Prostatic calculus occurs frequently in older men and is often discovered incidentally, as it is asymptomatic in most cases. Endogenous stones are formed by deposition of inorganic salts, mainly calcium phosphate, on the corpora amylacea of the prostatic acini. Corpora amylacea are small, round bodies made of lipids and proteins derived from epithelial cells [1]. Secondary calculi are formed from urine components [2] [3] in the prostatic duct [3]. Most stones are between 1 and 4 mm in size, and are usually multiple.

The proportion of men with prostatic calculi has varied widely in different studies [4]. This may be because of differences in the subjects selected for the studies, and because of the different methods and criteria used to detect the stones [4]. Among the risk factors, age is the most cited [5] [6]; older age is associated with more numerous and larger stones.

Prostatic calculi manifest with lower urinary tract symptoms, which include dysuria, rarely hematuria, pelvic pain, obstruction and infection. Although there is an association between prostatic calculi and urinary tract symptoms, the relationship is not quite clear, because the presence of stones is associated with other conditions that can also cause urinary tract problems. Men with chronic prostatitis were found to have a higher burden of calculi than the ones without prostatitis [7]. Another investigation found that among patients with chronic pelvic pain syndrome those who had prostatic stones harbored more bacteria in the prostatic fluid and showed a stronger indication of inflammation than those who did not have stones [8]. Larger calculi were more often found in patients with chronic prostatitis or chronic pelvic pain syndrome than small calculi [9]. With the frequent coexistence of the calculi and other conditions, it is not clear whether the stones can, in themselves, result in lower urinary tract symptoms. With the aim of answering this question, a multivariate analysis of both subjective and objective symptoms in relation to calculi, age, and prostate volume, concluded that the stones were not independent determinants of the symptoms [4] although patients with calculi were afflicted with more severe symptoms than those without. Calculi may contribute to urinary tract infection by blocking drainage from the prostate, thereby providing an environment for recurrent infections [10].

• Weakness

  Weak urine stream. Painful ejaculation. Grainy sand-like pebbles that may be discharged during urination or ejaculation. Symptoms disappear temporarily with prostate mediation or antibiotics, but the pain and symptoms eventually return. [menshealthcures.com]

  The Case A 63-year-old Asian male with no significant past medical history presented to the emergency department with a four month history of urinary frequency, urgency, nocturia, and a weak stream. [bjuinternational.com]

  Part of the bladder wall gets weak and drops into the vagina, which can block the flow of urine. Diet. [webmd.com]

  General symptoms of the prostatic calculi are: general sense of weakness; performance and concentration decrease; subfebrile temperature (37,5 0 С); nausea; frequent headaches; loss of appetite. [brulanta.com]

• Perineal Pain

  Such prostatic calculi may cause pelvic or perineal pain and dysuria and a certain degree of urinary obstruction. 3D ultrasound images of large prostate calculus- case-2 in this patient we see a large prostate calculus measuring almost 12 mm. [ultrasound-images.com]

  […] most of these calcification reveals either calcium phosphate or calcium carbonate. [9] Prostatic calcifications may be asymptomatic but usually present with symptoms of associated disease such as dysuria, infection, hematuria, obstruction, or pelvic/perineal [urologyannals.com]

  Chronic prostatitides (CPPS II, IIIa and IIIb) Patients are young adult to middle-aged, complaining of urethral burning, perineal pain, suprapubic discomfort and frequency. The prostate is not abnormal on DRE. [surgwiki.com]

• Swelling

  Bladder swelling. You may get this from a urinary tract infection. Cystocele. This happens only in women. Part of the bladder wall gets weak and drops into the vagina, which can block the flow of urine. Diet. [webmd.com]

  Symptom of Prostate Stones (Prostatitis) Frequent Pain and swelling of the prostate gland. Enlarged prostate (BPH). Pain in the groin. Weak urine stream. Painful ejaculation. [menshealthcures.com]

  Case presentation A 60-year-old Chinese man experienced pain and swelling of the penile-scrotal area and had a history of the passage of purulent fluid passing through a penile ventral fistula of 3 months’ duration (Fig. 1 ). [bmcresnotes.biomedcentral.com]

