The usefulness of transvaginal ultrasonography in the diagnosis of pelvic venous disorders.

Chronic Pelvic Pain (CPP) is one of the most common condition encountered in the daily practice of gynaecologists. Prevalence estimates for CPP vary from 6.4 to 25.4% depending on population and established criteria, resulting in a heavy social and economic burden. Among the possible reasons of CPP one of the most challenging are Pelvic Venous Disorders (PeVD). PeVD are a group of diseases characterized by the coexistence of CPP and varicose veins localized in the pelvis and lower abdomen. Although pelvic venography is considered the gold standard for diagnosing PeVD, in the clinical practice of a gynaecologist Transvaginal Ultrasonography (TVUS) is the predominant diagnostic method modality in patients with symptoms of PeVD. Our study aimed to assess the usefulness of TVUS in diagnosing PeVD and to determine ultrasound parameters that are useful in identifying such patients. This observational cross-sectional study included 197 patients hospitalized between September 2022 and April 2024. Pelvic venography was performed in 195 patients who met the ultrasonographic criteria for PeVD. Of the 195 patients in whom the TVUS revealed the presence of at least one parameter characteristic for PeVD, pelvic venography confirmed the TVUS findings in 187 (95.9%). PeVD was confirmed in 94.5% of patients with one positive ultrasound parameter, 95.1% with two positive ultrasound parameters, 96.4% with three positive ultrasound parameters, and 100% with four positive ultrasound parameters. Primary gynaecological diagnostics based predominantly on TVUS appears to be crucial in identifying patients with PeVD. Using appropriate criteria, high efficiency in the first-line diagnostics of such patients could be obtained.