A rare case of multiple visceral vascular variations around the kidneys: morphological and clinical aspects

Knowledge of the anatomical variations of the visceral branches of the abdominal aorta is important information for planning any surgeries in the region. We present here a rare constellation of variations of visceral vessels around the kidneys with a brief review of the recent literature. On the right side, an accessory renal artery was observed originating just distal to the main renal artery. The middle suprarenal artery was absent on the right side and there were two inferior suprarenal arteries originating from a branch of the main right renal artery. On the left side, the testicular artery had an arched course anterior to the left renal vein mimicking an unusual variety of nutcracker phenomenon. The right kidney was drained by two renal veins into the inferior vena cava. Knowledge of the coexistence of such complex anatomical variations might be helpful for clinicians during diagnostic and therapeutic procedures.

A case of novel combined variations of the renal and testicular vessels

Variations in the pattern of urogenital vessels can arise as a single occurrence or as a combination, which may increase the risk of unexpected injury during surgical procedures. Multiple variations in the renal and testicular vessels, in a novel combination, were observed during dissection of an 87-year-old Japanese male cadaver. In the present case, the patient had two renal arteries on each side. On the right side, the superior and inferior renal arteries emerged from the abdominal aorta at the L1 and L4 vertebrae levels, respectively. On the left side, the superior renal artery originated from the abdominal aorta at the level of the L1/L2 intervertebral disc, whereas the inferior renal artery arose at L4. The right testicular artery emerged from the abdominal aorta at the level of the L2 vertebra and crossed the inferior vena cava posteriorly. The venous system also exhibited some variations. The left renal vein passed posteriorly to the abdominal aorta and opened into the inferior vena cava at the level of the L2 vertebra. On the course to the inferior vena cava, the left renal vein was connected only to the first lumbar, azygos, and hemiazygos veins; blood was not collected from the left testicular and suprarenal veins, which usually open to the left renal vein. The patient had two right testicular veins. The lateral one opened into the angle between the right renal vein and the inferior vena cava at the level of the L2 vertebra, and the medial one drained into the inferior vena cava at a level slightly lower than the lateral one. Knowledge of the possible anatomical variations may be beneficial for performing safe retroperitoneal surgery and understanding the development of these vessels.

Doppler Examination of the Testicular Artery of Beagle-Breed Dogs from Birth to Puberty

The objectives were (a) the study of haemodynamic parameters of blood flow within the testicular artery, (b) the assessment of differences in these parameters at different segments of the artery (i.e., sequentially, as the artery flows through different regions of the testis), and (c) the identification of potential associations with measures of testicular maturation. Eight healthy beagle-breed male dogs were monitored at fortnightly intervals from the 4th to the 40th week of life, by using clinical, seminological, and ultrasonographic (B-mode, pulsed-wave Doppler) examinations. Haemodynamic parameters were assessed at four different segments of the testicular artery: at the distal supra-testicular, the marginal testicular at the cranial pole of the testis, the marginal testicular at the caudal pole of the testis, and the intratesticular. The study period was divided into three time slots (pre-puberty, puberty, and post-puberty) depending on testicular maturation and sperm production. No clinically evident abnormalities were seen in any animal throughout the study. Semen ejaculates were first collected on the 28th week, and spermatozoa were first seen on the 30th week of life. The results of B-mode examination indicated that in all dogs, the echogenicity of the testicular parenchyma was homogeneous. The waveforms of the blood flow in the testicular artery were monophasic with systolic peaks, low diastolic flow, and low vascular resistance. Most cases of significant differences between the three age periods were noted for the comparison of the pre-pubertal to pubertal periods (n = 11); among the parameters studied, the blood volume (n = 9) showed most instances of significant differences; finally, most cases of significant differences were noted in the distal supra-testicular artery (n = 12). Correlations were mainly seen for the end diastolic velocity, the peak systolic velocity and the blood volume (each with two semen evaluation parameters). The distal supra-testicular and the marginal artery at the cranial pole of the testis are recommended as the most appropriate segments of the vessel for performing a Doppler examination in the testicular artery due to the adequate size and the clear spectral waveforms as early as the 12th week of age of the animals.

