From the Guidelines
Dilation of the gonadal veins is most commonly caused by varicoceles, which affect up to 15% of males and are often treated with endovascular therapy embolizing the affected spermatic vein using coils or sclerosants, as shown in a study published in the American Family Physician in 2019 1. When considering the causes of gonadal vein dilation, it is essential to prioritize the most recent and highest quality evidence.
- Varicoceles are a significant cause, with studies demonstrating the effectiveness of gonadal vein embolization in relieving orchialgia, with 87% of patients experiencing complete pain relief at 39 months 1.
- Other potential causes of gonadal vein dilation include pelvic congestion syndrome, venous obstruction from tumors or thrombosis, anatomical abnormalities like Nutcracker syndrome, and increased intra-abdominal pressure from conditions such as ascites, obesity, or chronic coughing.
- The underlying mechanism of gonadal vein dilation involves the failure of valves within the veins, allowing blood to pool and causing vein enlargement, which can be exacerbated by various factors, including anatomical differences and increased pressure.
- It is crucial to consider the potential consequences of gonadal vein dilation, including orchialgia, infertility, and reduced testicular size in adolescents, and to prioritize treatment options that address the underlying cause and minimize morbidity, mortality, and impact on quality of life.
From the Research
Causes of Dilation of the Gonadal Veins
- Reflux or obstruction in gonadal, gluteal, or parauterine veins can cause dilation of the gonadal veins, leading to pelvic congestion syndrome (PCS) 2, 3
- Pelvic venous insufficiency is a main pathophysiological cause of PCS and varicoceles, which can result in dilation of the gonadal veins 4
- Valvular incontinence can cause genital venous insufficiency in men, leading to visible and recognizable peritesticular varicocele, while in women, it is more often generated by major, lasting, and possibly repeated pregnancy-related hyperpressure phenomena 5
- Compression of the left renal vein (LRV) between the superior mesenteric artery and the aorta, also known as the nutcracker syndrome, can also cause dilation of the gonadal veins 3
- Oxidative stress and pro-inflammatory cascades can contribute to the development of PCS and varicoceles, leading to dilation of the gonadal veins 4
Associated Conditions
- Varicoceles in males and pelvic congestion syndrome in females are closely related conditions that can cause dilation of the gonadal veins 4
- Chronic pelvic pain is a common symptom of PCS and can be attributed to reflux or obstruction of the gonadal, gluteal, or periuterine veins 2, 3
- Perineal or vulvar varices can be associated with PCS and dilation of the gonadal veins 2, 3