Prostatic Stone Paper

[dshoskes]

Published today:

Incidence and significance of prostatic stones in men with chronic prostatitis/chronic pelvic pain syndrome.

Urology. 2007 Aug;70(2):235-8

Authors: Shoskes DA, Lee CT, Murphy D, Kefer J, Wood HM

OBJECTIVES: Prostatic calcification is common in asymptomatic elderly men. However, young men with chronic pelvic pain syndrome (CPPS) often have significantly calcified prostates. We studied the incidence and significance of prostatic calcification in men with CPPS. METHODS: From July 2005 to August 2006, 130 new patients with chronic prostatitis / chronic pelvic pain syndrome were seen at our clinic. Of these 130 patients, 47 underwent transrectal ultrasonography. Prostatic calcification correlated with symptoms (National Institutes of Health chronic prostatitis symptom index score), examination findings, and culture results. The variables were compared using the Student t test, Wilcoxon unpaired test, or chi-square test. RESULTS: The 47 men who had undergone transrectal ultrasonography had symptoms identical to those who had not but were older (range 46.1 to 41.6 years, P = 0.02) and had had symptoms longer (median 60 versus 12 months, P = 0.0001). Of the 47 patients, 22 (47%) had significant calcification. The symptoms with or without calcification were identical (chronic prostatitis symptom score 23.7 versus 23.9). Men with calcification had had symptoms longer (median 84 versus 27 months, P = 0.05) but were similar in age (49 versus 45 years, P = 0.21) and had a similar prostate size (21.7 cm3 for both groups). Men with calcification were less likely to have pelvic floor tenderness (50% versus 85%, P = 0.03) but were more likely to have bacteria in the prostatic fluid (P = 0.05) and had a higher median white blood cell count (3.5 versus 0 white blood cells per high power field, P = 0.058). CONCLUSIONS: Prostatic calcification is common in patients with chronic prostatitis / chronic pelvic pain syndrome and is associated with greater inflammation, bacterial colonization, and symptom duration. Pelvic floor spasm is more common in patients without calcification. This might be an important parameter with which to stratify clinical trials.

PMID: 17826477 [PubMed - in process]

[webslave]

That's interesting, but the high finding of calcification seems to conflict with other studies with much larger cohorts, eg

Int J STD AIDS. 2007 Apr;18(4):276-80

Retrospective review of clinical practice in chronic pelvic pain syndrome (category III chronic prostatitis) at two hospital sites over five years 2000-2005 (an audit).

Evans DT, Jaleel H, Keefe A.
Department of Genitourinary Medicine, Southend Hospital NHS Trust, Westcliff on Sea, Essex, [email protected]

All category III chronic prostatitis cases in two hospital sites were retrospectively reviewed from the year 2000 until 2005. The mean age of the patients was 38.7 years. Of these, 56.6% were St Bartholomew's Genitourinary Medicine Department patients and 43.5% were Southend Genitourinary Medicine Clinic patients. We observed that 33.1% of these had at least one transrectal ultrasound of the prostate. The commonest abnormal findings in transrectal ultrasounds of the prostate of the series were focal calcification (16.2%), calculi (9.3%) and inflammatory changes (5.4%). Of this series, 35% were lost to follow-up. The vast majority of the remainder got better over periods ranging from approximately two weeks to approximately three years.

PMID: 17509180 [PubMed - indexed for MEDLINE]

[webslave]

Here's an old study, but one that seem eminently sensible in its conclusions to me (note that radical prostatectomy is no longer necessary to remove stones):

Prostate. 1985;7(1):91-6.Links

Prostatic calculi: a review.

Klimas R, Bennett B, Gardner WA Jr.

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.

PMID: 3909127 [PubMed - indexed for MEDLINE]

[webslave]

Stones associated with recurrent bacterial prostatitis:

Infect Dis Clin North Am. 1997 Sep;11(3):623-46.

Urinary tract infection in urology, including acute and chronic prostatitis.

Pewitt EB, Schaeffer AJ.
Department of Urology, Northwestern University Medical School, Chicago, Illinois, USA.

