BPH, or benign prostatic hyperplasia.

Your prostate surrounds part of your urethra, the tube that carries urine and semen out of your penis. When you have BPH, your prostate is larger than usual, which squeezes the urethra. This can cause your pee stream to be weak, waking you up a lot at night to go to the bathroom along. it also could lead to other bothersome urinary symptoms. 

BPH isn’t prostate cancer and doesn’t make you more likely to get it.

It’s a common condition, especially in older men, and there are a lot of treatments for it, from lifestyle changes to medication to surgery. Your doctor can help you choose the best care based on your age, health, and how the condition affects you.

What Causes BPH?

Doctors aren’t sure exactly what makes this happen. Some think it may have to do with normal hormonal changes as you age, but it’s not clear.

Early in puberty, your prostate actually doubles in size. Later in life, around age 25, it starts to grow again. For most men, this growth happens for the rest of their lives. For some, it causes BPH.

Symptoms

As the prostate gets larger, it starts to pinch the urethra. This causes symptoms that affect your urine flow, such as:

• Dribbling when you finish
• A hard time getting started
• A weak stream, or you pee in stops and starts

When your urethra is squeezed, it also means your bladder has to work harder to push urine out. Over time, the bladder muscles get weak, which makes it harder for it to empty. This can lead to:

• Feeling like you still have to pee even after you just went
• Having to go too often — eight or more times a day
• Incontinence (when you don’t have control over when you pee)
• An urgent need to pee, all of a sudden
• You wake up several times a night to pee

• Urinary tract infections, bleeding, bladder damage, and bladder stones

It rarely leads to other conditions, but it can, and a couple of them are serious. For example, BPH can lead to kidney damage or, worst-case, cause a problem where you can’t pee at all.

A larger prostate doesn’t mean you’ll have more or worse symptoms. It’s different for each person. In fact, some men with very large prostates have few, if any, issues.

Diagnosis and Tests

Your doctor will first talk to you about your personal and family medical history. You might also fill out a survey, answering questions about your symptoms and how they affect you daily.

Next, your doctor will do a physical exam. This may include a digital rectal exam. During this, they put on a glove and gently insert one finger into your rectum to check the size and shape of your prostate.

Basic tests: Your doctor may start with one or more of these:

• Blood tests to check for kidney problems
• Urine tests to look for infection or other problems that could be causing your symptoms
• PSA (prostate-specific antigen) blood test. High PSA levels may be a sign of a larger-than-usual prostate. A doctor can also order it as screening for prostate cancer.

Advanced tests: Based on the results of those tests, your doctor may order additional tests to rule out other problems or to see more clearly what’s happening. These might include:

• Different types of ultrasound to measure your prostate and see if it looks healthy.
• A bladder ultrasound to see how well you empty your bladder.
• Biopsy to rule out cancer.
• Urine flow test to measure how strong your stream is and how much pee you make. 
• Urodynamics testing to evaluate your bladder function.
• Cystourethroscopy is a procedure using a  camera to examine the inside of the prostate, urethra and bladder. 

Treatments

How your doctor handles your case varies based on your age, health, the size of your prostate, and how BPH affects you. If your symptoms don’t bother you too much, you can put off treatment and see how it goes.

Lifestyle changes: You may want to start with things you can control. For example, you can:

• Do exercises to strengthen your pelvic floor muscles
• Lower the amount of fluids you drink, especially before you go out or go to bed
• Drink less caffeine and alcohol

Medicine: For mild to moderate BPH, your doctor might suggest medicine. Some medications work by relaxing the muscles in your prostate and bladder. Others help shrink your prostate. For some men, it takes a mix of medicines to get the best results.

Procedures: If lifestyle changes and medications don’t work, your doctor has a number of ways to remove part or all of your prostate. Many of these are called “minimally invasive,” meaning they’re easier on you than regular surgery. They use probes or scopes and don’t require large cuts in your body.

Examples are TUMT, TUNA, Rezūm, and laser therapy to remove part of your prostate gland.

• Transurethral resection of the prostate, or TURP, in which the doctor uses a scope and cuts out pieces of the gland with a wire loop

• Transurethral incision of the prostate or TUIP, in which a few small cuts are made in the prostate to reduce the gland’s pressure on the urethra.

UroLift system is a permanently placed device used to lift and hold the enlarged prostate tissue out of the way, so it no longer blocks the urethra which use a varied form of energy to destroy part of the prostate.

In some cases, your doctor may also suggest a traditional, open surgery or a robotic procedure to remove your prostate.

Any Complications?

With any BPH surgery, there may be side effects or complications such as bleeding, narrowing of the urine tube also known as urethral stricture, urinary incontinence or leakage, erectile dysfunction, and retrograde ejaculation.

BPH doesn’t lead to prostate cancer or make you more likely to get it.

Prostate Gland : anatomy, size, weight and diseases

Anatomy of the prostate

The prostate is a small gland in the male reproductive system. It is situated in front of the rectum, below the bladder, and surrounds the urethra, which is the tube through which urine flows out of the body. The main function of the chestnut-sized prostate is to secrete part of the seminal fluid that combines with sperm to form semen.

What is the normal weight of the prostate ?

A healthy adult prostate weighs around 20 to 25 grams

What is the normal size of the prostate ?

A health adult prostate is approximately 4cm wide, 3cm high and 2cm thick.

Prostate scheme

1. Penis
2. Urethra
3. Testis
4. Scrotum
5. Bladder
6. Seminal vesicle
7. Prostate gland
8. Anus
9. Rectum

Diseases of the prostate

Prostatitis

The term prostatitis – or prostate infection – refers to a swelling of the prostate that usually occurs after the age of 40. The disease causes urinary symptoms (frequent urge to urinate, burning sensation, intermittent urination, etc.), and may also cause lower abdominal pain and fever. Prostatitis is treated with antibiotics.

