Testicular biopsy: puncture, open.

The diagnostic procedure – testicular biopsy – is performed relatively rarely, but is considered very informative for determining the causes of reproductive dysfunction in men, as well as other diseases associated with the male reproductive system.

A testicular biopsy is a specific operation, the purpose of which is to take tissue elements for further microbiological examination.

Indications for the procedure

The use of such a type of research as a testicular biopsy may be necessary for various diseases of the testicles, to exclude certain diseases, and also when a man is unable to conceive a child. Most often, people seek help from a testicular biopsy when their spermogram results are poor:

• in azoospermia (a condition in which ejaculate is released that does not contain spermatozoa );
• in necrospermia (a condition in which the ejaculate is present, but it contains only dead spermatozoa);
• with akinozoospermia (a condition in which there is an ejaculate with living but immobile spermatozoa);
• in case of other problems – for example, in case of low motility or stuck sperm;
• in case of prolonged inability to conceive a child, if the reasons for this situation are unknown.

In addition, a testicular biopsy is performed if the doctor suspects a malignant tumor.

Testicular biopsy in azoospermia is very important. What is azoospermia? It is a disordered spermatogenesis, in which there is seminal fluid, but no spermatozoa in it. In order for such a man to be able to become a father and conceive a child, doctors resort to the use of assisted reproductive techniques, for example, one of the most effective - ICSI. For this technology, an open or aspiration type of testicular biopsy (TESA / TESE), or epididymis (MESA, PESA) is used. Such methods help most patients - mainly those diagnosed with obstructive azoospermia. And only in some cases the causes of spermatogenesis disorders cannot be corrected.

Testicular biopsy for IVF is considered the optimal diagnostic procedure. It is appropriate to perform it in cases of insufficient sperm production, obstruction, decreased function and azoospermia - because in these cases it is quite difficult to identify the problems that occur in the man's body. Only a testicular biopsy will help to identify the true cause of the impossibility of conception, and even solve it.

In what situations is a testicular biopsy for IVF especially necessary:

• in case of pathological disorders in the testicles that interfere with the formation of spermatozoa;
• if mature spermatozoa are unable to penetrate the urethra (for example, due to obstruction).

Other indications for testicular biopsy include: the location of the testicles outside the scrotum ( cryptorchidism ), testicular failure ( hypogonadism ), and azoospermia of unknown etiology.

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Preparation

Doctors have defined a number of clear recommendations that must be followed before performing a testicular biopsy. Preparation should begin three months before the scheduled biopsy procedure.

• Any physical work, even of a moderate nature, is excluded.
• Only natural cotton, loose-fitting underwear is permitted.
• It is forbidden to go to the bathhouse, take hot baths or hot showers.
• Drinking alcohol and smoking are prohibited.
• Special adjustments to the diet are prescribed.

Four days before the testicular biopsy, the patient should not engage in sexual intercourse or masturbate.

The day before the testicular biopsy, other recommendations are added:

• If general anesthesia is to be used, then dinner is cancelled the evening before the biopsy procedure (a light snack is allowed until 8:00 PM). Eating will only be possible after the end of the intervention.
• You should not drink carbonated water or caffeinated beverages for 24 hours before a testicular biopsy.
• In the morning, a man needs to carefully shave his scrotum.

If the patient regularly takes any medications, it is necessary to tell the doctor about this in advance.

In advance, before performing a testicular biopsy, the doctor will send the patient to take tests to find out whether the man has any contraindications to the procedure. In most cases, the following tests must be taken:

• urethral smear;
• blood test for coagulation quality;
• analysis for RW, hepatitis, human immunodeficiency virus;
• general clinical blood test;
• blood type and Rh factor analysis (if necessary).

Additionally, the man needs to have a cardiogram.

All tests are taken at the same time, but such examinations should be taken in advance so that the results are ready by the time the testicular biopsy is performed.

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Technique testicular biopsies

A testicular biopsy is performed using an open method or a puncture.

Testicular puncture biopsy is performed using several methods:

• PESA is a procedure in which a special needle is inserted through the scrotal tissue and the required amount of material is sucked out.
• TESA is a procedure that involves the use of a special device equipped with a puncture needle.

Puncture biopsy options are considered minimally invasive and do not require specific operating conditions - the puncture can be performed in a regular manipulation room. The downside is that the material is collected randomly, so there is a risk of damage to the vessels (the result of such damage is a post-procedural hematoma).

An open testicular biopsy is a full-fledged surgical intervention. As a rule, it is performed when aspiration biopsy by puncture does not result in obtaining the required amount of material.

An open testicular biopsy can also be performed in different ways:

• TESE is an operation to excise a wedge-shaped portion of biomaterial, approximately 3-4 mm in diameter.
• MESA is a microsurgery that involves microscopically isolating a tubule from the epididymis, after which the fluid containing the sperm is suctioned out.
• Micro TESE is a micro-surgery with exposure of ovarian tissue. The exposed tissue is examined layer by layer and several tubules of satisfactory quality are removed for further spermatozoa collection.

An open-type biopsy of the epididymis is performed only in an operating room. In this case, doctors achieve the greatest effect with the micro TESE procedure.

Contraindications to the procedure

Like any other procedure, testicular biopsy has its own contraindications:

• monorchism (the presence of one testicle);
• impaired blood clotting, hemorrhagic diathesis;
• sexually transmitted infectious diseases;
• inflammatory pathologies of the reproductive organs.

