Clinical outcome after treatment of pelvic congestion syndrome: Sense and nonsense

2015 ◽  
Vol 30 (1_suppl) ◽  
pp. 73-80 ◽  
Author(s):  
MH Meissner ◽  
K Gibson
Keyword(s):  
Pelvic Pain ◽  
Transcatheter Embolization ◽  
Response To Treatment ◽  
Symptom Improvement ◽  
Inadequate Response ◽  
Pelvic Congestion Syndrome ◽  
Pain Scores ◽  
Embolic Agents ◽  
Vein Resection ◽  
Pelvic Congestion

Chronic pelvic pain accounts for approximately 10% of outpatient gynecologic visits and among the varied causes, pelvic congestion syndrome is second only to endometriosis in frequency. Manifestations may include pelvic pain, dyspareunia, dysuria, and dysmenorrhea as well as external varices and a number of psychosocial symptoms. Although a variety of treatments have been proposed—including pharmacologic ovarian suppression, hysterectomy with or without oophorectomy, and ovarian vein resection—transcatheter embolization is the least invasive and most efficacious management option. Complete or partial symptom improvement has been reported in 68.2–100% of patients and there has been a consistent reduction in visual analog pain scores after treatment. Based upon these results, recommendation of either pharmacotherapy or other surgical procedures is difficult to justify. However, it is also clear that 6–31.8% of patients do not get substantial relief from pelvic venous embolization. Potential explanations for an inadequate response to treatment include patient variability, procedural variability, and inadequate outcome measures. The latter are particularly important and future investigation should focus on the development of disease-specific quality of life measures as well as identifying those aspects of the procedure, such as choice of embolic agents and extent of embolization, associated with the best clinical outcomes.

Pelvic Congestion Syndrome: Surgical Treatment

2021 ◽  
Vol 8 (2) ◽  
Author(s):  
Zekilah SR ◽  
◽  
Sallam EM ◽  
Mashaal AB ◽  
Ageez MN ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Pelvic Pain ◽  
Varicose Veins ◽  
University Hospital ◽  
Pelvic Congestion Syndrome ◽  
Pain Scores ◽  
Internal Iliac ◽  
Work Up ◽  
Pelvic Congestion

Aims: To evaluate the mid and long term efficacy of surgical interruption of the refluxing ovarian veins as a treatment modality for pelvic congestion syndrome. Study Design: A prospective non comparative interventional study. Place and Duration of Study: This study was conducted between February 2015 and October 2019 in Alexandria Medical Centre and Tanta Main University Hospital. Methodology: The study included a 27 patient’s undergone surgical interruption of refluxing ovarian veins with or without sclerotherapy of vulval, perineal or thigh varices, and data were collected prospectively. Detailed history was taken and clinical examination was done for every patient along with routine laboratory investigations and radiological work up was transvaginal and abdominal venous duplex. Follow up was done considering the change in pelvic venous images and pelvic pain scores in comparison to the pre-operative state. Results: Twenty seven female patients were treated for pelvic congestion syndrome using single session surgical intervention with or without sclerotherapy to pudendal varices. The patients age ranged from 21 to 43 (mean 33.1). All patients presented with chronic continuous pelvic pain. Other associated symptoms as dyspareunia, dysmenorrhea and pudendal varices were found in some cases. Surgical ligation of the ovarian veins were done to all cases, sclerotherapy/ligation of internal iliac varices was done for 6 cases and scerotherapy or surgical interruption of pudendal or thigh varicose veins was done in 21 cases. Technical success was achieved in all patients. Mean pelvic pain score was improved from 7.33 preoperatively to 1.33 and 0.89 in 6 and 12 months of the post-operative recordings. On sonographic basis pelvic reflux disappeared in 26 patients by the end of the follow up. Out of 27 patients treated there were 24 patients satisfied of the procedures at the end of the follow up. Conclusion: Surgical treatment for pelvic congestion syndrome combined with sclerotherapy to the associated varices was found to be effective, safe and affordable modality of treatment.

How Does the Pathophysiology Influence the Treatment of Pelvic Congestion Syndrome and is the Result Long-lasting?

