Testicular biopsy

Specimen:

Open biopsy for assessment of fertility. 

Transcrotal testicular biopsy should not be used for diagnosis of malignancy due to alteration of the normal lymphatic drainage of the testis. 

Open biopsy for tumour should only be performed as an intra-operative procedure if immediate orchidectomy is possible following diagnosis of malignancy by frozen section. 

Bilateral biopsy should be undertaken for investigation of infertility.

Method:

Fixed tissue for light microscopy and electron microscopy. 

Formalin fixative should not be used due to distortion of testicular histology and Bonin's or Zenker's fixative is recommended. 

Wet touch preparations of fresh tissue are used to detect presence of motile spermatozoa with tails.

Application:

Investigation of infertility. 

Biopsy is limited to men with azoospermia, with testis of normal size and consistency, with detectable vas deferens and normal FSH levels.

Interpretation:

Identification of cause of infertility and specifically to distinguish between obstructive azoospermia and primary testicular failure.

Reference:

Wein AJ et al. Campbell-Walsh Urology. 10th ed. 2011. Elsevier.