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Normal performance

There is no standard protocol for the effectiveness of such a study as a testicular biopsy. In order for the results to be as positive and reliable as possible, it is necessary to carefully follow all the rules for preparing for the manipulation, following all the doctor's advice.

The results are interpreted by a doctor, taking into account the diagnosis and the problem with which the patient sought medical help.

Histology after testicular biopsy may reveal the following information:

• sperm quality does not deviate from normal values;
• presence of hypospermatogenesis;
• presence of desquamated germ cells;
• blocking cell maturation;
• presence of germ cell aplasia;
• the presence of malignant cells or benign tumor structures.

If a man has problems with conception, then a testicular biopsy most often reveals the following disorders:

• the presence of hypospermatogenesis ( decreased sperm secretion );
• block of cell maturation (failure of development of primary sperm cells or spermatids).

Also, in testicular biopsy, spermatogenesis is assessed using a scoring system:

• Ten points: intact spermatogenesis, in which less than 20 mature spermatids are formed, with a height of the germinal epithelial layer of 80 µm and frequent spermiation.
• Nine points – weak spermatogenesis, with the formation of less than 20 mature spermatids, with the height of the germinal epithelial layer greater than 80 µm and rare spermiation.
• Eight points – weak spermatogenesis, with the formation of more than 20 mature spermatids, with the height of the germinal epithelial layer more than 80 µm and the absence of spermiation.
• Seven points – impaired differentiation of spermatids, in the absence of mature spermatids and the massive presence of immature spermatids.
• Six points – impaired differentiation of spermatids, in the absence of mature spermatids and the presence of individual immature spermatids.
• Five points – blocking the maturation of primary sperm cells, in the absence of spermatids, with the presence of a large number of primary sperm cells.
• Four points – blockage of maturation of primary sperm cells, in the absence of spermatids, with the presence of individual primary sperm cells.
• Three points – blocking the maturation of primary sperm cells, in the absence of spermatids and primary sperm cells and in the presence of spermatogonia.
• Two points – Sertoli cell syndrome, in which only Sertoli structures are detected.
• One point – atrophic process in the tubules, in which degenerating Sertoli structures are detected. Germinal epithelium is absent.

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Complications after the procedure

After completing a diagnostic testicular biopsy, the patient may experience the following unpleasant consequences:

• accumulation of fluid in tissues, pain;
• internal accumulation of blood (hematocele);
• superficial hematoma in the puncture area;
• inflammatory reaction ( inflammation of the epididymis or the testicle itself).

The listed consequences are temporary and go away on their own or after further doctor’s orders.

Complications after a biopsy procedure are rare and do not occur in all patients. The main thing is to follow and not ignore the doctor's advice before and after the procedure. If symptoms such as acute or spasmodic pain, high temperature, redness of the scrotum appear, you must urgently see a doctor. If you start anti-inflammatory treatment in a timely manner, recovery will occur faster and will not cause much discomfort.

Open biopsy is less likely to cause complications than the puncture option. However, both the first and second types of testicular biopsy are considered very informative and give a man a chance not only to maintain his health, but also to become a parent.

How long does swelling last after a testicular biopsy?

Swelling after a testicular biopsy procedure can last from several days to 1-2 months. Such prolonged swelling is a consequence of the development of an inflammatory reaction in the scrotum: the organ increases in size, pain occurs, and the skin turns red. If this is exactly the picture, you should urgently consult a doctor for anti-inflammatory therapy.

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Care after the procedure

To ensure maximum rest, the scrotum is immobilized after a testicular biopsy; it is recommended to use a suspensory for several days to several weeks.

After the testicular biopsy procedure, you can only wear underwear made of natural soft fabrics. It should be comfortable and loose - it is better to choose swimming trunks one size larger to avoid friction and increased sweating in the groin area.

The external genitals should be washed every evening with warm water and soap. The underwear should also be changed every evening. The scrotum should be washed in such a way that the wound itself does not get wet after the testicular biopsy procedure.

If the procedure performed was an open testicular biopsy, then the wound is usually sutured with self-dissolving sutures that do not need to be removed. Such a wound is cared for as a normal postoperative wound: the damaged area is treated with an antiseptic solution in the morning and evening. Additionally, the wound can be treated after taking a shower. As the wound heals, the frequency of treatment is reduced to once a day.

Until the wound is completely healed, you should not engage in physical labor or sex, or take a hot bath, go to a bathhouse or sauna.

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Reviews

Testicular biopsy is an extremely informative and indispensable procedure that receives a lot of positive feedback from individual patients and couples.

Most patients also note that it is more comfortable to perform a testicular biopsy using a general type of anesthesia. Local use of anesthesia also eliminates the occurrence of painful sensations during the doctor's manipulations, but the fact that a man is aware of and imagines everything that happens during the intervention makes him unnecessarily worried and distract the surgeon with various questions. In addition, according to reviews, a testicular biopsy should not be performed in the summer heat, as this adds discomfort in the period after surgery and slows down tissue healing. It is optimal if a testicular biopsy is scheduled for winter, spring or autumn.

A testicular biopsy is a very necessary procedure that should not be feared. The main thing is to have a positive attitude. The doctor will do the rest - especially if it is a qualified specialist representing a good clinic.