Benign prostatic hyperplasia: the hypogonadal-obesity-prostate connection.

Prostatic enlargement occurs over the course of a lifetime and is associated with many risk factors. Recent observations demonstrate that valvular damage, occurring in the internal spermatic veins results in increased hydrostatic pressures that lead to venous backflow. Two consequences of venous backflow are the prolonged exposure to hydrostatic pressure and high testosterone levels that effect the prostate directly. Furthermore, aging and obesity related states have long been associated with BPH and diminished testosterone concentrations, which by itself, predisposes and allows for the preferential deposition of abdominal/visceral fat. The increasing abdominal obesity leads to elevated intra-abdominal pressure, which over time, causes increased venous pressure. Chronically elevated intra-abdominal venous pressure eventually causes progressive failure of the one way valves in the internal spermatic veins and venous insufficiency that leads to prostate damage. All of these factors promote conditions that cause chronic progressive prostatic disease and eventually BPH.