[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Anatomy](https://durgical.com/en/anatomy/) › [Pelvis · Male](https://durgical.com/en/anatomy/region/pelvis/) › Testicular veins and pampiniform plexus [Cardiovascular system](https://durgical.com/en/anatomy/system/cardiovascular-system/) · [Pelvis · Male](https://durgical.com/en/anatomy/region/pelvis/) # Testicular veins and pampiniform plexus The testicular veins drain the [testes](https://durgical.com/en/anatomy/testis/); in the [scrotum](https://durgical.com/en/anatomy/scrotum/) they form a mesh, the pampiniform plexus, that cools incoming blood. Widened, they form a varicocele. Official name: Testicular vein; pampiniform plexus [See in 3D →](https://durgical.app/?from=durgipedia&lang=en#region=pelvis&variant=male&select=testicular_veins&side=r) Opens in the Durgical app, no sign-up needed. ## What it is Veins that leave the testis as a network around the artery (pampiniform plexus) and join into one vein in the [abdomen](https://durgical.com/en/anatomy/region/abdomen/): the right one drains into the [inferior vena cava](https://durgical.com/en/anatomy/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 points - Left varicocele is far commoner: the left vein is longer, ends at a right angle in the [left renal vein](https://durgical.com/en/anatomy/right-renal-vein/), often lacks valves, and the left renal vein can be squeezed by the [superior mesenteric artery](https://durgical.com/en/anatomy/superior-mesenteric-artery/) - A [kidney](https://durgical.com/en/anatomy/kidney/) cancer growing into the left renal vein can block it and cause a sudden left varicocele - Varicocele is graded by examination: felt only with Valsalva (grade 1), felt at rest (2), seen at rest (3); subclinical ones show only on ultrasound ## Key facts **Drains** Testis and [epididymis](https://durgical.com/en/anatomy/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](https://durgical.com/en/anatomy/spermatic-cord/), merges into a few veins in the [inguinal canal](https://durgical.com/en/anatomy/inguinal-canal/) and a single vein near the deep ring, then runs up on [psoas major](https://durgical.com/en/anatomy/psoas-major/) beside the artery to its ending **Deep** In the cord, the [testicular artery](https://durgical.com/en/anatomy/testicular-artery-pelvis/), 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 - [Varicocele](https://durgical.com/en/conditions/varicocele/) ## 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. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/anatomy/testicular-vein-pampiniform-plexus/) 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 - [Spermatic cord](https://durgical.com/en/anatomy/spermatic-cord/) Sources: [Anatomy, Abdomen and Pelvis: Testes](https://www.ncbi.nlm.nih.gov/books/NBK470201/); [20.5 Circulatory Pathways](https://openstax.org/books/anatomy-and-physiology-2e/pages/20-5-circulatory-pathways) (OpenStax (Rice University), 2022) · adapted, [CC BY 4.0](https://creativecommons.org/licenses/by/4.0/). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/anatomy/testicular-vein-pampiniform-plexus/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/testicular-vein-pampiniform-plexus/