agxАндрология и генитальная хирургияAndrology and Genital Surgery2070-97812412-890210.17650/2070-9781-2022-23-2-11-18agx-560Research ArticleОРИГИНАЛЬНАЯ СТАТЬЯORIGINAL REPORTСиндром венозной компрессионной невропатии у пациентов с варикозной болезнью тазаSyndrome of venous compression neuropathy in patients with pelvic varicose veinshttps://orcid.org/0000-0002-1731-6365КаптоА. А.KaptoA. A.

Александр Александрович Капто

117198 Москва, ул. Миклухо-Маклая, 6

125130 Москва,  Старопетровский пр-д, 7а, стр. 30

125040 Москва, пер. Расковой, 14/22

 

Alexandr Alexandrovich Kapto

6 Miklukho-Maklaya St., Moscow 117198

Bld. 30, 7a Staropetrovskiy proezd, Moscow 125130

14/22 Raskovoy Ln., Moscow 125040

alexander_kapto@mail.ruФГАОУ ВО «Российский университет дружбы народов»; кафедра урологии АНО ДПО «Центр медицинского и корпоративного обучения»; Центр андрологии ООО «СМ-Клиника»РоссияRUDN University; Urology Department of the Professional Medical Training Center; Center of Andrology, SM-ClinicRussian Federation2022230620222321118Copyright © Капто А.А., 20222022Капто А.А.Kapto A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://agx.elpub.ru/jour/article/view/560

Цель исследования – изучение механизмов появления и развития тазовой симптоматики у пациентов с варикозной болезнью таза.

Материалы и методы

Материалы и методы. С 2015 по 2022 г. было обследовано 145 мужчин с варикозной болезнью таза. Обследование включало анкетирование пациентов с использованием опросников (шкал) и инструментальные методы: 1) ультразвуковое исследование органов мошонки с цветовым допплеровским картированием; 2) трансректальное ультразвуковое исследование предстательной железы и вен перипростатического сплетения; 3) магнитно-резонансную томографию нижней полой вены и сосудов малого таза или компьютерную (мультиспиральную) томографию органов брюшной полости с контрастированием; 4) флебографию ренокавального и илеокавального сегментов.

Результаты

Результаты. Вариантная анатомия фиброзных и фиброзно-костных каналов (туннелей) может объяснить тот факт, что при одинаково выраженном расширении тазовых вен у части пациентов отмечается тазовая симптоматика за счет сдавления нервов, а у части – нет. В пользу этой концепции говорит то, что у тех пациентов, у которых были жалобы на боли, дизурию и эректильную дисфункцию, после оперативного лечения варикозной болезни таза в большинстве случаев эти симптомы исчезали или их выраженность уменьшалась.

Заключение

Заключение. В качестве клинических проявлений варикозной болезни таза у пациентов отмечались болевой синдром (56,6 % случаев), эректильная дисфункция (51 %) и дизурия (17,9 %). Анализ данных после обследования и лечения пациентов с варикозной болезнью таза позволил нам определить «синдром венозной компрессионной невропатии» (venous compression neuropathy syndrome) как вероятную причину развития тазовой симптоматики у пациентов с варикозной болезнью таза. В зависимости от уровня локализации компрессии нервов варикозно-измененными венами мы предложили выделять 3 формы этого синдрома: 1) торакальную, 2) люмбарную и 3) сакральную.

The study objective is to investigate the pathogenesis of the development of pelvic symptoms in patients with pelvic varicose veins.

Materials and methods

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

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

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.

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The authors declare that there are no conflicts of interest present.