2012 ◽  
Vol 27 (1_suppl) ◽  
pp. 58-64 ◽  
Author(s):  
M Greiner ◽  
M Dadon ◽  
P Lemasle ◽  
P Cluzel
Keyword(s):  
Long Term Results ◽  
Cross Sectional ◽  
Pelvic Congestion Syndrome ◽  
Venous Anomalies ◽  
Embolic Agents ◽  
Cross Sectional Imaging ◽  
Pelvic Congestion

The objectives of this study are to consider the influence of pathophysiology in the treatment of pelvic congestion syndrome (PCS) and to determine the criteria which impact on the long-term results. A classification of venous pathology including three types of pathophysiological conditions, independent of the location of the pelvic venous pathology, is developed and illustrated. These types, diagnosed by cross-sectional imaging and confirmed by phlebography, are associated with a specific therapeutic plan. The long-term results are dependent on the quality of the initial Phlebographic mapping that must be selective and complete, the angiographic findings, in particular the study of collaterals feeding the venous anomalies, the treatment of all venous anomalies, the respect of contraindications, the use of appropriate materials and the occurrence of new pregnancies. In conclusion, the feasibility and satisfactory short-term results of endovascular treatment of PCS are admitted. Questions remain regarding the effectiveness of the different embolic agents and the long-term results of this treatment.

Compression treatment of pelvic congestion syndrome

2017 ◽  
Vol 33 (6) ◽  
pp. 418-424 ◽  
Author(s):  
SG Gavrilov ◽  
AV Karalkin ◽  
OO Turischeva
Keyword(s):  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Clinical Manifestations ◽  
Class Ii ◽  
Emission Computed Tomography ◽  
Compression Stockings ◽  
Pelvic Congestion Syndrome ◽  
Compression Treatment ◽  
Positive Effect ◽  
Pelvic Congestion

Aim To study the influence of compression treatment on clinical manifestations and venous hemodynamics of the pelvis in patients with pelvic congestion syndrome. Materials and methods A prospective study of the various options and modes of compression treatment was carried out and included 74 patients with pelvic congestion syndrome in 2008–2015. The patients were divided into three groups. The first group consisted of 48 patients with symptoms of pelvic congestion syndrome and chronic pelvic pain. They used Class II compression shorts. In the second group, there were 14 patients with pelvic congestion syndrome, vulvar varicosities without pelvic pain. They used Class II compression shorts and stockings. In the third group, 12 women with pelvic congestion syndrome and chronic pelvic pain used only the Class II compression stockings. The treatment continued for 14 days. A clinical criterion was the change of severity of chronic pelvic pain. The evaluation of the treatments has been performed using radionuclide venography and emission computed tomography with labeled in vivo red blood cells. Results Group 1: The compression shorts had a positive effect on the disease in 81.3% of patients. Chronic pelvic pain decreased from 6.4 ± 1.6 to 1.2 ± 0.7 points. The coefficient of pelvic congestion syndrome (Cpcs) decreased from 1.73 ± 0.32 to 1.12 ± 0.27 (p < 0.05). In 18.8% of patients, no positive effect was observed. Group 2: The results of radionuclide venographyshowed accelerating outflow of blood from the lower limbs and reduction of insufficiency of perforating veins. Mean radionuclide transit time decreased in all patients in the tendon, muscle pump parts, popliteal vein and was respectively: 23.6 ± 2.2 s, 29.6 ± 3.4 s, 32.3 ± 4.2 s and after treatment 16.4 ± 3.1 s, 22.1 ± 2.5 s, 25.7 ± 1.9 s (p < 0.05). Group 3: The use of compression stockings class II on the clinical manifestations of pelvic congestion syndrome in the patients. Cpcs also remained unchanged. Conclusion Research has shown the efficiency of class II compression shorts in the treatment of patients with isolated extension of intrapelvic venous plexuses. Class II compression stockings do not have any impact on the clinical manifestations of pelvic congestion syndrome.

