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Phlebologie 2010; 39(06): 317-324
DOI: 10.1055/s-0037-1622328
Original article
Schattauer GmbH

Valves of the gonadal veins

An anatomical studyKlappen der Gonadenveneneine anatomische Studie
A. Heinz
1   Division for Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Innsbruck Medical University, Austria
,
E. Brenner
1   Division for Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Innsbruck Medical University, Austria
› Author Affiliations
Further Information

Publication History

Received: 29 June 2010

Accepted: 01 September 2010

Publication Date:
05 January 2018 (online)

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Summary

Purpose: Varicocele seems not to rely on the number of valves within the pampiniform plexus, the initial failure might be located on a higher level. Therefore, the failure should also occur in females. There is a comparable disease, Pelvic congestion syndrome, as result of pelvic venous engorgement due to gross dilatation and incompetence of ovarian veins.

Thus, we need a detailed description of venous course, branching as well as frequencies and locations of valves within both genders. Page 3/23

Material and Methods: In 31 Caucasian formalin-fixed bodies (15 males, 16 females) we investigated course and valves from Ovaries or internal inguinal ring, respectively, up to termination into inferior vena cava or left renal vein, respectively. Specimens were documented photographically and by a distinct protocol.

Results: In general, we found one valve on each side (testicular vein right 41.93%, left 51.52%; ovarian vein right 51.61%, left 45.45%). Two specimens had two valves per vein, each in a left testicular vein, and 15 veins showed absent valves. Valves existed between 0.0–4.5 cm, mainly 0.0–1.0 cm. One corpse showed varicose ovarian veins.

Conclusion: If veins show varices, one would expect missing valves or insufficient function. In contrast, none of our 15 valve-less veins showed varices or even enlargement. Also surprising, the only case with varices had one valve on each side. The terminal segment in both genders was almost identical and the venous course was similar. Precisely: men frequently had (N=11) less valves then women (N=4).

Zusammenfassung

Zweck: Die Varikozele scheint nicht auf der Anzahl von Klappen innerhalb des Plexus pampiniformis zu beruhen, der eigentliche Defekt könnte auf einer höheren Etage liegen. Es gibt eine vergleichbare weibliche Krankheit, das spastische Parametropathie-Syndrom. Daher ist eine ausführliche Beschreibung des Venenverlaufs sowie der Häufigkeiten und Lagen der Klappen in beiden Geschlechtern notwendig.

Material und Methode: An 31 kaukasischen Formalin-fixierten Körpern (15 Männer, 16 Frauen) erforschten wir Verlauf und Klappen von den Eierstöcken beziehungsweise dem inneren Inguinalring bis zur Mündung in die untere Hohlvene beziehungsweise die linke Nierenvene.

Ergebnisse: Im Allgemeinen fanden wir eine Klappe auf jeder Seite (Männer: rechts 41,93%, links 51,52%; Frauen: rechts 51,61%, links 45,45%). In zwei Fällen warenzwei Klappen pro Vene vorhanden und 15 Venen zeigten keine Klappen. Klappen existierten zwischen 0,0–4,5 cm. Eine Leiche zeigte variköse Ovarialvenen.

Schlussfolgerung: Bei Varizen könnte man eine fehlende Klappe und/oder eine Veneninsuffizienz erwarten. Allerdings zeigte keine unserer 15 klappenlosen Venen Varizen oder auch Erweiterungen. Auch überraschend war, dass der einzige Fall mit Varizen eine Klappe auf jeder Seite hatte. Der Schlussteil war in beiden Geschlechtern fast gleich ausgeformt, der Verlauf war ähnlich.

Keywords

pelvic congestion syndrome - varicocele - gonadal vein - ovarian vein - spermatic vein - testicular vein

Schlüsselwörter

Anatomie - Pelvic Congestion Syndrom - Varicocele - Venen der Gonaden - Vena ovarica - Vena spermatica - Vena testicularis
 

