Testicular Biopsy

Testicular biopsy is a procedure to obtain a sample of tissue from the testicles.

Indication :
Indicated in Azoospermia men with testis of normal size and consistency, palpable vasa deferentia and normal FSH levels. Under these circumstances, a

biopsy distinguishes obstructive azoospermia from primary semniferous tubule failure.
The biopsy should be performed bilaterally. Good spermatogenesis is some times found in small firm testes whereas biopsies of larger healthy testes may

reveal maturation arrest.

Open testicular biopsy:
Anaesthesia:
Under local, general or spinal anaesthesia
Antibiotics
IV antibiotics of surgeon’s choice.
Position:
Supine position

When performing testes biopsy, the surgeon must provide an adequate tissue sample using a technique that avoids trauma to the specimen and avoid

injury to the epididymis and testicular blood supply.
The scrotal skin is stretched tightly over the anterior surface of the testis and confirm that the epididymis is posterior.
Bilateral 1cm transverse scrotal incision provides good exposure with a minimal scrotal skin bleeding. Alternatively a single vertical incision in

the median raphe may be employed
The incision is carried through the skin and the dartos muscle and the tunica vaginalis is opened.
The edge of the tunica vaginalis are held open with hemostats and any bleeding vessels are cautrerized.
A 3-4mm incision is made in the tunica albuginea with a 15degree microknife and small crossing vessels can be cauterized with a cautery. A pea

sized sample of seminiferous tubules is excised with a pair of Iris scissor.
The specimen is then deposited directly into either Bouins solution, Zenker’s solution or buffered Gluteraldehyde solution.
Then the tunica vaginalis is closed with a running 5-0 polypropylene suture for hemostasis.
The skin may be closed with a 5-0 monocryl suture.


Uses of testicular biopsy:
Diagnostic testicular biopsy is performed only on azoospermia patients.
Most clinician perform bilateral testicular biopsy but in patients with discrepant testicular volume the biopsy on the longer testes is

done.
The purpose of a diagnostic testicular biopsy is to differentiate between obstructive and non obstructive azoospermia.
Testicular biopsy is also performed for the management of patients with non obstructive azoospermia for sperm retrieval and IVF.
The Testicular biopsy may be performed either to obtain prognostic information or to harvest sperm for cryopreservation.
Testicular biopsy is not indicated in patients with oligospermia because the result will not alter theraphy
A Biopsy is rarely performed to rule out partial ductal obstruction in patients with severe Oligospermia, normal sized testes and normal FSH

values.





Interpretation :
The most commonly employed classification patterns are based on the appearance of spermatogenesis ranging from normal to sertoli cells only with

maturation arrest and hypospermato genesis in between

The examination should evaluate the size and the number of semniferous tubules the thickness of the semniferous tubule basement membrane, the relative and

type of germ cells with in the semniferous tubules, the degree of fibrosis in the intrestitium the presence of condition of leydig cells

COMPLICATIONS:
Haematoma
Wound infection
Inadvertent biopsy of the epididymis