Conservative treatment of partial testicular artery injury during transabdominal preperitoneal hernioplasty (TAPP)

Inguinal hernias are common conditions in general surgery. Laparoscopic approach, whether transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP), is favored for its lower rate of surgical site infection, shorter hospital stay, and faster return to daily activities. Complications still occur, albeit in a small percentage, but can prolong hospital stay or be fatal. We present a case of a 55-year-old male patient who underwent TAPP procedure with proposed iatrogenic testicular artery injury resulting in a bilateral retroperitoneal hematoma. The treatment was conservative, and the patient was discharged in good general condition after 13 days. Six months postoperatively, no signs of hernia recurrence were observed. According to available literature, this is the first conservatively treated occult testicular artery injury during TAPP inguinal hernioplasty.

Effects of Inadequate Folate Intake on the Onset and Progression of Hypertensive Vascular Injury

We investigated the effects of inadequate folate intake on the onset and progression of hypertensive organ injury. In the present study, 5-wk-old male stroke-prone spontaneously hypertensive rats (SHRSP) were fed with a normal-folate (control; 160-170 μg of folate/100 g diet) or low-folate (8-10 μg of folate/100 g diet) diet until they reached 25 wk of age. After the animals reached 10 wk of age, the bodyweight of the rats in the low-folate group was lower than that of the rats in the control group. Regarding blood pressure, both groups had severe hypertension of ≥230 mmHg at 12 wk of age that was not significantly different between the groups. At 16 wk of age, the low-folate group had a low number of blood cell types. The folate levels in the serum, liver, and kidneys of these rats were significantly lower (p<0.01) and the serum homocysteine level in the low-folate group was significantly higher than in the controls. The low-folate group had a significantly lower testicular weight than the control group (p<0.05) and arterial hypertrophy, spermatogenesis arrest, and interstitial connective tissue hyperplasia were observed. However, there was no clear difference in lesions in other organs. These results indicated that under low folate status, SHRSP causes hematopoietic disorders and exacerbates hypertensive vascular injury at various degrees by organ type.

Melatonin improves testicular haemodynamics, echotexture and testosterone production in Ossimi rams during the breeding season

The objective was to determine effects of a single parenteral dose of melatonin on testicular blood flow indices, testicular echogenicity and plasma testosterone concentrations in rams during the physiological breeding season. We hypothesized that melatonin enhances testicular blood flow, echogenicity and plasma testosterone concentrations during the breeding season in rams. During the breeding season, 12 sexually mature Ossimi rams were randomly allocated to either a melatonin group (n = 8) that received 18 mg of melatonin in 1 ml of corn oil (injected SC) or a control group (n = 4) that received 1 ml corn oil only. Blood collection and ultrasonographic assessment of the testes and supratesticular arteries were conducted immediately before treatment (W0) and once weekly for 6 weeks after melatonin injection (W1-W6). Mean plasma testosterone concentrations were greater (p < .05; at least 1 ng/ml) in the melatonin-treated group compared to the control group from W4 to W6 after treatment. A decrease (p < .05) in both resistive index (RI) and pulsatility index (PI) began 1 week after melatonin injection (W1) and persisted until the end of the experiment, with mean RI and PI values in the melatonin group lower (p < .05) than those in the control group on W3 and W4. Furthermore, plasma testosterone concentrations in melatonin-treated rams were inversely correlated to both RI and PI (r = -.7 and -.6, respectively, p < .01). Testicular echogenicity decreased (p < .05) 1 week after melatonin injection (W1) and remained lower (p < .05) in the melatonin-treated group compared to the control group until the end of the study (W6). In conclusion, melatonin administration significantly altered testicular blood flow and echogenicity and increased plasma testosterone concentrations in Ossimi rams during the breeding season.

