Varicocele: the origin of benign prostatic hypertrophy? Testosterone dosages in the periprostatic plexus

Caestecker, Karel De; Lumen, Nicolaas; Spinoit, Anne‐Françoise; Everaert, Karel; Fiers, Tom; Oosterlinck, Willem

doi:10.1179/2295333715y.0000000062

Cited by 4 publications

(4 citation statements)

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“…Our results are in the same line as the Otunktemur, Strunk and De Caesteker studies (De Caestecker et al., 2016; Otunctemur et al., 2014; Strunk et al., 2015). We did not find statistically significant differences in the percentage of clinical and subclinical varicocele between patients with prostates under 40 ml and patients with 40 ml or more.…”

Section: Discussionsupporting

confidence: 93%

“…Prostate growth in men over 40 years of age is a unique process as it occurs despite a progressive decrease in testosterone levels, a hormone that plays a preponderant role in stimulating stromal and epithelial growth of the gland (Feldman et al., 2002; Goren & Gat, 2018; Madersbacher et al., 2019; Roberts et al., 2004). This ‘paradox’ led Gat et al to formulate a hypothesis according to which the varicocele plays a predominant role in BPH development (De Caestecker et al., 2016; Gat & Goren, 2018; Gat et al., 2008; Goren & Gat, 2018). According to his theory, based on venographic studies, varicocele increases the hydrostatic pressure in the Santorini plexus, conditioning a flow of venous blood rich in testosterone through the deferential vein towards the pelvis.…”

Section: Discussionmentioning

confidence: 99%

“…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). In addition, De Caesteker measured the levels of testosterone in the periprostatic venous blood of patients undergoing prostatectomy with the Millin technique and compared them with those obtained from peripheral blood, obtaining higher concentrations in the first sample in only 2 of 7 patients who had varicocele and BPH (De Caestecker et al., 2016).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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We investigated the association between varicocele and benign prostatic hyperplasia in men over the age of 40 years. A total of 296 outpatients were evaluated. Prostate volume was measured with transrectal ultrasound. Varicocele was diagnosed by physical examination and ultrasound. Prostatic hyperplasia was defined as prostate volume greater than or equal to 40 ml. Two groups were compared: patients with prostate volume less than 40 ml and patients with prostate volume greater than or equal to 40 ml. There was a statistically significant difference between the groups in terms of mean age, post‐void residual, International Prostate Symptom Score and PSA. The percentage of patients with clinical varicocele in the group with a volume less than 40 ml and the group with a volume equal to or greater than 40 ml was 38.2% and 47.7% respectively (p = .12). There were no differences between the two groups in the percentage of patients with clinical or subclinical varicocele (43.2% vs. 52.2%, respectively, p = .12). No differences were found in the percentage of patients with varicocele when comparing men with prostates smaller than 40 ml and greater than or equal to 40 ml.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…Even low-grade varicoceles may undermine epididymal function causing infertility issues which might be apparent even when the spermiogram is normal (37). Another intriguing aspect lies on the intercommunication between the pampiniform and the periprostatic plexus (38,39). In the varicoceleassociated infertility, patients with deteriorated motility undergoing varicocelectomy might not experience improvement if the periprostatic plexus is apparently dilated which implicates the complexity in the pathophysiology of the condition (40).…”

Section: Discussionmentioning

confidence: 99%

Role of total motile sperm count in the evaluation of young men with bilateral subclinical varicocele and asthenospermia

Tsampoukas

Dellis

Katsouri

et al. 2020

Arch Ital Urol Androl

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Introduction: In comparison to its clinical analogue, the subclinical varicocele represents a questionable entity and specific guidelines for the optimal management are lacking. In our previous study of patients with subclinical varicocele, we showed that bilateral condition is associated with risk of dyspermia. In the present study, we evaluated the risk of deterioration of semen quality in men with bilateral disease and impaired motility according to WHO criteria. Materials and methods: Men with bilateral subclinical varicocele, not desiring fatherhood at the time of presentation, were included in study. During initial evaluation, the number of Total Motile Sperm Count (TMSC) was calculated and the patients’ age, total testicular volume (TTV), maximum venous size and mean resistive index (RI) of the intratesticular arteries were recorded. We classified the participants in five classes according to the TMSC reading: class A-: TMSC < 5 x 106, class A: TMSC between 5-10 x 106, class B: TMSC between 10-15 x 106, class C: TMSC between 15-20 x 106, and class D: TMSC > 20 x 106 per ejaculate. The participants were seen after 6 months for a repeat spermiogram and physical examination. If clinical varicocele was diagnosed or a new abnormality in the spermiogram was noted, the participants were excluded from the study. The remaining patients were allocated to two groups according to the repeat TMSC reading: patients sub-classified into a lower class (group 1), and patients remaining at the same class (group 2). A comparative analysis was performed between two groups. Results: Nineteen men were included. Nine patients were subclassified (group 1). Three patients moved to A- class (< 5 x 106). Ten patients remained in the same class having no deterioration (group 2). Comparing the two groups, no statistically significant difference was recognized for age, TTV, maximum venous size on both sides, and mean RI (p > 0.05). However, the initial reading for TMSC was 14.57 x 106 in group 1, and 22.84 x 106 in group 2, respectively. This difference was statistically significant (p < 0.05). Additionally, in a paired analysis there was a significant difference in TMSC after 6 months (p < 0.05), too. Summary Conclusions: Young men with bilateral varicocele and asthenospermia seem to be at risk of deterioration in their semen quality after a follow-up of 6 months. The measurement of TMSC can unmask patients at risk, whereas men with the lowest readings seem to be at highest risk for deterioration. The possibility of a worsening sperm quality should be considered in the appropriate clinical context.

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Interventionelle Therapie der benignen Prostatahyperplasie

Rauch

Strunk

2017

Radiologe

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Embolization of the testicular veins is a minimally invasive method for the treatment of BPH. The procedure can be performed in an outpatient setting. In the intermediate course up to 6 months after treatment, promising results were demonstrated in recent studies. Randomized studies, data on long-term results and comparisons to alternative methods (e. g. arterial prostatic embolization and surgical procedures) are missing.

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Varicocele: the origin of benign prostatic hypertrophy? Testosterone dosages in the periprostatic plexus

Abstract: Gat's theory, concerning the role of varicocele in the origin of BPH, could not be confirmed in this study. Technical limitations can be responsible for this.

Cited by 4 publications

References 10 publications

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

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

Role of total motile sperm count in the evaluation of young men with bilateral subclinical varicocele and asthenospermia

Interventionelle Therapie der benignen Prostatahyperplasie

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