Prevalence of variants in gonadal vessels: a systematic review with meta-analysis

Gonadal arteries (GAs) and gonadal veins (GVs) display substantial anatomical variation, which has direct implications for surgical procedures, radiological interpretation, and fertility management. This study aimed to systematically review and meta-analyze the prevalence, origin, course, and drainage patterns of gonadal vessels in human anatomy. A systematic review and meta-analysis were conducted in line with current Evidence-Based Anatomy and PRISMA 2020 guidelines. A comprehensive search of major databases and anatomical journals yielded 31 eligible studies, comprising data on 2,875 gonadal vessels. The typical GA anatomy (single artery arising from the abdominal aorta) was observed in 98.72% of cases. Accessory GAs were found in 1.12%, most commonly arising from the renal artery (5.52%), with rare origins (<0.01%) from the accessory renal or suprarenal arteries. A normal arterial course was present in 90.24%, while an arched course occurred in 9.76%. The typical GV pattern (single vein draining into the inferior vena cava [IVC] or renal vein) was seen in 94.97%, and accessory GVs in 5.03%. The right GV drained into the IVC in 96.51%, with aberrant drainage to the right renal vein in 4.41%. The left GV drained into the left renal vein in 95.35%, with aberrant IVC drainage in 4.17%. Although the typical gonadal vascular anatomy predominates, variants, especially in GA origin and GV drainage, are not rare and must be recognized. These findings underscore the clinical importance of anatomical awareness in surgical planning, radiological evaluation, and the management of urological and reproductive conditions.