Testicular Biopsy


Indications


Obstructive Azoospermia: confirmation of the presence of normal spermatogenesis may be desired before surgical correction of the obstruction is planned. This does not apply for men with a history of vasectomy or for men with congenital absence of the vas deferens, unless testicular volume is reduced or follicle-stimulating hormone is elevated.


Testicular Sperm Extraction: multiple testicular biopsies are usually needed for sperm harvesting in men with Non Obstructive Azoospermia. Part of the specimen should be used for histological examination to predict the chance for future successful sperm harvesting and to diagnose CIS of the testis. Microdissection may improve the success of sperm harvesting.


Diagnosis of Carcinoma InSitu of the testis: Risk factors for CIS are male infertility together with other risk factors, such as a history of cryptorchidism, testicular germ cell tumour and in the case of idiopathic testicular atrophy.


Procedure


⦁ Testicular biopsy can be performed under local and general anaesthesia. Usually, the procedure is performed as day-care surgery in an outpatient clinic setting.


⦁ For a diagnostic testicular biopsy, a scrotal incision of 2–3 cm could allow enough exposure of the tunica albuginea of the testis


⦁ A small incision in the capsule of the testicular of about 0.5 cm is made for obtaining a biopsy of about 3×3×3 mm.


⦁ For adequate classification of spermatogenesis, the removed tissue should contain at least 100 seminiferous tubules.


⦁ The tissue should not be squeezed with a forceps since this may disrupt testicular tissue architecture and hamper proper evaluation of the seminiferous tubules. The wound is closed with absorbable sutures.