Chronic pelvic pain in congestion pelvic syndrome: clinical impact and electromyography pelvic floor activity prior and after endovascular treatment

Abstract

Abstract Background To characterize clinical impact of endovascular treatment in Chronic Pelvic Pain (CPP) patients due to Pelvic Congestion Syndrome (PCS) and to assess the diagnostic value of surface electromyography (sEMG) study of pelvic floor musculature (PFM) in PCS patients pre- and post-endovascular treatment. Between January 2019 and July 2023, we studied consecutive patients who were referred for interventional radiology assessment and treatment to a tertiary trauma care Hospital, had evidence of non-obstructive PCS by Magnetic Resonance Imaging (MRI), had performed a sEMG of PFM and underwent endovascular treatment. The primary outcome was clinical, defined as change in symptoms severity after endovascular treatment. The secondary outcome was a difference in the sEMG values pre- and after endovascular therapy. Results We included 32 women (mean age 38 years). CPP was the leading symptom in 100% patients, followed by dysmenorrhea (75%) and post-coital pain (68.7%). Endovascular therapy included ovarian vein embolization in 28 patients (87.5%) and internal iliac vein embolization in only 2 patients (6.2%). After a median of 8 (range 6–10) months from endovascular treatment, 29 (90%) of patients reported improvement of the main symptoms, and 15 (46%) were symptom-free. The sEMG values didn’t show a statistical difference pre- and after PCS endovascular treatment. Conclusions Endovascular treatment appeared to be highly effective in CPP due to PCS and was associated with a low rate of complication. sEMG study could be useful in revealing alteration of PFM electrophysiology, but a difference pre and after embolization in PCS patient wasn’t demonstrated.