SEM and X-ray microanalysis of human prostatic calculi

An overlooked complication of the clean intermittent catheters: prostate calculi

OBJECTIVE

Although the clinical importance of prostate calculi has been understood over time, it is a urinary system disease that can cause different symptoms and can be ignored by urologists sometime. Clean intermittent catheter (CIC) is the gold standard method for bladder rehabilitation and urinary drainage in patients with neurogenic bladder. The aim of this study was to compare the incidence of prostate calculi and related pathologies between patients using CIC and not using CIC.

MATERIAL-METHOD

A total of 314 neurogenic bladder patients who were followed up and treated in our urology clinic were included in this study. The patients were divided into two groups as patients non-using CIC (Group-1, n:154) and patients using CIC (Group-2, n:160).Presence of prostate calculi, the number of CIC used per/day, plasma uric acid levels, urine parameters, mean-stone-density (MSD) and calculi sizes were retrospectively scanned from patient records.

RESULTS

In this study, no significant difference was observed between the parameters such as age, uric acid level, MSD, urine parameters, and other electrolyte levels (Table 1) While the incidence of prostate calculi in Group 1 was 23.4%; The incidence of prostate calculi in group 2 was 37.5(p = 0.007) (Fig. 2). CONCLUSıON: In this study, it was tried to show the relationship between the use of CIC and prostate calculi that cause LUTS and dysuria, which are generally ignored in clinical evaluation but do not pass in patients. As a result of this study, it was determined that the incidence of prostate calculi increased in patients using CIC.

The influence of prostatic calculi on lower urinary tract symptoms and sexual dysfunction: a narrative review

Prostatic calculi (PC) are commonly found in patients who present for urologic consultation. However, the effect of PC on urinary symptoms remains controversial. In this study, we searched the Embase and PubMed databases for literature related to the following keywords: “prostatic calculi”, “prostatic stone”, “prostatic lithiasis” and “prostatic calcification”, along with the limits, “lower urinary tract symptoms”, “sexual dysfunction”, “erectile dysfunction”, “erectile function”, and “premature ejaculation”. According to the literature, there are various subtypes of PC based on X-ray or ultrasound findings, including type I/II, type A/B, and endogenous PC/extrinsic PC. Furthermore, the formation of PC remains unclear, and more importantly, the ability of PC to cause lower urinary tract symptoms (LUTS) and sexual dysfunction (SD) is worth exploring. We retrospectively reviewed all available literature and found that most studies agreed that PC are associated with LUTS. The factors which may play an important role in the pathogenesis of LUTS include the size and location of PC, induced inflammation, and the blood flow of the prostate. Similarly, SD was also examined in the patients with PC, and psychological factors cannot be ignored in this regard. However, more in-depth study of the molecular mechanisms, including prospective, controlled, longitudinal, and large- sample studies, are needed in the future.

[Voluminous juvenile prostatic lithiasis complicated by perineal fistula: about a case reported at the regional hospital in Gao]

Les lithiases prostatiques correspondent à des calculs développés au sein du tissu prostatique (acini, canaux), elles sont rares chez l'enfant mais fréquentes chez l'homme. Nous rapportons le cas d'un patient de 24 ans présentant depuis quelques mois des troubles de la miction à type de pollakiurie et dysurie suivie d'une fuite urinaire périnéale lors de la miction. L'échographie réno-vésico-prostatique a montré une grosse calcification prostatique. La radiographie standard de l'arbre urinaire et une fistulographie de l'orifice périnéal ont montrés une communication avec la vessie et montré une grosse calcification se projetant sur le pubis. Le diagnostic de lithiase prostatique a été retenu. La prise en charge a été faite par une antibiothérapie avant, pendant et après l'extraction chirurgicale de la grosse lithiase. Les suites opératoires ont étés favorables.

Lower urinary tract symptoms in benign prostatic hyperplasia patients: orchestrated by chronic prostatic inflammation and prostatic calculi?

OBJECTIVE

This study aims to examine the relationship between chronic prostatic inflammation and prostatic calculi, and clinical parameters of benign prostatic hyperplasia (BPH).

MATERIALS AND METHODS

This study was based on 225 patients who underwent transurethral resection of the prostate for BPH. Chronic inflammation was graded as 0 (n = 44), I (n = 54), II (n = 88) or III (n = 39) according to severity. Prostatic calculi were classified into types A (n = 66), B (n = 44), M (n = 77) and N (n = 38). The relationship between inflammation and calculus type was analyzed, and clinical parameters of BPH were compared for each group.

RESULTS

There was no correlation between severity of inflammation and calculus type. Prostatic volume increased with the severity of inflammation and showed significant differences between G2, G3 and G0. The International Prostate Symptom Score also increased with increasing inflammation. There was no significant difference between each clinical parameter according to calculus type.

CONCLUSIONS

Prostatic calculi had no significant association with chronic inflammation and clinical parameters of BPH. Chronic inflammation was associated with the volume of the prostate and storage symptoms; thus, it is not only presumed to be related to the progression of BPH, but may also be one of the causes of lower urinary tract symptoms.

Influence of prostatic calculi on lower urinary tract symptoms in middle-aged men

OBJECTIVES

To investigate the incidence and echographic patterns of prostatic calculi, and to determine whether the presence of prostatic calculi is an associated factor for moderate lower urinary tract symptom (LUTS) in middle-aged men.

METHODS

Between October 2007 and June 2010, 1575 consecutive ostensibly healthy Korean men aged 40-59 years visited the health promotion center for a routine check-up and were enrolled. All men had a complete history, physical examination, and an international prostate symptom score (IPSS) questionnaire. Based on the echo patterns of the prostatic calculi by transrectal ultrasound, the men were divided in 3 groups-no calculi; type A calculi (discrete, small echoes); and type B calculi (large masses of multiple echoes, much coarser).

