Multiple prostatic calculi: a case series and literature review

The reported prevalence of prostatic calculi / stones ranges from 7% to 99% and depends on patient age. Prostatic calculi are found in 9% of men aged 18 – 29 years, in 32.3% of those aged 50 – 59 years, and in 66.7% of those aged 70 – 79 years. Prostatic calculi associated with benign prostatic hyperplasia (BPH) are often asymptomatic and are usually detected incidentally during surgical treatment of BPH. Large or multiple calculi, as well as stones associated with chronic prostatic inflammation, may cause nonspecific lower urinary tract symptoms (LUTS). In addition, patients with prostatic calculi may present with hematuria, post‑micturition dribbling, urinary incontinence, and chronic pelvic pain syndrome. Prostatic calculi occurring in the setting of chronic inflammation of the gland can serve as a nidus for bacterial colonization and may promote the selection of microorganisms resistant to antimicrobial therapy. Asymptomatic calculi generally do not require specific treatment and are most often removed incidentally during surgery for prostate cancer. In symptomatic cases, the efficacy of conservative treatment, particularly antibiotic therapy, is limited because the stones themselves represent a persistent source of infection. Therefore, in such patients, the preferred management option, in combination with antibacterial therapy, is endoscopic removal. In this paper, we present our clinical cases in patients with multiple symptomatic and asymptomatic prostatic calculi and provide a review of the relevant literature.