Patient's question:
Prostatic calculi, what impact do they have on the body.Doctor's answer:
In layman's terms, prostate stones refer to stones that form in the prostate gland. Humans have been aware of this condition since as early as 1586. Strictly speaking, prostate stones are true stones that form either primordially or endogenously within the prostate glandular acini and ducts. These stones can be as small as millet grains or as large as peas, and may be round, oval, or polyhedral in shape. The number of stones can range from one to hundreds, and they are typically brownish-yellow, dark brown, or black in color. Small stones are often smooth, while large or multiple stones can occupy the entire glandular lumen and are hard in texture. These stones usually contain organic components such as proteins, cholesterol, and citric acid, and are completely different from ureteral stones, so they should not be confused. In some cases, prostate stones can break through the mucous membrane of the prostatic urethra and enter the urethra, and should be differentiated from ureteral stones. Prostate stones often hide a large number of bacteria, making them potential infection foci that store bacteria, while antibacterial antibiotics find it difficult to penetrate the stones to take effect.Prostate Stones [Edit Section]
Symptoms and Manifestations of Prostate Stones
Prostate stones often show no symptoms and only manifest symptoms when coexisting with other conditions. When accompanied by urethral stricture and benign prostatic hyperplasia, symptoms may include difficulty urinating, weak urine stream, dribbling urine, or urinary frequency. When coexisting with prostatitis, symptoms may include discomfort or pain in the lumbosacral region, scrotum, perineum, penis, pubis, abdomen, and rectum. Pain in the rectum may increase during defecation, and there may be secretions at the urethral meatus. Sitting on hard surfaces may exacerbate perineal pain. When coexisting with posterior urethritis and urinary tract infections, symptoms may include urinary frequency, urgency, and dysuria, sometimes with hematuria, particularly terminal hematuria.
The manifestations of prostate stones vary. Some may remain asymptomatic, earning them the nickname "quiet stones." However, this condition often coexists with benign prostatic hyperplasia, prostatitis, and urethral stricture, leading to clinical symptoms such as urinary frequency, urgency, hematuria, and difficulty urinating. These symptoms become more pronounced if infection is present. Other possible symptoms include dribbling urine, urinary retention, burning-like dysuria, radiating pain in the waist, perineum, or vaginal area, decreased libido, pain during ejaculation, hematospermia, and abnormal penile erections. Some small stones may spontaneously pass into the urine stream, causing dull pain in the perineum, vaginal area, and lower back before and after excretion. The presence of stones will eventually worsen glandular infection, with symptoms gradually intensifying. If stones lead to abscess formation and are left untreated, they may rupture into the urethra, rectum, or perineum, or even form fistulas above the pubis. This can result in severe perineal, rectal, and lower back pain, fever, and significant tenderness upon local digital rectal examination of the prostate.
Treatment:
For most small, numerous, asymptomatic stones discovered during routine X-ray examinations, treatment is often unnecessary. For symptomatic stones with mild infection, prostate massage and antibiotics can be used to control symptoms, followed by follow-up X-rays to monitor changes in stone size. When stones coexist with benign prostatic hyperplasia, transurethral resection of the prostate can be performed, with efforts made to remove the stones simultaneously. For large or numerous stones, perineal prostatectomy and stone removal may be required. Simple prostatectomy alone often leads to the formation of new stones within the prostatic cavity. When prostate stones are accompanied by chronic prostatitis and seminal vesiculitis, treatment should focus on symptomatic relief, including hot sitz baths, antibiotics, and urinary spasmolytics to alleviate posterior urethral irritation.
True prostate stones are relatively rare, and most do not require treatment. Even when symptoms are present, the prognosis is generally favorable, and surgery is rarely needed. Therefore, when diagnosed with prostate stones, there is no need to panic. Active treatment and regular follow-up are essential.
Diagnosis:
Since most prostate stones are asymptomatic, and symptoms that do appear are primarily due to coexisting conditions rather than specific manifestations of stones, clinical symptoms alone are insufficient for diagnosis. The main methods for diagnosing prostate stones include:
① Digital rectal examination: Stones can be palpated directly, with a grinding or crinkling sound, but this method is not highly accurate.
② Urethral scope examination: Inserting a urethral scope allows direct observation of the posterior urethra and prostatic duct openings. Digital rectal examination is then easier to detect the crinkling sound. If stones are directly observed protruding from the prostatic duct openings into the urethra or blocking the urethra, a definitive diagnosis can be made.
③ X-ray imaging: Observing the shadow of stones on X-rays can confirm the diagnosis. Most prostate stones are diagnosed through X-ray imaging, with common findings including:
(1) Prostate stones discovered during routine X-ray examinations.
(2) Stones found incidentally during X-ray examinations for benign prostatic hyperplasia.
Therefore, when prostate diseases are suspected, it is important to consider the possibility of coexisting prostate stones.