A cadaveric study of the testicular artery and its clinical significance
Um estudo da artéria testicular em cadáveres e sua relevância clínica
Sushma R. Kotian, Arvind Kumar Pandey, Supriya Padmashali, Judith Jaison, Sneha Guruprasad Kalthur
Abstract
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.
Keywords
Resumo
Contexto: O conhecimento de variações da artéria testicular é vital para assegurar que essas artérias não serão negligenciadas durante a realização de diferentes técnicas operatórias, já que qualquer dano poderia causar atrofia testicular. Objetivos: Este estudo teve como objetivo identificar variações na origem e no trajeto das artérias testiculares. Foi feita uma tentativa de classificar as artérias com base em suas diferentes origens. Métodos: Este estudo examinou 42 cadáveres de adultos do sexo masculino com idade entre 40 e 70 anos preservados em formol. As diferentes origens da artéria testicular foram identificadas e classificadas. Variações na origem e no trajeto da artérias foram coloridas, fotografadas e documentadas. Foram medidas as distâncias entre a origem das artérias testiculares e o ponto médio da origem das artérias renais. Resultados: As artérias testiculares foram classificadas em quatro categorias com base em sua origem. Essa variabilidade foi definida com relação às artérias renal e mesentérica inferior. A distância média entre a origem da artéria testicular e o ponto médio da origem da artéria renal foi de 3,08 e 3,47 cm nos lados direito e esquerdo, respectivamente. As variações foram encontradas quase exclusivamente no lado esquerdo. As variações observadas incluíram múltiplos ramúsculos formando a artéria testicular, artérias suprarrenais surgindo a partir da artéria testicular, e duplicação da artéria testicular. Conclusão: Este estudo traz informações sobre variações da artéria testicular e propõe uma classificação que poderia ajudar os cirurgiões durante diferentes procedimentos realizados no abdome e na pelve de pacientes do sexo masculino.
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References
1. Williams PL, Warwick R, Dyson M, Bannister LH, editors. Gray’s Anatomy. 37th ed. Edinburgh: Churchill Livingstone; 1989. p. 808-10.
2. Bergman RA, Thompson SA, Afifi AK. Compendium of human anatomic variation: text, atlas, and world literature. Baltimore: Urban & Schwarzenberg; 1988. 83 p.
3. Gupta A, Singal R, Singh D. Variations of gonadal artery: embryological basis and clinical significance. Int J Biol Med Res. 2011;2(4):1006-10.
4. Bergman RA, Cassell MD, Sahinoglu K, Heidger PM Jr. Human doubled renal and testicular arteries. Ann Anat. 1992;174(4):313-5. PMid:1416060. http://dx.doi.org/10.1016/S0940-9602(11)80292-X.
5. Ravery V, Cussenot O, Desgrandchamps F, et al. Variations in arterial blood supply and the risk of hemorrhage during percutaneous treatment of lesions of the pelviureteral junction obstruction: report of a case of testicular artery arising from an inferior polar renal artery. Surg Radiol Anat. 1993;15(4):355-9. PMid:8128346. http://dx.doi.org/10.1007/BF01627892.
6. Ozan H, Gümüşalan Y, Onderoğlu S, Simşek C. High origin of gonadal arteries associated with other variations. Ann Anat. 1995;177(2):156-60. PMid:7741277. http://dx.doi.org/10.1016/S0940-9602(11)80066-X.
7. Brohi RA, Sargon MF, Yener N. High origin and unusual suprarenal branch of a testicular artery. Surg Radiol Anat. 2001;23(3):207-8. PMid:11490935. http://dx.doi.org/10.1007/s00276-001-0207-7.
8. Loukas M, Stewart D. A case of an accessory testicular artery. Folia Morphol (Warsz). 2004;63(3):355-7. PMid:15478116.
9. Xue HG, Yang CY, Ishida S, et al. Duplicate testicular veins accompanied by anomalies of testicular arteries. Ann Anat. 2005;187(4):393-8. PMid:16163852. http://dx.doi.org/10.1016/j.aanat.2005.04.007.
10. Kocabiyik N, Yalçin B, Kiliç C, Kirici Y, Ozan H. Accessory renal arteries and an anomalous testicular artery of high origin. Gulhane Tip Derg. 2005;47:141-3.
11. Rusu MC. Human bilateral double renal and testicular arteries with a left testicular arterial arch around the left renal vein. Rom J Morphol Embryol. 2006;47(2):197-200. PMid:17106531.