Heightened awareness of patients with increased risk for severe or potentially severe UTIs is paramount for early diagnosis and treatment. Urologic assessment of these patients is frequently necessary for cure and to prevent significant sequelae. Unresolved infections are usually caused by resistant bacteria and are treated by modification of therapy based on antimicrobial sensitivity testing. When unresolved bacteriuria is caused by organisms sensitive to the initial antimicrobial therapy, azotemia or a large bacterial mass density should be suspected. Recurrent infections at close intervals or with the same organism are usually caused by a bacterial focus in an acquired or congenital abnormality of the urinary tract, such as infection stones. The bacterial focus must be removed to cure the recurrent infections. If the bacterial focus within the urinary tract cannot be removed, long-term, low-dose antimicrobial suppression will prevent the morbidity of recurrent infections. Reinfection requires careful bacteriologic monitoring and low-dose prophylactic, intermittent, or postintercourse antimicrobial therapy. In the setting of prostatitis syndrome, the patient must first be classified into one of three categories: bacterial prostatitis, nonbacterial prostatitis, or pelviperineal pain syndrome. Bacterial prostatitis frequently responds to appropriate antimicrobial agents, whereas nonbacterial prostatitis and pelviperineal pain require an empiric multimodal approach.

PMID: 9378927 [PubMed - indexed for MEDLINE]

[webslave]

Prostatic calculi associated with disordered metabolism:

Can J Urol. 2007 Jun;14(3):3577-9.

Hypercalciuria associated with pediatric prostatic calculi.

Al-Taheini K, Filler G, Leonard M.
Division of Pediatric Urology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.

Prostatic calculi, though common in adult men, are rare in children. We report three cases of pediatric prostatic calculi seen at our clinic that were associated with hypercalciuria and elevated urinary calcium/creatinine ratios. The patients had no symptoms from their prostatic calcification, but one patient had recurrent symptomatic renal calculi. In patients with prostatic calculi, determination of spot urine calcium/creatinine ratios is recommended. If significant hypercalciuria is found, treatment to prevent upper urinary tract calculi may be considered.

PMID: 17594749 [PubMed - indexed for MEDLINE]

[kevin]

Neat study. I have always been interested in finding out in what ways chronic prostatitis / chronic pelvic pain syndrome patients can be broken into subgroups.

[webslave]

I'm not sure this does break them into subgroups, since prostate stones are very common in men without CPPS, and those with prostatitis where stones are acting as a reservoir for bacteria are not chronic prostatitis / chronic pelvic pain syndrome patients anyhow.

[webslave]

Old study here (1992), and it doesn't say bacterial or nonbacterial chronic prostatitis, but the results are still interesting because they tally more or less with the British 2007 study above (post #2):

Lik Sprava. 1992 Nov-Dec;(11-12):93-6.

Calculus formation in the prostate in chronic prostatitis

Gorpinchenko II, Proshchako KV, Pedchenko OIa.

The authors examined 350 patients with chronic prostatitis. In 48 (13.7%) of patients, calculi in the prostate were found. The typical clinical manifestations of calculi formation in the prostate, diagnostic criteria and treatment principles developed in the Department of Sexopathology of Kiev Research Institute of Urology and Nephrology are outlined.

PMID: 1292237 [PubMed - indexed for MEDLINE]

[carld]

I find this very interesting . So how do you reduce the calcification in the prostate

Is this something any accredited quercetin product or . Any accredited quercetin product would aid in?

Can you see any calcification in the prostatic urethra in a cystoscopy when the prostatic ducts are viewed to see if they are wide open or not

[webslave]

Of the 47 patients, 22 (47%) had significant calcification.

A 2003 study of men without prostatitis found prostatic calculi in 198 of the 486 men (40.7%), which means that the incidence of stones in men with CP/CPPS is virtually the same as the normal population.

Also:

Acta Pathol Microbiol Immunol Scand [A]. 1987 May;95(3):141-5.

Prostatic calculi.
Søndergaard G, Vetner M, Christensen PO.

The presence of calculi in 300 whole prostates from consecutive autopsies were investigated by the Faxitron imaging technique. Calculi were found in 99% of the prostates, their number and size increasing with age. They were mainly localized in the ducts in the borderzone between the middle lobes and the periferal prostate posterolaterally, but often some were also found anteriorly in the centreline. Calculi were never seen in the middle lobes. We found no statistically significant relation between the number, size or localization of calculi and other morphological or pathological parameters. Prostatic calculi seem to be a part of the normal process of aging, and do in only exceedingly rare cases assume any clinical importance.

PMID: 2440234 [PubMed - indexed for MEDLINE

[mpozatek]

How do you get rid of the calcification. I have had ultrasounds done and the doc said I have calcification. Nothing was ever done about though. He said it is just there.

[webslave]

Only worth doing if your stone/s are large and perhaps causing obstruction of the ducts. There are a lot of ways to go about it:

• microexplosion lithotripsy (in this list of studies)
• Nanobac Labs protocol (EDTA suppositories and calcium-leaching tetracycline)
• By injection from Dr Guercini in Italy
• by taking Calcium EDTA under supervision