Prostatic calculi in men with chronic prostatitis and chronic pelvic pain syndrome: A systematic review (2015-2025)

Prostatic calculi are frequently detected on transrectal ultrasound (TRUS) and computed tomography (CT), yet their clinical relevance in prostatitis remains uncertain. To systematically evaluate the association between prostatic calculi and prostatitis-related outcomes in adult men. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review was conducted. PubMed, Ovid Embase, CINAHL, and Google Scholar were searched for studies published between January 1, 2015 and October 31, 2025. Eligible studies assessed prostatic calculi by presence, burden, location, or density and compared outcomes with men without calculi or with lower burden. Outcomes included prostatitis diagnoses, validated symptom measures (National Institutes of Health-chronic prostatitis symptom index [NIH-CPSI], International Prostate Symptom Score [IPSS], International Index of Erectile Function - 5), inflammatory markers, and treatment response. Risk of bias was assessed using the Critical Appraisal Skills Programme tool. A total of 198 records were identified, of which 10 studies were included. Most were cross-sectional, with one prospective CP/chronic pelvic pain syndrome cohort. Greater calcification burden and peri-urethral distribution were associated with higher NIH-CPSI and IPSS scores and less favorable symptom improvement following medical therapy. CT-based cohorts reported associations between higher-density calculi and worse lower urinary tract symptoms, erectile dysfunction, pelvic pain, and reduced quality of life. A prostatectomy series demonstrated bacterial biofilm within calcifications, providing biological plausibility. Prostatic calculi - particularly when extensive or peri-urethral - are associated with increased symptom burden and may identify men with more refractory disease. However, current evidence is observational and heterogeneous, with incomplete confounder control. Standardized imaging classifications and prospective studies are required to clarify causal relationships and inform management strategies.