Sensitivity and specificity of clinical findings for the diagnosis of pelvic congestion syndrome in women with chronic pelvic pain

2017 ◽  
Vol 33 (5) ◽  
pp. 303-308 ◽  
Author(s):  
Ana Lucia Herrera-Betancourt ◽  
Juan Diego Villegas-Echeverri ◽  
Jose Duván López-Jaramillo ◽  
Jorge Darío López-Isanoa ◽  
Jorge Mario Estrada-Alvarez
Keyword(s):  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Diagnostic Performance ◽  
Abdominal Mass ◽  
Clinical Score ◽  
Trigger Points ◽  
Clinical Findings ◽  
Diagnostic Tools ◽  
Pelvic Congestion Syndrome ◽  
Pelvic Congestion

Background Pelvic congestion syndrome is among the causes of pelvic pain. One of the diagnostic tools is pelvic venography using Beard’s criteria, which are 91% sensitive and 80% specific for this syndrome. Objective To assess the diagnostic performance of the clinical findings in women diagnosed with pelvic congestion syndrome coming to a Level III institution. Methods Descriptive retrospective study in women with chronic pelvic pain taken to transuterine pelvic venography at the Advanced Gynecological Laparoscopy and Pelvic Pain Unit of Clinica Comfamiliar, between August 2008 and December 2011, analyzing social, demographic, and clinical variables. Results A total of 132 patients with a mean age of 33.9 years. Dysmenorrhea, ovarian points, and vulvar varices have a sensitivity greater than 80%, and the presence of leukorrhea, vaginal mass sensation, the finding of an abdominal mass, abdominal trigger points, and positive pinprick test have a specificity greater than 80% when compared with venography. Conclusion This study may be considered as the first to evaluate the diagnostic performance of the clinical findings associated with pelvic congestion syndrome in a sample of the Colombian population. In the future, these findings may be used to create a clinical score for the diagnosis of this condition.

scholarly journals Pelvic congestion syndrome as a cause of chronic pelvic pain

2021 ◽  
Vol 15 (4) ◽  
pp. 451-460
Author(s):  
N. Yu. Novikova ◽  
V. I. Tsibizova ◽  
P. D. Puzdriak ◽  
E. V. Komlichenko ◽  
I. G. Tsnobiladze ◽  
...  
Keyword(s):  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Varicose Veins ◽  
Venous Pressure ◽  
Chronic Pelvic Pain Syndrome ◽  
Pain Syndrome ◽  
Pelvic Pain Syndrome ◽  
Clinical Criteria ◽  
Pelvic Congestion Syndrome ◽  
Pelvic Congestion

Altered pelvic venous circulation, which may occur due to pelvic venous congestion and varicose veins of the vulva, may be among the causes for developing chronic pelvic pain syndrome. Pelvic congestion syndrome (PCS) is characterized by chronic discomfort in the pelvic area, which may be aggravated during coitus or acquire orthostatic position, and result in severe dysfunction of the pelvic organs. Varicose veins of the vulva develop due to obstruction of the veins, increased venous pressure, and venous insufficiency in the pelvis. Varicose veins may be isolated or associated with varicose veins of the lower extremities. The diagnosis and treatment of such patients are limited by the lack of definitive clinical criteria for early diagnostics, which were discussed in the current study.

Pelvic congestion syndrome: chronic pelvic pain caused by ovarian and internal iliac varices

2007 ◽  
Vol 22 (3) ◽  
pp. 100-104 ◽  
Author(s):  
A D Liddle ◽  
A H Davies
Keyword(s):  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Significant Proportion ◽  
Duplex Ultrasound ◽  
Childbearing Age ◽  
Pelvic Congestion Syndrome ◽  
Non Invasive ◽  
Internal Iliac ◽  
Mechanical Factors ◽  
Pelvic Congestion

Chronic pelvic pain is a common and disabling condition affecting women of childbearing age. A specific diagnosis for the condition is often difficult, and referred pain from the abdominal viscera, neurogenic and psychogenic factors have all been implicated, as have pelvic conditions such as endometriosis, pelvic inflammatory disease and ovarian cysts; no diagnosis is made in 60% of patients. Pelvic congestion syndrome (PCS), the presence of varices of the pelvic veins, has been shown to be the underlying aetiology in a significant proportion of patients with chronic pelvic pain; the development of these varices is caused by a combination of endocrine and mechanical factors. Given the positional nature of these varices, they are rarely diagnosed with conventional methods such as B-mode ultrasound and diagnostic laparoscopy. Diagnosis is best made with selective ovarian venography, although newer, non-invasive methods such as magnetic resonance imaging and duplex ultrasound are increasingly gaining favour. Pelvic varices are eminently treatable, either using ovarian suppression or by the ligation or embolization of the pelvic veins.

Sign in / Sign up

Export Citation Format

Share Document