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Variations in Testicular Veins: an Anatomico-Clinical Review

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Variations in Testicular Veins: an Anatomico-Clinical Review Galore International Journal of Health Sciences and Research Vol.5; Issue: 2; April-June 2020 Website: www.gijhsr.com Review Article P-ISSN: 2456-9321 Variations in Testicular Veins: An Anatomico-Clinical Review Gupta Nidhi1, Dwivedi Amod2, Pandey Suniti3 1Assistant Professor, Department of Anatomy, GSVM Medical College Kanpur 2Consultant Urologist, Dr. Amod Uro-Gynae Centre, Kanpur 3Professor & Department Head, Department of Anatomy, GSVM Medical College Kanpur Corresponding Author: Gupta Nidhi ABSTRACT epididymis and redistributes itself into thin walled vascular network over the spermatic The pattern of formation of individual testicular cord called as pampiniform plexus. This vein and their disposition within plexus entwines the testicular artery (TA) abdominopelvic cavity exhibit spectrum of while ascending along the ventral surface of variations on either side of body. The the ductus deferens in the inguinal canal. [1] anatomical aspects of its number, formation, course, valvular configuration, termination, Pampiniform venous plexus blends at the ontogeny and clinical connotations have been level of internal inguinal ring to constitute studied in abundance. As the majority of the venae commitantes of TA. Immediately depictions discussed in past comprised of either after leaving the internal inguinal ring, two one or arbitrary combination of few such to three slender trunks of venae features, the evaluation of an aberrant commitantes entangling testicular artery encountered variation based upon comparison subsequently combines to form a single vein vis-à-vis the available literature becomes termed as testicular veins (TVs), at the level cumbersome and inconclusive. Therefore, the of fourth lumbar vertebra on either side. [2] consolidation of all information hitherto TVs contains inconsistent regarding a particular feature would serve as a unidirectional valves in its course. [3]TVs platform to compare and assess the basis of such variations. conclude on different veins on either side. The current endeavor compiles and highlights After formation, the left testicular vein the relevant facts of individual morphological (LTV) ascends perpendicularly to drain into parameter of testicular veins. The parameters left renal vein (LRV). The LRV, after considered are Formation of testicular veins, collecting left testicular tributary and left numbers, course and termination, valvular suprarenal vein (LSRV), crosses the design collateral communications and abdominal aorta (AA) superficially to drain Ontogenic revelation of errors, which can into inferior vena cava (IVC).However, the correlate with anomaly in testicular veins. right testicular vein (RTV) on the other These refinements in approach to variant hand discharges unswervingly in the (IVC) anatomical architecture strengthen the outlook while maintaining an ascending oblique for clinical practices and academic opinions: thereby, supplementing precise management of course. As the TVs may demonstrate a related venous disorders. spectrum of dissimilarity vis-à-vis contralateral side in same individual and Keywords: Pampiniform plexus: Testicular vein: even same side in two different individuals, Variation: Varicocoele: Development. an optimum analysis of deviation in structural architecture and its distribution in BACKGROUND population is necessary. Therefore, probable The venous stream of human testis ontogenic revelation and review of literature emerges from its dorsal aspect, drains is endeavored, to consolidate the scattered Galore International Journal of Health Sciences and Research (www.gijhsr.com) 56 Vol.5; Issue: 2; April-June 2020 Gupta Nidhi et. al. Variations in testicular veins: an anatomico-clinical review information about variations obtained in Variations in the formation of testicular autopsy, radiographic and operative study. veins: Three venous trails were proposed to The current review, evaluate the explain the drainage of testis and associated formation of TVs, their disposition in the scrotal structures. [8] The first trail consists abdominopelvic cavity, coexistence of of pampiniform plexus, which drains the accessory or supernumerary vessels leading venous blood from the marginal vein of the to numerical discrepancy, their pattern of epididymis in addition to ‘submediastinal drainage and clinico-embryological coronary plexus’ (formed by venous deductions. The augmented comprehension channels draining the parenchyma of of variant patterns in TVs is imperative for testis),[9] through ‘centripetal and centrifugal success of invasive intervention practiced venous counter current pathways. [8] Second by the surgeons, radiologist and urologist in pathway consists of veins draining the vas general; consequently, the thoughtfulness deferens and the third track comprises of about the array of disparity in cremasteric vein, which is interposed retroperitoneal urogenital veins is valuable between external and internal spermatic in the background of unorganized literature fascia.