Advances of Laparoscopy for the Diagnosis of Pelvic Congestion Syndrome.

Christos Arnaoutoglou,Aris Ioannidis,Nikolaos Machairiotis,Rita S Variawa,Paul Zarogoulidis

doi:10.3390/medicina57101041

Abstract

The objective of this review is to describe the effectiveness of laparoscopy in the diagnosis and treatment of pelvic congestion syndrome (PCS). PCS is a cause of chronic pelvic pain (CPP) and is associated with dysfunction of the pelvic venous system. PCS is more common in women of reproductive age, and hormonal changes are associated with its development along with other reasons (e.g., working and living habits). There is an urgent need to establish an effective algorithm for the diagnosis and treatment of CPP, which could have a dramatic effect in patients’ everyday life. This algorithm should be able to overcome known issues that lead to the underdiagnosis of PCS, such as the overlap of its symptoms with other diseases. Here, we present our findings from literature articles about the methods used in practice today for the diagnosis of this syndrome. We also compare the methods to propose the most promising technique for providing a diagnosis with high accuracy. In our understanding, laparoscopy is superior when compared to other methods. It can provide a diagnosis of PCS while excluding or identifying other comorbidities and can also lead toward the next steps for the treatment of PCS.

Highlights

Pelvic congestion syndrome (PCS) is a condition that refers to dysfunction of the pelvic venous system
Non-invasive and invasive imaging techniques are the primary tool for the diagnosis of pelvic congestion syndrome (PCS), which include ultrasound (US) assessment, transabdominal duplex ultrasound, transvaginal duplex ultrasound and duplex ultrasonography, catheter-directed selective venography and intravascular ultrasound-cross-sectional computed tomography (CT), magnetic resonance venography (MRV), and laparoscopy [25]
CT scans and MRV are usually used in combination to determine the underlying cause of pelvic pain

Summary

Introduction

Pelvic congestion syndrome (PCS) is a condition that refers to dysfunction of the pelvic venous system The cause of this condition is pelvic vein insufficiency, which results in the abnormal dilation of the interlinked venous channels of the ovarian veins and the internal iliac veins. Pelvic varices occur in the ovarian veins in most of the cases and 60% of these are diagnosed with PCS In these cases, incompetency of the internal pudendal and broad ligament parametrial branches has been reported [1]. It may arise due to the absence of the venous valves or the incompetency of the valves This may be associated with the alteration of any characteristic of the valvular system that causes its failure (e.g., elasticity of the vein wall, valvular dilation, venous valves). PCS refers to ovarian veins and lower extremity pelvic pain

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Conclusion