Adenoma

The constituent tissue of the prostate may become hypertrophied (i.e. abnormally over-developed) with age. This phenomenon is known as prostate adenoma or benign prostate hyperplasia (BPH). This is a benign disease, not cancer, but it often goes undiagnosed until it causes discomfort and/or painful urination. Prostatic adenoma causes urinary disorders because it develops around the urethra, which is the tube through which urine flows from the bladder to the exterior. The symptoms are the result of the adenoma compressing the urethra.

Prostate cancer

The human body is made up of cells that divide and reproduce throughout our lives. Sometimes, new cells may contain a defect. Cancer occurs when these cells in turn reproduce, creating more and more abnormal malignant cells. Prostate cancer is the fourth most common cancer in both sexes combined and the second most cancer in men, with 1.1 million new cases diagnosed in 2012 around the world (1 111 689 cases identified in 2012 according to the World Cancer Report 2014*). However, because prostate cancer is a slow-developing disease that tends to affect older men, fatality rates directly attributable to the disease are reasonably low. With an estimated 307,000 deaths in 2012**, prostate cancer is the fifth leading cause of death from cancer in men (6.6% of the total men deaths).

*: ©International Agency for Research on Cancer, 2014  – World Cancer Report

**:©GLOBOCAN 2012 (IARC) , Section of Cancer Surveillance (13/3/2017)

Prostate cancer diagnosis

Prostate cancer often develops without any symptoms and in many cases is diagnosed at an early stage by screening. Cancer may also be diagnosed at a later stage, when the patient reports symptoms such as a frequent urge to urinate, difficulty urinating or painful ejaculations. As these symptoms are the same as for prostatic adenoma, several examinations are necessary in order to reliably diagnose cancer.

Prostate cancer risk factors

• Age
• Hereditary factors
• Ethnic origin
• Fatty diet
• Other factors: sedentary lifestyle, obesity, etc.

HIFU Prostate, your expert in HIFU treatment for the ablation of prostate tissue

What is the best medicine for enlarged prostate? – AnswersToAll

What is the best medicine for enlarged prostate?

What medicines are used to treat an enlarged prostate?

• Alpha-blockers, such as tamsulosin (Flomax) or terazosin (Hytrin), which relax muscle tissue.
• 5-alpha reductase inhibitors, such as dutasteride (Avodart) and finasteride (Proscar), which shrink the prostate.

What is the latest treatment for enlarged prostate?

Water ablation is a new treatment for prostate enlargement. There are 2 types of water ablation procedure. In the first, water is injected into the prostate using a probe passed up the urethra. The pressure of the water is then used to destroy some of the prostate tissue, making it smaller.

What tablets can you take for enlarged prostate?

Names: Your doctor might suggest one of these alpha blockers:

• Alfuzosin (Uroxatral)
• Doxazosin (Cardura)
• Prazosin (Minipress)
• Silodosin (Rapaflo)
• Tamsulosin (Flomax)
• Terazosin (Hytrin)

What are prostatic concretions?

Prostatic concretions or corpora amylacea are found in the glands of older men. Corpora amylacea appear in sections as concentric lamellated bodies that may be partly calcified and are believed to form by precipitation of secretory material around cell fragments.

How can I reduce my enlarged prostate without surgery?

To help control the symptoms of an enlarged prostate, try to:

1. Limit beverages in the evening.
2. Limit caffeine and alcohol.
3. Limit decongestants or antihistamines.
4. Go when you first feel the urge.
5. Schedule bathroom visits.
6. Follow a healthy diet.
7. Stay active.
8. Urinate — and then urinate again a few moments later.

What will a urologist do for enlarged prostate?

With this surgery, a urologist uses a high-energy laser to destroy prostate tissue. The urologist uses a cystoscope to pass a laser fiber through the urethra into the prostate. The laser destroys the enlarged tissue.

What are prostatic concretions made of?

In the prostate gland, where they are also known as prostatic concretions, corpora amylacea are rich in aggregated protein that has many of the features of amyloid, whereas those in the central nervous system are generally smaller and do not contain amyloid.

Are prostate concretions normal?

The fibromuscular stroma between the glands accounts for about half of the volume of the prostate. As a male ages, there are more likely to be small concretions within the glandular lumina, called corpora amylacea, that represent laminated concretions of prostatic secretions.

Is banana good for BPH?

In summary, banana flower extract may be used as a therapeutic agent for BPH via anti-proliferative and anti-inflammatory activities. Benign prostatic hyperplasia (BPH), an enlarged prostate gland, is the most common urological disease affecting about 50% of men aged over 50 years (1-3).

What happens if BPH is left untreated?

First, although it has nothing to do with cancer, untreated BPH has the potential to lead to serious complications, ranging from urinary tract infections and stones in the bladder or kidney to urinary retention and kidney damage.

Can enlarged prostate Be Cured?

Because BPH cannot be cured, the treatment focuses on reducing the symptoms. The treatment is based on how severe the symptoms are, how much they bother the patient and whether there are complications.

What hormone is produced by the prostate gland?

The prostate is responsible for the production of the male hormones dihydrotestosterone (DHT) which happens when testosterone is converted to DHT by the 5-alpha-reductase enzyme in the prostate.

At what size of prostate requires surgery?

The EAU guidelines, based on grade A evidence, recommends TURP for prostates between 35 and 80 ml. Over that limit, open surgery seems to remain the only option for treating BPH, according to available clinical evidence.

