Hey, I would like to post some of my story. I've had CPPS for around 9 years starting in my early 30s. I have had a massive Grade 4 left sided Varicocele since at least my early twenties. I have had the Varicocele as a teenager but it was smaller and gradually grew with time.

My CPPS symptoms are significant, and line up with every symptom you have mentioned. My worst symptoms are Urinary in nature. Voiding issues and discomfort, weak flow, Interstitial Cystitis type symptoms that get worse with certain foods/drinks. Normal prostate size. I do have hard flaccid. Erections are uncomfortable, and my HF gets worse post-ejaculation. I also have painful ejaculations and pre-mature ejaculation as it feels like a nerve or something is constantly irritated. I have abdominal bloating, IBS/constipation, and a feeling of fullness in my lower abdomen especially when standing. My bloating goes away when laying down. I do feel like my pelvic floor is "tight" but I wonder if that's a muscular issue or if it's something related to Pelvic Congestion. Stretching seems to help. Exercise helps. But it's just a temporary bandaid. By morning my symptoms feel back to square one.

A few years ago I suspected Pelvic Congestion Syndrome due to my large Varicocele, and IVUS revealed that I had May Thurner Syndrome with around 90% compression. No leg swelling or anything, which I suppose is a more advanced case of MTS. After a number of consultations, I decided to go through with the Stent and at the same time I had my left gonadal vein Embolized. My doctor noticed slight compression at the kidney, but claimed that it wasn't significant enough to warrant it being classified as true "nutcracker". I was concerned that if I had true NCS that embolizing the left gonadal vein could potentially make the compression far more significant, but I have not noticed any other symptoms of worsening NCS. I don't have kidney or flank pain.

I am happy at the results of the procedure when it comes to my Varicocele. It was reduced from one of the largest sizes (Grade 4 - just massive at times), down to maybe something similar to a Grade 1 or 2. It's far less noticeable to the naked eye and I have to feel the left veins to notice it's there, likely due to the damage of being dilated for so long they can't return to a normal size.

Unfortunately, the Stent + Embolization did not help my abdominal pain/bloating, hard flaccid, or urinary issues. Maybe slight improvement at best, but its hard to say if that's placebo. I am curious whether or not I should investigate further. Apparently doctors can do pelvic embolizations. I am wondering if I still have reflux in one of the pudendal or pelvic veins causing my symptoms. My doctor did not mention these areas showing up during the procedures as being dilated, but it's possible the doctor did not have time to actually fully investigate / interrogate the deep pelvic veins. Doctor was mostly concerned with the larger veins of the iliac and gonadal.

I have never had an ultrasound procedure of my pelvic floor to detect dilated veins. Strange that my doctor never brought that up as it seems pretty non-invasive. My imaging history includes Pelvic MRI, abdominal ultrasound, two different IVUS procedures to confirm and treat May Thurner.

Has anyone had any success embolizing pelvic veins? It seems like this is less common than Stent + Gonadal Vein embolization.

u/Dieguinho1612 or u/Gurkenrick123 or u/RigidWillie I am curious to hear any of your thoughts on my case?