Diagnostik und Therapie des pelvinen Stauungssyndroms

Pelvic congestion syndrome (PCS) is defined as a symptom complex including chronic pelvic pain with a duration of 6 months, feeling of heaviness, dysuria or dyspareunia, which is attributed to pathological changes of the veins in the pelvic region. In addition, there can be an association with perineal or pudendal varices. The underlying pathophysiology is complex. The most frequent cause of complaints is venous hypertension caused by a reflux in the left ovarian vein. Furthermore, stenosis or obstructions of the pelvic or abdominal veins can be the cause. In cases with corresponding clinical signs a basic phlebological examination should be carried out with appropriate sonographic diagnostics. After exclusion of the most frequent differential diagnoses further diagnostics should be carried out using computed tomography or magnetic resonance imaging. The gold standard is invasive diagnostics with phlebography, which if necessary can be performed in the same session. Embolization of the left ovarian vein is mostly carried out with coils, which leads to an improvement of the symptoms in approximately 80% of patients.