Transvaginal color Doppler study of uterine artery: Is there a role in chronic pelvic pain?

Somprasit, Charintip; Tanprasertkul, Chamnan; Suwannarurk, Komsun; Pongrojpaw, Densak; Chanthasenanont, Athita; Bhamarapravatana, Kornkarn

doi:10.1111/j.1447-0756.2010.01284.x

Cited by 4 publications

(6 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…6,16,23,40,77,78 A further four studies considered the prevalence of PVI in non-pain populations 68,76,79,80 and three studies investigated the relationship between PVI and venous insufficiency of the lower limbs. 37,77,81 The quality assessment of the case-control studies is summarised in Table 3.…”

Section: Resultsmentioning

confidence: 99%

“…79 All women had transvaginal Doppler ultrasound that measured the resistance and pulsitility indices of the uterine artery instead of assessing venous flow. The authors found that indices were significantly lower in women with CPP than in asymptomatic controls, in contradiction to results from women with primary dysmenorrhoea, 81 where these indices were lower in the pain-free controls.…”

Section: A Review Of the Association Between Pelvic Vein Incompetencementioning

confidence: 99%

See 1 more Smart Citation

The relationship between pelvic vein incompetence and chronic pelvic pain in women: systematic reviews of diagnosis and treatment effectiveness

Champaneria

Shah

Moss³

et al. 2016

Health Technol Assess

View full text Add to dashboard Cite

BackgroundPelvic congestion syndrome (PCS) is described as chronic pelvic pain (CPP) arising from dilated and refluxing pelvic veins, although the causal relationship between pelvic vein incompetence (PVI) and CPP is not established. Non-invasive screening methods such as Doppler ultrasound and magnetic resonance venography are used before confirmation by venography. Percutaneous embolisation has become the principal treatment for PCS, with high success rates often cited.ObjectivesOur proposal aimed to systematically and critically review the definitions and diagnostic criteria of PCS, the association between PVI and CPP, the accuracy of various non-invasive imaging techniques and the effectiveness of embolisation for PVI; and to identify factors associated with successful outcome. We also wished to survey clinicians and patients to assess awareness and management of PCS and gauge the enthusiasm for further research.Data sourcesA comprehensive search strategy encompassing various terms for pelvic congestion, pain, imaging techniques and embolisation was deployed in 17 bibliographic databases, including MEDLINE, EMBASE and Web of Science. There was no restriction on study design.MethodsMethodological quality was assessed using appropriate tools. Online surveys were sent to clinicians and patients. The quality and heterogeneity generally precluded meta-analysis and so results were tabulated and described narratively.ResultsWe identified six association studies, 10 studies involving ultrasound, two studies involving magnetic resonance venography, 21 case series and one poor-quality randomised trial of embolisation. There were no consistent diagnostic criteria for PCS. We found that the associations between CPP and PVI were generally fairly similar, with three of five studies with sufficient data showing statistically significant associations (odds ratios of between 31 and 117). The prevalence of PVI ranged widely, although the majority of women with PVI had CPP. Transvaginal ultrasound with Doppler and magnetic resonance venography are both useful screening methods, although the data on accuracy are limited. Early substantial relief from pain symptoms was observed in approximately 75% of women undergoing embolisation, a figure which generally increased over time and was sustained. Reintervention rates were generally low. Transient pain was a common occurrence following foam embolisation, while there was a < 2% risk of coil migration. Confidence in the embolisation technique is reasonably high, although there is a desire to strengthen the evidence base. Even among women with CPP, fewer than half had any knowledge about PCS.ConclusionsThe data supporting the diagnosis and treatment of PCS are limited and of variable methodological quality. There is some evidence to tentatively support a causative association, but it cannot be categorically stated that PVI is the cause of CPP in women with no other pathology, as the six most pertinent drew on clinically disparate populations and defined PVI inconsistently. Embolisation appears to provide symptomatic relief in the majority of women and is safe. However, the majority of included studies of embolism were relatively small case series and only the randomised controlled trial was considered at risk of potential biases. There is scope and demand for considerable further research. The question of the association of PVI and CPP requires a well-designed and well-powered case–control study, which will also provide data to derive a diagnostic standard. An adequately powered randomised trial is essential to provide evidence on the effectiveness of embolisation, but this faces methodological challenges.Study registrationThis study is registered as PROSPERO CRD42012002237 and CRD42012002238.FundingThe National Institute for Health Research Health Technology Assessment programme.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: A Review Of the Association Between Pelvic Vein Incompetencementioning

confidence: 99%

The relationship between pelvic vein incompetence and chronic pelvic pain in women: systematic reviews of diagnosis and treatment effectiveness