  • Literature

  • 1 Ahlberg NE, Bartley O, Chidekel N. Circumference of the left gonadal vein. An anatomical and statistical study. Acta Radiol 1965; 3 (06) 503-512.
    Search in Google Scholar
  • 2 Ahlberg NE, Bartley O, Chidekel N. Right and left gonadal veins. An anatomical and statistical study. Acta Radiol 1966; 4 (06) 593-601.
    Search in Google Scholar
  • 3 Albayrak S, Can C, Sarica K. Extended vein ligation: a new aspect of the surgical treatment of varicocele. Urol Int 1993; 51 (04) 220-224.
    CrossrefPubMedSearch in Google Scholar
  • 4 Bähren W, Biehl C, Danz B. Frustrane Sklerotherapieversuche der V. spermatica interna: retrospektive Analyse bei 1141 Patienten mit idiopathischer Varikozele. RöFo 1992; 157 (04) 355-360.
    PubMedSearch in Google Scholar
  • 5 Beck EM, Schlegel PN, Goldstein M. Intraoperative varicocele anatomy: a macroscopic and microscopic study. J Urol 1992; 148 (04) 1190-1194.
    CrossrefPubMedSearch in Google Scholar
  • 6 Belenky A, Bartal G, Atar E, Cohen M, Bachar GN. Ovarian varices in healthy female kidney donors: incidence, morbidity, and clinical outcome. Am J Roentgenol 2002; 179 (03) 625-627.
    CrossrefPubMedSearch in Google Scholar
  • 7 Bensussan D, Huguet J. Radiological anatomy of the testicular vein. Anat Clin 1984; 6 (02) 143-154.
    CrossrefPubMedSearch in Google Scholar
  • 8 Braedel H, Steffens J, Ziegler M, Polsky M, Platt M. A possible ontogenic etiology for idiopathic left varicocele. J Urol 1994; 151 (01) 62-66.
    CrossrefPubMedSearch in Google Scholar
  • 9 Chopard RP, Biazotto W, Speranzini MM, Antonopoulos I, Lucas GA. Morphology, distribution and types of valves in the adult male’s testicular veins. Bull Assoc Anat (Nancy) 1992; 76 (232) 25-28.
    PubMedSearch in Google Scholar
  • 10 Ergün S, Bruns T, Soyka A, Tauber R. Angioarchitecture of the human spermatic cord. Cell Tissue Res 1997; 288 (02) 391-398.
    CrossrefPubMedSearch in Google Scholar
  • 11 Favorito LA, Costa WS, Sampaio FJB. Applied anatomic study of testicular veins in adult cadavers and in human fetuses. Int Braz J Urol 2007; 33: 176-180.
    CrossrefPubMedSearch in Google Scholar
  • 12 Franklin KJ. Valves in Veins: An Historical Survey. Proc R Soc Med 1927; 21 (01) 1-33.
    PubMedSearch in Google Scholar
  • 13 Fritsch H, Kühnel W. 2. Innere Organe. 9. überarbeitete und erweiterte ed. Stuttgart: Thieme; 2005
    Search in Google Scholar
  • 14 Garel L, Dubois J, Rypens F. et al. Variantes anatomiques de la veine spermatique lors du traitement endovasculaire des varicoceles gauches: une serie pediatrique. Can Assoc Radiol J 2004; 55 (01) 39-44.
    PubMedSearch in Google Scholar
  • 15 Gat Y, Zukerman Z, Chakraborty J, Gornish M. Varicocele, hypoxia and male infertility. Fluid Mechanics analysis of the impaired testicular venous drainage system. Hum Reprod 2005; 20 (09) 2614-2619.
    CrossrefPubMedSearch in Google Scholar
  • 16 Geier B, Barbera L, Mumme A. Reflux patterns in the ovarian and hypogastric veins in patients with varicose veins and signs of pelvic venous incompetence. Chir Ital 2007; 59 (04) 481-488.
    PubMedSearch in Google Scholar
  • 17 Lechter A, Lopez G, Martinez C, Camacho J. Anatomy of the gonadal veins: a reappraisal. Surgery 1991; 109 (06) 735-739.
    PubMedSearch in Google Scholar
  • 18 LePage PA, Villavicencio JL, Gomez ER, Sheridan MN, Rich NM. The valvular anatomy of the iliac venous system and its clinical implications. J Vasc Surg 1991; 14 (05) 678-683.
    CrossrefPubMedSearch in Google Scholar
  • 19 McHanwell S, Brenner E, Chirculescu ARM. et al. The legal and ethical framework governing Body Donation in Europe – A review of current practice and recommendations for good practice. Eur J Urol 2008; 12 (01) 1-24.
    Search in Google Scholar
  • 20 Park SJ, Lim JW, Ko YT, Lee DH, Yoon Y, Oh JH, Lee HK, Huh CY. Diagnosis of pelvic congestion syndrome using transabdominal and transvaginal sonography. Am J Roentgenol 2004; 182 (03) 683-688.
    CrossrefPubMedSearch in Google Scholar
  • 21 Raman JD, Goldstein M. The presence of vasal vessels in men with congenital bilateral absence of the vas deferens. J Urol 2004; 172 (05) Pt 1): 1941-1943.
    CrossrefPubMedSearch in Google Scholar
  • 22 Richardson G. Pelvic congestion syndrome: Diagnosis and Treatment. In: Bergan JJ. (Hrsg.) The Vein Book. Burlington: Academic Press; 2007: 315-321.
    Search in Google Scholar
  • 23 Richardson GD, Beckwith TC, Sheldon M. Ultrasound windows to abdominal and pelvic veins. Phlebology 1991; 6: 111-125.
    CrossrefSearch in Google Scholar
  • 24 Salter SJH. Vein. In: Todd RB. (Hrsg.) Cyclopaedia of anatomy and physiology. London: Longman, Brown, Green, Longmans, & Roberts; 1849-1852 1367–1403.
  • 25 Scultetus AH, Villavicencio JL, Gillespie DL, Kao TC, Rich NM. The pelvic venous syndromes: Analysis of our experience with 57 patients. J Vasc Surg 2002; 36 (05) 881-888.
    CrossrefPubMedSearch in Google Scholar
  • 26 Wishahi MM. Anatomy of the venous drainage of the human testis: testicular vein cast, microdissection and radiographic demonstration. A new anatomical concept. Eur Urol 1991; 20 (02) 154-160.
    CrossrefPubMedSearch in Google Scholar
  • 27 Wishahi MM. Detailed anatomy of the internal spermatic vein and the ovarian vein. Human cadaver study and operative spermatic venography: clinical aspects. J Urol 1991; 145 (04) 780-784.
    CrossrefPubMedSearch in Google Scholar