Reproductive System and Mammary Gland
Pritam S. Sahota, James A. Popp, Jerry F. Hardisty, Chirukandath Gopinath, Page R. Bouchard in Toxicologic Pathology, 2018
The testicular artery (branching from the aorta), which anastomoses with the artery of the ductus deferens (originating from the internal iliac artery), provides the vascular supply to the testis. The testicular vein forms an extensive (pampiniform) plexus around the artery within the spermatic cord, thereby creating a countercurrent heat exchange system to maintain a lower testicular temperature. Vessels populate the tunica albuginea, traverse fibrous lamellae to the mediastinum in the dog and NHP, and send branches (intertubular arterioles) to the interstitium, giving rise to intertubular and peritubular capillaries. In the rat, vessels radiate and arborize from the area of the rete testis on the caudodorsal aspect of the testis. A protein-rich filtrate escapes the interstitial capillaries (depending on the species) to lymphatic channels or the interstitium (Fawcett et al. 1973) to supply the seminiferous tubules. The transudate penetrates the myoid cell layer and seminiferous tubular basement membrane to reach the Sertoli cells and spermatogonia.
Complications of Benign Adult Penile and Scrotal Surgery
Kevin R. Loughlin in Complications of Urologic Surgery and Practice, 2007
The three sources of blood flow to the testis are the testicular, cremasteric, and deferential arteries. When not branched, the testicular artery has an average diameter of 1 mm, and in more than half of men the testicular artery is larger than the cremasteric and deferential arteries combined (135) (Fig. 11). At the inguinal level the testicular artery is surrounded by densely adherent veins in 30% of cases, and this increases to 90% in the subinguinal portion of the cord (127). In spite of this, arterial injury during microsurgical subinguinal surgery is rare. Chan et al. reported 19 (0.9%) instances of accidental arterial ligation in 2102 varicocelectomies (136). Only one of the 15 patients followed clinically after arterial injury developed any testicular atrophy, which in this case was a loss of 20% of volume. Jarow et al. and Ralph et al. both reported an approximately 20% rate of arterial injury during laparoscopic varicocelectomy, though Jarow et al. reported significant improvement with experience (116,122). They both reported no cases of testicular atrophy. Palomo, who intentionally divided the testicular artery during high retroperitoneal ligation, reported no instances of atrophy in 40 cases (112). He attributed this result to flow from the more distally located cremasteric and deferential arteries.
Pelvis and perineum
David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings in McMinn’s Concise Human Anatomy, 2017
Pelvic nerves - the sacral plexus (Fig. 3.20) lies anterior to piriformis; most of its branches are examined in dissections of the gluteal region or radiologically (Figs. 7.3, 8.5). The sacral parts of the sympathetic trunks lie medial to the anterior sacral foramina and S2-S4 nerves give off parasympathetic branches. The internal iliac vessels and their branches lie anterior to the nerves and supply the pelvic viscera (Figs. 7.4A, 7.5A), although the ovarian artery arises superiorly from the abdominal aorta and reaches the ovary through its own fold of peritoneum, the suspensory ligament of the ovary. The corresponding testicular artery is part of the spermatic cord in the inguinal canal.
Microscopic subinguinal varicocelectomy in 100 consecutive cases: Spermatic cord vascular anatomy, recurrence and hydrocele outcome analysis
Published in Arab Journal of Urology, 2018
Ahmed M. Al-Kandari, Abdulnasser Khudair, Abdelghaffar Arafa, Fouad Zanaty, Ahmed Ezz, Mohamed El-Shazly
The arterial supply to the testis is derived from three sources: the internal spermatic artery, the deferential (vasal) artery, and the external spermatic (or cremasteric) artery [22]. The internal spermatic artery is intimately associated with the pampiniform plexus of veins. The testicular artery is consistently the largest calibre arterial vessel, with a diameter equal to or greater than the sum of the vasal and cremasteric arteries in >50% of the spermatic cords. This suggests that although the vasal and cremasteric arteries combined contribute significantly to the testicular blood supply, the testicular artery provides most of the blood flow to the human testes. Preservation of the testicular arteries is recommended for optimal testicular blood flow [23]. There is evidence showing deleterious effects of its ligation on germinal epithelium and spermatogenesis from testicular ischaemia in both human and animal models [24].
Impact of body mass index on semen parameters and reproductive hormones among men undergoing microsurgical subinguinal varicocelectomy
Published in Arab Journal of Urology, 2023
Mohammed Mahdi, Ahmad Majzoub, Haitham Elbardisi, Mohamed Arafa, Kareim Khalafalla, Sami Al Said, Walid El Ansari
Varicocelectomy was performed using the microsurgical subinguinal approach. All cases were done by the same urology team using a standardized approach [25]. Procedures were done under general anesthesia, utilizing a 2–3 cm subinguinal incision. After delivery of the spermatic cord, any dilated external spermatic veins were ligated. Following dissection of the external spermatic fascia, a surgical microscope (Pentero 900, Carl Zeiss Meditec, Jena, Germany) was used under × 18 magnification to explore the cord and dissect, separate, ligate (using titanium clips) and divide the internal spermatic veins. A micro Doppler probe was also used during the procedure to identify and preserve the testicular artery. Vas deferens and lymphatic vessels were preserved.
Conservative treatment of partial testicular artery injury during transabdominal preperitoneal hernioplasty (TAPP)
Published in Acta Chirurgica Belgica, 2022
Goran Augustin, Lucija Brkic, Maja Hrabak Paar
With the TAPP inguinal hernioplasty, vascular injuries are possible at multiple operational steps. Injury may occur with the introduction of the Veress needle, the first trocar insertion, and during insertion of other trocars. During dissection of the preperitoneal space and the hernia sac, injuries to deep inferior epigastric arteries, testicular arteries, deferential arteries, and both external iliac arteries and veins are possible. All these vascular injuries are can occur during the mesh and peritoneum fixation with tacks. In our case, after TAPP, bilateral retroperitoneal hematoma developed. CT showed that both deep inferior epigastric arteries and right testicular artery had a normal flow up to periphery. The contrast of the left testicular artery was visible up to the hematoma, but without active extravasation. A left testicular vein was visible up to the left renal vein. The assumption was that the most likely cause of bleeding is a small injury of the left testicular artery, which did not actively bleed intraoperatively due to stretch from manipulation, raised intraabdominal pressure, and reflex vasoconstriction. Postoperatively, a large hematoma possibly compressed the injured artery resulting in cessation of extravasation. Another exclusion of the testicular vein injury is that it would not result in such a massive hematoma. Iatrogenic injury of the testicular artery is very rare and is most commonly encountered during orchiectomy [6]. With such injuries, the vitality of the testis could be an issue. These represent high testicular artery injuries and other uninjured arteries contributing to testicular blood supply are sufficient for adequate testicular perfusion.
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