Background: The aim of this study was the development of quantitative assessment of prostatic calcifications at prostatic ultrasound examination by the use of an image analyzer. Materials and Methods: A group of 82 patients was evaluated by medical history, physical, and transrectal ultrasound examination. Patients had a urethral swab, a 4-specimen study and culture of the seminal fluid. Patients were classified according to National Institute of Diabetes and Digestive and Kidney Diseases/National Institutes of Health. Subjective symptoms were scored by Chronic Prostatitis Symptom Index (CPSI) questionnaire. Ultrasound images were analyzed by the digital processing software Image J to quantitatively assess the presence of calcifications. Results: Computer-assessed calcified areas were significantly higher in chronic bacterial prostatitis (n = 18; group II; 6.76 ± 8.09%) than in the chronic pelvic pain syndrome group IIIa (n = 26; 2.07 ± 1.01%) and IIIb (n = 38; 2.31 ± 2.18%). The area of calcification of the prostate was significantly related to the CPSI score for domains of micturition (r = 0.278, p = 0.023), Prostatic Specific Antigen values (r = 0341, p = 0.005), postvoiding residual urine (r = 0.262, p = 0.032), total prostate volume (r = 0.592, p = 0.000), and adenoma volume (r = 0.593; p = 0.000). Conclusions: The presence of calcifications is more frequently observed in patients with chronic bacterial prostatitis and is related to urinary symptoms.

Keywords:
Prostatic calcifications, Computer assisted image analysis, Prostatitis, Chronic pelvic pain syndrome
1.
Shoskes DA, Lee CT, Murphy D, Kefer J, Wood HM: Incidence and significance of prostatic stones in men with chronic prostatitis/chronic pelvic pain syndrome. Urology 2007; 70: 235–238.
2.
Soric T, Selimovic M, Bakovic L, Šimurina T, Selthofer R, Dumic J: Clinical and biochemical influence of prostatic stones. Urol Int 2017; 98: 449–455.
3.
Zhao WP, Li YT, Chen J, Zhang ZG, Jiang H, Xia D, Wang S, Wang P: Prostatic calculi influence the antimicrobial efficacy in men with chronic bacterial prostatitis. Asian J Androl 2012; 14: 715–719.
4.
Meares EM, Stamey TA: Bacteriologic localization patterns in bacterial prostatitis and urethritis. Invest Urol 1968; 5: 492–518.
5.
Krieger JN, Nyberg L Jr, Nickel JC: NIH consensus definition and classification of prostatitis. JAMA 1999; 282: 236–237.
6.
Litwin MS, McNaughton-Collins M, Fowler FJ Jr, Nickel JC, Calhoun EA, et al: The National Institutes of Health chronic prostatitis symptom index: development and validation of a new outcome measure. J Urol 1999; 162: 369–375.
7.
Propert KJ, Litwin MS, Wang Y, Alexander RB, Calhoun E, et al: Responsiveness of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI). Qual Life Res 2006; 15: 299–305.
8.
Khan SR, Glenton PA, Backov R, Talham DR: Presence of lipids in urine, crystals and stones: implications for the formation of kidney stones. Kidney Int 2002; 6: 2062–2072.
9.
Kavanagh JP: Sodium, potassium, calcium, magnesium, zinc, citrate and chloride content of human prostatic and seminal fluid. J Reprod Fertil 1985; 75: 35–41.
10.
Sutor DJ, Wooley SE: The crystalline composition of prostatic calculi. Br J Urol 1974; 46: 533–535.
11.
Torres Ramirez C, Aguilar Ruiz J, Zuluaga Gomez A, Espuela Orgaz R, Del Rio Samper S. A crystallographic study of prostatic calculi. J Urol 1980; 124: 840–843.
12.
Dessombz A, Meria P, Bazin D, Daudon M: Prostatic stones: evidence of a specific chemistry related to infection and presence of bacterial imprints. PLoS One 2012; 7:e51691.
13.
Zaichick VY, Sviridova TV, Zaichick SV: Zinc concentration in human prostatic fluid: normal, chronic prostatitis, adenoma and cancer. Int Urol Nephrol 1996; 28: 687–694.
14.
Chen J, Xu Z, Zhao H, Jiang X: Citrate in expressed prostatic secretions has the feasibility to be used as a useful indicator for the diagnosis of category IIIB prostatitis. Urol Int 2007; 78: 230–234.
15.
Kavanagh JP, Darby C, Costello CB: The response of seven prostatic fluid components to prostatic disease. Int J Androl 1982; 5: 487–496.
16.
Mazzoli S: Biofilms in chronic bacterial prostatitis (NIH-II) and in prostatic calcifications. FEMS Immunol Med Microbiol 2010; 59: 337–344.
17.
Eykyn S, Bultitude MI, Mayo ME, Lloyd-Davies RW: Prostatic calculi as a source of recurrent bacteriuria in the male. Br J Urol 1974; 46: 527–532.
18.
Razek AA, Elhanbly S, Eldeak A: Transrectal ultrasound in patients with hematospermia. J Ultrasound 2010; 13: 28–33.
19.
Doble A, Carter SS: Ultrasonographic findings in prostatitis. Urol Clin North Am 1989; 16: 763–772.
20.
Smith V: Prostatic corpora amylacea and their calcification. Surg Forum 1965; 16: 501–502.
21.
Sfanos KS, Wilson BA, de Marzoa AM, Isaacs WB: Acute inflammatory proteins constitute the organic matrix of prostatic corpora amylacea and calculi in men with prostate cancer. Proc Natl Acad Sci U S A 2009; 106: 3443-3448.
22.
Park SW, Nam JK, Lee SD, Chung MK: Are prostatic calculi independent predictive factors of lower urinary tract symptoms. Asian J Androl 2010; 12: 221–226.
23.
Hwang EC, Choi HS, Im CM, Jung SI, Kim SO, et al: Prostate calculi in cancer and BPH in a cohort of Korean men: presence of calculi did not correlate with cancer risk. Asian J Androl 2010; 12: 215–220.
24.
Ma J, Gharaee-Kermani M, Macoska JA: Prostatic fibrosis is associated with lower urinary tract symptoms. J Urol 2012; 188: 1375–1381.
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2018
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