PracticeUpdate: Conference Series

BENIGN GYNAECOLOGY

Pelvic vein incompetence and chronic pelvic pain are strongly associated The frequency of pelvic vein incompetence in both chronic pelvic pain patients and healthy women has been shown to be very much higher than expected, with a strong statistical association between chronic pelvic pain and pelvic venous incompetence, a case-control study shows.

" Though chronic pelvic pain was clearly associated with reduced self-perception of health, patients were often discharged from clinical services before pelvic vein incompetence has been excluded.

Though chronic pelvic pain was clearly associated with reduced self-percep- tion of health, patients were often dis- charged from clinical services before pelvic vein incompetence has been excluded. A randomised controlled trial of coil/foam occlusion of incompetent pelvic veins in women with chronic pelvic pain is underway to explore the ef cacy of treatment.

position with reflux into second-order veins, pelvic varices, or the thigh. All par- ticipants completed validated symptom and generic health status questionnaires. An interim analysis was conducted after recruiting 100 subjects, including 44 matched case-control pairs. Pelvic vein incompetence was found in 15 (34.1%) women with chronic pelvic pain and in seven (15.9%) healthy controls (P = 0.046). Pelvic varices were found in 12 (27.3%) women with CPP and only one (2.3%) control (P = 0.002). ‘Dull’ pain was expe- rienced by 54.5% of women with pelvic vein incompetence (case or control) vs 22.7% of those without pelvic vein incom- petence (P = 0.005). Women with pelvic vein incompetence were more likely to experience pain throughout the day. Mean EuroQol-5D 3L quality of life scores were signi cantly lower in cases than controls for overall health evaluation (72.6% vs 86.9%, P < 0.001) and health state description (69% vs 98%, P < 0.001). Dr Riding concluded that the frequency of pelvic vein incompetence in both chronic pelvic pain patients and healthy women was very much higher than expected, with a strong statistical asso- ciation between pelvic vein incompe- tence and chronic pelvic pain. Pelvic vein incompetence was also associated with a characteristic symptom pro le of dull lower abdominal, pelvic and thigh pain that lasts throughout the day.

Dr David Riding

D avid Riding, MSc, MBChB, MRCS, of the University of Manchester and University Hospital of South Manchester, UK, explained that chronic pelvic pain affects 24% of premenopausal women, accounts for 20–30% of gynaecology outpatient appointments, and costs €3.8 billion per year. Despite extensive investigation includ- ing laparoscopy, 55% of women fail to receive a diagnosis and endure persis- tent symptoms. Women with pelvic vein incompetence describe a dull pelvic ache throughout the day that is worse on standing and sitting. Dr Riding and colleagues set out to explore the frequency of pelvic vein incompetence in women with chronic pelvic pain vs matched healthy controls. Women with chronic pelvic pain with no gynaecological cause despite diagnostic laparoscopy investigation were invited to participate. Age- and parity-matched healthy volunteers were recruited as controls. A validated transvaginal Duplex ultra- sound technique was used to detect pelvic vein incompetence, de ned as reflux >0.7 s throughout the ovarian or internal iliac veins in the semistanding

© RCOG World Congress 2017

PRACTICEUPDATE CONFERENCE SERIES • RCOG World Congress 2017 16