Editing Testicle (section)

== Vasculature ==

=== Arterial supply (3): ===

* '''<span style="color:#ff0000">Testicular (internal spermatic) artery</span>'''
** '''<span style="color:#ff0000">Arises from the abdominal aorta'''
** Crosses psoas muscle and the ureter to reach the internal inguinal ring to enter the spermatic cord
* '''<span style="color:#ff0000">Artery of the vas deferens (vasal/deferential artery)</span>'''
** '''<span style="color:#ff0000">Arises from the superior vesical artery</span> (usually, but can arise from the inferior vesical artery)''', which arises from the internal iliac artery
* '''<span style="color:#ff0000">Cremasteric (external spermatic) artery</span>'''
** '''<span style="color:#ff0000">Arises from the inferior epigastric artery</span>''' '''(Cream in the Belly)''', which arises from the external iliac artery
*** 
** '''Testicular artery'''
*** '''Main blood supply to the testicle'''
**** '''Diameter of the testicular artery > (diameter of artery of vas + cremasteric arteries)'''
**** '''In case of testicular artery ligation, the deferential and cremasteric arteries can potentially provide adequate blood supply to the testis; however, atrophy and/or azoospermia has resulted from testicular artery ligation'''
**** '''Because the deferential artery may have been compromised during a prior vasectomy, careful attention is needed to preserve the testicular artery in future surgeries, such as varicocelectomy, in men with a prior vasectomy'''
** Penetrates the tunica albuginea and then travel inferiorly along the posterior surface of the testis within the parenchyma. Branching arteries pass anteriorly over the testicular parenchyma. Major testicular artery branches also travel over the inferior pole of the testis, pass anteriorly, and branch out over the surface of the testis.
*** '''Clinical implication: testicular biopsy should target the midsection of the testis because this area has relatively fewer vessels compared with superior or inferior areas'''
** '''Supplies the tunica testis vasculosa in the anterior portion of the upper pole of the testis and the anterior, medial, and lateral portions of the lower pole of the testis'''
** '''Genital branch of the genitofemoral nerve travels along the testicular artery to reach the testis'''
*** '''Primarily supplies sensation to the parietal and visceral tunica vaginalis and the overlying scrotum'''

=== Venous drainage ===

* Unlike most other venous patterns in the body, '''veins within the testis do not travel with their corresponding arteries.'''
* Small parenchymal veins either drain into a group of veins near the mediastinum testis, or they drain into veins on the surface of the testis. These two groups of veins anastomose with each other and the deferential veins to '''form the pampiniform plexus'''
* '''Pampiniform plexus'''
** '''A network of testicular veins that anastomose as they ascend surrounding the testicular artery'''
** '''Allows for a counter-current heat exchange that cools the blood flow within the testicular artery and keeps the testis 2-4°C lower than rectal temperature'''
** '''Ultimately, these veins join one another to form 2-3 veins at the level of the inguinal canal, and then they form one vein (gonadal vein) that ascends to drain into the inferior vena cava on the right and into the renal vein on the left side'''
** '''Dilated in a varicocele (see Varicocelectomy Chapter Notes);''' there may be variations where the testicular veins can anastomose to other veins and this can result in recurrence of varicocele following ablation.
* '''Deferential veins'''
** '''Follow the vas deferens and empty into the internal iliac ('''hypogastric) '''veins'''
** '''Spared during varicocele ligation surgery'''