A review of the pathophysiology and evidence-based management of varicoceles and pelvic congestion syndrome

• Published in: Human fertility (Cambridge, England) Vol. 26; no. 6; p. 1597
• Main Authors: Galea, Matteo, Brincat, Mark R, Calleja-Agius, Jean
• Format: Journal Article
• Language: English
• Published: England 01.12.2023
• Subjects: Embolization, Therapeutic - adverse effects; Embolization, Therapeutic - methods; Female; Humans; Male; Pelvic Pain - diagnosis; Pelvic Pain - etiology; Pelvic Pain - therapy; Pelvis; Varicocele - complications; Venous Insufficiency - complications; Venous Insufficiency - therapy; Varicoceles; embolisation; subfertility; pelvic congestion syndrome; varicocelectomy
• ISSN: 1742-8149
• DOI: 10.1080/14647273.2023.2212846

Pelvic congestion syndrome (PCS) in females and varicoceles in males may be regarded as closely related conditions since the main pathophysiological cause for both processes is pelvic venous insufficiency. Varicoceles are more prevalent amongst sub-fertile males, with an approximate incidence of 15% in the general male population. PCS is commonly diagnosed amongst premenopausal multiparous women, representing one of the leading causes of chronic pelvic pain. Both conditions appear to be predominantly left-sided and are associated with oxidative stress and pro-inflammatory cascades with subsequent effects on fertility. Clinical examination and pelvic ultrasonography play an essential role in the assessment of varicoceles, PCS and chronic pelvic pain. Venography is generally considered as a gold-standard procedure for both conditions. There is still much debate on how these conditions should be managed. This review article provides a comparative analysis of the underlying pathophysiological mechanisms of both PCS and varicoceles, their impact on fertility, as well as their clinical management.