Assessment of the accuracy of testicular dysfunction detection in male donkey (Equus asinus) with the aid of colour-spectral Doppler in relation to plasma testosterone and serum nitric oxide levels

This study aimed to determine the usefulness of colour and pulsed Doppler modes for the accurate diagnosis of donkeys suffering from subfertility to determine whether testicular vascularity assessment could be an indicator for sperm functionality. The study sample was composed of 10 male donkeys with normospermia (control group) and 10 donkeys with hypospermia. Animals underwent scrotal circumference measurement, testicular Doppler examination, seminal evaluation, blood sampling and hormonal assay. Semen volume and concentration were significantly (p ≤ .05) lower in the subfertile group (30.25 ± 1.22 ml and 89.44 ± 2.55 × 10⁶ /ml) as compared with the control group (82.76 ± 1.65 ml and 452.78 ± 1.25 × 10⁶ /ml), and total sperm/ejaculation was significantly (p ≤ .05) higher in the normal donkeys (28.30 ± 2.32 × 10⁹ /total ejaculated) as compared with the subfertile group. Intratesticular coloured area showed a marked decline in the hypospermic males. There was no significant difference between the two groups in testosterone level, although the normal group showed an increase in nitric oxide metabolites. Both Doppler indices of the three branches of the testicular artery were elevated significantly (p ≤ .05) in abnormal donkeys, whereas Doppler peak systolic and end-diastolic velocities were increased in the normal group. Male donkeys with subfertility demonstrated lower arterial vascularity parameters in the form of intratesticular coloured area and blood flow rate; therefore, the most optimal parameters for differentiating subfertile hypospermic from normospermic donkeys were found to be the two Doppler indices, velocities parameters, testicular blood flow rate and nitric oxide levels.

New Approaches to Assess Fertility in Domestic Animals: Relationship between Arterial Blood Flow to the Testicles and Seminal Quality

The early identification of infertile males improves reproduction efficiency at a production level and is essential to secure high production rates. Before entering a breeding program, males must pass an initial breeding soundness examination (BSE) which consist of several diagnostic exams whose end point is to estimate their future fertility. There is ongoing research to find new markers that allow better identification of fertile males. Doppler mode allows the quantitative and qualitative evaluation of the irrigation of organs. When evaluating the reproductive system, Doppler mode has been successfully used for the evaluation of the uterine and ovarian irrigation. In males, it is gaining relevance for the evaluation of testicular irrigation. Researchers have found a relationship between pulsed-wave Doppler velocimetric parameters and seminal quality in various domestic animal species. This suggests Doppler ultrasound parameters should be considered as objective parameters to evaluate testicular function. In this review, we analyze the results in the main domestic animal species and discuss the differences and similarities among the results. We also discuss the effect of the location of the measurements, breed, season and laterality in the measurement of Doppler velocimetric parameters as well as the impact and limitations of this method of assessing breeding soundness.

Relationship between angioarchitecture of the testicular artery and spermiogram parameters in Egyptian buffalo bulls (bubalus bubalis)

The current study aimed to investigate the effect of testicular artery angioarchitecture on the spermiogram parameters in Egyptian Buffalo bulls. Eight adult buffalo bulls aged between 2 and 8 years were used for semen evaluation. For anatomical studies, the masculine gonads were collected after slaughtering 30 adult bulls and prepared for injection by different masses (Urographine^® , Latex and Epoxy) through the testicular artery. The mass activity of the ejaculate was assessed immediately after collection. The sperm motility in fresh bull ejaculate was more than 80%. The overall mean percentage of sperm abnormalities was <18%. The recorded sperm abnormalities were mostly secondary one including distal protoplasmic droplet, fragmented tail, detached head, detached galea capitis and bent tail. The highest percentage of sperm viability was recorded just after sperm collection (alive > 85%). The results revealed that testicular artery can be divided into three parts (abdominal, funicular and marginal parts) along its course. The coils of the funicular part forming a cone-like structure with its base fixed to the head of the testis. Two epididymal branches to the head and tail of epididymis emanate from the funicular part which continues as pars marginalis on the lateral surface of testis before its division into the lateral and medial testicular arteries on approaching the tail extremity of the testis. The increase in the length of the testicular artery with increase in the size of the testes played a great role in the degree of complexity of the architectural vascular patterns. The degree of complexity is affected by the number of coils formed by the vessel. The increase in the convolutions of the vessel will reduce the speed of blood flow to the gonads. Thus in turn will enabling the thermoregulatory mechanism to work more efficiently and will affect the semen value.

