Prostate calcification worsen lower urinary tract symptoms in middle-aged men

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The role of prostatic urethral angle and intravesical prostatic protrusion on surgical capsule calculi formation in the prostate: A retrospective study

PURPOSE

To investigate the relationship between prostatic urethral angle (PUA) and the development of surgical capsule calculi (SCC) within the prostate, and to examine the presence and impact of intravesical prostatic protrusion (IPP).

MATERIALS AND METHODS

A retrospective analysis was conducted on 90 patients who underwent radical prostatectomy, with preoperative assessments using both transrectal ultrasound of the prostate (TRUS) and magnetic resonance imaging. Patients were divided into groups with and without SCC and further categorized into type 1 and type 2 stones based on the location and severity of the calculi. Statistical analysis included chi-square and independent sample t-tests, with p<0.05 considered significant.

RESULTS

Of the patients, 82.2% were diagnosed with SCC. No significant difference in PUA was found between patients with and without SCC. However, a notable disparity in IPP presence was observed, suggesting an inverse correlation with SCC development. Additionally, no significant differences were identified when comparing the two types of SCC based on PUA and IPP measurements.

CONCLUSIONS

The presence of IPP exhibited an inverse relationship with SCC, suggesting diminished urine flow pressure over the prostatic urethra may reduce the likelihood of SCC formation. However, no direct association between PUA and the presence or severity of SCC was identified. These findings highlight the complexity of factors contributing to prostatic calculi development and the potential role of IPP in this context.

Associated Factors for Prostate Enlargement in Chinese Adult Men Aged <40 Receiving Checkups

PURPOSE

Prostate enlargement (PE) is an increase in prostate volume in morphology. PE was also observed in some patients aged <40 with chronic prostatitis. This study aimed to explore the associated factors for PE in Chinese adult men aged <40.

METHODS

The medical records of 1851 consecutive Chinese adult men aged <40 in a single center were retrospectively analyzed. The checkup indicator characteristics between the PE and non-PE groups were compared by univariate analysis, and the associated factors were analyzed by multivariate analysis.

RESULTS

The overall prevalence of PE (defined as prostate volume ≥ 20 ml) in adult men aged < 40 was 10.4%. Age and the proportions of subjects with prostate calcification or hypertension were different between the PE and non-PE groups (P < 0.05). Multivariate logistic analysis showed that prostate calcification (odds ratio [OR], 1.831; 95% confidence interval [CI], 1.281-2.619; P=0.001), hypertension (OR, 1.528; 95% CI, 1.125-2.076; P=0.007), and age (OR, 1.117; 95% CI, 1.078-1.159; P < 0.001) were associated factors for PE in adult men aged <40.

CONCLUSIONS

The prevalence of PE in Chinese adult check-up men aged <40 was not rare. In addition to age, prostate calcification and hypertension were associated factors for PE in Chinese adult men aged <40.

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.

Clinical Correlation of Prostatic Calculi With Semen Parameters in Adult Men With Fertility Intention

To investigate the correlation of prostatic calculi (PC) with semen parameters in men with fertility intention, this retrospective case-control study enrolled 1,303 participants ranging from 20 to 59 years old; 725 were diagnosed with PC using abdominal ultrasonography. Patients with PC were classified into the type A calculi group (discrete and small echoes) and type B calculi group (coarse and large masses of multiple echoes). Five hundred and seventy-eight men without PC were recruited for the control group. The clinical data of each group were collected and analyzed. The total motility was significantly lower for subjects with type B calculi (41.84% ± 17.50%) than for subjects in the type A calculi (51.78% ± 20.84%; p < .001) and control (54.47% ± 20.74%; p < .001) groups. The percentage of progressively motile was significantly lower for the type B calculi (31.66% ± 14.68%) group than the type A calculi (40.17% ± 17.09%; p < .001) and control (41.83% ± 17.05%; p < .001) groups. The results of the hypo-osmotic swelling test yielded significantly lower percentages in the type B calculi group (59.88% ± 17.13%) than the type A calculi (65.28 ± 14.43%; p = .005) and control (66.92 ± 16.12%; p < .001) groups. The type B calculi group had a significantly higher percentage of round cell concentration than control (4.5% vs. 1.0%; p = .007) did. Small and discrete PC may not influence semen quality among adult men with fertility intention, but larger and coarser PC are associated with decreased sperm motility.