What are the signs of a bad prostate?

Symptoms of Prostate Problems

• Frequent urge to urinate.
• Need to get up many times during the night to urinate.
• Blood in urine or semen.
• Pain or burning urination.
• Painful ejaculation.
• Frequent pain or stiffness in lower back, hips, pelvic or rectal area, or upper thighs.
• Dribbling of urine.

Is tamsulosin like Viagra?

Both Flomax (generic name tamsulosin) and Viagra (generic name sildenafil) are medications prescribed to treat symptoms of benign prostatic hyperplasia (BPH), which causes an enlarged prostate. Flomax is an alpha-blocker prescribed to treat difficulty urinating a symptom of BPH.

What is the main cause of prostate enlargement?

The cause of prostate enlargement is unknown, but it’s believed to be linked to hormonal changes as a man gets older. The balance of hormones in your body changes as you get older and this may cause your prostate gland to grow.

What is the best thing to drink for your prostate?

Drink tea. Both green tea and hibiscus tea are among the top drinks for prostate health. Both types of tea contain potent antioxidants. Studies show that green tea can help prevent prostate cancer from forming and may also slow the growth of aggressive prostate cancer.

Calculous prostatitis in men: symptoms, treatment, prevention

Methods for treating calculous prostatitis depend on the size of the stones and whether the infection has joined and there are no other complications. If there is, first eliminate them, and then begin to fight the stones.

Medicines. For inflammation, antibiotics are used to fight bacteria, anti-inflammatory suppositories, and also anti-spasm drugs and pain relievers. They make it easier to urinate and relieve pain.

Calcium-binding drugs are prescribed in order to delay the progression of the disease – excess calcium is excreted, and does not settle on the stones, increasing their size. After a course of medication, the patient’s condition improves and the risk of complications decreases. But the stones, unfortunately, will not disappear anywhere, they are removed by other methods.

Physiotherapy. Physiotherapy is actively used for calculous prostatitis: magnet, electrophoresis, ultrasound and others. It is usually effective for small stones, but sometimes it does not work and surgical treatment is required.

Prostate massage, which is often done in case of other types of prostatitis, is prohibited in case of calculous prostatitis. Pressure on stones in the prostate gland can damage the prostate, causing swelling and pain.

Surgical intervention. Without surgery, stationary stones can be removed using ultrasound, magnetic waves and laser. The first methods do not damage the tissues in any way, and the last procedure is carried out by inserting the sensor through the urethra. The laser is used less frequently because it crushes stones into sharp fragments that can injure narrow tubules.

Sometimes the stones are mobile and medium-sized – then they are “pushed” into the bladder and dissolved with the help of lithotripsy – the stones are crushed, large fragments are removed with a special device, and the fine sand comes out on its own.

If complications and inflammation occur, the abscess is opened and the stones are removed along with the pus. Large immobile stones cannot always be removed – and then the prostate gland is removed completely together with them. This is extremely rare.

Diet. During treatment, a gentle diet is always prescribed so that problems with stool and gas formation do not worsen the condition. To maintain immunity, they eat a lot of vegetables and fruits, take vitamins.

I was diagnosed with calculous prostatitis

Material Information

Category: Ask the doctor

Published: 08 May 2019

Views: 8 360 90 033

Hello Doctor.I was diagnosed with calculous prostatitis. Stones up to 5mm in the prostate tissue itself. As I studied the Internet, I read that in your clinic, stones are removed with a laser, and by a non-contact and non-invasive method. Does such a technique really exist? If not, how can they be safely removed (conservatively or surgically)?

Very grateful in advance for your reply.

Best regards, Stanislav

Hello, Stanislav. The senior researcher of the Institute of Urology and Human Reproductive Health of the Sechenov University, Ph.M.Sc. Dmitry Korolev.

Calculous prostatitis is an inflammation of the prostate gland, complicated by the formation of stones in the prostate or compaction (calcification) of certain areas of its tissue. Calculous prostatitis is a consequence of long-term chronic prostatitis. Chronic prostatitis is characterized by a sluggish course of inflammation in the prostate and is periodically exacerbated throughout the year.

The predisposing factors for it are physical inactivity, stagnation of venous blood in the small pelvis and chronic infection.Against the background of chronic inflammation, stagnation of secretions occurs in the prostate, which over time crystallizes with the formation of calculi. Symptoms of calculous prostatitis are identical to chronic sluggish prostatitis: impaired urination (weakening of the urine stream, pain during urination), pain (most often in the perineum) and impaired erectile function. Prostate calculi are most often diagnosed accidentally by ultrasound. The sizes of calculi can be from a few mm to a few cm.Answering your question about laser prostate stone removal is a myth. The laser removes only stones located in the lumen of the urinary tract (bladder, ureters, calyx-pelvic system). Prostate stones are localized in the tissue of the prostate gland, outside the lumen of the urinary tract and their removal is possible only by incision (endoscopic or open) of the prostate tissue. Removal of prostate stones is performed if the patient has a prostate adenoma requiring surgical treatment – removal of the adenoma.In these cases, in parallel with the removal of the prostate adenoma, the removal of prostate stones is performed. In all other cases, treatment of calculous prostatitis is performed by conservative methods: anti-inflammatory, antibacterial, analgesic, improving microcirculation and immunomodulatory drugs are prescribed. Physiotherapy is also helpful. But it must be remembered that prostate massage is strictly contraindicated for patients with calculous prostatitis.

