Endovascular management of pelvic congestion syndrome in males: A report of 2 cases

Pelvic congestion syndrome is a well-recognized cause of chronic pelvic pain in women, but it remains underdiagnosed and rarely reported in men. Distinguishing male pelvic venous disorders from pain related to varicocele may be challenging because clinical features and imaging findings often overlap, particularly when pelvic venous reflux does not involve the pampiniform plexus. We describe 2 male patients with chronic pelvic pain in whom non-invasive imaging excluded pampiniform plexus dilation and reflux, while selective venography demonstrated abnormal venous drainage involving the paravesical, paraprostatic, pudendal, lumbar or contralateral pelvic venous plexuses. Both patients underwent targeted endovascular treatment, consisting of balloon-assisted foam embolization or vascular plug occlusion, selected according to venous hemodynamic. Each patient experienced complete and durable symptom resolution during follow-up. These cases highlight that pelvic congestion syndrome in men can appear independently of varicocele and may emerge after previous spermatic vein surgery. Recognition of this condition requires high clinical suspicion and selective venography, and tailored endovascular therapy can provide effective and sustained relief.