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In this study an analysis of the examination and treatment of 66 patients with bilateral varicocele, varicose veins of the pelvic organs due to ileal venous compression was performed. The obtained data testify to the need to review existing approaches to the surgical treatment of bilateral and recurrent varicocele. Carrying out balloon angioplasty and stenting in varicose veins of the pelvic veins in men due to the syndrome of ileal venous compression is currently an innovative and promising direction in urological practice at the interface of specialties. (For citation: Kapto AA. Endovascular surgery of the iliac veins with bilateral varicocele and varicose veins of the pelvic organs in men. Urologicheskie vedomosti. 2018;8(1):11-17. doi: 10.17816/uroved8111-17).

For the present study, we analyzed previously known and current data on arteriovenous conflicts in men from the perspective of urologists and andrologists. The least studied and controversial decision-making position was for iliac venous compression and pelvic varicose veins in men. The data testify to the need to revise the traditional and generally accepted positions for managing varicocele. (For citation: Kapto AA. Arteryovenous conflicts in men with urological pathology. Urologicheskie vedomosti. 2018;8(2):53-63. doi: 10.17816/uroved8253-63).

The study objective is to describe the anastomoses between the left renal and iliac veins in the inferior vena cava system and to classify these anastomoses.Materials and methods. From 2015 to 2020, 340 men with varicose veins of the pelvic organs and bilateral varicocele were examined. Delayed imaging for 10–30 s with phlebotesticulography of 157 patients allowed us to study in more detail the vascular venous x-ray anatomy of the scrotum and various options for collateral circulation.Results. The data obtained by us during phlebography allowed us to offer our own classification of anastomoses between the left renal vein and the common iliac vein in the inferior vena cava system (reno-iliac intrasystemic anastomoses of the inferior vena cava): 1) through the vein of the vas deferens (v. ductus deferens), 2) through the cremasteric vein (v. cremasterica), 3) through the external testicular vein (v. testicularis externa). In addition to the classification, the terms for specific types of anastomoses are also proposed by us for the first time and do not have a name in the medical scientific literature. A new definition of the term “venous anastomotic node (nodus venarum anastomoticus) of the testis and its appendage” is proposed, which describes the anatomical relationship between the 4 veins: the internal testicular vein, external testicular vein, vena cremasterica and veins of the vas deferens. A new term is proposed “pseudo-varicocele” that defines the compensatory expansion of the internal testicular vein during normal antegrade blood flow through it.Conclusion. In this work, we give an X-ray anatomical description of the development of various types of collateral circulation in the system of the inferior vena cava between the left renal vein and iliac vessels in various types of arteriovenous conflicts of both the upper (nutcracker syndrome, posterior nutcracker syndrome) and the lower level (May–Thurner syndrome).

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.