[8] Thin walled pampiniform venous encompassing all relevant attributes. plexus (syn. spermatic venous plexus) is fabricated by the venous networks draining DISCUSSION testis at the level of spermatic cord and The TVs express noteworthy convey venous blood in intrascrotal and anatomical inconsistency in their formation, intrainguinal preceding tracts of TVs. In disposition, morphological characteristics, another portrayal, the testicular venous anastomosis, number, valvular configuration networks in the spermatic cord were and drainage pattern. [4-7]Traditionally, their outlined in ‘two major groups’ coexisting variations were classified considering the side by side. [10] However, further number of veins and effluence pattern into exploration exposed that while profuse four categories. [4] Type 1.Totally duplicated veno-venous anastomosis takes place within LTV: Type 2.Partially duplicated LTV: one group, the anastomoses linking two Type 3. Bilaterally duplicated TVs with groups were observed to be quite scarce. [11] beaded wall: and Type 4. The drainage of After meticulous investigations, vascular LTV and RTV into IVC and RRV arrangement of pampiniform plexus were respectively. The categorical details of each classified into four broad groups. [11] particular entity like formation, number, ‘Group-I’ revealed firm plexus entwining itinerary, valvular composition and endings testicular artery through veno-venous were sparingly audited in the literary works. anastomoses: ‘Group-II’ was formed by Majority of earlier investigations have veno-venous anastomosis among each other described their observations based upon one located in fatty tissue with no distinct or more random combination of specific relation with the testicular artery: ‘Group- attributes, consequently it becomes at times III’ resulted from anastomoses between very intricate and cumbersome to analyze ‘Group-I’ and ‘Group-II’: and ‘Group-IV’ one study vis-à-vis other. Since, the decisive emphasized distinct arteriovenous statistical frequencies of such variations are anastomosis with the testicular artery. Based discrete, unsorted and not weighed against upon hemodynamics, three mechanisms for amongst different studies; a fair compilation venous drainage of testis were asserted of such findings is called for, taking into namely: ‘direct testicular outflow’ where the account individual parameters under which blood directly channelized into pampiniform the discrepancies of TVs may be plexus: ‘indirect testicular outflow’ in which categorized. Therefore, the differences in the blood reaches pampiniform plexus with particular characteristic are evaluated in involvement of the communicating veins: different relevant subheadings. and ‘mixed outflow’ where outflow into vas Galore International Journal of Health Sciences and Research (www.gijhsr.com) 57 Vol.5; Issue: 2; April-June 2020 Gupta Nidhi et. al. Variations in testicular veins: an anatomico-clinical review deferens exist side by side with ‘indirect Retrograde spermatic venography has testicular outflow’.[12] Moreover, the revealed the accurate structure of venous scrupulous dissection suggested that, the networks in pampiniform plexus, which is initial column of veins of the epididymis localized as condensed dye stained area in and the caudal veins of the epididymis radiographic images. However, the staining forms the ‘testicular venous arch’.[12]This can range from sparse condensation to its ‘arch’ anastomoses with cremasteric venules frank absence. On the odd occasion when at that specific site, where the tail of plexus is absent, testis was found to be epididymis transits into vas deferens and rudimentary within the inguinal canal. [16] was named as ‘testicular venous plexus’. [12] Variation in the number of testicular When traced further, fine venous veins: TVs usually exist solitarily on either intermediaries, derived from the side but can be double triple, quadruple on organization of pampiniform plexus within either side in different individual or the spermatic cord, pierced the cord to exit concomitantly in the same individual. [3-5]It on its dorsal aspect and emerged as slender can be nonexistent in a small number of vessels running within the inguinal canal. In cases, where it is associated with a little while, these channels coalesce again characteristic agenesis of testis. [16] The to appear as venae commitantes of testicular remarkable inconsistencies in the number of artery, at the level of internal inguinal ring. TVs with particular analysis of its [13] Physiologically,
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