Testicular biopsy: puncture, open

Diagnostic procedure - testicular biopsy - is relatively rare, but it is considered very informative to determine the causes of impaired fertility in men, as well as other diseases associated with the male reproductive system.

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

Indications for the procedure

The use of this kind of research, such as testicular biopsy, may be necessary for various diseases of the testicles, for the exclusion of certain diseases, and also when it is impossible to conceive a child from the male side. The most frequently asked for help is a testicular biopsy with poor sperm counts:

• with azoospermia (this state, when there is excretion of the ejaculate, which does not contain spermatozoa );
• with necrospermia (a condition where ejaculate is present, but it contains only dead sperm);
• with akinozoospermia (a condition where there is ejaculate with live, but still sperm);
• at other malfunctions - for example, at inactive or glued spermatozoons;
• with 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.

A testicular biopsy with azoospermia is very important. What is azoospermia? It is impaired spermatogenesis, in which the seminal fluid is present, but there are no spermatozoa in it. In order that such a man still could become a father and conceive a child, doctors resort to the use of auxiliary reproductive techniques, for example, to 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 - mostly those who have an obstructive form of azoospermia. And only in some cases, the causes of the violation of spermatogenesis can not be corrected.

A testicle biopsy for IVF is considered an optimal diagnostic procedure. Her conduct is appropriate for inadequate sperm production, in violation of patency, with reduced function and azoospermia - because in these cases it is difficult to identify the problems that occur in the body of a man. Only a biopsy of the testicle will help to identify the true cause of the impossibility of conception, and even solve it.

In what situations is a testicular biopsy necessary for IVF?

• with pathological disorders in the testicles, which interfere with the formation of spermatozoa;
• if ripened spermatozoa do not have the ability to penetrate into the urethra (for example, with obstruction).

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

[1], [2], [3], [4], [5],

Preparation

Doctors have identified a number of clear recommendations that are mandatory for use before a testicular biopsy. Preparation should begin three months before the scheduled procedure for biopsy.

• Any physical work, even of a moderate nature, is excluded.
• It is allowed to put on only natural cotton non-tight underwear.
• It is forbidden to go to the bath, take a hot bath or a hot shower.
• It is forbidden to drink alcohol and smoke.
• Special amendments are made to the food ration.

Four days before the testicular biopsy, the patient should not practice sex life or masturbate.

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

• If the use of general anesthesia is supposed, then in the evening, on the eve of the biopsy procedure, supper is canceled (a light snack of 20-00 is allowed). Take food will be possible only after the end of the intervention.
• One day before a testicular biopsy, you can not drink carbonated water and caffeinated drinks.
• In the morning the man needs to shave the scrotum carefully .

If the patient regularly takes any medications, you should tell the doctor about it in advance.

In advance, before carrying out a testicle biopsy, the doctor will send the patient to take tests to find out if the man has contraindications to the procedure. In most cases, you have to take such tests:

• a smear from the urethra;
• blood test for coagulation quality;
• analysis on RW, hepatitis, human immunodeficiency virus;
• general clinical analysis of blood;
• analysis of the blood group and Rh factor (if necessary).

Additionally, a man needs to have a cardiogram.

All tests are given at the same time, however, it is necessary to pass such studies beforehand so that by the time of the biopsy of the testicle their results are ready.

[6], [7], [8]

Technique of the testicular biopsies

A testicular biopsy is done by an open method or by puncture.

Puncture biopsy of the testicle is carried out by several methods:

• PESA is a procedure in which a special needle is inserted through the scrotum, through which the required amount of material is sucked.
• TESA is a procedure that involves the use of a special device equipped with a needle for puncture.

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

Open biopsy of the testicle is already a full-fledged surgical intervention. As a rule, it is carried out when the aspiration biopsy by the method of puncture did not result in obtaining the necessary amount of material.

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

• TESE - the operation of excision of the wedge-shaped part of the biomaterial, about 3-4 mm in diameter.
• MESA is a micro-operation, in which microscopic isolation of the tubule from the epididymis is carried out, after which the liquid is drained with spermatozoa.
• Micro TESE is a micro-operation with exposure of the ovary tissue. Nude tissue is examined layer by layer and several canals of satisfactory quality are seized, for further production of spermatozoa.

A biopsy of the epididymis of the open type is carried out only in the operating room. In this case, the greatest effect of the doctors is obtained with the procedure of micro TESE.

Contraindications to the procedure

Like any other procedure, testicular biopsy has its contraindications for carrying out:

• monarchism (the presence of one testicle);
• impaired blood clotting, hemorrhagic diathesis;
• infectious diseases that are sexually transmitted;
• inflammatory pathology of the reproductive organs.

