Transection of the spermatic vessels (Bevan's technique): an experimental study

Intraoperative characterization of arterial vasculature in spermatic cord

OBJECTIVES

To characterize the arterial microanatomy within the spermatic cord.

METHODS

Between June 2002 and March 2003, 72 men underwent 120 microsurgical subinguinal varicocelectomies for the treatment of varicocele. A micro-ruler was used to measure the diameter of each artery in the spermatic cord at the external inguinal ring.

RESULTS

A single testicular artery was identified in 83 (69%), two testicular arteries in 32 (27%), and three arteries in 4 (3%) of 120 cases. The testicular artery diameter ranged from 0.2 to 1.9 mm (mean 1.0). A single vasal artery was identified in 117 (98%) of 120 cases, with the vasal artery diameter ranging between 0.2 and 1.8 mm (mean 0.6). A single cremasteric artery was identified in 66 (55%), two arteries in 37 (31%), and three arteries in 5 (4%) of 120 cases. The cremasteric artery diameter ranged from 0.1 to 1.5 mm (mean 0.5). The diameter of the testicular artery was equal to or greater than the sum of the vasal and cremasteric artery diameters in 69 (57.5%) of 120 spermatic cords.

CONCLUSIONS

The testicular artery was consistently the largest caliber arterial vessel, with a diameter equal to or greater than the sum of the vasal and cremasteric arteries in more than 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.

Microsurgery for intra-abdominal testicular retention

OBJECTIVES

In cases of high intra-abdominal retention of the testis a standard technique of cryptorchidy treatment will not be able to bring down the testis into the scrotum. In this study we wanted to evaluate the feasibility and reliability of the technical aspects of testicular autotransplantations in children under the age of 5 years.

STUDY DESIGN

A series of 25 microsurgical autotranslantations of testes performed on 17 boys since July 1984 are reviewed. Emphasis was placed on the microvascular transplantation technique, the age of the patient and the long term viability of the autotransplants. An end-to-end microvascular anastomosis between the deep inferior epigastric artery and the testicular artery was performed in an end-to-end way using mattress stitches to accommodate the difference in diameter between the donor and recipient vessels. Also the testicular veins were anastomosed to the deep inferior epigastric veins.

RESULTS

Of the 25 transplantations (96%) were successful after a mean follow up of 24 months, the one failure was ascribed arterial thrombosis.

CONCLUSION

Our results show a 96% survival of the transplanted testes using the end-to-end vascular anastomosis as described here.

Variability of venous anatomy of rat testis: application to experimental testicular surgery

The venous drainage of the testis of the laboratory rat was observed in 31 animals. The right testicular (internal spermatic) vein drained directly into the right common iliac vein in 77.4%, and into the inferior vena cava in 22.6% of the animals. The left testicular vein drained into the left common iliac vein in all animals, but in 90.3% there was also an accessory branch of the testicular vein draining into the left renal vein. These observations suggest that in the rat the exact anatomy of the venous drainage of each testis should be identified prior to undertaking any surgical procedure on the testis where the venous vasculature plays a major role such as testicular transplantation or the creation of an experimental varicocele.

The functional value of collateral testicular vascularisation. An experimental study

The functional value of the collateral testicular vascularisation has been studied in the rat. In some cases the spermatic artery was sectioned at different levels and in others the vasal artery was sectioned. Hormonal, pathological and anatomical parameters were investigated. The results support the concept that the vasal artery is the most important collateral artery and that the cremasteric artery plays little, if any, part. They also support the view that following proximal section of the testicular artery, the collateral testicular blood supply is variable and the effects of this division are unpredictable and inconsistent.