title: The complex blood supply to the equine testis as a cause of failure in laparoscopic castration.
abstract: BACKGROUND
  Intra-abdominal ligation/ transection of the spermatic cord may result in necrosis of the testis; castration of abdominal cryptorchids via laparoscopy has therefore become common. Notwithstanding some adaptations of the technique, a small percentage of operations fail, prompting research into the anatomical background and clinical relevance of the procedure.
  
  
  OBJECTIVE
  That an alternate blood supply may prevent complete necrosis of the testis after spermatic cord transection.
  
  
  OBJECTIVE
  To establish the prevalence of the problem in normal and cryptorchid stallions.
  
  
  METHODS
  In a preliminary study, the spermatic cords of 8 normal stallions were ligated and transected at different sites and in various manners. Five weeks later the testes were removed and the vitality of both the testes and epididymes was evaluated. In a prospective clinical trial, intra-abdominal spermatic cord transection was performed in 241 cryptorchid and normal stallions. In cases of surgical failure, the testes were removed and histology performed.
  
  
  RESULTS
  Examination of the specimen removed from the 8 animals of the preliminary study revealed that all epididymes were completely or largely spared. All except one testis were completely necrotic. In the patients that underwent surgery all abdominally retained testes (n = 123) were necrotic, while 5 out of 88 inguinally retained and 8 out of 236 normally descended testes had partially survived. The pattern of survival differed between inguinally retained and normally descended testes. The epididymes of these 13 horses were (largely) vital. The (partial) survival of the epididymes and inguinally retained testes was ascribed to an alternate blood supply via anastomosing vessels derived from the cremasteric artery. A tributary from the external pudendal artery was considered responsible for the partial survival of normally descended testes.
  
  
  CONCLUSIONS
  After intra-abdominal transection of the entire spermatic cord, 5.6% of inguinally retained and 3.4% of normally descended testes failed to become completely necrotic, as a result of an alternate blood supply via the cremasteric and/or external pudendal artery. Therefore, laparoscopic castration without orchidectomy cannot be recommended as a trustworthy method for castration of inguinal cryptorchids and normal stallions.
authors.affiliation: Department of Equine Sciences, Faculty of Veterinary Medicine, University of Utrecht, Yalelaan 12, 3584 CM Utrecht, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Voermans
authors.forename: A B M
authors.initials: AB
authors.lastname: Rijkenhuizen
authors.forename: M A
authors.initials: MA
authors.lastname: van der Velden
mesh_terms: D000818:Animals; D003456:Cryptorchidism / Q000601:surgery / Q000662:veterinary*; D006734:Horse Diseases / Q000601:surgery*; D006736:Horses / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods / Q000662:veterinary*; D008297:Male; D009919:Orchiectomy / Q000379:methods / Q000662:veterinary*; D013737:Testis / Q000098:blood supply*; D017211:Treatment Failure; D014659:Vasectomy / Q000379:methods / Q000662:veterinary