[9], [10], [11], [12], [13],

Normal performance

There is no standard protocol for the effectiveness of such research, as a testicular biopsy. In order to ensure that the results are as positive and reliable as possible, all the rules for preparing for manipulation must be carefully observed, following all the advice of a doctor.

The doctor decides the results, taking into account the diagnosis and the problem with which the patient asked for medical help.

Histology after a testicular biopsy may indicate such information:

• sperm quality does not deviate from normal parameters;
• presence of hypospermatogenesis;
• presence of depleted germ cells;
• blocking the maturation of cells;
• presence of aplasia of germinal cells;
• presence of malignant cells or structures of a benign tumor.

If a man has problems with conception, then with a testicle biopsy, the following are most often found:

• presence of hypospermatogenesis ( lowering of semen secretion );
• blocking the maturation of cells (failure of the development of primary cells of sperm or spermatids).

Also, with a testicular biopsy, spermatogenesis is assessed using a point system:

• Ten points of intact spermatogenesis, in which less than 20 mature spermatids are formed, with an embryonic epithelial layer 80 μm in height and frequent spermatization.
• Nine points - weak spermatogenesis, with the formation of less than 20 mature spermatids, with the height of the embryonic epithelial layer greater than 80 μm and rare sperm.
• Eight points - weak spermatogenesis, with the formation of more than 20 mature spermatids, with the height of the embryonic epithelial layer greater than 80 μm and the absence of sperm.
• Seven points are the 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 - blocking the 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 the structures of Sertoli are found.
• One point is the atrophic process in the tubules, in which the degenerating structures of Sertoli are found. The embryonic epithelium is absent.

[14], [15], [16], [17], [18], [19], [20], [21], [22],

Complications after the procedure

After the completion of the diagnostic testicular biopsy, the patient may face such 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 directly of the testicle).

The listed consequences are temporary and pass independently, or after further appointments of a doctor.

Complications after the procedure of biopsy occur infrequently and not in all patients. The main thing is to perform and not to ignore the doctor's advice before and after manipulation. If there are signs such as acute or spasmodic pains, high fever, redness of the scrotum, it is necessary to appear urgently to the doctor. If the anti-inflammatory treatment is started in time, the recovery will come faster and not cause much discomfort.

Open biopsy is less often accompanied by the development of complications, in contrast to the puncture option. However, both the first and second type of testicular biopsy is considered very informative, and gives the man a chance not only to maintain his health, but also to become a parent.

How much does the edema persist after a testicular biopsy?

Edema after the procedure of testicular biopsy can be kept from several days to 1-2 months. Such a prolonged edema is a consequence of the development of an inflammatory reaction in the scrotum: the organ increases in size, pains occur, skin blushes turn red. If this is the case, then you need to see a doctor urgently for an anti-inflammatory therapy.

[23], [24], [25], [26], [27], [28], [29]

Care after the procedure

To ensure maximum rest, the scrotum is immobilized after a testicular biopsy - use of the suspension for several days to several weeks is recommended.

After the procedure of testicular biopsy, you can put on linen only from natural soft tissues. It should be comfortable and free - it is better to choose fusions for a larger size to exclude friction and increased sweating in the groin area.

External genitals should be washed every evening with warm water and soap. Linen is also changed every evening. Flushing of the scrotum is carried out in such a way that the wound itself after manipulation of the testicle biopsy is not wet.

If the procedure performed was an open biopsy of the testicle, then, as a rule, the wound is covered with self-absorbing sutures, which are not required to be removed. For such an injury, they take care of the usual postoperative treatment: treat the damaged area with an antiseptic solution in the morning and in the evening. Additionally, you can treat the wound after a shower visit. As the wound is healed, the frequency of treatment is reduced to once a day.

Until the wound is fully healed, you can not engage in physical labor and sex, and also take a hot bath, go to the sauna or sauna.

[30], [31], [32], [33]

Reviews

A testicle 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 a testicular biopsy is more comfortable to use, using a general type of anesthesia. The local use of anesthesia also excludes the appearance of painful sensations during the manipulation of the doctor, but the fact that the man is aware and represents everything that occurs during the intervention makes him unnecessarily worried and distract the surgeon with various questions. In addition, according to reviews, do not perform a testicular biopsy in the summer heat, as this adds discomfort in the postoperative period and slows tissue healing. Ideally, if a testicle biopsy is scheduled for winter, spring or autumn.

A testicle biopsy is a very necessary procedure, which should not be feared. The main thing is to tune in positively. The rest will be done by the doctor - especially if it is a qualified specialist who represents a good clinic.