Abstract
The gold standard for the diagnosis of pelvic congestion syndrome (PCS) is venography (VG), although transvaginal ultrasound (TVU) might be a noninvasive, nonionizing alternative. Our aim is to determine whether TVU is an accurate and comparable diagnostic tool for PCS. An observational prospective study including 67 patients was carried out. A TVU was performed on patients, measuring pelvic venous vessels parameters. Subsequentially, a VG was performed, and results were compared for the test calibration of TVU. Out of the 67 patients included, only 51 completed the study and were distributed in two groups according to VG results: 39 patients belonging to the PCS group and 12 to the normal group. PCS patients had a larger venous plexus diameter (15.1 mm vs. 12 mm; p = 0.009) and higher rates of crossing veins in the myometrium (74.35% vs. 33.3%; p = 0.009), reverse or altered flow during Valsalva (58.9% vs. 25%; p = 0.04), and largest pelvic vein ≥ 8 mm (92.3% vs. 25%). The sensitivity and specificity of TVU were 92.3% (95% CI: 78.03–97.99%) and 75% (95% CI: 42.84–93.31%), respectively. In conclusion, transvaginal ultrasonography, with the described methodology, appears to be a promising tool for the diagnosis of PCS, with acceptable sensitivity and specificity.
Highlights
Pelvic congestion syndrome (PCS) is one of the existing causes of chronic pelvic pain (CPP) in women, which consists of the dilation and stasis of the pelvic venous plexus
The Symptoms– Varices–Pathology (SVP) classification has been published for pelvic venous disorders, encompassing three domains: symptoms, varices, and pathophysiology, while including the anatomy of abdominal and pelvic veins associated with hemodynamic anomalies and etiology
Out of the 67 patients included, only 51 completed the study and were distributed in two groups according to the venography results: 39 patients belonging to the pelvic congestion syndrome (PCS) group (PCSG) and 12 to the normal group (NG)
Summary
Pelvic congestion syndrome (PCS) is one of the existing causes of chronic pelvic pain (CPP) in women, which consists of the dilation and stasis of the pelvic venous plexus. CPP is defined as the noncyclical pain in the hypogastric, lumbosacral, or perineal area, which lasts 6 months or longer It is quite an important health problem that causes up to 40% of referrals for gynecology units [1,2]. The Symptoms– Varices–Pathology (SVP) classification has been published for pelvic venous disorders, encompassing three domains: symptoms, varices, and pathophysiology, while including the anatomy of abdominal and pelvic veins associated with hemodynamic anomalies and etiology. This instrument, once validated, could help to obtain homogeneous study groups with unified diagnostic criteria [3]
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