Anatomy of the venous drainage of the human testis: testicular vein cast, microdissection and radiographic demonstration. A new anatomical concept.

The venous drainage of the testis was identified and described in an autopsy, radiographic and operative series of 30, 28 and 7 adult males, respectively. Testicular vein cast--right and left--was prepared in autopsy specimens to identify the course, tributaries and communications of the testicular vein. Intraoperative spermatic venography was done in 17 men with and in 11 men without varicocele. The retrograde spermatic venography showed the precise anatomy of the pampiniform plexus. Antegrade spermatic venography was done to identify the valves. During cystectomy in 7 adult men, the whole tree of the spermatic vein was taken and microdissected. Our findings show that the venous drainage of the testis cannot be looked upon as it is in the standard anatomy; on the contrary, it deviates from the description in the text. We demonstrated that the venous drainage of the testis is via the pampiniform plexus, which is primarily drained by the testicular and external pudendal veins. The testicular vein--midway between the internal inguinal ring and the lower pole of the kidney--divides into the medial and lateral branch to form a delta. The medial branch communicates with the ureteral and contralateral veins; there, it terminates in the left renal vein or inferior vena cava on the right side. The lateral branch communicates with colonic and renal capsular veins and terminates in the perinephric space. There is no cross-communication between the left and right testicular venous systems in the scrotal, retropubic or pelvic areas. The only cross-communication is in the abdomen, and is seen in only 50% of men. The testicular vein has no valves.