Pelvic venous insufficiency in men The Phlebology Clinic / Pelvic venous insufficiency in men Introduction Description of the condition Risk factors Treatment options Frequently asked questions Varicose veins of the spermatic cord Introduction Pelvic venous insufficiency in men (male pelvic venous insufficiency) is a condition of the venous system that for many years has been overshadowed by its female counterpart. Long-standing research by the team at the Department of Phlebology into the problem of the male form of pelvic venous insufficiency indicates that this problem affects approximately 20% men with chronic pain in the pelvic floor and perineum. In many men with lower extremity venous insufficiency, it is the male form of pelvic venous insufficiency that initiates venous disease in the legs. We now know of many forms of male-type venous insufficiency, by far the most common of which is left testicular vein insufficiency with secondary varices of the spermatic cord. According to data from our study, it accounts for approximately 70% of all forms of pelvic venous insufficiency in men and is the most common cause secondary to pelvic venous insufficiency, venous insufficiency of the lower extremities. Male pelvic venous insufficiency is characterised by blood stasis in the veins of the pelvis, perineum and scrotal sac, often due to impaired outflow or increased inflow from the vascularisation area of the main venous trunks of the epigastrium, intra-abdomen and lower abdomen. In the male form of pelvic venous insufficiency, there is usually dilatation of the gonadal veins (more often the left) and internal iliac veins, including the internal vulvar, perianal and perianal veins. This results in chronic organ or wall congestion of the pelvic floor and the development of characteristic symptoms resulting from increased receptor sensitisation. Most common symptoms Pelvic venous insufficiency of the male type include: chronic pain in the lower abdomen and pelvic floor area, aggravated by sitting, standing or weightlifting discomfort (burning) in the perineal and scrotal area erectile dysfunction and sexual dysfunction a feeling of heaviness in the lower abdomen pain radiating to the thighs and back urinary problems Mechanism of pelvic venous insufficiency The causes of venous insufficiency in men - as in women - are very different. The mechanism of post-pregnancy insufficiency - the most significant causative factor among women - is absent in men. In the male population, the very common causative mechanisms are power sportswhich are responsible for the dilatation of the venous bed (most commonly the left testicular vein). In young men (under 20 years of age), the most common cause of pelvic venous insufficiency is anatomical abnormalities in the structure of the venous system, causing venous blood flow disorders (e.g. in hypoplasia of the left renal vein) and secondary dilatations of the main trunks that physiologically ensure venous blood outflow from the abdomen and pelvis. Venous valve insufficiency is usually secondary and results from overstretching of the outflow vascular trunks. Valvular insufficiency leads to blood backflow and venous stasis in the pelvic venous plexuses, perineum or scrotal sac.From years of research by the team at the Department of Phlebology, it has become apparent that abnormalities of venous vessel formation and developmental stenosis are much more common than typical compression phenomena such as the May-Thurner or 'nutcracker' phenomena. Genetic predisposition may play a role in the development of male pelvic venous insufficiency, although specific genes have not yet been identified. Did you know? Pelvic venous insufficiency of the male type is one of the most underestimated phenomena in modern phlebology, causing venous disease of the pelvis and lower limb veins. dr n. med. Cezary Szary Risk factors for the occurrence of male pelvic venous insufficiency genetic predisposition (e.g. genetically determined stretching of the venous vessels) anatomical abnormalities of the venous system (e.g. hypoplasia of the left renal vein) overuse of strength training high rise obesity generating high intra-abdominal pressure and impaired venous outflow in the sitting position chronic constipation prolonged standing or sitting (e.g. by drivers) Overuse of strength training is one of the most common factors initiating pelvic venous insufficiency in men. Treatment methods 01 / Microsclerotherapy 02 / Foam sclerotherapy 03 / Laser vein sealing 04 / Varicose vein taping 05 / Miniflebectomy 06 / Venous embolisation Doctors performing these procedures dr n. med. Cezary Szary - phlebologist, radiologist Phlebology, Radiology and Imaging Diagnostics Dr Dominika Plucińska - phlebologist, radiologist radiology and diagnostic imaging, phlebology Tomasz Grzela, MD - phlebologist, surgeon General surgery, phlebology dr n. med. Jerzy Leszczyński - vascular surgeon General surgery, vascular surgery dr n. med. Justyna Wilczko – flebolog, internista Phlebology, internal medicine, radiology and diagnostic imaging Dr Krzysztof Celejewski - phlebologist, surgeon general surgery, phlebology dr n. med. Łodyga Małgorzata - phlebologist, cardiologist cardiology, phlebology, Doppler ultrasonography Dr Marcin Napierała - phlebologist, surgeon general surgery, phlebology Dr Michał Zawadzki, MD - interventional radiologist radiology and diagnostic imaging, interventional radiology Mostlyquestions asked Can male pelvic venous insufficiency affect fertility? Yes, chronic venous blood stasis in the pelvis and the veins of the scrotal sac can adversely affect male fertility. Disturbed blood flow leads to increased temperature in the scrotum, which can impair spermatogenesis. In addition, venous stasis can lead to inflammation and oxidative stress, which also adversely affect sperm quality. Early diagnosis and treatment are therefore particularly important in men planning to have offspring. It is important that testicular venous insufficiency, leading to varicose veins of the spermatic cord, is caught at the stage of unilateral venous insufficiency. This significantly increases the chances of improving the spermatic cord condition. Can pelvic venous