• Anemia

  With more severe chronic symptoms of BPH, blood creatinine of blood urea nitrogen (BUN) and hemoglobin are measured to rule out kidney damage and anemia. [hopkinsmedicine.org]

• Constipation

  […] conditions are under control (e.g. diabetes and high blood pressure); Do pelvic floor muscle exercises to help stop urine leaking from the bladder (a special nurse or a physiotherapist can teach you the exercises); Boost your fibre intake to avoid becoming constipated [mydr.com.au]

  […] prostate-specific antigen by 50%; combination therapy with an alpha blocker recommended in patients with an enlarged prostate Finasteride (Proscar) 5 mg $10 ($135) Anticholinergic agents † Fesoterodine (Toviaz) 4 to 8 mg NA ($210) Dry mouth and eyes, constipation [aafp.org]

• Diarrhea

  […] acidosis promotes stone formation Chronic Diseases – Obesity – Diabetes Mellitus – Hypertension – Gout – Metabolic acidosis – Renal Tubular Acidosis (Type 1) – Sarcoidosis – Cystinuria – Inflammatory bowel disease – Primary hyperparathyrodidism – Chronic diarrhea [auanet.org]

• Dysuria

  The patient was a 37-year-old man, with urinary incontinence for 22 years and intermittent dysuria with frequent micturition for 9 years, aggravated in the past 3 months. He had received surgery for spina bifida and giant vesico-prostatic calculus. [unboundmedicine.com]

  Prostatic calculi manifest with lower urinary tract symptoms, which include dysuria, rarely hematuria, pelvic pain, obstruction and infection. [symptoma.com]

  Acute bacterial prostatitis is a febrile illness with sudden onset; pain in the lumbar and perineal regions, dysuria with frequency of urination, urgency, and nocturia urination; a tender, swollen prostate; and other symptoms. [wordinfo.info]

  […] is06009 (free article and images) Large cyst of seminal vesicle This elderly male patient had history of dysuria and urgency and other symptoms of prostatism. [ultrasound-images.com]

  EVIDENCE SUMMARY The initial history and physical examination focus on excluding etiologies of lower urinary tract infections other than BPH ( Table 1 ). 1 – 5 In addition to onset and duration of symptoms, any history of fever, dysuria, gross hematuria [aafp.org]

• Nocturia

  Symptoms are those of bladder outlet obstruction—weak stream, hesitancy, urinary frequency, urgency, nocturia, incomplete emptying, terminal dribbling, overflow or urge incontinence, and complete urinary retention. [merckmanuals.com]

  Optional tests include postvoid residual urine measurement if history and physical examination findings suggest urinary retention, and use of a frequency volume chart if nocturia is the predominant symptom. [aafp.org]

  As a result, daily use of an alpha-adrenergic bloeftv drug may increase urinary flow and relieve symptoms of urinary freurgency, and nocturia. [hopkinsmedicine.org]

  Although a degree of prostatomegaly may be completely asymptomatic, the most common presentation is with lower urinary tract symptoms (LUTS) including 1-4 : poor stream despite straining hesitancy, frequency and incomplete emptying of the bladder nocturia [radiopaedia.org]

  Acute bacterial prostatitis is a febrile illness with sudden onset; pain in the lumbar and perineal regions, dysuria with frequency of urination, urgency, and nocturia urination; a tender, swollen prostate; and other symptoms. [wordinfo.info]

• Prostatic Disease

  Original Article E Ogwuche, M Hameed, E Animashaun Keywords prostatic diseases, transabdominal ultrasonography Citation E Ogwuche, M Hameed, E Animashaun. Urological Transabdominopelvic Ultrasound Findings In Patients With Prostatic Diseases. [ispub.com]

  […] calculus with neurogenic bladder disease and prostate diverticulum. [unboundmedicine.com]

  Andriole, MD, Royce Distinguished Professor and Chief of Urologic Surgery, Barnes-Jewish Hospital, Washington University School of Medicine Click here for Patient Education Benign Prostate Disease Benign Prostatic Hyperplasia (BPH) Prostatitis Prostate [merckmanuals.com]

  These patients suffer LUTS for underlying prostatic disease, such as prostatitis or BPH. It is unclear whether prostatic calculi independently produce LUTS. [webmedcentral.com]

