Correlation of sonografic findings with clinical presentation and surgical management of prostatic lithiasis

Objectives: To investigate correlations between sonografic findings and clinical presentation as well as surgical management of prostatic lithiasis.

Methods: A number of 1870 males with low urinary tract symptoms (LUTS) or chronic pelvic pain syndrome were screened with ultrasound prostate imaging between 1987 and 2006. 581 cases with prostatic lithiasis were diagnosed. According to the severity of the symptoms, size and number of prostatic calculi and presence of complications, patients were divided in two therapeutic groups. The group with milder symptoms (181 patients –31%) was submitted to medical treatment while patients with severe symptoms (156 patients –27%) or complications (244 patients –42%) underwent endoscopic surgery.

Results: In the first group, short-term clinical improvements were recorded in 15% of the cases with fast relapse. As expected, no stone-free cases were observed with ultrasound imaging. In the surgically treated group major clinical improvements and fast recovery was obtained in most cases using transurethral resection of the prostate (TURP) for older patients with associated benign prostatic hyperplasia or ultrasound guided transurethral incision of the prostate (TUIP) with subsequent urethral drainage for younger patients.

Conclusions: Treatment decision in prostatic lithiasis should only be taken after correlating clinical presentation with sonografic findings. Ultrasound guided transurethral surgical treatment is most efficient and highly recommended for symptomatic prostatic lithiasis irrespective of the stone number or size. Medical treatment alone provides poor clinical improvements for these patients and should only be reserved as initial therapy for milder cases.

Key-words: Prostatic lithiasis, LUTS, ultrasound guided TUIP