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The pampiniform plexus () is a venous plexus – a network of many small
vein Veins () are blood vessels in the circulatory system of humans and most other animals that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are those of the pulmonary and feta ...
s found in the human male
spermatic cord The spermatic cord is the cord-like structure in males formed by the vas deferens (''ductus deferens'') and surrounding tissue that runs from the deep inguinal ring down to each testicle. Its serosal covering, the tunica vaginalis, is an exten ...
, and the
suspensory ligament of the ovary The suspensory ligament of the ovary, also infundibulopelvic ligament (commonly abbreviated IP ligament or simply IP), is a fold of peritoneum that extends out from the ovary to the wall of the pelvis. Some sources consider it a part of the broad ...
. In the male, it is formed by the union of multiple
testicular vein The testicular vein (or spermatic vein), the male gonadal vein, carries deoxygenated blood from its corresponding testis to the inferior vena cava or one of its tributaries. It is the male equivalent of the ovarian vein, and is the venous counte ...
s from the back of the
testis A testicle or testis ( testes) is the gonad in all male bilaterians, including humans, and is Homology (biology), homologous to the ovary in females. Its primary functions are the production of sperm and the secretion of Androgen, androgens, p ...
and tributaries from the
epididymis The epididymis (; : epididymides or ) is an elongated tubular genital organ attached to the posterior side of each one of the two male reproductive glands, the testicles. It is a single, narrow, tightly coiled tube in adult humans, in length; ...
.


In the male

The veins of the plexus ascend along the
spermatic cord The spermatic cord is the cord-like structure in males formed by the vas deferens (''ductus deferens'') and surrounding tissue that runs from the deep inguinal ring down to each testicle. Its serosal covering, the tunica vaginalis, is an exten ...
in front of the
vas deferens The vas deferens (: vasa deferentia), ductus deferens (: ductūs deferentes), or sperm duct is part of the male reproductive system of many vertebrates. In mammals, spermatozoa are produced in the seminiferous tubules and flow into the epididyma ...
. Below the
superficial inguinal ring The inguinal canal is a passage in the anterior abdominal wall on each side of the body (one on each side of the midline), which in males, convey the spermatic cords and in females, the round ligament of the uterus. The inguinal canals are large ...
they unite to form three or four veins, which pass along the
inguinal canal The inguinal canal is a passage in the anterior abdominal wall on each side of the body (one on each side of the midline), which in males, convey the spermatic cords and in females, the round ligament of the uterus. The inguinal canals are lar ...
, and, entering the abdomen through the
deep inguinal ring The inguinal canal is a passage in the anterior abdominal wall on each side of the body (one on each side of the midline), which in males, convey the spermatic cords and in females, the round ligament of the uterus. The inguinal canals are large ...
, coalesce to form two veins. These again unite to form a single vein, the
testicular vein The testicular vein (or spermatic vein), the male gonadal vein, carries deoxygenated blood from its corresponding testis to the inferior vena cava or one of its tributaries. It is the male equivalent of the ovarian vein, and is the venous counte ...
, which opens on the right side into the
inferior vena cava The inferior vena cava is a large vein that carries the deoxygenated blood from the lower and middle body into the right atrium of the heart. It is formed by the joining of the right and the left common iliac veins, usually at the level of the ...
, at an acute angle, and on the left side into the left
renal vein The renal veins in the renal circulation, are large-calibre veins that drain blood filtered by the kidneys into the inferior vena cava. There is one renal vein draining each kidney. Each renal vein is formed by the convergence of the interlobar v ...
, at a right angle. The pampiniform plexus forms the chief mass of the cord. In addition to its function in venous return from the testes, the pampiniform plexus also plays a role in the temperature regulation of the testes. It acts as a countercurrent
heat exchanger A heat exchanger is a system used to transfer heat between a source and a working fluid. Heat exchangers are used in both cooling and heating processes. The fluids may be separated by a solid wall to prevent mixing or they may be in direct contac ...
, cooling blood in adjacent arteries. An abnormal enlargement of the pampiniform plexus is a medical condition called
varicocele A varicocele is an abnormal enlargement of the pampiniform venous plexus in the scrotum; in a woman, it is an abnormal painful swelling to the List of related male and female reproductive organs, embryologically identical pampiniform venous plexu ...
.


In the female

In females, the pampiniform plexus drains the ovaries. The right ovary drains to the pampiniform plexus to the ovarian vein to the inferior vena cava. The left ovary drains to the pampiniform plexus, left ovarian vein, then the left renal vein, to the inferior vena cava. While
varicocele A varicocele is an abnormal enlargement of the pampiniform venous plexus in the scrotum; in a woman, it is an abnormal painful swelling to the List of related male and female reproductive organs, embryologically identical pampiniform venous plexu ...
is the diagnostic term for swelling in the valveless venous distribution of the male pampiniform plexus, this embryological structure, common to males and females, is often incidentally noted to be swollen during laproscopic examinations in both symptomatic and asymptomatic females. Diagnosis of female varicocele, properly called pelvic compression syndrome, should be expected to be as frequent as male varicocele (15% of healthy asymptomatic men which are thought to develop primarily during puberty and prevalence increases approximately 10% per decade of life). While one may expect that the female to have equal prevalence of pelvic compression syndrome due to the identical embryological origin of the valveless pampiniform plexus, this condition is thought to be underdiagnosed due to the broad differential of the pain pattern: unilateral or bilateral pain, dull to sharp, constant to intermittent pain worsening with any increase in abdominal pressure. Physical exam has specificity of 77% and sensitivity of nearly 94% when the patient is noted to be tender over adnexa during physical examination with a history of postcoital pain for differentiating pelvic congestion syndrome from other pathologies of pelvic origin. Confirmatory imaging requires ultrasound while performing the
Valsalva maneuver The Valsalva maneuver is performed by a forceful attempt of exhalation against a closed airway, usually done by closing one's mouth and pinching one's nose shut while expelling air, as if blowing up a balloon. Variations of the maneuver can be ...
, while the gold standard remains ovarian and iliac catheter venography showing veins in diameter during Valsalva.


Clinical significance

Damage to the plexus during inguinal hernia repair is the chief cause of ischaemic
orchitis Orchitis is inflammation of the testicles. It can also involve swelling, pains, and frequent infection, particularly of the epididymis, as in epididymitis. The term is from the Ancient Greek ὄρχις meaning "testicle"; same root as ''orchid ...
following this surgery; such orchitics typically presents within a week post-surgery and is almost always self-limiting. Its incidence is <1% for primary hernia repair, but more for recurrent hernia repairs.


See also

* Rete mirabile, vascular countercurrent heat- and mass-exchanging structures found in many vertebrate organs


References


External links

* - "Inguinal Region, Scrotum and Testes: Veins" * - "Male Reproductive System: spermatic cord, pampiniform plexus" * - "Spermatic cord" * * ()
Diagram
at
Rutgers Rutgers University ( ), officially Rutgers, The State University of New Jersey, is a public land-grant research university consisting of three campuses in New Jersey. Chartered in 1766, Rutgers was originally called Queen's College and was aff ...
{{DEFAULTSORT:Pampiniform Venous Plexus Veins of the torso Scrotum