Kidney stone in prostate cancer

Stones in the prostate - how to prevent and cure?

One of the most formidable and frequent complications of chronic pathology of the prostate gland is stones in the prostate. Approximately 8-10 years after the onset of the disease, 40% of men can detect the formation of calculi in the gland.

How are stones formed in the prostate?

Prostate stones can be organic or inorganic. They are dense, located in the acini and ducts of the gland. The percentage of patients with prostate stones increases strongly with age. So at the age of 35, calculi occur in about 10% of cases, and by the age of 50, 80% of patients with prostatitis have these foreign bodies in the prostate gland.

This is a stagnation of the secretion of a glandular organ, its infection. Stagnation, in turn, is provoked by blockage of the ducts during inflammation and an increase in the size of the organ.

This theory was formed after a detailed crystallographic analysis of stones in the prostate, when it was noticed that most of the stones are composed of urine salts.

Despite this, it is still worth considering that amyloid bodies (the result of the formation of prostatic secretion) serve as the nucleus for the formation of calculi, around which urine salts are already deposited.

Stones are dangerous due to their location (acini and ducts), as they can clog them and lead to injury to soft tissues, disruption of blood circulation in the organ. In addition, stones support the inflammatory process, because they are a source of microorganisms.

Classification of stones

All stones may differ in composition, be organic or inorganic. Their main components are: phosphate salts, uric acid salts, calcareous salts, oxalic acid salts, proteins, desquamated duct epithelium, prostate secretion.

Thus, the calculi are divided by composition into:

• Phosphate. From the name it is clear that the main component is phosphate salts;
• The greatest danger is posed by calcifications, which turn out to be the hardest and most difficult to treat with medication;
• In the presence of a large amount of salts of oxalic acid, the stones are called oxalate;
• If uric acid predominates in their composition, then they are called urate.

Stones are also divided according to the method of formation:

• Exogenous. They are less common, because their formation requires the presence of reflux, that is, the reflux of the contents of the urethra (urine) into the prostate. Therefore, such foreign bodies can be found only in the final sections of the organ, and in composition they are urate, oxalate. Their diameter usually does not exceed 4 mm., And the edges are sharp;
• Endogenous. They appear in any part of the body, as they are the result of stagnation of blood and secretions. Prolonged stagnation of prostate secretion leads to the appearance of amyloid bodies, that is, as a result of thickening. Already on the bodies of amyloid, salts of phosphates and calcifications are subsequently deposited. Their diameter is not more than 2.5 mm., oblong shape and smooth edges.

Specialists distinguish two more categories of prostatic calculi: true ones, which are formed in the gland, and false ones, which are brought from the urinary organs (kidneys, bladder) into the prostate with the flow of urine due to the resulting reflux.

How does calculous prostatitis progress

When stones form in the prostate gland, typical symptoms occur, however, their intensity depends on the size of the stones, on how long the disease is, as well as the factors that cause them.

Nonspecific signs: weakness, fever to subfebrile numbers, chronic fatigue syndrome, decreased performance, headaches, changes in appetite, nausea.

Of the pathognomonic symptoms in the presence of stones in the prostate, the following should be mentioned:

• Pain syndrome. It is bright, with irradiation to the perineum, scrotum, penis, gluteal region. Increases or appears after or during walking, shaking or after sexual intercourse;
• Pain occurs during urination, during the act of defecation, ejaculation;
• Regular pains in the lumbar and sacral spine;
• Urination becomes more frequent, especially at night. Pain can appear both before, during and after the act of urination;
• Imperative urge when little urine is passed;
• Blood appears in urine and semen;
• The attraction to the female sex changes, or rather begins to disappear;
• Stones found in the prostate affect potency, while they can be brought from the bladder and kidneys. This means that patients who have chronic pyelonephritis due to the presence of stones in the renal pelvis should be aware of this possibility and visit a specialist regularly.

What causes calculous prostatitis

High risk of getting complications in those patients who have stones in the gland:

• The risk of infection increases exponentially. This is due to microtrauma, as the calculi constantly cut the capillaries, which contributes to the introduction of microbes into the blood;
• Frequent microtraumas lead to the formation of gland abscesses;
• The inability to have a normal sexual life, the presence of constant pain and urination disorders lead to psychological trauma;
• The urinary system also suffers. The urge to urinate is frequent, accompanied by pain, the outflow of urine is disturbed, patients urinate in small portions, which leads to stagnation and infection of urine in the bladder;
• Infection of the sexual partner. When growth of abnormal flora is observed in prostatitis;
• Male infertility. The result of prostatitis is a weak erection, the presence of areas of sclerosis in the gland, the phenomenon of stagnation and a violation of the outflow of prostatic secretions. Despite the widespread belief that prostatitis and impotence almost always exist side by side, inflammation of the prostate does not lead to impotence in a chronic course. All these reasons become triggers for reproductive imbalance;
• Iron becomes thinner over time, changes shape, and dries out. In a word, the organ gradually dies, ceases to perform its functions.

The most reasonable solution when symptoms of the disease appear is to contact a specialist in a timely manner. Strict medical supervision and timely prevention of prostatitis and stone formation will help to avoid the disease or the development of its complications.