• Painful Ejaculation

  While annoying and even painful, often resulting in frequent prostate pain; painful ejaculation; dry ejaculation, in which a male reaches climax during sexual intercourse or masturbation without the release of semen; or weak urine stream, most urologists [menshealthcures.com]

  or between the testicles and anus painful ejaculation Chronic bacterial prostatitis is caused by a bacterial infection. [healthline.com]

  It is notable that urgency, frequency, and nocturia are identical to storage IPSS whereas pain and painful ejaculation are not IPSS items. [ajandrology.com]

  Cautery involving the verumontanum is discouraged because it can result in painful ejaculation. Immediately cauterize larger bleeding vessels that interfere with vision because another chance may not be available later. [emedicine.medscape.com]

• Urinary Incontinence

  Seventeen months of postoperative follow-up showed dramatically improved urinary incontinence and thicker urine stream. [unboundmedicine.com]

  […] retention, renal insufficiency, recurrent urinary tract infection, or urinary incontinence) at a rate of 4.5 events per 100 person-years. 9 Men presenting with bothersome, moderate to severe BPH symptoms may be treated with lifestyle modifications, medications [aafp.org]

  Resection around or even near the verumontanum is not recommended because of the increased risk of postoperative urinary incontinence in these patients. [emedicine.medscape.com]

Prostatic stones are often discovered in older men incidentally when imaging studies are performed for other reasons. The stones can also be palpated during a digital rectal examination.

Tests for associated lower urinary tract symptoms include the Meares-Stamey four-glass test to check for bacteria and white blood cells in urine and expressed prostatic secretions [4]. Prostatic stones are measured with the transrectal ultrasound scan. The calculi appear as hyperechoic areas with shadows [4]. The stones can be identified on radiographs and computerized tomography scans, as well on samples from transurethral resection of the prostate.

• Nephrolithiasis

  The overall incidence of nephrolithiasis is increasing. [auanet.org]

  Thiosulfate reduces calcium phosphate nephrolithiasis. J Am Soc Nephrol 2009; 20: 1246-53. 28. Goyal NK, Goel A, Sankhwar S. Transurethral holmium-YAG laser lithotripsy for large symptomatic prostatic calculi: initial experience. [ajandrology.com]

• Pyuria

  Persisting pyuria may be due to resolving UTI, stone, foreign body, sloughed papilla and, uncommonly in Australasia, tuberculosis (TB). [surgwiki.com]

  Infection is suggested by fever, elevated WBC count, and urine microscopy demonstrating pyuria and bacteriuria. [auanet.org]

[…] of Prostate Cancer 541 Treatment of Locally Advanced Prostate Cancer 542 Clinical State of the Rising PSA Value after Definitive Local Therapy 544 Hormone Therapy for Prostate Cancer 547 Treatment of CastrationResistant Prostate Cancer 551 Normal Development [books.google.com]

Treatment Prostatic calculi treatment involves a complex step therapy: antibiotics, anti-inflammatory therapy and physiotherapy treatment techniques. Sometimes a surgery is required. [brulanta.com]

Treatment When is BPH treatment necessary? The course of BPH in any individual is not predictable. [hopkinsmedicine.org]

When the cause is unknown, treatment of the symptoms may be the best course of action. Even when the condition can’t be cured, men who receive treatment for chronic prostatitis are usually able to find relief from symptoms. [healthline.com]

Post-Radical Prostatectomy Our post-radical prostatectomy nomogram can be used by patients after their surgical treatment for prostate cancer. [mskcc.org]

The Gleason grading system is used to help evaluate the prognosis of men with prostate cancer using samples from a prostate biopsy. [en.wikipedia.org]

MRI enlarged transition zone heterogeneous signal with an intact low signal pseudocapsule in the periphery Treatment and prognosis Medical management for early disease typically commences with an alpha blocker such as tamsulosin given in combination with [radiopaedia.org]

Consequences Timely treatment increases the chances on positive prognosis for a patient. [brulanta.com]

The faster the PSA returns to the normal range, the better the response and prognosis. [surgwiki.com]