Champaneria

Shah

Moss³

et al. 2016

Health Technol Assess

View full text Add to dashboard Cite

show abstract

“…US Pelvis Transvaginal. Pelvic US using a combined transabdominal and transvaginal approach is the initial imaging study of choice to evaluate postmenopausal subacute or chronic pelvic pain localized to the deep pelvis [9][10][11][12]. US can provide anatomic information about uterine size and endometrial canal distension, fallopian tube dilation, ovaries, and adnexal masses.…”

Section: Discussion Of Procedures By Variantmentioning

confidence: 99%

“…Although it is rated as a separate imaging procedure per ACR methodology, the expert panel considers Doppler imaging to be a standard component of pelvic sonography. Special considerations for women with chronic pelvic pain may include evaluation of uterine artery blood flow with low-resistance waveforms in women with chronic pelvic pain [12] and altered venous flow in the setting of pelvic congestion. When pelvic venous disorders are suspected clinically, color and spectral Doppler evaluation may be used to document engorged periuterine and periovarian veins (8 mm), low-velocity flow, altered flow with Valsalva maneuver, retrograde (caudal) flow of the ovarian veins, and direct connection between engorged pelvic veins and myometrial arcuate veins [9][10][11].…”

Section: Discussion Of Procedures By Variantmentioning

confidence: 99%

Section: Discussion Of Procedures By Variantmentioning

confidence: 99%

See 1 more Smart Citation

ACR Appropriateness Criteria® Postmenopausal Subacute or Chronic Pelvic Pain

Maturen

Akin

Dassel

et al. 2018

Journal of the American College of Radiology

View full text Add to dashboard Cite

Pelvic pain is common in both reproductive age and postmenopausal women, and the major etiologies change throughout the life cycle. Chronic pain is defined as lasting for at least 6 months. There are many gastrointestinal and urinary disorders associated with chronic pain in this age group, which are not discussed in this guideline. Pain may be localized to the deep pelvis, with potential causes including pelvic congestion syndrome, intraperitoneal adhesions, hydrosalpinx, chronic inflammatory disease, or cervical stenosis. Ultrasound is the initial imaging modality of choice, while CT and MRI may be appropriate for further characterization of sonographic findings. Alternatively, pain may be localized to the vagina, vulva, or perineum, with potential causes including vaginal atrophy, vaginismus, vaginal or vulvar cysts, vulvodynia, or pelvic myofascial pain. Imaging is primarily indicated in context of an abnormal physical exam and ultrasound is the initial modality of choice, while MRI may be appropriate for further characterization in select cases. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

show abstract

Dolor pélvico en mujeres y el papel de la imágenes diagnósticas

Ochoa

2012

MedUNAB

View full text Add to dashboard Cite

El dolor pélvico es un motivo de consulta frecuente tanto en los servicios de consulta externa como de urgencias, e implica un reto diagnóstico para los médicos, especialmente en el caso de las mujeres, en quienes hay un amplio espectro de diagnósticos diferenciales debido a las estructuras contenidas que implican varios sistemas. Con este preámbulo vemos la necesidad de realizar una revisión de la literatura basada en la evidencia acerca del uso adecuado de las imágenes diagnósticas en estas patologías para obtener los mayores beneficios.

show abstract

Transvaginal color Doppler study of uterine artery: Is there a role in chronic pelvic pain?

Abstract: Doppler flow indices demonstrated significant increase of uterine arteries vascularization in CPP women related to pelvic causes. Transvaginal ultrasound with noninvasive Doppler study could be a useful primary investigation for CPP women, especially when financial resource is an issue.

Cited by 4 publications

References 18 publications

The relationship between pelvic vein incompetence and chronic pelvic pain in women: systematic reviews of diagnosis and treatment effectiveness

The relationship between pelvic vein incompetence and chronic pelvic pain in women: systematic reviews of diagnosis and treatment effectiveness

ACR Appropriateness Criteria® Postmenopausal Subacute or Chronic Pelvic Pain

Dolor pélvico en mujeres y el papel de la imágenes diagnósticas

Contact Info

Product

Resources

About