RESULTS

In total, 1563 men were included. Measurable calcifications in the prostate gland were found in 799 men (51.1%). Small calculi (type A) were found in 615 men (39.3%) and large calculi (type B) were found in 184 men (11.8%). In the multivariate analysis, old age (>50 years), obesity (body mass index >25 kg/m(2)), and large calculi (type B) were significant associated factors for higher IPSS ≥8. The likelihood of IPSS being ≥8 was related to large calculi group with a 1.784-fold increase in risk over no and small calculi (P <.001).

CONCLUSIONS

The presence of large prostatic calculi is a significant associated factor of moderate LUTS, whereas there was no statistical difference in IPSS analyzed between the no calculi and small calculi group.

Fine structure and mineral components of primary calculi in some human prostates

The fine structure of prostatic calculi has not been elucidated yet, although the chemical components were reported in detail. We studied the primary or endogenous calculi removed from eight human prostates by secondary scanning electron microscopy, backscattered electron imaging, energy-dispersive X-ray microanalysis and X-ray diffraction. The primary calculi containing Mg, Zn and S, besides Ca and P were basically classified into four stone groups (I-IV) by fine structure and mineral components. Stone I had the core deposits of calcospherites showing concentric rings and the laminated deposits concentrically around the core. Their deposits were identified as apatite. Stone II was occupied with the calcospherite deposits of apatite although the stone growth showed a rough concentric formation. Stone III contained the core of calcospherites and concentric laminated structures, similar to a smaller type of group I, whereas the wider peripheral region was deposited with needle-like structures, identified as calcium oxalates. Stone IV had the core deposits containing small hexahedral structures, identified as whitlockite, which were surrounded with several incompletely concentric laminated bands of apatite. Whitlockite crystals were also found between the fused large calculi. The initial and formative calculi were basically observed as the deposition of mineralizing spherical structures suggesting variously sized corpora amylaceous bodies. Thus, the primary prostatic calculi of stones I-III will begin from the mineralization of amylaceous bodies as a core, while the organic substances, which form stone IV, might be derived from the simple precipitation of prostatic secretion.

Clinical correlation of prostatic lithiasis with chronic pelvic pain syndromes in young adults

OBJECTIVE

To investigate the incidence, morphology and clinical presentation of prostatic calculi in a selected population of young adults and to examine any possible correlation with chronic prostatitis/chronic pelvic pain syndromes (CP/CPPS).

METHODS

A population of 1374 young adults was screened with ultrasound imaging of the prostate and 101 cases with prostatic lithiasis were selected. Patients were divided in two groups, according to the type of prostatic calculi (type A: small, multiple or type B: larger, coarser calculi). Further evaluation included history and physical examination, recording of lower urinary tract symptoms and the Meares-Stamey test.

RESULTS

Calculi were type A in 71.3% and type B in 28.7% of cases. Localization (central/periurethral) was not correlated with other parameters. Age was closely related to calculus burden ( p =0.034 ). Type B calculi were more often associated with symptoms and chronic prostatitis/CPPS (chi(2)-test, p=0.007 and 0.018 respectively).

CONCLUSIONS

Small, multiple calcifications are a normal, often incidental ultrasonographic finding in the prostate and represent a result of age rather than a pathologic entity. However, larger prostatic calculi may be related to underlying inflammation and require further evaluation and possibly, treatment.

Structural changes in the aging submucosa: new morphologic criteria for the evaluation of the unstable human bladder

Biopsies from continent human bladders, ranging in age from six weeks to 95 years, were examined ultrastructurally to establish the organization of the submucosa. The submucosa was found to have a distinct organizational pattern. Collagen fibers are bound into fascicles with arborizing intercollagenous channels. These channels form an intricate network throughout the submucosa. With age, the fascicles separate into individual fibers and there is a commensurate widening of the intercollagenous channels. This process is accelerated in obstruction. As aging occurs, the channels progressively fill with an electron-dense fine particulate matter of unknown origin. The collagen reorganization and accumulation of extracellular matrix particles is thought to alter the permeability and compliance of the submucosa and to encroach upon the neurovascular bundle. A baseline set of morphologic criteria describing the natural history of the continent aged bladder is offered as a framework for future group identification in the incontinent patient.

Prostatic calculi: a review

Prostatic calculi are rare in children, infrequent below age 40, and common in males over 50. They may be solitary but usually occur in clusters and are associated with some other disease process (nodular hyperplasia, prostatic carcinoma, metabolic abnormalities). They are most often asymptomatic; however, symptoms that may be attributable to prostatic calculi include reduction of the urinary stream, prostatism, and intense lower back and leg pain. Treatment may be accomplished by transurethral resection, but prostatectomy is the best means to insure complete removal. Prostatic calculi may form by two related mechanisms with obstruction and stasis of prostatic fluid as central entities in both. These mechanisms are calcification of corpora amylacea and simple precipitation of prostatic secretion. They may arise spontaneously, initiating an inflammatory reaction that contributes to their growth, or they may arise as the consequence of another pathologic situation producing acinar obstruction. It appears that infection probably occurs secondary to stone formation.

Cowper's gland calcification: a new radiographic finding

Cowper's gland calcification is reported in 3 elderly patients. The anatomy, pathology, and radiology of Cowper's glands are reviewed. Postulated etiologies of Cowper's gland calcification include ductal obstruction with stasis of secretions, infection with urea-splitting organisms, and sequelae of diabetes mellitus.