Pelvic congestion syndrome and May-Thurner syndrome as causes for chronic pelvic pain syndrome: neuropelveological diagnosis and corresponding therapeutic options

Objective: To report on diagnosis and management of pelvic congestion including the May-Thurner syndrome (MTS) as potential etiologies for intractable pelvic neuropathic pain. Design: Retrospective study of women presented with intractable pelvic neuropathic pain, who had left sided venous uterine plexus above 6mm with reversed and slow flow on Doppler, with dilated arcuate veins passing through the uterine muscle. Those with suspicion of MTS underwent further radiological investigations and if applicable, endovascular interventions. Setting: Tertiary referral unit specialized in advanced gynaecological surgery and neuropelveology. Intervention: 61 consecutive patients were included. 14 with visceral pain presumed to be caused by Pelvic Congestion Syndrome were treated by ovarian vein embolization. An improvement of pain was observed in all patients – mean pain reduction of 3.93 points, from 7.21 (±1.42; 4-10) to 3.28 pts (±1.54; 1-6) over 6 months (p<0.01). 47 presented with pelvic somatic neuropathic pain; 19 underwent endovascular intervention (angioplasty, stenting) and finally all of them a laparoscopic exploration/decompression of the sacral plexus and the endopelvic portion of the pudendal nerves, with an overall VAS reduction from 8.56 (±1.1712;7-10) to 2.63 (±1.53; 0-6) at one-year-follow-up (p<0.01). Conclusion: Laparoscopic exploration/decompression of the nerves seems to be effective in a carefully selected group of patients. Endovascular interventions for pelvic somatic neuropathies may not be an effective treatment. We recommend that Doppler studies of the uterine vessels are performed as an extension to gynaecological examination in women with intractable pelvic pain.

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Pelvic congestion syndrome as a cause of chronic pelvic pain

Obstetrics Gynecology and Reproduction ◽

10.17749/2313-7347/ob.gyn.rep.2021.236 ◽

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.

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Treatment of patients with chronic pelvic pain syndrome: result of single-center follow up study

Herald Urology ◽

10.21886/2308-6424-2018-6-4-27-35 ◽

2019 ◽

Vol 6 (4) ◽

pp. 27-35

Author(s):

V. A. Kruglov ◽

F. R. Asfandiyarov ◽

S. N. Vybornov ◽

K. S. Seyidov

Keyword(s):

Neuropathic Pain ◽

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Pain Therapy ◽

Prostate Gland ◽

Chronic Pelvic Pain Syndrome ◽

Pain Syndrome ◽

Pelvic Pain Syndrome ◽

Perineal Region ◽

Inflammatory Changes

Introduction. Chronic pelvic pain syndrome is an urgent and widely discussed problem in the medical community. Despite the efforts made by a wide range of specialists, there is currently no universally accepted universal approach to the diagnosis and treatment of this condition. The article provides a description and results of applying its own approach to the management of patients with chronic pelvic pain syndrome.Purpose of research. The aim of the work was to improve the practical results of treatment of patients suffering from chronic pelvic pain syndrome.Materials and methods. The results of the examination and treatment of 46 men aged from 26 to 57 years are presented. The leading complaint of the patients was the long-term pain in the pelvic and / or perineal region. According to the survey results, 43.5% of patients showed signs of inflammation in the prostate gland, 56.5% showed no symptoms. Patients with proven inflammatory changes in the prostate gland were divided into two groups: the first group received the “standard” therapy of chronic prostatitis (antibiotics, prostate-tropic drugs, microcirculation and immunocorrection enhancers, physiotherapy), in the second group the patients received the “standard” treatment in combination with myofascial blockades and neuropathic pain therapy. Patients without inflammatory changes in the prostate were combined into a third group and received only myofascial blockade and neuropathic pain therapy.Results. Pain in chronic pelvic pain syndrome is most often localized in the perineal region and in the inguinal zones, while the presence or absence of a proven inflammatory component in the prostate gland does not significantly affect the localization and degree of pain, nor the assessment of quality of life. The pelvic myofascial syndromes are detected in the majority of patients with CPPS and their targeted correction in the framework of complex therapy has a positive effect on the results of patient treatment.Conclusions. Correction of musculo-tonic disorders in chronic pelvic pain syndrome was accompanied by a statistically significant reduction in pain on a 10-point numerical rating scale for pain, a decrease in the I-PSS index.

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PD01-11 SENSORY GLIAL GQ-GPCR SIGNALING ALLEVIATES VISCERAL PAIN AND IMPROVES MICTURITION FUNCTION IN AN ANIMAL MODEL OF UROLOGICAL CHRONIC PELVIC PAIN SYNDROME

The Journal of Urology ◽

10.1097/ju.0000000000001965.11 ◽

2021 ◽

Vol 206 (Supplement 3) ◽

Author(s):

Alison Xie ◽

Randall Meacham ◽

Anna Malykhina

Keyword(s):

Animal Model ◽

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Visceral Pain ◽

Chronic Pelvic Pain Syndrome ◽

Pain Syndrome ◽

Pelvic Pain Syndrome ◽

Gpcr Signaling

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Pelvic pain syndrome caused by ovarian varices

Acta Radiologica ◽

10.1080/02841859709172123 ◽

1997 ◽

Vol 38 (6) ◽

pp. 1023-1025 ◽

Cited By ~ 3

Author(s):

P. G. Tarazov ◽

K. V. Prozorovskij ◽

V. K. Ryzhkov

Keyword(s):

Chronic Pain ◽

Pelvic Pain ◽

Clinical Effect ◽

Pain Syndrome ◽

Therapeutic Embolization ◽

Pelvic Pain Syndrome ◽

Percutaneous Embolization ◽

Pelvic Congestion Syndrome ◽

Pelvic Congestion

Purpose: the aim of this study was to evaluate the clinical effect of therapeutic embolization in the pelvic congestion syndrome caused by ovarian varices Material and Methods: Six women, aged 25–40 years, with pelvic pain syndrome and marked left (n=5) or bilateral (n=1) ovarian varicocele were treated by transcatheter retrograde venous embolization Results: the pelvic pain syndrome disappeared in all patients within 4 weeks, and there was regression of the periodic pain in 2 women with dysmenorrhoea. the patients were free of symptoms during the 1–4-year follow-up Conclusion: Marked ovarian varices may cause a pelvic pain syndrome. Percutaneous embolization improves both the chronic pain and the dysmenorrhea in these patients. Transcatheter treatment could be considered as an alternative to surgical or laparoscopic ligation in ovarian varicocele

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