Pelvic congestion syndrome in male patients

Prof. Whiteley's lecture focused on increasing interest in Pelvic Congestion Syndrome (PCS) in males and how PCS was previously assumed to only impact fertile women who have had children, but this has been disproven by their unit's research.

Mark Whiteley

According to the study, 10% of PCS patients in the unit have never had children, and 25% are postmenopausal. Prof. Whitely covered the symptoms of pelvic congestion syndrome in both men and women and mentioned that varicose veins can develop near the testicles. Historically, men's varicoceles and women's hemorrhoids were treated separately, However, research has revealed that it is a progressive disorder that can lead to infertility and chronic pelvic pain as patients are not being evaluated, and symptoms are not being reported, which leads to misdiagnosis and insufficient treatment.

Prof. Whietely emphasized the significance of addressing venous stasis and inflammation as underlying causes of pelvic congestion syndrome, as well as the necessity for more awareness and study in this area.

He discussed various treatment options for sigmoidoscopy, where they do not typically check for some sort of compression syndrome as the cause. hemorrhoid staples, sclerotherapy, and direct thermal ablation are commonly used. Leg varicose veins are also examined, and he mentioned a study that found a link between some males and leg varicose veins, primarily from the pelvis but also many conditions that might lead to incompetent male pelvic congestion, such as impotence, persistent pelvic pain, and prostatitis. The issue that these are tough topics to research, and there is no analogous outpatient care for men with gynecological concerns as there is for women.

Prof. Whietely talked about the underlying venous problem that defines conditions including prostatitis, IBS, and interstitial cystitis. In men, the problem can be obstruction or reflux in the testicular veins or internal eyelid veins. He emphasized that embolization of the gonadal vein can aggravate a genuine Nutcracker and he pointed out the Trendelenburg test for determining which patients have a pseudo-Nutcracker, as well as the importance of functional testing for determining a functional problem as well as something observed physically for patient treatment.

Prof. Whiteley outlined the challenges while the use of transabdominal duplex ultrasound and why it might be ineffective in detecting pathology. Transabdominal duplex has limitations such as the inability to see distal veins and poor image quality in larger individuals. Instead, he proposed employing the Harrison protocol, which has patients position themselves at 45 degrees and push their buttocks together while using the Kegel technique. This procedure mimics the way leg veins are evaluated and can avoid the same problems found during previous leg vein imaging. He also discussed research undertaken on 54 patients with leg varicose veins, in which 86 limbs were evaluated and the many reflux connections discovered, including varicoceles and spermatic veins, were reviewed.

Prof. Whiteley discussed the pattern of pelvic congestion syndrome (PCS) in men and women. PCS does not appear to be associated with an internal iliac issue in male patients, as it is in women. The variation in anatomy, however, makes imaging difficult in men, and further research is needed to better characterize PCS in men and women. It is critical to raise awareness among gynecologists and urologists because many patients are not identified with PCS, which can produce physical inflammatory changes and symptoms if left untreated.

Prof. Whiteley discuss the underestimation of male pelvic congestion and the lack of knowledge among urologists about the source of reflex. They also discuss a negotiation that can be made with urologists to observe recurring patients and analyze the cause of reflux. However, there is a concern about using sclerotherapy on the veins around the testicle due to the potential inflammation it can cause. The speakers emphasize the need for research into different patterns and optimal treatments for male pelvic congestion.

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