Is the presence of varicocele associated with static and dynamic components of benign prostatic hyperplasia/lower urinary tract symptoms in elderly men?

Abstract

Abbreviations & Acronyms BMI = body mass index BPH = benign prostatic hyperplasia CV = coefficient of variability IPSS = International Prostate Symptom Score LUTS = lower urinary tract symptoms PSA = prostate-specific antigen PV = prostate volume Qmax = maximum flow rate t-PSA = total prostate-specific antigen t-testosterone = total testosterone Objectives: To evaluate the relationship between varicocele and benign prostatic hyperplasia/lower urinary tract symptoms in patients over the age of 40 years. Methods: A total of 1040 patients with benign prostatic hyperplasia/lower urinary tract symptoms were evaluated for prostate volume, testicular volume, testicular consistency, total testosterone, total prostate-specific antigen and body mass index. A questionnaire including International Prostate Symptom Score and a uroflow test were also carried out. The presence and grade of varicocele was determined in each patient by physical examination. Results: Varicocele was found bilaterally in 22.3% and unilaterally in 25.7% of the patients. There was no difference in terms of age and body mass index distribution between subgroups. When grouping patients for varicocele laterality, total testosterone (P = 0.04), prostate volume (P = 0.009) and total prostate-specific antigen (P = 0.02) level were significantly different. Similarly, these parameters were significant between patients with grade 1, 2 and 3 varicocele. Total testosterone level (P = 0.02) and prostate volume (P = 0.035) were found to be significantly different when patients were grouped according to testicular size. A positive correlation was found between testosterone level and prostate volume (P = 0.004; r 2 = 0.084). Conclusions: Bilateral and/or higher-grade varicocele is associated with lower prostate volume and testosterone levels, as well as lower prostate-specific antigen levels. However, it is not associated with dynamic components of benign prostatic hyperplasia/lower urinary tract symptoms in patients over the age of 40 years.

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

“…In contrast with Gat's theory, some authors dispute the causal relationship between varicocele and BPH. Otunctemur et al prospectively studied 1,040 patients older than 40 years with BPH and found that bilateral varicocele was associated with a lower prostate volume (Otunctemur et al., 2014). Strunk et al performed percutaneous embolisation of the spermatic veins in 30 patients with BPH and did not find a significant decrease in prostate volume after six months of follow‐up (Strunk et al., 2015).…”

Letter to the editor regarding the article “Varicocele is the root cause of BPH: Destruction of the valves in the spermatic veins produces elevated pressure which diverts undiluted testosterone directly from the testes to the prostate”

“…Very well-documented and schematised explanation of this phenomenon had attracted our attention. We also had carried out an observational study on the association between varicocele grade, laterality and prostate volume, prostate symptom score, PSA level (Otunctemur et al, 2014). Of course, being a cross-sectional analysis, our study had limited knowledge of the cause and effect relationship between varicocele and BPH, but the results were not similar.…”

Editorial Comment from Dr Zampieri to Is the presence of varicocele associated with static and dynamic components of benign prostatic hyperplasia/lower urinary tract symptoms in elderly men?

“…One of the possible mechanisms is that varicocele can affect testicular Leydig cells function and result in a reduction of testosterone production. 1 Benign prostatic hyperplasia is a major disease among aging men, and its etiology is not clear. 2 In this interesting study, Otunctemur et al investigated the association between varicoceles and benign prostatic hyperplasia/ lower urinary tract symptoms in patients over the age of 40 years.…”