Surgical treatment of androgenital manifestations of pelvic vein disease

Abstract

The main clinical androgenital manifestations of pelvic vein disease in men were represented by venogenic erectile dysfunction (ED), primary and secondary varicose veins of the superficial and deep veins of the penis, varicocele, hematospermia, hematuria, and chronic pelvic pain syndrome (CPPS). The criteria for choosing the method of surgical correction of venogenic ED were the following: terminal blood flow velocity, the presence or absence of retrograde blood flow in the deep vein of the penis, the diameter of the vein, the presence of pelvic varicose veins, the presence or absence of venous obstruction due to arteriovenous conflict, the presence of varicose veins of the superficial venous system of the penis and the veins of the spermatic cords according to the CEAP classification and multispiral computer phlebography.A total of 45 roentgen-endovascular occlusions of the veins of the periprostatic plexus (REVOPP) were performed through the deep vein of the penis and/or the femoral vein with ligation of the proximal segment of the deep vein of the penis; open phlebectomies of the superficial veins of the penis with vein extraction according to Babcock, saphenofemoral crossectomy combined with circumcision and ligation of the veins in the coronal sulcus were performed in 10 cases; two-stage - REVOPPs and open phlebectomies of the superficial veins (in combination with circumcision) in 7 cases. In 25 cases of patients with venogenic ED combined with varicocele after REVOPP, microsurgical phlebectomy of the veins of the spermatic cord on the left was performed from the subinguinal approach; isolated microsurgical resection of the deep vein of the penis with circumcision was performed in 1 case. 7 left common iliac vein stentings and one bilateral common iliac vein stenting were performed in patients with May- Thurner syndrome.