Editorial Commentary

Abstract

Song N-H, Wu H-F, Xu N-C, Yang J. The composition and structure of stones in enlarged prostatic utricles (EPU). J Androl. 2012;33:45–49. Song et al (2012) evaluated the composition, morphology, and structure of enlarged prostatic utricle (EPU) stones by using scanning electron microscopy, x-ray diffraction analysis, and Fourier transformation infrared spectral analysis. They showed 2 significant results: EPU calculi should belong to the category of prostatic pseudocalculi. EPU calculi were not caused by the abnormal change of urine composition, but should be ascribed to continuously concentrated EPU liquid by absorption of capsule walls and calculous matrix mainly coming from deciduous epithelial cells of EPUs. The authors have importantly focused our attention on urogenital system stones, particularly prostatic calculi. The research of prostatic calculi pathophysiology, formation, and clinical implication are extremely recent and fascinating. In particular, I'd like to stress a specific aspect: the role of amorphous matrix. The authors find that calculous matrix mainly came from deciduous epithelial cells of EPUs, but they didn't carry out bacterial cultures for calculi because the preservation time of some stones was too long. Some authors have stated that the calculus matrix is a kind of mucoprotein compound that may come from the organic matter of bacterial debris (Saita et al, 2007). Recently, Mazzoli (2010) showed that prostatic calcifications consisted of bacteria-like forms similar to the species isolated from biological materials and calcifications of patients, highlighting that bacterial strains able to produce biofilms consistently are present in chronic bacterial prostatitis. Moreover, the change observed in the pH value in EPUs should be taken into account, because of the fact that some bacteria, such as Mycoplasmata (Ureaplasma urealyticum), are able to change pH value by means of their urease production ability (Kaya et al, 2003). This aspect should support the theory that bacteria are implicated in genitourinary calculi formation. Finally, the role of anti-inflammatory therapy purposed by the authors should be highlighted. Anti-inflammatory drugs are routinely used in the treatment of prostate inflammatory disease with poor results. However, even if no bacteria were detected in EPU calculi, I believe that fluoroquinolone drugs should have a relevant impact in the treatment of symptoms because of inflammation, with subsequent improvement of patients' quality of life. Indeed, some quinolones are able to decrease the level of some proinflammatory cytokines, such as interleukin (IL)-6 or IL-8, with a subsequent reduction of tissue inflammation (Tsivkovskii et al, 2010). Our group recently found that prulifloxacin shows a pharmacological superiority in mucosal immunoglobulin A and IL-8 levels decreasing if compared to Doxiclin in a group of patients affected by chronic prostatitis due to Chlamydia trachomatis infection (Cai et al, 2010). Moreover, the effect on proinflammatory cytokines should reduce the chronic stimuli and control the inflammation with a subsequent relief of symptoms. In conclusion, the way to total comprehension of genitourinary calculi and their related symptoms is still long, but this kind of research allows us to make a little step in a good direction.