Abstract OBJECTIVE To study the etiology, clinical manifestation, diagnosis and treatment of giant prostatic calculus with neurogenic bladder disease and prostate diverticulum. [unboundmedicine.com]

The etiology of this stone formation seemed to be based on some exogenous pathways combined with urinary stasis and chronic urinary infection due to compression fracture of the lumbar vertebra. [ncbi.nlm.nih.gov]

Epidemiology and Natural History 482 Evaluation and Nonsurgical Management of Benign Prostatic Hyperplasia 486 Minimally Invasive and Endoscopic Management of Benign Prostatic Hyperplasia 493 Retropubic and Suprapubic Open Prostatectomy 496 Epidemiology Etiology [books.google.com]

Etiology Prostatic calculi (stones in the prostate) is the presence of organic or non-organic particles within the acini and the prostatic tubules. The disease affects 80% of men over 55 years old. [brulanta.com]

The patients (including those reported in the literature) were characterized by age, origin, location of calculus, size of calculus, fistulous track, and etiological factors. [bmcresnotes.biomedcentral.com]

[…] and Natural History 482 Evaluation and Nonsurgical Management of Benign Prostatic Hyperplasia 486 Minimally Invasive and Endoscopic Management of Benign Prostatic Hyperplasia 493 Retropubic and Suprapubic Open Prostatectomy 496 Epidemiology Etiology [books.google.com]

Moreover, recent studies suggest epidemiological and pathologic links between benign prostate hypertrophy and prostate cancer [29]. [journals.plos.org]

Epidemiology of & Natural history of BPH. Urol clinic North Am. 1990: 17; 495 – 497. 4. Fred T. Lee, Jr. and John R. Thornbury. The Urinary Tract in: Paul and Juhl's Essentials of Radiologic Imaging 7th edition (September 15, 1998): by John H. [ispub.com]

BPH: epidemiology and comorbidities. Am J Manag Care. 2006;12(5 suppl):S122–S128. ... 2. McVary KT, Roehrborn CG, Avins AL, et al. Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol. 2011;185(5):1793–1803. 3. [aafp.org]

Cutaneous Continent Urinary Diversion 459 Orthotopic Urinary Diversion 465 Genital and Lower Urinary Tract Trauma 468 Lower Urinary Tract Calculi 471 Development Molecular Biology and Physiology of the Prostate 476 Benign Prostatic Hyperplasia Etiology Pathophysiology [books.google.com]

Stones are a pathophysiologic phenomenon occurring during the aging process, mainly after age 50 years. [wjmh.org]

Pathophysiology Urinary calculi may have various compositions which include, in order of decreasing frequency: calcium oxalate, uric acid, struvite or infection (triple phosphate = magnesium ammonium calcium phosphate), calcium phosphate and cystine. [auanet.org]

Therefore, prevention of prostatic calculi has gained increasing attention. [alliedacademies.org]

Can I Prevent Them? Ideally, you prevent them by treating the cause of the bladder stones. That’s not always possible, but there are some options: Bladder diverticula: You could get surgery to remove them. [webmd.com]

Jackstones often must be removed via cystolithotomy. [10] Prevention [ edit ] The best way to prevent bladder stones is to drink plenty of liquids. Juices containing citrates are thought to reduce the risk of stone formation. [en.wikipedia.org]

Natural History 482 Evaluation and Nonsurgical Management of Benign Prostatic Hyperplasia 486 Minimally Invasive and Endoscopic Management of Benign Prostatic Hyperplasia 493 Retropubic and Suprapubic Open Prostatectomy 496 Epidemiology Etiology and Prevention [books.google.com]

Bacterial forms of chronic prostatitis can be prevented with good hygiene. By keeping the penis clean, the risk of bacteria entering the urethra is lower. [healthline.com]

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7. Ludwig M, Weidner W, Schroeder-Printzen I, et al. Transrectal prostatic sonography as a useful diagnostic means for patients with chronic prostatitis or prostatodynia. Br J Urol 1994;73: 664 – 666.
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syndromes in young adults. Eur Urol. 2004;45:333-337.
10. Eykyn S, Bultitude MI, Mayo ME, Lloyd-Davies RW. Prostatic calculi as a source of recurrent bacteriuria in the male. Br J Urol. 1974;46(5):527-532.