Prospective evaluation of the association between varicocele and benign prostatic hyperplasia in men over 40 years of age

Role of varicocele sclerotherapy in the management of benign prostatic hyperplasia and its associated lower urinary tract symptoms (pilot study)

Background

Benign prostatic hyperplasia (BPH) is inescapable with aging and can cause lower urinary tract symptoms, worsening the quality of life. New pathophysiologic mechanisms of BPH development are currently under study to modulate its management. The valvular destruction of the spermatic veins (varicoceles development) incurs a testicular-prostatic hydrostatic pressure gradient, which conveys free undiluted testosterone to the prostate via a testicular-prostatic backdoor passage. Subsequently, prostatic congestion and androgen-dependent prostatic hyperplasia occur resulting in lower urinary symptoms development. The purpose of our study is to detect the effect of testicular venous sclerotherapy on the prostatic enlargement and the related urinary symptoms.

Results

Our single-arm interventional study included 36 patients with an age range of 40–80 years. The patients complained of urinary symptoms and had prostatomegaly with varicoceles by sonography. A median international prostatic symptom score (IPSS) of 19 and a quality of life (QoL) score ranging (3–6) reflected the severity of the urinary symptoms. Venography showed reflux in all cannulated spermatic veins with subsequent sclerotherapy on the left side and bilaterally in 80.6% and 11.1% of the patients, respectively. The technical and clinical success rates reached 91.7% and 83.3%, respectively, with a statistically significant reduction in the IPSS and QoL scores. We observed a statistically insignificant improvement in the sexual satisfaction, prostatic volumes, post-void residual volumes, and PSA levels. Minimal self-limiting complications occurred with an overall rate of 38.9%. Only 16.66% of cases needed further surgery, while the rest had sufficient symptomatic relief post sclerotherapy.

Conclusion

Varicoceles sclerotherapy can be employed to resolve the testicular venous insufficiency and mitigate the severity of the prostatic-related urological symptoms in middle-aged and elderly men, so varicoceles can be considered a confounding variable in the development of the prostatic-related lower urinary tract symptoms.