The specialists of our clinic have extensive experience in treating patients with chronic calculous prostatitis. You can sign up for a consultation either to me or to the head of the department prof. Enikeev Mikhail Elikovich. The official visiting day is Friday from 9 am to 14. I also advise on Sundays from 1 pm to 2 pm. On the rest of the weekdays we operate, so long waiting times are possible. It is also possible to make an appointment with the doctors of our diagnostic and treatment department Inoyatov Zh.S., Snurnitsina O.V. and Taratkin M.S. They will answer all your questions and carry out initial diagnostics, and then they will transfer the data for decision-making to us. Phone +7 (495) 2013995 or online at urologypro.ru. Call on weekdays during business hours. Good luck to you.

90,000 Causes of calculous prostatitis and methods of treatment

Calculous prostatitis is a chronic form of the inflammatory process that occurs in the prostate. The disease is accompanied by the formation of calculi of the excretory ducts of the gland.

Prostatitis affects more and more men every year. This is due to a tendency to lead a sedentary lifestyle, promiscuous sex, mutation of viruses with a decrease in their sensitivity to antibacterial agents. Chronic calculous prostatitis is the most common form of the disease. Acute inflammation is often complicated by the formation of stones and can lead to prostate adenoma and early extinction of sexual function.

Chronic calculous prostatitis

Chronic prostatitis – calculous form can be both secondary and primary.Initially, stones are formed in the ducts of the gland, secondarily – they enter the prostate from the kidneys, urethra and bladder. The disease often develops in the presence of urolithiasis.

Main predisposing factors:

• benign prostatic hyperplasia;
• sedentary lifestyle;
• genitourinary infections that lead to obstruction of the ducts of the prostate and thickening of its secretion;
• stagnant processes in the pelvic organs;
• urethro-prostatic reflux, which is accompanied by the throwing of a small amount of urine during urination from the urethra into the ducts of the prostate.

The main reason for the development of chronic calculous prostatitis is urethral stricture. Against its background, urine is thrown into the ducts of the prostate gland. The subsequent crystallization leads to the formation of stones.

Clinical manifestations of the disease are most noticeable with exacerbation of a chronic inflammatory process. The leading symptom is pain syndrome. Pain in calculous prostatitis is dull and aching, localized mainly in the pubis and perineum, may appear in the lower back.Increased pain syndrome is often associated with intimate contacts, increased physical activity, urination and defecation. Prolonged walking also causes pain.

Often, experts find calculi of the prostate gland quite by accident during a comprehensive examination. But in severe cases, the disease can lead to acute urinary retention, abscess, hematuria, decreased sex drive and impotence.

Chronic calculous prostatitis treatment

With proper treatment, the risk of exacerbation of prostatitis is minimal.Beware of infection with sexually transmitted infections, do not overcool, avoid increased physical exertion and stress. For reliable prophylaxis, it is recommended, after the extinction of an acute inflammatory reaction, to take special probiotics that can increase the number of beneficial microorganisms that live on the mucous membrane of the urethra. This will increase resistance to pathogens and negate the risk of exacerbation of prostatitis.

Cost of services for the treatment of calculous prostatitis

The cost of treating calculous prostatitis depends on the severity of clinical manifestations, the duration of the course of the disease and many other factors.The price includes an examination, which allows you to correctly diagnose and select treatment methods.

In our clinic, the treatment of chronic calculous prostatitis is performed by qualified urologists who have at their disposal all the necessary diagnostic and therapeutic techniques.

See also:

90,000 Urolithiasis symptoms, kidney stones symptoms, ureteral stones symptoms

Symptoms of urolithiasis

The most common symptom of urolithiasis is pain. The nature and intensity of pain depends on the location of the stone and the degree of impairment of the outflow of urine through the urinary tract. The pain syndrome can be different in intensity, ranging from aching pains, discomfort in the lumbar region, ending with very pronounced pain. Such severe pain is called renal colic, often renal colic is accompanied by restless behavior, nausea, vomiting, and frequent urination.

Also symptoms of urolithiasis are changes in urine , both visible (admixture of blood, “sand”, stones) and found in laboratory research (admixture of erythrocytes, leukocytes, salt crystals, low urine pH).

Kidney stones symptoms

With kidney stones, symptoms may be as follows: discomfort in the lumbar region, aching, pulling pains in the lumbar region, urine analysis may reveal erythrocytes, crystals, salts. Often, kidney stones are asymptomatic and are detected during a routine ultrasound or X-ray examination. A pronounced clinical picture develops when the stone moves from the kidney to the ureter (see.rice No. 1)

Ureteral stones Symptoms

The most characteristic symptom of a ureteral stone is pain. Renal colic develops, which is characterized by very intense pain syndrome, anxiety. The patient is worried about pain in the side, lumbar region, which radiate down into the perineum, genitals (see Fig. No. 2), there may be nausea, vomiting. If the stone is located in the lower third of the ureter, a symptom such as frequent urination develops.

The mechanism of development of renal colic is as follows: a stone, passing through the ureter, causes its spasm, which causes intense, sharp pain. In addition, the stone prevents the outflow of urine through the ureter, so the ureter, above the site of obstruction (“blockage”) and pelvis expand. (see fig. No. 3) Increased pressure in the pelvis leads to edema of the renal parenchyma and stretching of its capsule, provoking pain in the lumbar region.

Changes in urine may not be with complete “blockage” of the ureter stone. If the outflow of urine is partially preserved, then such a symptom of a stone in the ureter as an admixture of blood in the urine may be observed.

Bladder stones Symptoms

Bladder stones, as well as kidney stones , may not show symptoms, and are discovered by chance during examination. Symptoms of urinary bladder stones are as follows: discomfort in the womb, increased urge to urinate, a symptom of a jet stream (abrupt cessation of urination, with blockage of the bladder neck with a stone).

