What is the role of intraprostatic ductal reflux and prostatic calculi in the pathogenesis of chronic bacterial prostatitis (CBP)?

Updated: Jan 15, 2019
  • Author: Samantha D Kraemer, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

Intraprostatic ductal reflux and prostatic calculi 

  • The peripheral zone of the prostate is composed of a system of ducts with a poor drainage system, which prevents the dependent drainage of secretions and makes that zone the most susceptible to reflux. As the prostate enlarges with age, the poorly draining ducts can become obstructed and reflux. [14]
  • High-pressure dysfunctional voiding from anatomic or neurophysiologic obstruction may result in reflux in addition to contributing to symptoms of prostatitis with development of chronic pain.
  • Pathogenic bacteria can directly enter the prostate via ascending urethral infection with refluxing urine and may exist as aggregates protected by prostatic calculi. 
  • Refluxing urine, even when sterile, may cause chemical irritation and initiate tubule fibrosis and prostatic stone formation, which then can lead to intraductal obstruction and stagnation of intraductal secretions. Prostatic stones and stagnant fluid can serve as a nidus for relapsing infections and prostatitis.
  • Prostatic calculi are generally evidence of intraprostatic reflux because they are composed of substances only found in urine and not in secretions from the prostate. They serve as a source of bacterial colonization allowing bacterial to aggregate or form biofilms leading to recurrent UTIs despite adequate antimicrobial therapy. 
  • Prostatic calculi are also common in men with chronic inflammatory prostatitis, compared with men without prostate inflammation. [15]

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