Cardiovascular system · Pelvis · Male
Testicular veins and pampiniform plexus !
The testicular veins drain the testes; in the scrotum they form a mesh, the pampiniform plexus, that cools incoming blood. Widened, they form a varicocele.
Official name: Testicular vein; pampiniform plexus
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What it is
Veins that leave the testis as a network around the artery (pampiniform plexus) and join into one vein in the abdomen: the right one drains into the inferior vena cava, the left one into the left renal vein.
What it does
Drain the testis; the pampiniform plexus also cools the arterial blood before it reaches the testis.
Key facts
- Drains
- Testis and epididymis by the pampiniform plexus, which wraps the testicular artery and cools its blood (countercurrent exchange)
- Into
- Single vein near the deep ring; right into the IVC, left into the left renal vein at a right angle, so varicocele is far more common on the left
Relations
- Course
- The plexus rises in the spermatic cord, merges into a few veins in the inguinal canal and a single vein near the deep ring, then runs up on psoas major beside the artery to its ending
- Deep
- In the cord, the testicular artery, which the plexus surrounds
How to find it
Examined standing: a varicocele feels like a 'bag of worms' above the testis, usually on the left, filling with straining and emptying when lying down.
Examination
- Valsalva manoeuvre standing: enlargement of the plexus confirms a small varicocele
- Lying down: a varicocele that does not empty suggests obstruction higher up, such as a renal or retroperitoneal mass
On imaging
Colour Doppler ultrasound shows dilated plexus veins with reversed flow during Valsalva; size cut-offs vary between guidelines. CT is used when a secondary cause is suspected.
Common problems
- Varicocele: widened plexus veins, much more often on the left. A varicocele that appears suddenly or only on the right needs a check of the abdomen.
How it is diagnosed
Examination; Doppler ultrasound shows the blood flow (torsion) and widened veins (varicocele).
Treatment
- Ligation or embolisation if it causes pain or affects fertility.
Clinical notes
- Varicocele can lower sperm quality, probably by raising testicular temperature; it is treated by ligation (microsurgical, sparing artery and lymphatics) or by embolization
- A hydrocele can form after varicocele repair if the lymphatics are tied
Anatomical variants
- The right vein sometimes ends in the right renal vein instead of the inferior vena cava; parallel or duplicated veins are common, and a missed branch is one reason a varicocele returns after repair
Related conditions
Test yourself
Think of the answer, then tap the question to see it.
Why is varicocele far commoner on the left?
The left testicular vein is longer, ends at a right angle in the left renal vein, often lacks valves, and the renal vein can be squeezed by the superior mesenteric artery.
What does a sudden left varicocele, or one that does not empty lying down, suggest?
Obstruction higher up, such as a kidney cancer growing into the left renal vein or a retroperitoneal mass.
How is varicocele graded on examination?
Grade 1: felt only with Valsalva; 2: felt at rest; 3: seen at rest. Subclinical ones show only on ultrasound.
What is the thermoregulatory role of the pampiniform plexus?
It wraps the testicular artery and cools its blood by countercurrent exchange before it reaches the testis.
Educational information, not medical advice. For any symptom, see a health professional.
Its names
- Official Latin (TA2)
- vena testicularis; plexus pampiniformis
- Official Spanish (DeCS)
- Vena testicular; plexo pampiniforme
- English (TA2)
- Testicular vein; pampiniform plexus
- Also called
- internal spermatic vein
Related
Sources: Anatomy, Abdomen and Pelvis: Testes; 20.5 Circulatory Pathways (OpenStax (Rice University), 2022) · adapted, CC BY 4.0.
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Representative model, for educational purposes only.