Doctor sexopathologist-andrologist of the 1st category. Work experience: 27 years

Features of surgical treatment of patients with a combination of prostate cancer and ureteral stone

Alyaev Yu.G., Pshikhachev A.M., Shpot E.V., Akopyan G.N., Chinenov D.V. I.M

Introduction. The presence of a ureteral stone in patients with prostate cancer (PCa) poses a task for the surgeon to determine the nature and sequence of Surgical treatment of this category of patients.

The purpose of the study. To determine the tactics of treating patients with prostate cancer in combination with a ureteral stone.

Materials and methods. For the period from 2006 to 2015. In the clinic of urology, 1602 patients were operated on for prostate cancer, among which 54 (3.4%) patients had concomitant urolithiasis. In 36 (2.2%) patients from this group at the time of hospitalization there were indications for surgical treatment for both diseases. In 17 (47.2%) patients, the stone was located in the ureter.

Results. The leading clinical manifestations of ureteral stone were: in 9 (52.9%) patients - renal colic, in 4 (23.5%) - dull pain in the lumbar region, in 3 (17.6%) - acute obstructive pyelonephritis. In 1 patient, a ureteral stone was diagnosed by chance during examination for prostate cancer. In 15 (88.2%) patients, prostate cancer was localized, in the rest it was locally advanced. In the majority (94.1%) of patients, first of all, surgical treatment was performed aimed at getting rid of the ureteral stone. Only 1 patient with acute obstructive pyelonephritis caused by a stone in the upper third of the ureter underwent drainage of the upper urinary tract (UUT) with a stent catheter followed by radical prostatectomy (RP) due to a high risk of progression. In the postoperative period, 2 sessions of extracorporeal shock wave lithotripsy (ESWL) were performed with complete removal of stone fragments. For ureteral stones, the majority (82.4%) of patients underwent contact ureterolithotripsy (URL) or ESWL. 2 (28.6%) patients underwent percutaneous nephrolithotripsy due to large stones in the upper third of the ureter (in one case, the stone was previously displaced into the kidney during drainage of the upper urinary tract with a stent catheter for acute obstructive pyelonephritis).

Surgical treatment for prostate cancer in 53.0% of patients was performed in the volume of open, and in 23.5% - laparoscopic radical prostatectomy (RP). 4 (23.5%) patients underwent high-intensity focused ultrasound ablation of the prostate. Among the patients of this group there were also 2 patients with bilateral stones of the upper urinary tract. One patient with bilateral ureteral stones (without obstruction on one side) underwent successive ESWL sessions with complete removal of stone fragments, followed by open RP. The second patient with a ureteral stone on one side and a stone of the opposite kidney also successfully underwent ESWL sessions on both sides against the background of a catheter-stent on the side of the ureteral stone, followed by open RP at the second stage. In 2 patients with prostate cancer, in addition to ureteral stones, bladder stones were detected. One of them underwent laser cystolithotripsy and URSL at the first stage, then open RP. Another patient also underwent laser cystolithotripsy with simultaneous percutaneous ureterolithotripsy, and the second stage - open RP.

Conclusion.If a ureteral stone is detected in patients with prostate cancer, initially therapeutic measures should be aimed at ridding the patient of a ureteral stone, followed by surgical treatment of prostate cancer in the second stage. In the case of a high risk of progression of the tumor process and the expected long time for the patient to get rid of the ureteral stone, surgical treatment for prostate cancer should be carried out as the first stage against the background of drainage of the upper urinary tract.

Treatment of chronic prostatitis against the background of urolithiasis

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The most common urological disease - prostatitis has many causes and factors that provoke its exacerbation and progression. This and, already known to everyone from our previous publications, hypothermia, and sexual abstinence, and stagnation of blood in the vascular plexus of the small pelvis, sexually transmitted infections, alcohol and spicy food.

But there is another factor, or rather, a disease that has a multifaceted effect on the entire genitourinary system and on the prostate gland in particular. This is urolithiasis. Moreover, we are not necessarily talking about large stones in the pelvis, ureters or bladder. It can be microliths - small stones up to 0.3-0.5 cm, or just sand and high salt content in the urine.

Urologists often face problems in the treatment of chronic prostatitis, when even after adequate anti-inflammatory, antibacterial, local therapy in men, symptoms of inflammation of the prostate gland either remain or quickly return and the number of leukocytes in the prostate juice increases. Moreover, neither crops for flora, nor PCR reveal any pathogenic and opportunistic flora. And only ultrasound of the urinary system organs determines the presence of sand or stones.

What happens in this case, when prostatitis progresses against the background of urolithiasis?

There seem to be several factors involved:

Therefore, we strongly recommend that patients with prostatitis be carefully examined in more detail in terms of diagnosing KSD:

And, accordingly, if even minor signs of urolithiasis are detected, prescribe appropriate therapy that allows you to remove existing stones and relieve swelling and inflammation from the prostate gland, which also prevent the free exit of stones. That is, this treatment should simultaneously affect the KSD and chronic prostatitis.

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