View source for Pampiniform plexus

{{Short description|Vein network in the human sex organs}}
{{Missing information|pampiniform plexus in female - the origin of the ovarian veins|date=November 2010}}
{{Infobox vein
| Name        = Pampiniform plexus
| Latin       = plexus venosus pampiniformis, plexus pampiniformis
| Image       = Gray1147.png
| Caption     = Spermatic veins
| Image2      =
| Caption2    =
| DrainsFrom  = [[Testicle]], [[epididymis]]
| Source      =
| DrainsTo    = [[Testicular vein]]
| Artery      =
}}

The '''pampiniform plexus''' ({{ety|la|pampinus|tendril||forma|form}}) is a [[venous plexus]] – a network of many small [[vein]]s found in the human male [[spermatic cord]], and the [[suspensory ligament of the ovary]]. In the male, it is formed by the union of multiple [[testicular vein]]s from the back of the [[testis]] and tributaries from the [[epididymis]].

==In the male==
The veins of the plexus ascend along the [[spermatic cord]] in front of the [[vas deferens]]. Below the [[superficial inguinal ring]] they unite to form three or four veins, which pass along the [[inguinal canal]], and, entering the abdomen through the [[deep inguinal ring]], coalesce to form two veins. These again unite to form a single vein, the [[testicular vein]], which opens on the right side into the [[inferior vena cava]], at an acute angle, and on the left side into the left [[renal vein]], 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 exchange|countercurrent]] [[heat exchanger]], cooling blood in adjacent arteries. An abnormal enlargement of the pampiniform plexus is a medical condition called [[varicocele]].

==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.<ref>{{cite book |last1=Le |first1=Tao |last2=Bhushan |first2=Vikas |title=First Aid for the USMLE Step 1 2013 |date=2013 |publisher=McGraw Hill Professional |isbn=978-0-07-180233-8 }}{{pn|date=June 2023}}</ref> 

While [[varicocele]] 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.<ref>{{cite journal |last1=Tu |first1=Frank F. |last2=Hahn |first2=David |last3=Steege |first3=John F. |title=Pelvic Congestion Syndrome-Associated Pelvic Pain: A Systematic Review of Diagnosis and Management |journal=Obstetrical & Gynecological Survey |date=May 2010 |volume=65 |issue=5 |pages=332–340 |doi=10.1097/OGX.0b013e3181e0976f |pmid=20591203 |s2cid=27110647 }}</ref> 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<ref>{{cite journal |last1=Alsaikhan |first1=Bader |last2=Alrabeeah |first2=Khalid |last3=Delouya |first3=Guila |last4=Zini |first4=Armand |title=Epidemiology of varicocele |journal=Asian Journal of Andrology |date=2016 |volume=18 |issue=2 |pages=179–181 |doi=10.4103/1008-682X.172640 |pmid=26763551 |pmc=4770482 |doi-access=free }}</ref>). 

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.<ref>{{cite journal |last1=O'Brien |first1=Marlene T. |last2=Gillespie |first2=David L. |title=Diagnosis and treatment of the pelvic congestion syndrome |journal=Journal of Vascular Surgery: Venous and Lymphatic Disorders |date=January 2015 |volume=3 |issue=1 |pages=96–106 |doi=10.1016/j.jvsv.2014.05.007 |pmid=26993690 }}</ref> Confirmatory imaging requires ultrasound while performing the [[Valsalva maneuver]], while the gold standard remains ovarian and iliac catheter venography showing veins {{nowrap|5–10 mm}} in diameter during Valsalva.

== Clinical significance ==
Damage to the plexus during [[inguinal hernia repair]] is the chief cause of ischaemic [[orchitis]] following this surgery; such orchitis 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.<ref>{{Cite book |title=Schwartz's Principles of Surgery |edition=11th |publication-date=2019 |pages=1620}}</ref>

== See also ==
* [[Rete mirabile]], vascular countercurrent heat- and mass-exchanging structures found in many vertebrate organs

==References==
{{Gray's}}
{{Reflist}}

==External links==
* {{SUNYAnatomyLabs|36|st|07|01}} - "Inguinal Region, Scrotum and Testes: Veins"
* {{BUHistology|17304ooa}} - "Male Reproductive System: spermatic cord, pampiniform plexus"
* {{OklahomaHistology|81_05}} - "Spermatic cord"
* {{ViennaCrossSection|pembody/body18b}}
* {{NormanAnatomy|inguinalregion}} ({{NormanAnatomyFig|spermaticcord}})
* [https://web.archive.org/web/20070325232746/http://animalsciences.rutgers.edu/faculty/katz/pampiniformplexus.jpg Diagram] at [[Rutgers]]

{{Veins of the torso}}
{{Portal bar|Anatomy}}
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{{DEFAULTSORT:Pampiniform Venous Plexus}}
[[Category:Veins of the torso]]
[[Category:Scrotum]]