Office-based diagnostic percutaneous testis biopsy

Abstract

SummaryPercutaneous testicular biopsy correlates with open biopsy. Successful in vitro fertilization (IVF) and pregnancy have been reported with testicular sperm extraction (TESE), thus the indications for testis biopsy have expanded. We examined the results, intraoperative findings and eventual patient outcomes in 22 patients with azoospermia or severe oligospermia (<5 million sperm ml−1). 22 patients, age 29–48, underwent percutaneous testis biopsy in the office with local anesthesia. Work-up included: history, physical exam, testicular volumes, serum follicle stimulating hormone (FSH), testosterone, and two semen analyses. Biopsy was performed with an 18 G core biopsy system. Two passes with the biopsy gun were made: bilaterally in the majority of patients. A touch imprint was obtained for cytology and the remaining tissue was placed in Bouin's solution for pathologic examination. One patient developed a scrotal hematoma, which responded to aspiration with no further treatment needed. No adhesions or ductal injuries were observed in the patients who were surgically explored, or received TESE. Adequate tissue was obtained for evaluation in all patients. The cytology coincided with the pathologic diagnosis in all but one patient. Histologic diagnoses included: normal (four); hypospermatogenesis (eight); maturation arrest (three); Sertoli cell only (SCO) (three) and SCO/focal spermatogenesis (four). One patient had ductal reconstruction, with a resultant pregnancy. Five patients had TESE: one had no sperm retrieved and underwent donor sperm IVF with a resultant pregnancy. 10 of the 22 patients underwent the therapeutic modality as recommended by the urologist. Of these, a 70% fertilization rate and 50% pregnancy rate was obtained. Five pregnancies were obtained through the following modalities: artificial insemination with donor sperm (AID) (two); intracytoplasmic sperm injection (ICSI) (one); TESE/ICSI (one); and ductal reconstruction (one). All patients returned to normal activity within 24 hours. Percutaneous testis biopsy is a safe, reliable procedure which can be performed comfortably in the office setting. It consistently yields sufficient diagnostic information to allow for therapeutic decision making. The cost is significantly lower than a comparable open procedure.