Automatic matching using intraprostatic calcifications as a volume of interest in CBCT images during prostate radiotherapy: a comparative study

Aim:

The study aimed to assess the clinical feasibility of employing an automatic match during cone beam computed tomography (CBCT) imaging using prostatic calcifications within the 95% isodose set as the region of interest.

Materials and methods:

CBCT images were analysed on the 5th fraction in 34 patients evaluating the difference between standard manual soft tissue anatomy matching versus auto calcification matching. An assessment of the clinical feasibility of using prostatic calcifications during matching alongside considering the effect a more automated matching process has been conducted on interobserver variability.

Results:

The standard deviation values of the difference between the soft tissue match (baseline) versus automatic calcification matches fluctuated around 1 mm in all three axes for all of the matches carried out. The interobserver variability observed between the two radiographers was 0·055, 0·065 and 0·045 cm in the vertical, longitudinal and lateral axes, respectively.

Findings:

The clarity of the calcifications on the CBCT images might explain the low interobserver variability displayed by the two matching radiographers. A calcification provides a clear starting point for image matching before commencing a check of volumetric coverage, if the matching process begins in the same place, it can allow for a standardisation of matching technique between radiographers.

Predictors Of Postoperative Lower Urinary Tract Symptoms Improvements In Patient With Small-Volume Prostate And Bladder Outlet Obstruction

Objective

To explore the factors associated with improvement of lower urinary tract symptoms (LUTS) after transurethral plasmakinetic enucleation of the prostate (PKEP) and transurethral resection of the prostate (TURP) in patients with a small-volume prostate and bladder outlet obstruction (BOO).

Methods

The clinicopathologic data of 257 patients with BOO and a small-volume prostate from January 2013 to January 2018 were retrospectively collected preoperatively, 3 months postoperatively, and 12 months postoperatively. Patients were divided into postoperative success and failure groups based on the IPSS, IPSS-v, and IPSS-s. The relationship between each parameter and the improvement of postoperative LUTS was analyzed. Subgroup analysis was performed to compare the differences between the TURP and PKEP groups.

Results

Among patients followed up for 3 months postoperatively, multivariate analysis demonstrated that IPP, PUA, and post-PCB were significant predictors of postoperative IPSS improvement; TZI, IPP, and PUA were significant predictors of postoperative IPSS-v improvement; post-PCB and the surgical procedure were significant predictors of IPSS-s improvement; and IPP and PUA were significant predictors of postoperative Qmax improvement. Among patients followed up for 12 months postoperatively, multivariate analysis revealed that IPP, PUA, and post-PCB were significant predictors of postoperative IPSS improvement; PUA was a significant predictor of postoperative IPSS-v improvement; post-PCB was a significant predictor of IPSS-s improvement; and IPP and PUA were significant predictors of postoperative Qmax improvement. The post-PCB was significantly lower in the PKEP than the TURP group and the prostatic calculi removal rate was significantly higher in the PKEP than the TURP group.

Conclusion

Patients with a greater preoperative IPP and PUA and smaller post-PCB showed greater improvement of postoperative LUTS. PKEP might help to remove calculi from between the transitional and peripheral zones of prostate. Compared with conventional TURP, PKEP may improve the early postoperative storage symptoms of LUTS in patients with a small-volume prostate and BOO.

Current Knowledge of the Potential Links between Inflammation and Prostate Cancer

Inflammation is inherent in prostatic diseases and it is now accepted that it may facilitate cellular proliferation in both benign and malignant conditions. The strong relationship between prostatic inflammation and pathogenesis of benign prostatic hyperplasia (BPH) is supported by epidemiologic, histopathologic and molecular evidence. Contrariwise, the role of inflammation in prostate carcinogenesis is still controversial, although current data indicate that the inflammatory microenvironment can regulate prostate cancer (PCa) growth and progression. Knowledge of the complex molecular landscape associated with chronic inflammation in the context of PCa may lead to the introduction and optimization of novel targeted therapies. In this perspective, evaluation of the inflammatory component in prostate specimens could be included in routine pathology reports.

Prostate calcifications: A case series supporting the microbial biofilm theory

PURPOSE

Prostate calcifications are a common finding during transrectal prostate ultrasound in both healthy subjects and patients, but their etiopathogenesis and clinical significance are not fully understood. We aimed to establish a new methodology for evaluating the role of microbial biofilms in the genesis of prostate calcifications.

