Edit concept Create issue ticket

Prostatic Calculus

Prostate Calculus

A prostatic calculus (stone) is frequently asymptomatic and is often associated with benign prostatic hypertrophy. Nevertheless, in some cases, hypertrophy and stones can cause lower urinary tract symptoms. Surgical removal of the stones is either by transurethral procedures, sometimes combined with ultrasound observation, or by suprapubic extraction; however, surgery is not usually necessary.


Presentation

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].

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]
  • pain. [6] , [7] Occasionally, calcifications can be passed through the urethra and present as prostatic urethral calculi. [9] Silent asymptomatic prostatic calculi or calcification does not warrant any treatment as it could be an age-induced phenomenon[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]
Impulsivity
  • Seite 442 - Insanity, or madness consisting in a morbid perversion of the natural feelings, affections, inclinations, temper, habits, moral dispositions, and natural impulses, without any remarkable disorder or defect of the intellect or knowing and reasoning[books.google.de]
  • Seite 442 - Moral insanity, or madness consisting in a morbid perversion of the natural feelings, affections, inclinations, temper, habits, moral dispositions, and natural impulses, without any remarkable disorder or defect of the intellect or knowing[books.google.com]
Forgetful
  • Seite 443 - Rapid succession or uninterrupted alternation of insulated ideas, and evanescent and unconnected emotions ; continually repeated acts of extravagance ; complete forgetfulness of every previous state ; diminished sensibility to external impressions[books.google.de]
  • Seite 442 - Rapid succession, or uninterrupted alternation of insulated ideas and evanescent and unconnected emotions ; continually repeated acts of extravagance ; complete forgetfulness of every previous state ; diminished sensibility to external impressions[books.google.com]
  • Do not forget to check the instruments yourself just before you start the surgery to make sure all the parts are secure and there are no leaks. Bigger is better. If possible, use a larger (eg, 28F) resectoscope sheath for bigger prostates.[emedicine.medscape.com]
Excitement
  • Seite 60 - In febrile diathesis, or predisposition, from whatever cause — obstructed perspiration, undue excitement by stimulating liquors, overloading the stomach with food — fear, anger, or whatever depresses or disturbs the nervous system — the villous[books.google.com]
Dysuria
  • Prostatic calculi manifest with lower urinary tract symptoms, which include dysuria, rarely hematuria, pelvic pain, obstruction and infection.[symptoma.com]
  • 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]
  • 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]
  • Reference: (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]
  • 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]
  • […] appear after a long sitting or walking, sex or other physical activities; pain aggravation during defecation; sharp pain during erection and ejaculation; continuous pain in the lumbosacral region; Urinary dysfunction: intensive painful spasms, oliguria, nocturia[brulanta.com]
Prostatic Disease
  • . , , , , , Source MeSH Adult Calculi Diverticulum Humans Male Prostatic Diseases Urinary Bladder, Neurogenic Pub Type(s) Case Reports English Abstract Journal Article Review Language chi PubMed ID 23441456[unboundmedicine.com]
  • 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]
  • 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]
  • Discussion Prostatic calculi show a high incidence rate in prostatic disease and the rate increases with age. About 5% of men have prostatic calculi, especially those more than 50 years old. Prostatic calculi account for 5.3% of urinary calculi.[alliedacademies.org]
  • 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
  • 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. Elevated PSA score.[menshealthcures.com]
  • ejaculation Chronic bacterial prostatitis is caused by a bacterial infection.[healthline.com]
  • Calculi in this case can cause poor flow of semen during ejaculation, hemospermia and painful ejaculation.[ultrasound-images.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]
  • ., four-point increase in AUA-SI score, acute urinary 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[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]

Workup

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.

Treatment

  • […] 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]
  • The objective is to provide guidelines for prevention and treatment of prostatic calculi.[alliedacademies.org]
  • 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 decision of treatment strategy is affected by the size, shape and position of the calculus and by the status of the urethra. If the stone is large and immovable, it may be extracted via the perineal or the suprapubic approach.[link.springer.com]
  • Treatment When is BPH treatment necessary? The course of BPH in any individual is not predictable.[hopkinsmedicine.org]

Prognosis

  • 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]

Etiology

  • 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]
  • Abstract OBJECTIVE To study the etiology, clinical manifestation, diagnosis and treatment of giant prostatic calculus with neurogenic bladder disease and prostate diverticulum.[unboundmedicine.com]
  • 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]
  • Nanobacteria: a possible etiology for type III prostatitis. J Urol 2010; 184: 364-369. Usta MF, Baykara M, Erdogru T. Idiopathic prostatic giant calculi in a young male patient. IntUrolNephrol 2005; 37: 295-297.[alliedacademies.org]
  • 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]

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]
  • 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]
Sex distribution
Age distribution

Pathophysiology

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

Prevention

  • Therefore, prevention of prostatic calculi has gained increasing attention.[alliedacademies.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]
  • 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]
  • Prevention Bladder stones usually result from an underlying condition that's hard to prevent, but you can decrease your chance of developing bladder stones by following these tips: Ask about unusual urinary symptoms.[mayoclinic.org]
  • 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]

References

Article

  1. Venyo A. Prostatic Calculi: A Review of the Literature. Webmed Central UROLOGY. 2012;3(6):WMC003463.
  2. Najoui M, Qarro A, Ammani A, Alami M. Giant prostatic 
calculi. Pan Afr Med J. 2013;14:69.
  3. Torres Ramirez C, Aguilar Ruiz J, Zuluaga Gomez A, 
Espuela Orgaz R, Del Rio Samper S. A crystallographic 
study of prostatic calculi. J Urol. 1980;124(6):840-843.
  4. Park SW, Nam JK, Lee SD, Chung MK. Are prostatic calculi independent 
predictive factors of lower urinary tract symptoms? Asian J Androl. 2010;12:221-226.
  5. Søndergaard G, Vetner M, Christensen PO. Prostatic calculi. Acta Pathol Microbiol Immunol Scand A. 1987;95 (3): 141-145.
  6. Klimas R, Bennett B, Gardner WA Jr. Prostatic calculi: a review. Prostate 1985; 7: 91–96.
  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.
  8. Shoskes DA, Lee CT, Murphy D, Kefer J, Wood HM. Incidence and significance of prostatic stones in men with chronic prostatitis/chronic pelvic pain syndrome. Urology 2007; 70: 235–238.
  9. Geramoutsos I, Gyftopoulos K, Perimenis P, et al. Clinical correlation of prostatic lithiasis with chronic pelvic pain 
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.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2018-06-22 06:19