Treatment of benign prostatic hyperplasia by occlusion of the impaired urogenital venous system - first experience.

Purpose: To effect regression of benign prostatic hyperplasia (BPH), Gat et al. (Andrologia 2008) proposed to occlude incompetent spermatic veins to reduce increased hydrostatic pressure on the prostatic venous plexus and prevent reflux with androgen rich blood from the testicles. Our aim was to implement this treatment strategy in clinical practice and to report about first results.
Methods: Embolization of the spermatic veins was performed in 30 patients with BPH. In 16 patients, we obtained follow-up data from at least 6 months. The sonographic transabdominal prostatic volume, prostate-specific antigen (PSA) and peripheral total testosterone levels were determined before and 6 months after the intervention. Subjective symptomatology was assessed using standardized questionnaires (International Prostate Symptom Score [IPSS] and Quality of Life score [QoL]) before and 6 months after the procedure.
Results: The age of all treated patients was 46 - 77 years. The age of the 16 patients who received follow-up was 51 - 77 years. IPSS (median 18 [IQR 20.75 - 14.50] vs. 9 [IQR 11.00 - 7.25], p < 0.0001) and QoL score (4 [IQR 5 - 3] vs. 2 [IQR 3 - 1], p < 0.001) were significantly decreased 6 months after the intervention. The subjective improvement of symptoms did not correspond with prostatic volumes, which did not change significantly (54.31 ± 30.90 vs. 50.50 ± 29.26 ml, p = n. s.). 4/16 patients had a measurable post-void urine volume, which decreased in two patients 6 months after the procedure, remained unchanged in one patient, and was no longer detectable in one patient. 4 of the 11 had a sonographically detectable varicocele before the intervention, and one patient had a trabeculated bladder. Both the peripheral total testosterone levels (4.55 ± 1.27 vs. 3.93 ± 1.00 ng/ml; p = n. s.) and PSA levels (3.74 ± 2.83 vs. 4.06 ± 3.34 ng/ml; p = n. s.) showed no significant differences.
Conclusion: Interventional occlusion of the spermatic veins in patients with BPH is a feasible outpatient procedure with a low complication rate. Intermediate results are satisfactory. Mid- and long-term results and pathophysiologic mechanisms need to be further elucidated.
(© Georg Thieme Verlag KG Stuttgart · New York.)