Arterial supply to the rabbit male genital organs

The improvement of veterinary care has prolonged the lifespan of rabbits, and the number of rabbits suffering from age-related, male genital disorders may increase in the near future. This could result in increased opportunities for male genital surgery, requiring knowledge of their arterial anatomy, which, however, has not been sufficiently studied. Therefore, the arteries supplying the genitals were observed in 20 male New Zealand White rabbits. The testis was supplied by the testicular artery originating from the abdominal aorta. The right testicular artery usually emerged at a more cranial level than the left artery (65%). The testicular artery encircled the testis in the sagittal plane and bifurcated (95%) or trifurcated (5%) at the caudal extremity of the testis before entering the parenchyma. The epididymis was supplied by the epididymal branches, either from only the testicular artery (75% of the right and 80% of the left halves) or from both the testicular artery and aorta. The deferent duct was supplied in all halves by the dorsal and ventral branches of the deferential artery, which usually arose from the umbilical artery. The accessory genital glands were supplied by the dorsal branch of the deferential artery and the prostatic artery. The latter, which emerged from the internal iliac artery, exhibited 3 branching types. The most frequent type (55% of the right and 45% of the left halves) had 3 branches supplying the accessory genital glands. These findings will help improve rabbit genital surgery.

Sperm Tail Defects and Abnormal Testicular Blood Flow in a Beagle Dog: A Case Report

A 5-year-old male Beagle dog produced ejaculates with a high percentage of spermatozoa with abnormal morphology, especially sperm tail defects. Although libido and semen volume were normal, ejaculates showed asthenospermia, oligozoospermia, and teratozoospermia. The spermatozoa exhibited morphologic defects affecting the flagellum, mainly coiled tails with or without macrocephalia (33.5 ± 2.1%), bent tails (18.3 ± 3.4%), and proximal cytoplasmic droplets (6.7 ± 2.8%). The peripheral plasma testosterone level was 2.76 ± 0.21 ng/mL. The resistive index and the pulsatility index from marginal and intratesticular vessels measured by Doppler ultrasound showed higher values in the right testicle than in the left testicle. Histologic evaluation revealed focal reduction in the number of germ cells and sperm in the seminiferous tubules in the right testicle. This is the first report that describes simultaneously the presence of sperm tail defects in the ejaculate and changes in the blood flow of testicular vessels in the dog.

A cadaveric study of the testicular artery and its clinical significance

Background

Knowledge of testicular artery variations is vital to ensure that they are not neglected during a variety of different operative techniques, since damage can cause testicular atrophy.

Objectives

The present study was therefore intended to identify variants in the origin and course of the testicular arteries. An attempt was made to classify the arteries based on their various origins.

Methods

This study examined 42 formalin-fixed cadavers of 40 to 70-year-old adult males. Variant origins of the testicular artery were identified and classified. Variations in the origin and course of the artery were colored, photographed, and documented. The distances between the origins of the testicular arteries and the mid-points of the origins of the renal arteries were measured.

Results

Testicular arteries were classified into four categories on the basis of origin. This variability was defined in relation to the renal and inferior mesenteric arteries. The mean distance between the origin of the testicular artery and the mid-point of the origin of the renal artery were 3.08 and 3.47 cm, on the right and left sides respectively. Variations were almost exclusively found on the left side. The variations observed included multiple arterial twigs forming the testicular artery, suprarenal arteries arising from the testicular artery, and testicular artery duplication.

Conclusion

This study provides an insight into variations in the testicular artery and proposes a classification which could help surgeons during a variety of procedures on the male abdomen and pelvis.