insufficiency in men cause erectile dysfunction? Pelvic venous insufficiency of the male type can significantly contribute to erectile dysfunction. The mechanism of this phenomenon is complex. During a normal erection, blood flows into the penile corpora cavernosa and a special venous mechanism helps to keep it in this area. When there is pelvic venous insufficiency, this delicate mechanism can be disrupted and the venous blood flows abnormally into the penile corpora cavernosa or escapes from it too quickly.The problem of erectile dysfunction in pelvic venous insufficiency can manifest itself in several ways: difficulty achieving a full erection problems maintaining an erection premature loss of erection a feeling of heaviness and discomfort during intercourse Can the problem of pelvic venous insufficiency in men be cured or do you have to live with it? Pelvic venous insufficiency is a condition that can very often be successfully treated. Many therapeutic approaches are available, ranging from conservative to surgical. The key is to implement appropriate treatment at an early stage. Treatment methods are selected individually, depending on the severity of the symptoms and the cause of the problem. In most cases, treatment of pelvic venous insufficiency in men is treated intravenously, How is pelvic venous insufficiency diagnosed in men? Diagnosis of male venous insufficiency always begins with taking a medical history and performing a physical examination. Key imaging examinations include Doppler ultrasonography of the venous vessels of the abdomen, pelvis and scrotum to assess the anatomy and function of the venous system (assess blood flow) in different body positions. In more complicated cases and as part of the planning of the repair procedure, a CT or MRI venography with contrast is performed. Sometimes phlebography, which is direct imaging of the veins with contrast, is also necessary. Which form of male pelvic venous insufficiency is most common? The most common form of male pelvic venous insufficiency is the variant associated with left testicular (gonadal) vein insufficiency and secondary varicocele. This form affects approximately 15-20% of the general male population, and the proportion rises to 35-40% among men struggling with infertility. Explore our latest publications and research papers. The scientific activities of the team at the Department of Phlebology make a significant contribution to the development of modern phlebology. Our scientific research and publications confirm the effectiveness of innovative and proprietary treatment methods, setting new standards in the treatment of venous diseases. 1 / Do patients with recurrent venous disease benefit more from sequential treatment than patients without previous venous interventions? The doctors of the Phlebology Clinic have pioneered the causal treatment of venous disease worldwide. Our proprietary treatment methods, validated by scientific research and prestigious publications, have opened up new possibilities for all phlebology patients. 2 / Can the number of pregnancies be a predictor of venous disease progression and influence the effectiveness of treatment? The introduction of a proprietary haemodynamic and radiological classification used in the assessment of ovarian venous insufficiency has facilitated treatment planning for patients with pelvic venous insufficiency. This proprietary method allows for a precise assessment of blood flow abnormalities, enabling clinicians to select the optimal therapeutic strategy. 3 / Radiological-hemodynamic classification of ovarian venous insufficiency The doctors of the Phlebology Clinic were pioneers in the use of the varicose vein bonding method in Poland. We were the first to introduce this innovative, minimally invasive technique into clinical practice in our country. We encourage you to read the results of a study comparing the effectiveness of adhesive and intravenous laser ablation in the treatment of venous insufficiency of the lower limbs. 4 / A 2-year follow-up study evaluating treatment of limbic venous insufficiency using cyanoacrylate glue and intravenous laser ablation Vascular Laboratory of the Department of Phlebology Dr Venus: virtual patient advisor Looking for an answer to your vein question? Ask our Dr. Venus! Ask Dr Venus a question My husband and I have been trying to have a baby for 2 years. Can his varicocele affect his fertility? Yes, varicocele can affect a man's fertility. It is estimated that between 30 and 40% cases of established infertility in men may be due to this condition. 01 / Vascular spider veins Pajączki naczyniowe to drobne, czerwone lub sine rozszerzenia naczyń krwionośnych pod skórą, przypominające swoim wyglądem pajęczynę. 02 / Varicose veins of the lower limbs Varicose veins are permanent dilations of the superficial veins of the legs, visible through the skin, resulting from venous valve insufficiency. 03 / Venous edema of the shin Venous oedema of the shin is a visible enlargement of tissue volume in the lower leg area, caused by venous blood stasis and increased vascular permeability. 04 / Pelvic venous insufficiency Pelvic venous insufficiency manifests as chronic pelvic pain and discomfort, resulting from stagnation of venous blood in the venous plexuses of the reproductive organs. 05 / Venous compression syndromes Venous compression syndromes arise from obstruction of venous blood outflow through large vascular trunks in the pelvis and abdominal cavity. 06 / Venous disease in pregnancy Venous disease in pregnancy develops under the influence of hormonal and mechanical changes associated with the developing pregnancy, leading to venous stasis and varicose vein formation. 07 / Varicose veins of the spermatic cord Vestibular varices are the most common symptom of a condition called male pelvic venous insufficiency. 08 / Venous thrombosis Venous thrombosis is a serious condition of the venous system in which a thrombus (clot) forms inside an altered venous vessel. 01 / 08 Modern vein treatment We offer treatment both on an outpatient basis and in day ward admissions. The stay is of short duration. The patient spends between 1 and 5 hours in the Clinic. Make an appointment
