Pelvis and perineum
David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings in McMinn’s Concise Human Anatomy, 2017
A varicoele is an abnormal dilatation of the pampiniform venous plexus within the spermatic cord. It is much more commonly found on the left side. What is the most likely reason for this?The left testicular vein lies behind the external iliac artery and is likely to be compressed by it.The left testicular vein drains into the left renal vein, where it is most likely compressed.The left testicular vein drains directly into the inferior vena cava, where it is most likely compressed by the aorta.The left testicular artery lies anterior to the left testicular vein and compresses it.The left testicular vein lacks valves to prevent back flow, unlike the right testicular vein.
Male reproductive system
Aida Lai in Essential Concepts in Anatomy and Pathology for Undergraduate Revision, 2018
Varicocoele More common on LHSVaricosity of pampiniform plexus of veins around spermatic cordMay be due to malfunction of valves in veinsCauses infertilitySymptoms: – scrotal swelling– veins tortuous and dilatedManagement: – ligation of testicular vein
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.
The prevalence and severity of varicocele in adult population over the age of forty years old: a cross-sectional study
Published in The Aging Male, 2019
Huseyin Besiroglu, Alper Otunctemur, Murat Dursun, Emin Ozbek
Varicocele is an abnormal dilatation of internal spermatic veins within the pampiniform plexus. Varicoceles are a frequent scrotal finding in normal males. Although the pathogenesis and natural history remain controversial, varicocele is thought to contribute to the risk of infertility in men. Furthermore, two population-based studies indicate that 85% of men with varicocele have fathered children suggesting that its effect on paternity is less clear [1,2]. The underlying pathologic process is not well known, but varicoceles have been associated with turbulent venous flow related to the right angle insertion of the left testicular vein into the left renal vein, which could be an explanation why left-sided varicocele is observed more frequently. In addition, the nutcracker phenomenon, defined as the compression of the left renal vein between superior mesenteric artery and aorta, may contribute to the pathogenesis of varicocele [3,4].
Outcome of varicocelectomy on different degrees of total motile sperm count: A systematic review and meta-analysis
Published in Systems Biology in Reproductive Medicine, 2019
Qun Wang, Yang Yu, Yanhong Liu, Libo Wang
It is crucial to identify the factors predicting the response to varicocelectomy. Some investigators have claimed that testicular vein with higher grades of reflux and diameter >2.5 mm resulted in greater improvement in sperm parameters (Mehraban et al. 2012), while others have reported that postoperative varicocele size failed to demonstrate any statistically significant improvement in SP rates (Marks et al. 1986). Similarly, some studies have confirmed the absence of testicular atrophy as a predictor of higher postoperative SP rates (Marks et al. 1986), while others have concluded that a small-sized left testis decreases the likelihood of improvement in pregnancy (Fujisawa et al. 2002). Additionally, several studies have demonstrated that men with raised FSH levels are more likely to show non-response to varicocelectomy (Schrepferman et al. 2000; Fujisawa et al. 2002). Sperm concentration independently predicts the efficacy of varicocelectomy, and it is reported that men with sperm concentration >2 million/mL had a 56.3% improvement in sperm parameters and a 25% improvement in SP rates (Enatsu et al. 2014). While others have concluded that if sperm concentration is <5 million/mL, then couples should initially consider ART rather than varicocelectomy, because of its low SP rates (Kamal et al. 2001).
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.
Related Knowledge Centers
- Gonadal Vein
- Inferior Vena Cava
- Testicular Artery
- Renal Vein
- Epididymis
- Spermatic Cord
- Vas Deferens
- Testicle
- Ovarian Vein
- Pampiniform Plexus