Андрология и генитальная хирургия. 2022; 23: 11-18
Синдром венозной компрессионной невропатии у пациентов с варикозной болезнью таза
https://doi.org/10.17650/2070-9781-2022-23-2-11-18Аннотация
Цель исследования – изучение механизмов появления и развития тазовой симптоматики у пациентов с варикозной болезнью таза.
Материалы и методы. С 2015 по 2022 г. было обследовано 145 мужчин с варикозной болезнью таза. Обследование включало анкетирование пациентов с использованием опросников (шкал) и инструментальные методы: 1) ультразвуковое исследование органов мошонки с цветовым допплеровским картированием; 2) трансректальное ультразвуковое исследование предстательной железы и вен перипростатического сплетения; 3) магнитно-резонансную томографию нижней полой вены и сосудов малого таза или компьютерную (мультиспиральную) томографию органов брюшной полости с контрастированием; 4) флебографию ренокавального и илеокавального сегментов.
Результаты. Вариантная анатомия фиброзных и фиброзно-костных каналов (туннелей) может объяснить тот факт, что при одинаково выраженном расширении тазовых вен у части пациентов отмечается тазовая симптоматика за счет сдавления нервов, а у части – нет. В пользу этой концепции говорит то, что у тех пациентов, у которых были жалобы на боли, дизурию и эректильную дисфункцию, после оперативного лечения варикозной болезни таза в большинстве случаев эти симптомы исчезали или их выраженность уменьшалась.
Заключение. В качестве клинических проявлений варикозной болезни таза у пациентов отмечались болевой синдром (56,6 % случаев), эректильная дисфункция (51 %) и дизурия (17,9 %). Анализ данных после обследования и лечения пациентов с варикозной болезнью таза позволил нам определить «синдром венозной компрессионной невропатии» (venous compression neuropathy syndrome) как вероятную причину развития тазовой симптоматики у пациентов с варикозной болезнью таза. В зависимости от уровня локализации компрессии нервов варикозно-измененными венами мы предложили выделять 3 формы этого синдрома: 1) торакальную, 2) люмбарную и 3) сакральную.
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30. Ramírez García S., Gutiérrez Salinas J., Núñez Ramos N.R. et al. [May–Thurner syndrome as a cause of neurovascular compression of the pudendal nerve (In Spanish)]. Ginecol Obstet Mex 2013;81(2):105–8. PMID: 23596733.
31. Possover M., Khazali S., Fazel A. Pelvic congestion syndrome and May–Thurner syndrome as causes for chronic pelvic pain syndrome: neuropelveological diagnosis and corresponding therapeutic options. Facts Views Vis Obgyn 2021;13(2):141–8. DOI: 10.52054/FVVO.13.2.019.
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37. Condorelli R.A., Calogero A.E., Mongioiʼ L. et al. Varicocele and concomitant dilation of the periprostatic venous plexus: effects on semen viscosity sperm parameters. J Endocrinol Invest 2016;39(5):543–7. DOI: 10.1007/s40618-015-0401-9.
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Andrology and Genital Surgery. 2022; 23: 11-18
Syndrome of venous compression neuropathy in patients with pelvic varicose veins
https://doi.org/10.17650/2070-9781-2022-23-2-11-18Abstract
The study objective is to investigate the pathogenesis of the development of pelvic symptoms in patients with pelvic varicose veins.
Materials and methods. From 2015 to 2022, 145 men with pelvic varicose veins were examined. The examination included questioning of patients using questionnaires (scales) and instrumental methods: 1) ultrasound examination of the scrotum with color Doppler mapping; 2) transrectal ultrasound examination of the prostate and veins of the periprostatic plexus; 3) magnetic resonance imaging of the inferior vena cava and pelvic vessels or computer (multispiral) tomography of the abdominal organs with contrast; 4) phlebography of the renocaval and ileocaval segments.
Results. The variant anatomy of fibrous and fibro-osseous canals (tunnels) can explain the fact that with equally pronounced expansion of the pelvic veins, some patients have pelvic symptoms due to nerve compression, while the other part does not. This concept is supported by the fact that in those patients who had complaints of pain, dysuria and erectile dysfunction, after surgical treatment of pelvic varicose veins, in most cases they disappeared or decreased.
Conclusion. Pain syndrome (56.6 % of cases), erectile dysfunction (51 % of cases) and dysuria (17.9 % of cases) were noted as clinical manifestations in patients with pelvic varicose veins. Analysis of data after examination and treatment of patients with pelvic varicose veins allowed us to identify “venous compression neuropathy syndrome” as a probable cause of the development of pelvic symptoms in patients with pelvic varicose veins. Depending on the level of localization of nerve compression by varicose veins, we proposed to distinguish three forms of this syndrome: 1) thoracic, 2) lumbar, and 3) sacral form.
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30. Ramírez García S., Gutiérrez Salinas J., Núñez Ramos N.R. et al. [May–Thurner syndrome as a cause of neurovascular compression of the pudendal nerve (In Spanish)]. Ginecol Obstet Mex 2013;81(2):105–8. PMID: 23596733.
31. Possover M., Khazali S., Fazel A. Pelvic congestion syndrome and May–Thurner syndrome as causes for chronic pelvic pain syndrome: neuropelveological diagnosis and corresponding therapeutic options. Facts Views Vis Obgyn 2021;13(2):141–8. DOI: 10.52054/FVVO.13.2.019.
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37. Condorelli R.A., Calogero A.E., Mongioiʼ L. et al. Varicocele and concomitant dilation of the periprostatic venous plexus: effects on semen viscosity sperm parameters. J Endocrinol Invest 2016;39(5):543–7. DOI: 10.1007/s40618-015-0401-9.
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