MATERIALS AND METHODS

Ten consecutive patients who had undergone radical prostatectomy were enrolled in this study. All of the patients presented with prostate calcifications during transrectal ultrasound evaluation before surgery and underwent Meares-Stamey tests and clinical evaluation with the National Institutes of Health Chronic Prostatitis Symptom Index and the International Prostate Symptom Score. At the time of radical prostatectomy, the prostate specimen, after removal, was analyzed with ultrasonography under sterile conditions in the operating room. Core biopsy specimens were taken from the site of prostate calcification and subjected to ultrastructural and microbiological analysis.

RESULTS

The results of the Meares-Stamey test showed only 1 of 10 patients (10%) with positive cultures for Escherichia coli. Two of five patients (40%) had positive cultures from prostate biopsy specimens. Enterococcus faecalis, Enterococcus raffinosus, and Citrobacter freundii were isolated. Ultrastructural analysis of the prostate biopsy specimens showed prostate calcifications in 6 of 10 patients (60%), and a structured microbial biofilm in 1 patient who had positive cultures for E. faecalis and E. raffinosus.

CONCLUSIONS

Although the findings are supported by a low number of patients, this study highlights the validity of the proposed methodology for investigating the role of bacterial biofilms in the genesis of prostate calcification.

The burden of prostatic calculi is more important than the presence

Prostatic calculi are a common finding on transrectal prostate ultrasound. However, it remains unclear whether they are significantly associated with lower urinary tract symptoms (LUTS). Our objective was to evaluate the association between prostatic calculi and LUTS with a focus on “calculi burden” because no studies have investigated prostatic calculi using “calculi burden” as an indicator. A total of 606 participants who received transrectal prostate ultrasound were divided into two groups according to the presence of prostatic calculi. “Calculi burden” was defined as the sum of the transverse diameters of all visible calculi within the prostate. The International Prostatic Symptom Score (IPSS) and a quality of life (QoL) score were collected. Both groups were compared, and a multivariate analysis was performed to predict moderate/severe LUTS. Linear correlation was evaluated between calculi burden and IPSS in the calculi group. No differences in total IPSS, voiding IPSS, or QoL score were detected between the two groups, but storage IPSS was significantly higher in the calculi group than that of controls. The multivariate analysis showed that the presence of prostatic calculi was not an independent predictor of moderate/severe LUTS. A positive linear correlation was detected between calculi burden and storage IPSS in calculi group (r = 0.148). However, no correlation was found between calculi burden and total IPSS, voiding IPSS, or QoL score. Our results showed that the presence of prostatic calculi was not a significant factor predicting moderate/severe LUTS. However, an increased calculi burden may be associated with aggravating storage symptoms.

Prostatic Calculi: Do They Matter?

INTRODUCTION

Prostatic calculi (PC) are frequently detected at computed tomography or ultrasound in men attending the health center or the urology outpatient department. PC have attracted more attention from urologists, but the clinical significance of PC is unknown.

AIM

To review the available literature on the effects of PC on prostatic diseases and sexual function in men.

METHODS

Relevant clinical trials were identified by searching the PubMed, Embase, and Cochrane Library databases. Results were classified, summarized, and analyzed.

MAIN OUTCOME MEASURES

Transabdominal and rectal ultrasonography; urodynamics analysis; International Prostate Symptom Score; pathologic examination of prostatic tissue; prostate-specific antigen; and expressed prostatic secretion.

RESULTS

PC can not only prolong the duration of bothersome symptoms but also decrease the cure rate of antibacterial therapy in patients with chronic prostatitis. Patients with PC usually have more severe lower urinary tract symptoms (LUTS), and some studies reported that moderate to marked PC are a predisposing factor for moderate to severe LUTS. Studies also reported that the serum level prostate-specific antigen is not influenced by PC. In addition, the presence of PC is not associated with an increased risk of prostate cancer. However, the correlation between PC in the peripheral zone and prostate cancer is statistically significant. In addition, the association between PC and Gleason scores is controversial. Some novel studies suggested that PC might play an important role in sexual impairment in middle-age men or men with chronic pelvic pain syndrome or chronic prostatitis. Recently, PC were found to increase the incidence of severe LUTS, urinary retention, and hematospermia after transrectal ultrasound-guided prostate biopsy.

