Ovarian vein surgical ablation versus endovascular technique for treatment of pelvic vein incompetence.

OBJECTIVE: Chronic pelvic pain in women is a disorder brought on by pelvic vein incompetence (PVI). In this prospective, randomized study, the effects of percutaneous coil embolization and surgical ovarian vein ligation and division combined with retrograde sclerotherapy were compared with regard to ovarian vein occlusion, improvement of pelvic congestion symptoms, and their influence on estradiol level after intervention. METHODS: A total of 50 patients with PVI were enrolled, with a mean age of 31.9 ± 4.7 years and a pain score of 9 (range, 0-10; from 0 [no pain] to 10 [the highest level of pain]). Both percutaneous coil embolization of ovarian veins (endovascular group) and surgical ovarian vein ablation with retrograde sclerotherapy were offered to the patients at random. RESULTS: In the open group, the pain level decreased to 2, whereas in the endovascular group, it decreased to 1 (range, 0-10). Estradiol levels were 224 (range, 9-612) in the open group and 478 (range, 18-613) in the endovascular group before the intervention, with no significant change (P = .1120). After 1 week of intervention, estradiol levels in the open group were 89 (range, 18-243) and 124 (range, 22-298) in the endovascular group, respectively, with statistical insignificance (P = .225). After 1 month of intervention, the endovascular group's estradiol level was 101 (range, 20-196) and the open group's was 89 (range, 15-190) (P = .382). After 3 months of intervention, the open group's estradiol level was 78 (range, 12-132) and the endovascular group's was 65 (range, 18-110) (P = .045). CONCLUSIONS: In addressing PVI, both methods seemed to have promising results. Nevertheless, endovascular management was more effective at decreasing estrogen levels and relieving discomfort. Three months should be the time at which estradiol levels are measured, because this is when they are at their lowest. In both the open and endovascular groups as well as in the pooled data, there was a significant association between estradiol level from before the intervention and improvement in pain scores (P = .005). Because it was linked to a lower pain score, the high preoperative estradiol level can be used to predict postintervention improvement.

Unilateral ovarian drilling in polycystic ovarian syndrome: a prospective randomized study.

Ovarian drilling is a well-accepted intervention for ovulation induction in clomiphene citrate-resistant polycystic ovarian syndrome (PCOS) patients. The aim of this study was to evaluate the effect of unilateral and bilateral ovarian drilling by electrocautery in PCOS women. In this prospective randomized clinical study, 87 patients with ovulation failure as a result of PCOS were randomly allocated to either unilateral (group A; n = 43 patients) or bilateral (group B; n = 44 patients) laparoscopic ovarian drilling by electrocautery. The average time required for unilateral ovarian drilling was shorter than for bilateral drilling. In patients who ovulated after drilling, there was a significant fall in serum LH concentration (group A, P < 0.05, group B, P < 0.05). Ovulation, pregnancy and miscarriage rates were similar in both groups. It seems that unilateral ovarian drilling in PCOS is effective, less time-consuming and probably associated with fewer complications.