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90,000 Urolithiasis – symptoms, signs and treatment at the MEDSI clinic in St. Petersburg

Contents

Urolithiasis is a disease manifested by the formation and presence of stones in the kidneys and other parts of the urinary system (ureters, bladder, less often the urethra).Stones can be single, sometimes several or even many stones are formed – they consist of insoluble salts of different chemical composition (phosphates, urates, oxalates), but in 70% of cases they have a mixed chemical structure. The size of the stones can be different: from 1 mm to more than 10 cm in diameter. In some patients, the stones do not increase in size for a long time, in others, in six months they can fill, for example, the entire renal pelvis. Often, stones are formed again, then there is a relapse of the disease.

Urolithiasis is one of the most common urological diseases, which affects 1 to 3% of the population in various regions of the world. The prevalence of urolithiasis depends on the composition of the water, climatic, ecological, ethnic, dietary and other characteristics of the region and its population. St. Petersburg and the Leningrad Region belong to areas with a moderately high prevalence of urolithiasis. It occurs in children and adults and often manifests itself not only in old age, but also in the most active period of life.In addition to a congenital predisposition, a whole complex of various factors leads to the occurrence of urolithiasis: dietary habits, water composition, harmful working conditions, a sedentary lifestyle, a lack of vitamin A and B vitamins in food, a deficiency of enzymes leading to metabolic disorders, diseases of the parathyroid glands, gastrointestinal tract, the use of certain drugs. Also, stones can form due to violations of the outflow of urine from the kidneys and bladder (developmental anomalies, functional disorders, narrowing of various parts of the ureter, prostate adenoma, urethral stricture), urinary tract infection and the presence of foreign bodies in it (usually suture and others materials remaining after surgical interventions).

Symptoms of urolithiasis

The most characteristic symptom of urolithiasis is renal colic – a sudden onset of severe back pain. A change in body position does not affect the intensity of pain in any way. Often the pain is accompanied by nausea, vomiting, frequent urge to urinate and cramps. This acute condition is caused by a violation of the outflow of urine through the urinary tract and can occur after intense physical activity or the intake of a large amount of fluid, when the stone begins to move, falls into the narrow places of the urinary tract (the neck of the renal calyx, the pelvic-ureteric segment, the ureter and its narrowing in the zone iliac vessels and exit to the bladder).When the stone is in the lower parts of the ureter, pain occurs not only in the lumbar region, but also in the lower abdomen, radiating to the groin and external genitals. If the size of the stone does not exceed 5-6 mm (the diameter of the ureter), then, as a rule, it leaves itself along with the urine. If the stone is large and is in the urinary tract for a long time, without shifting and disrupting the outflow of urine, then the intervention of a specialist urologist is necessary. Otherwise, atrophic (hydronephrosis) and inflammatory (abscess, carbuncle) processes may occur in the kidney, which can lead to the loss of its functions, the development of a life-threatening septic condition, and even the need to remove the kidney.

Diagnostics

The diagnosis of urolithiasis is established on the basis of characteristic symptoms, as well as with the help of:

• Imaging – X-ray, Ultrasound, CT, MRI
• Instrumental – urethrocystoscopy, ureteroscopy
• Laboratory research

The MEDSI St. Petersburg clinic has everything you need for an accurate diagnosis: it is necessary to carry out ultrasound examination of the kidneys and urinary tract, all types of necessary X-ray examinations and, if indicated, computed and magnetic resonance imaging.These methods make it possible to accurately establish the localization and size of the stone, the state of the urinary tract (cavity system of the kidney, ureter and bladder, urethra) and outflow of urine, the prospect of independent discharge or the need to remove the stone. Our own laboratory provides the necessary results of blood and urine tests, which allow us to assess the presence and danger of a urinary tract infection to the body, within minutes or hours.

Treatment of urolithiasis at MEDSI St. Petersburg

• Expert consultation – 2 970p
• CT of the urinary system (kidneys, ureters, bladder) – 3 900p
• Internal optical urethrotomy (hospitalization 1 day) – 42 554p
• Endoprosthetics of the urethra (hospitalization 1 day) – 42 554p
• Contact lithotripsy (hospitalization 1 day) – 43 792p
• Percutaneous nephrolithotripsy – crushing and removal of large kidney stones (hospitalization up to 3 days) – 69 554p
• Percutaneous mini-nephrolithotripsy – a minimally invasive method of crushing kidney stones up to 2 cm of any density (hospitalization for 2 days) – 58 214p
• Ureteroscopy and endoureterotomy (hospitalization 1 day) – 54 387p
• Laparoscopic plastic ureter (hospitalization up to 3 days) – 89 714p

* The cost of surgical interventions includes: surgery, anesthesia and hospital stay.

Treatment of urolithiasis

Treatment of urolithiasis at the MEDSI St. Petersburg clinic aims not only to remove the stone from the urinary system, but also to prevent its re-formation. Most stones (up to 70-80%) are up to 0.5 – 1.0 cm in size and move away on their own. This is helped by conservative treatment carried out under the supervision of a physician. In most cases, we recommend a significant increase in fluid intake. Painkillers (analgesics), drugs that relax the smooth muscles of the ureter and bladder (antispasmodics), antibacterial and anti-inflammatory drugs are widely used.

If there is a situation that threatens the kidney (the outflow of urine is impaired, the risk of purulent inflammation) or the stone does not leave on its own for a long time, urgent intervention by a urologist is necessary. To restore the outflow of urine from the kidney, it can be drained with a ureteral catheter-stent, which remains in the urinary system until the stone or its fragments are completely removed and then removed. In some cases, the kidney has to be drained urgently by puncture directly in the lumbar region under ultrasound guidance.