CONCLUSION

PC can aggravate LUTS, chronic prostatitis, and sexual dysfunction in men, but the association between PC and prostate cancer is still controversial. Cao J-J, Huang W, Wu H-S, et al. Prostatic Calculi: Do They Matter? Sex Med Rev 2018;6:482-491.

Is periurethral calcification associated with urinary flow rate and symptom severity in men with lower urinary tract symptoms-benign prostatic hyperplasia? A retrospective review

OBJECTIVE

To evaluate the association of periurethral calcification (PUC) with urine flow rate and symptom severity in men with lower urinary tract symptoms-benign prostatic hyperplasia (LUTS-BPH).

METHODS

The records of 1199 LUTS-BPH patients were obtained from a prospectively maintained database of men on their first visit from April 2010 to April 2013. Patients with incomplete data or comorbidities affecting voiding function were excluded. The degree of PUC was scored by evaluating the ratio of the calcified urethra to the entire prostatic urethra on the midsagittal plane of a transrectal ultrasonogram. The relationships between prostate-related parameters, International Prostate Symptom Score (IPSS), and uroflowmetric parameters were evaluated.

RESULTS

A total of 1030 patients were eligible for final analysis. There were 654 patients (63.5%) with no PUC, 233 (22.6%) with mild PUC, and 143 (13.9%) with moderate to severe PUC. The total IPSS was 16.21 ± 7.29, 17.74 ± 7.77, and 17.75 ± 7.60 in no, mild, and moderate to severe PUC groups, respectively (P = .007), whereas peak urinary flow rate (Qmax) was 15.05 ± 7.59, 13.62 ± 6.68, and 12.20 ± 6.39 mL/s, respectively (P <.001). In an age-adjusted partial correlation test, PUC significantly associated with total IPSS, the storage symptom score, and Qmax (P <.05). Multivariate analysis revealed that PUC independently associated with Qmax (P = .012), total IPSS (P = .042), and the storage symptom score (P = .018) but not with postvoid residue, the voiding symptom score, or the postmicturition symptom score.

CONCLUSION

PUC is independently associated with Qmax and urinary symptoms indirectly advocating for the recent idea that periurethral fibrosis and stiffness could cause LUTS-BPH in men.

Quality of life of postmenopausal women and their spouses: a community-based study

BACKGROUND

Most women spend more than one-third of their lives after menopause. Due to physiologic changes in that period, menopause can cause a series of symptoms such as vasomotor symptoms, psychologic problems, and sexual dysfunction, which can affect the women's quality of life (QoL) and other family members, especially their spouse.

OBJECTIVES

The present study aimed to determine the association between the QoL of postmenopausal women and their husbands.

PATIENTS AND METHODS

This descriptive-inferential cross-sectional study was conducted according to the census of 2006 in Iran. A total of 400 postmenopausal women aging 50 to 59 years and their spouses in 80 cluster heads of Ilam City residents were selected and studied in collaboration with the Statistical Center of Iran. The required data were gathered using the short-form health survey (SF-36) questionnaire and demographic questionnaire developed by the researcher-trained interviewers. Data were analyzed by SPSS 18 through Kruskal Wallis test, Wilcoxon signed ranks test, and correlation.

RESULTS

The participants' mean age was 54.2 ± 2.8 years for women and 61.1 ± 6.1 years for their spouses. More than half of the women (57%) and about one-third of men (32.8%) were illiterate. The employed educated women aging 50 to 54 years had a higher mean score of SF-36 domains. The difference in education was significant in all domains except for mental health. There was a significant difference in age in all domains except in general health. The mean score of all domains of QoL was significantly less in the illiterate men than in the literate ones (P < 0.05). The results of the present study showed a significant correlation (P < 0.05) between the couples' QoL, vasomotor symptoms, and aging. Spearman test showed a significant positive correlation in all domains of QoL between postmenopausal women and their spouses (correlation coefficient, 0.48-0.63).

CONCLUSIONS

Based on the results of the present study and other performed studies in this regard, menopause, aging, vasomotor symptoms, and education had significant association with the QoL of postmenopausal women. The reduced QoL in postmenopausal women could eventually lead to the reduced QoL of their spouses. Therefore, it is necessary to plan for the education of these women and their husbands to broaden their understanding of the changes of menopause and ways to improve their QoL.