Ovarian vein syndrome

Overview

Ovarian Vein Syndrome (OVS) is a rare and often underdiagnosed condition in which a dilated or thrombosed ovarian vein compresses the adjacent ureter, leading to chronic ureteral obstruction. This compression may result in flank pain, hydronephrosis (swelling of the kidney due to urine buildup), and urinary symptoms. OVS most commonly affects women of reproductive age and is typically seen on the right side due to anatomical variations and the pathway of the right ovarian vein.

The condition may arise as a complication of pregnancy or pelvic congestion syndrome and is often confused with other causes of pelvic or flank pain. Accurate diagnosis relies on a combination of imaging techniques and clinical suspicion. If left untreated, chronic ureteral obstruction can lead to renal impairment.

Causes

Ovarian Vein Syndrome is caused by the anatomical compression of the ureter by an abnormally enlarged, tortuous, or thrombosed ovarian vein. Several factors contribute to the development of this condition.

Primary Causes

• Pregnancy: Increased blood flow and hormonal changes during pregnancy can lead to ovarian vein dilation, which may persist postpartum.

• Pelvic congestion syndrome: A condition characterized by varicose veins in the pelvis, often associated with chronic pelvic pain.

• Venous insufficiency or valvular incompetence: Leads to dilation and tortuosity of the ovarian vein.

• Ovarian vein thrombosis: Can cause inflammation and secondary compression of the adjacent ureter.

Anatomical Factors

• The right ovarian vein drains directly into the inferior vena cava and travels close to the right ureter, making right-sided OVS more common.

• The left ovarian vein drains into the left renal vein and is less frequently involved in OVS.

Symptoms

Symptoms of Ovarian Vein Syndrome are often vague and overlap with other urological or gynecological conditions, leading to diagnostic delays.

Common Symptoms

• Flank pain: Usually on the right side; may be constant or intermittent

• Pelvic pain: Dull, aching discomfort, especially in the lower abdomen or pelvis

• Urinary symptoms: Frequency, urgency, dysuria (painful urination)

• Hematuria: Occasional blood in the urine due to ureteral irritation

Associated Symptoms

• Dyspareunia (pain during intercourse)

• Lower back pain

• Pelvic fullness or heaviness

• Symptoms may worsen during menstruation or after prolonged standing

Diagnosis

Diagnosis of Ovarian Vein Syndrome involves a combination of clinical assessment and imaging studies. Because of the nonspecific nature of symptoms, high clinical suspicion is necessary.

Clinical Evaluation

• Detailed history of chronic flank or pelvic pain, especially postpartum or in women with multiple pregnancies

• Physical examination may reveal abdominal or flank tenderness

Imaging Techniques

• Ultrasound: May show hydronephrosis or dilated ovarian veins; Doppler imaging can assess blood flow

• CT Urography: Useful for identifying ureteral compression and associated hydronephrosis

• MR Venography: Provides a noninvasive view of pelvic veins and ovarian vein anatomy

• Intravenous pyelogram (IVP): Historically used to evaluate urinary tract obstruction

• Retrograde pyelography: Invasive test showing narrowing of the ureter at the site of vein compression

Other Diagnostic Considerations

• Rule out other causes of flank pain (e.g., kidney stones, infections, tumors)

• Evaluate for signs of pelvic congestion syndrome if present

Treatment

Treatment of Ovarian Vein Syndrome depends on the severity of symptoms and the degree of ureteral obstruction. Options range from conservative management to surgical or endovascular intervention.

Conservative Management

• Analgesics for pain relief

• Observation in mild or asymptomatic cases

• Treat underlying pelvic congestion if present

Surgical and Interventional Treatments

• Ovarian vein ligation or excision: Laparoscopic or open surgery to remove or tie off the dilated vein causing compression

• Endovascular embolization: A minimally invasive procedure to block blood flow in the problematic vein, relieving pressure on the ureter

• Ureterolysis: Surgical release of the ureter from surrounding compressive structures

• Ureteral stenting: Temporary solution to relieve obstruction and maintain urine flow

Prognosis

The prognosis for Ovarian Vein Syndrome is generally good with timely diagnosis and appropriate treatment. Most women experience significant relief of symptoms following surgical or endovascular intervention.

If left untreated, chronic ureteral compression can lead to persistent hydronephrosis, urinary tract infections, and progressive kidney damage. Long-term follow-up is recommended to monitor kidney function and ensure resolution of ureteral obstruction.

Awareness of OVS among clinicians is essential to reduce misdiagnosis and provide targeted therapy for women suffering from chronic, unexplained flank or pelvic pain.