For the destruction of urinary stones up to 1.0 cm in size, the technique of remote shock wave lithotripsy (ESWL) has been widely used for more than 25 years, when stones of the kidneys and ureters are destroyed using focused shock waves generated by a source outside the patient’s body and directed at him using X-ray or ultrasound guidance. Despite the seeming simplicity and ease of the method, many shortcomings have been revealed over the years of its use.The use of ESWL is possible only with relatively small stones, since the passage of a large number of fragments of large stones is often difficult and causes complications. The shock wave effect on the kidney in many patients over time causes the development of hypertension and deterioration of the kidney function. In this regard, in recent years, video endoscopic interventions have become the most preferred methods for removing stones from the urinary system, when directly to the stone through the ureter (ureteroscopy) or by a puncture in the lumbar region (percutaneous nephroscopy) under anesthesia and an optical instrument (ureteroscope or nephroscope) is brought in completely painlessly ), with the help of which the stone is removed entirely or destroyed and its fragments are also removed.These methods remove stones of almost any size from the urinary system, including coral stones, without a high risk for kidney function.

Ureteroscopy operation

In the MEDSI St. Petersburg clinic, along with the provision of all types of emergency care for renal colic, ureteroscopy operations are actively performed – removal and destruction of ureteral and kidney stones using a special instrument – a ureteroscope. A lot of positive experience has been accumulated.In about 15% of cases, when the stones consist only of uric acid salts (urates), with the help of medicines it is possible to dissolve them without surgery. But the treatment of urolithiasis with the removal of the stone does not end, since the conditions for its re-formation remain in the body. In order for this not to happen, the following is necessary:

• Correction of violations of the outflow of urine from the kidneys and bladder, depending on their cause
• Analysis of the mineral composition of the stone in order to determine the optimal diet, drinking regimen and medications for the specific prevention of its re-formation
• Biochemical blood and urine tests, hormonal studies for the study of various specific metabolic disorders in the body and their correction

After receiving the results of these studies, patients are given specific recommendations (program of metaphylaxis of urolithiasis).The doctors of the MEDSI St. Petersburg clinic carefully monitor the patient and control the implementation and effectiveness of the appointments made. Thus, in the MEDSI St. Petersburg clinic there is an opportunity not only to get rid of stones, but also to put urolithiasis under full control!

You can make an appointment online or call +7 (812) 748 38 95.

Benign prostatic hyperplasia (BPH, adenoma)

BPH ( benign prostatic hyperplasia, prostate adenoma) is a benign proliferation of gland tissues, an increase in its volume.The overgrown gland compresses the urethra passing through it, causing urinary disorders – this is the main symptom of the disease.

Benign prostatic hyperplasia is detected in 20% of men 40 years old, 70% – 60 years old, 90% – 80 years old. The main reason for the development of BPH is a change in the hormonal background of a man (a decrease in testosterone levels with age).

Possible complications of BPH

• Joining inflammation
• Stone formation
• Formation of diverticula (protrusions of the bladder wall)
• Acute urinary retention
• Development of renal failure

A study of patients with prostate cancer showed that in 80% of cases, the development of a malignant process occurred against the background of a long-standing benign prostatic hyperplasia.

Diagnosis of BPH

The diagnosis of BPH is established by the urologist on the basis of complaints, history, medical urological examination of the patient and examination results. Accurate information on the frequency of urination and its volume during the day (with indication of time) is important.

Signs of prostatic hyperplasia

• Difficulty urinating, sluggish urine stream
• The need to make an effort to start urinating
• Feeling of incomplete emptying of the bladder, forcing the man to repeatedly return to the toilet
• Frequent, persistent urge to urinate, including at night

Analyzes and studies

General clinical blood and urine tests

Biochemical blood test (urea, creatinine) – exclusion / assessment of renal failure

Determination of the level of prostate-specific antigen (PSA) in the blood (a marker of inflammation and prostate cancer).PSA in benign prostatic hyperplasia is examined regularly. The level and rate of increase in PSA matters.

Prostate biopsy (with elevated PSA) to exclude / confirm prostate cancer

Uroflowmetry (measurement of urine flow rate). Double when detecting deviations.

Ultrasound examination (ultrasound) of the kidneys and urinary system, prostate – transabdominal and transrectal (TRUS), including the study of the volume of residual urine.Allows you to identify / exclude urolithiasis, expansion of the calyx-pelvic apparatus, tumors of the urinary system, diverticula of the bladder, to assess the size, shape of the prostate gland.

Echoes of BPH (detected by ultrasound)

• Increase in prostate volume up to 20 cm and more ³ .
• Inhomogeneous structure of the prostate gland, the presence of seals (scars), stones – calcifications (traces of inflammation), nodules.
• A residual urine volume of more than 50 ml is regarded as pathological.

Plain urography, excretory, retrograde urography – X-ray examination of the urinary system – kidneys, ureters, bladder, urethra, including using X-ray contrast medium. Assessment of the function, structure of the urinary system, the position of the kidneys, etc.

Stages of BPH

BPH 1 – compensation stage – prostate gland 30 cm or more ³ in volume, symptoms from the bladder are absent or minimally expressed.Due to the slight compression of the urethra, the detrusor muscle in the bladder wall is hypertrophied, but completely copes with its emptying.

BPH 2 – stage of subcompensation – the prostate increases, the urethral compression increases, the muscular wall of the bladder ceases to cope with the complete expulsion of urine, its hypertrophy is replaced by hypotrophy, thinning. Incomplete urination -> 80 ml of residual urine remains in the bladder. Difficulty in urine diversion causes its stagnation and expansion of the higher divisions – the ureters, calyxes and renal pelvis.Renal failure gradually develops.

