Testicular arteries anatomy applied to fowler-sthephens surgery in high undescended testis – a narrative review

Abstract

Objectives: In this review we will describe the testicular vessels anatomy and the implications of these vessels in surgical treatment of high undescended testis. Material and Methods: We performed a narrative review of the literature about the role of the testicular arteries anatomy in the treatment of high undescended testis. We also studied two human testes to illustrate the testicular vascularization. Results: Each testis is irrigated by three arteries: testicular artery (internal spermatic artery), a branch of the right aorta; deferential artery (vasal artery), a branch of the inferior vesicle artery that originates from the anterior trunk of internal iliac artery and cremasteric artery (external spermatic artery), a branch of the inferior epigastric artery. There are important communications among the three arteries with visible anastomotic channels between the testicular and deferential arteries. Conclusions: Laparoscopic transection of the testicular vessels by dividing the spermatic vessels (Fowler-Stephens surgery) is safe in patients with high abdominal testis due to the great collateral vascular supply between testicular, vasal and cremasteric arteries; also, two-stage Fowler-Stephens orchiopexy appears to carry a higher rate of success than the single stage approach.

Abdominal testicular vessel distribution in human fetuses - basis for Fowler-Stephens surgery

“…Irrespective of the surgical technique, preservation of an adequate arterial supply for the testes is crucial for successful orchidopexy to ensure normal testicular size and texture ( 19 ). The anatomy of testicular arteries is very important to the success of the surgical procedures ( 11 , 20 ). Each testis is irrigated by three arteries: the testicular artery (internal spermatic artery), a branch of the aorta; deferential artery (vasal artery), a branch of the inferior vesicle artery that originates from the anterior trunk of internal iliac artery and cremasteric artery (external spermatic artery), a branch of the inferior epigastric artery.…”

“…Each testis is irrigated by three arteries: the testicular artery (internal spermatic artery), a branch of the aorta; deferential artery (vasal artery), a branch of the inferior vesicle artery that originates from the anterior trunk of internal iliac artery and cremasteric artery (external spermatic artery), a branch of the inferior epigastric artery. These three arteries penetrate the organ in the mediastinal region, where they provide ample communication ( 11 , 21 ).…”

“…The majority of vessels ending to the testis, regardless of their origin, enter through the testis hilum and hence the upper testis ( 11 , 21 ). The anastomoses between the testicular, deferential and cremasteric arteries occur outside the testis ( 21 , 22 ).…”

“…The anastomoses between the testicular, deferential and cremasteric arteries occur outside the testis ( 21 , 22 ). The cremasteric anastomoses possibly occur via the epidiymal branch of the testicular artery and gubernaculum vessels what makes gubernaculum preservation important to maximise collateral flow to the testis during Fowler Stephens orchidopexy ( 11 ).…”

Editorial Comment: Open Versus Laparoscopic Gubernaculum-Sparing Second-Stage Fowler-Stephens Orchiopexy for Intra-Abdominal Testis: A Long-Term Study

“…The gubernaculum is the most important structure in the inguinoscrotal stage of testicular migration (1, 2). The knowledge of testicular and gubernaculum vascular anatomy is a key point in this procedure (3). In this paper the authors retrospectively studied a cohort of patients who underwent laparoscopic first-stage FSO and open versus laparoscopic gubernaculum-sparing second-stage FSO and concluded that the second-stage gubernaculum-sparing FSO achieved high testicular survival rates and satisfactory testicular positions.…”