12. Deepthinath R, Nayak BS, Mehta RB, et al. Multiple variations in the paired arteries of the abdominal aorta. Clin Anat. 2006;19(6):566-8. PMid:16283657. http://dx.doi.org/10.1002/ca.20207.
13. Shoja MM, Tubbs RS, Shakeri AB, Oakes WJ. Origins of the gonadal artery: embryologic implications. Clin Anat. 2007;20(4):428-32. PMid:17109441. http://dx.doi.org/10.1002/ca.20438.
14. Nayak SR, Jiji PJ. Multiple anomalies involving testicular and suprarenal arteries: embryological basis and clinical significance. Rom J Morphol Embryol. 2007;48(2):155-9. PMid:17694220.
15. Pai MM, Vadgaonkar R, Rai R, et al. A cadaveric study of the testicular artery in the South Indian population. Singapore Med J. 2008;49(7):551-5. PMid:18695863.
16. Notkovich H. Variation of the testicular and ovarian arteries in relation to the renal pedicle. Surg Gynecol Obstet. 1956;103(4):487-95. PMid:13360658.
17. Ne A, Bartley O, Chidekel N. Right and left gonadal veins: an anatomical and statistical study. Acta Radiol Diagn (Stockh). 1966;4(6):593-601. PMid:5929114.
18. Machnicki A, Grzybiak M. Variations in testicular arteries in fetuses and adults. Folia Morphol (Warsz). 1997;56(4):277-85. PMid:9635363.
19. Mijac M, Goldner B, Joksimović B, Lolić-Draganić V. Variations in the origin of ovarian and testicular arteries. Srp Arh Celok Lek. 1983;111(5):609-15. PMid:6665614.
20. Asala S, Chaudhary SC, Masumbuko-Kahamba N, Bidmos M. Anatomical variations in the human testicular blood vessels. Ann Anat. 2001;183(6):545-9. PMid:11766526. http://dx.doi.org/10.1016/S0940-9602(01)80064-9.
21. Merklin R, Michels N. The variant renal and suprarenal blood supply with data on the inferior phrenic, ureteral and gonadal arteries. J Int Coll Surg. 1958;29(1 Pt 1):41-76. PMid:13502578.
22. Singh R, Jaiswal A, Shamal SN, Singh SP. Variation in the origin of the testicular arteries and drainage of the right testicular vein. Int J Morphol. 2011;29(2):614-6. http://dx.doi.org/10.4067/S0717-95022011000200052.
23. Ambos MA, Bosniak MA, Lefleur RS. Blood flow to the kidney via the gonadal-renal capsular artery. Urol Radiol. 1979;1(1):11-6. PMid:553360.
24. Grine F, Kramer B. Arched gonadal arteries in the South African Negro. J Anat. 1981;132(3):387-90. PMid:7298490.
25. Jyothsna P, Mohandas RK, Somayaji SN, Ashwini LS. Multiple vascular anomalies involving testicular, suprarenal arteries and lumbar veins. N Am J Med Sci. 2012;4(3):154-6. PMid:22454832. http://dx.doi.org/10.4103/1947-2714.93880.
26. Shinohara H, Nakatani T, Fukuo Y, Morisawa S, Matsuda T. Case with a high-positioned origin of the testicular artery. Anat Rec. 1990;226(2):264-6. PMid:2301743. http://dx.doi.org/10.1002/ar.1092260216.
27. Onderoglu S, Yuksel M, Arik Z. Unusual branching and course of the testicular artery. Anat Anz. 1993;175(6):541-4. PMid:8297041. http://dx.doi.org/10.1016/S0940-9602(11)80219-0.
28. Ciçekcibaşi AE, Salbacak A, Seker M, Ziylan T, Büyükmumcu M, Uysal II. The origin of gonadal arteries in human fetuses: anatomical variations. Ann Anat. 2002;184(3):275-9. PMid:12056759. http://dx.doi.org/10.1016/S0940-9602(02)80126-1.
29. Felix W. Mesonephric arteries (Aa Mesonephricae). In: Keibel F, Mall FP, editors. Manual of Human embryology. 2nd ed. Philadelphia: Lippincott; 1912. p. 820-5.
30. Larsen WJ, Sherman LS, Potter SS, Scott WJ. Human embryology. 3rd ed. London: Elsevier Health Sciences; 2001. 201 p.
31. Cussenot O, Desgrandchamps F, Bassi S, Teillac P, Lassau JP, Le Duc A. Anatomic basis of laparoscopic surgery in the male pelvis. Surg Radiol Anat. 1993;15(4):265-9. PMid:8128333. http://dx.doi.org/10.1007/BF01627877.
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