BPH 3 – stage of decompensation – inability to empty the overflowing bladder, since its stretched detrusor muscle is no longer capable of contraction. At the same time, a drip of urine occurs. It is spontaneously squeezed out drop by drop from the bladder into the urethra due to the constant flow from the kidneys. There is a real threat of acute urinary retention – the impossibility of emptying the bladder with an irresistible desire to urinate.This situation requires urgent surgical attention.

BPH Treatment

Conservative

• improvement of urine outflow due to relaxation of the bladder neck, urethra,
• reduction in the size of the gland,
• Improving the condition of the detrusor muscle of the bladder.

Combined pharmacotherapy is used, which is selected individually and adjusted during the course of treatment by the urologist observing the patient.

Surgical

With the ineffectiveness of conservative therapy, the progression of BPH, severe urinary disorders, an increase in the volume of residual urine, the development of complications (stone formation, hematuria – erythrocytes in the urine, renal failure, etc.), an operation is required.

In the Yauza Clinical Hospital, a modern method of surgical treatment of prostate adenoma is practiced – endoscopic laser vaporization , in which the access to the prostate gland is carried out through the urethra, and the excess tissue of the gland is evaporated with a laser.

Acute and chronic prostatitis: signs, symptoms and treatment

Inflammation of the prostate today is the leader in the group of male diseases, predominantly sexually transmitted. Its complications threaten with infertility, decreased libido, impotence.

Symptoms of prostatitis are not just pain, urination disorders, inflammation of the spermatic cord. The most dangerous consequence of advanced inflammation can be a cancerous degeneration of the prostate gland.Whereas a timely diagnosed pathological process is easily stopped.

Causes of inflammation

The risk of developing prostate inflammation increases due to the fault of various factors predisposing to the disease:

• Hypothermia, one-time or associated with the nature of work in the open air.
• A sedentary lifestyle leading to a disruption in the functioning of the digestive system.
• Chronic somatic diseases (diabetes mellitus, hypertension).
• Foci of focal, perifocal infection (rhinitis, tonsillitis, stomatitis, gastritis).
• Persistent UGI (chlamydia, trichomoniasis, herpes virus).
• Stress, insomnia, chronic fatigue syndrome.
• Decreased immunity due to past illness, surgery, emotional stress.
• Bad habits leading to the development of intoxication: alcohol, smoking, strong coffee.
• Occupational injuries to the perineum of car drivers, athletes, workers in hazardous industries.
• Promiscuous sex life, interrupted intercourse, lack of sensuality, intercourse with incomplete ejaculation, prolonged lack of intimacy (low demand for sperm leads to stagnation in the gland).
• Sexually transmitted diseases.

Despite a fairly large number of provocative moments, the essence of prostatitis is the occurrence of stagnation inside the organ against the background of impaired blood circulation and lymph outflow.

Classification

In modern urology, there is no single classification of the disease. However, practicing doctors prefer this variant of the classification of the inflammatory process in the prostate:

1. Due to illness:

• Acute prostatitis. It accounts for more than 50% of cases of the disease in people under 30-35 years old.
• Chronic variant. It is considered a non-aging category.It does not manifest itself for a long time, the impetus for development is a cold, an infection.

• Bacterial inflammation of the prostate gland, prevails in men under 40, occurs against the background of UHI, does not go beyond the boundaries of the organ.
• Non-bacterial pathological changes in the gland, mainly of a chronic course.
• Viral inflammation of the prostate is characterized by an acute course affecting the entire genital area.

• Fibrous prostatitis is characterized by rapid irreversible growth of the gland and requires radical intervention. Clinically similar to prostate adenoma.
• Calculous inflammation of the prostate gland occurs due to the formation of calculi inside the prostate. Considered as a harbinger of cancer.
• Stagnant prostatitis, the result of a sedentary lifestyle, is diagnosed in every second patient.

Signs of illness

If a man discovers at least two of the following symptoms of prostatitis, you should immediately contact a qualified specialist:

• Urinary disorder with intermittent, weak urine stream, unusually short range, splashing, difficulty and pain before urinating. Frequent urge to empty the bladder occurs mainly at night.
• Soreness, which is localized in the lower abdomen, radiates to the scrotum, perineum, rectum.
• Sexual dysfunction.
• Problems with ejaculation, changes in semen (consistency, quantity).

Acute prostatitis

The disease begins with a sharp rise in temperature (up to 40 degrees), excruciating headache, fever. The symptoms that appear are accompanied by pain in the groin, perineum, back, discharge from the urethra, frequent urination and constant urge to urinate.

Emptying of the bladder occurs with a delay, a burning sensation.The urine itself becomes cloudy, and an admixture of blood may appear in it. There is irritability, fatigue.

The outcome of acute prostatitis can be a complete resolution of the process (with timely treatment started). Since changes occur in many organs of the small pelvis, they should not be allowed to take their course, otherwise there will be corresponding complications:

• Vesiculitis – inflammation of the seminal vesicles, the cause of the appearance of pus in the semen, which not only reduces the quality of the ejaculate, but leads to the loss of reproductive function.
• Colliculitis – inflammatory changes in the seminal tubercle are the reason for the development of the strongest pain syndrome during sex, interruption of orgasm, impotence of a psychological nature.
• The formation of an abscess in the body of the prostate, its rupture, purulent lesion of the rectum leads to an exacerbation of symptoms, powerful intoxication of the body, up to death.
• Stagnation in the tissues of the prostate leads to a change in their structure, violation of innervation, blood supply, both the gland itself and the organs located nearby, with a violation of their functions.Erection becomes insufficient for a full sexual intercourse, there is premature ejaculation, prolonged sexual intercourse without the onset of orgasm.
• Cicatricial changes in the gland and spermatic cord lead to infertility, a decrease in the qualitative composition of sperm, and sperm motility. Narrowing of the urethra interferes with the normal process of urination, obstruction of the bladder can cause acute urinary retention, requiring emergency surgical care.

