Pelvic congestion syndrome and its treatment: topic review

Abstract

Pelvic congestion syndrome (PCS) is a pathology characterized by pain in the pelvic region that occurs chronically and is usually associated with the presence of varicose veins in the genital, vulvar or perineal region as a consequence of venous reflux of gonadal, gluteal or peri uterine veins, as well as compression syndromes in the left renal veins or iliac segments, which can lead to a spectrum of clinical symptoms ranging from dysuria, pain when standing, dyspareunia and intense dysmenorrhea, or equally psychological symptoms such as mood disorders or depression, which affect the quality of life of patients. Despite its high prevalence, this disease continues to be underdiagnosed and mistreated. The etiology varies involving factors in mechanics, hemodynamics, anatomical defects, anomalies of venous return, multiparity, including hormonal factors, obesity, or sedentary lifestyle, which favor blood stasis and consequent venous dilation. The diagnosis is made with an appropriate clinical examination, and confirmed with imaging studies, phlebography being the gold standard due to its diagnostic and therapeutic usefulness. There is currently a wide variety in the treatment of PCS, however endovascular management with sclerotherapy and embolization is the one that has shown the best results with clinical improvement and quality of life. This article seeks to review the literature on pelvic congestion syndrome with the aim of understanding a frequently overlooked disease and the diagnostic and therapeutic alternatives to treat these patients.