Chronic prostatitis

The main feature of the disease is the blurring of clinical symptoms during a long, persistent course of the process.More often the chronic form arises independently, as a primary pathology against the background of stagnation of blood in the vessels (prostatosis), abacterial prostatitis.

The main symptoms of chronic prostatitis are:

• fever;
• pain occurs in the scrotum, perineum, anus, back;
• violation of urination;
• Mucous or mucopurulent discharge from the rectum, urethra, even in the absence of urination or defecation;
• Erectile dysfunction, painful ejaculation, interrupted intercourse, prolonged intercourse without a sense of satisfaction.

Inaction and improper treatment of chronic prostatitis can cause complications:

• Infertility is the result of chronic inflammation in the spermatic cord, vesicles, testicles, and their appendages.
• Cystitis, pyelonephritis (other diseases of the genitourinary system) – a consequence of hematogenous and mechanical spread of microbes.
• Sepsis.
• Persistent decrease in immunity.
• Untreated prostatitis in 35 – 40% of cases can cause cancer.

Diagnostics

The clinical picture of the disease is typical, so the diagnosis is not difficult. It is put by a urologist on the basis of anamnesis, examination of the patient, laboratory minimum using the most modern medical devices:

• Rectal examination of the gland, taking secretions for examination (culture with determination of sensitivity to antibiotics).
• UAC, OAM, urine culture.
• Smear for STDs, UGI study.
• Daily monitoring of the rhythm of urination, measurement of the rate of urination (uroflowmetry).
• For differential diagnosis, ultrasound or TRUS is performed.
• If it is necessary to exclude oncology, a biopsy is taken, an urography is performed, and PSA is determined – prostate specific antigen.
• For the diagnosis of infertility, a spermogram is prescribed – an analysis of the ejaculate to establish a man’s fertility.

Based on the results of the patient’s examination, an individual scheme for the complex treatment of prostatitis is drawn up. When prescribing drugs, take into account the form of pathology, the presence of concomitant diseases. The doctor decides where to administer therapy (inpatient or outpatient). The course of treatment takes place with careful laboratory monitoring of the results.

One of the most modern centers for the treatment of prostatitis are the clinics of the Mother and Child Group of Companies. Since the problem of infertility is closely related to inflammatory urological diseases, medical professionals pay great attention to this problem.

In the Mother and Child clinics, each patient has the opportunity to undergo a full cycle of special examinations, receive psychological support, receive treatment with the latest generation drugs used in this area, and get acquainted with the newest methods of treating prostate inflammation. Not the last place in the complex therapy of prostatitis is occupied by the issue of effective rehabilitation of patients, dispensary observation, prevention.

Treatment of acute prostatitis

Acute prostatitis requires bed rest, a special salt-free diet, and sexual rest.

Methods of course treatment:

• The most effective treatment for prostatitis is etiotropic therapy. If the basis of prostatitis is an infection, the priority is the course of antimicrobial agents, which relieves the manifestations of inflammation.
• Pain syndrome is treated with analgesics, antispasmodics, rectal suppositories, microclysters with warm solutions of anesthetic drugs. The use of NSAIDs is possible.
• Immunostimulants, immunomodulators, enzymes, vitamin complexes, a combination of microelements have proven their effectiveness.
• Physiotherapy methods are possible only in the subacute stage of the disease. They improve microcirculation, increase immunity: UHF, microwave, electrophoresis, laser, magnetotherapy.
• Massage is another effective method of influencing the prostate. It opens the ducts, normalizes blood circulation in the scrotum and small pelvis.
• Acute renal filtrate retention can be corrected by catheterization, trocar cystostomy.
• A purulent process involves surgical intervention.
• Consulting a psychologist.

Chronic prostatitis treatment

With a long, course (at least a month) exposure to the prostate, there is no 100% guarantee of cure. Priority for phyto drugs, immunocorrection, change of household habits:

• Phyto drugs (for example, Likoprofit) are widely used in urological practice. They are able to accumulate in the place of the most active pathological process, protect cells from oxidation, remove free radicals, and prevent the proliferation of glandular tissue.
• Antibiotic therapy is selected individually, based on the sensitivity of microbes to drugs.
• Drugs that increase immunity, not only help to cope with prostatitis, they also correct the negative effect of antibiotics that disrupt the function of the immune system.
• Pain syndrome is stopped by the appointment of alpha-blockers, muscle relaxants.
• Prostate massage allows you to mechanically remove the “extra” gland secretion through the urethra, improve blood circulation, and minimize congestion.
• Physiotherapy: laser, magnet, ultrasound, iontophoresis, sedentary warm baths or microclysters with herbs.
• In severe cases, intravenous fluids with diuretics are indicated. This stimulates the abundant flow of urine, prevents symptoms of intoxication, the development of ascending cystitis, pyelonephritis.
• For constipation, herbal laxatives are used.
• A urologist, a psychologist, together with the patient, develops an individual long-term program of the daily regimen, the necessary rest, diet, dosed physical activity, and sexual activity.
• In case of resistance of the chronic process to the therapy, blocking the outflow of urine, surgical intervention is prescribed: removal of all affected tissues (transurethral resection of the prostate) or complete removal of the gland with surrounding tissues (prostatectomy).