Testicular biopsy: procedure and consequences

Egg biopsy is an invasive procedure that allows you to get spermatozoa if they are not in the ejaculate. Manipulation is carried out with azoospermia to determine its cause and develop further tactics for managing the patient. Spermatozoa obtained by testicular biopsy are used in ART programs( assisted reproductive technologies).

There are two types of testicular biopsy: open microsurgical and puncture biopsy of the epididymis( PESA / PESA) or testis( TESA / TESA)

Azoospermia is the main indication for a testicular biopsy. With this pathology, men do not show sperm in the ejaculate. To find out the reason of such condition and to receive necessary for fertilization male sexual cells it is possible by means of a biopsy. Invasive procedure can be performed with cryptorchidism and other testicular pathology to assess a man's ability to conceive a child.

There are two forms of azoospermia:

• Obstructive: spermatozoa are produced, but can not pass the vas deferens due to their obstruction.
• Non-obstructive: impaired sperm production in the testicles with passable vas deferens.

Contraindications

A testicular biopsy is not performed in the following conditions:

• acute infectious diseases with fever;
• exacerbation of chronic pathology, significantly impairing the patient's condition;
• inflammatory diseases of the skin of the external genitalia;
• purulent processes of the testis.

With all these conditions, it is necessary to achieve full recovery and only then decide whether to conduct a biopsy.

Preparation of

Testicular biopsy is an invasive procedure that requires some preparation. The process takes place in three stages:

Collecting analyzes and data

Before conducting a biopsy, a man must undergo a test:

1. A smear on the flora from the urethra( 2 hours before the last urination).
   

   Smear sampling on the flora of the urethra

2. Examination for STIs( gonococci, Trichomonas, chlamydia, mycoplasma, ureaplasma, gardarnella, herpes simplex virus, cytomegalovirus, Candida fungi).
3. Complete blood count. Blood group and Rh factor.
4. Coagulogram.
5. Examination for HIV infection, viral hepatitis, syphilis.
6. ECG.
7. Consultation of the therapist.

Sperm accumulation

Before biopsy, a sufficient number of viable spermatozoa should accumulate in the testes. For an optimal result 4-5 days before the procedure, it is necessary: ​​

1. Abstain from sexual intercourse.
2. Refuse to visit the sauna.
3. Do not drink alcohol.

Drinking alcohol and high temperatures adversely affect sperm status and can cause misdiagnosis and biopsy failures.

In some cases, stimulation of the synthesis of spermatozoa in the testicles is performed prior to the procedure. Indications for stimulation and duration of therapy are determined by the attending physician.

Direct preparation

The day before the biopsy:

1. Hunger for 12 hours( the evening before the biopsy nothing is after 20.00).
2. Shaving of the scrotum, skin of the thigh and lower abdomen( the morning before the procedure).
3. You can drink water without gas without restrictions.

If you need to constantly take any medications, you should discuss this with your doctor in advance. If the drug does not affect the blood coagulation system and does not interfere with the biopsy, you can take it as usual.

Technique for performing

There are two options for performing a testicular biopsy - open and aspirated. The choice of method will depend on the general condition of the patient, the survey data and the technical capabilities of the clinic.

TESA( Testicular Sperm Aspiration) - testicular aspiration

Aspiration of spermatozoa from testicles is performed under local or general anesthesia. The procedure does not require a skin cut. During the operation, the surgeon makes a neat puncture of the skin of the scrotum and testicles, after which he takes the necessary material for the examination. Stitches after the procedure are not superimposed. All manipulations take no more than 15 minutes.

Pros: rapid recovery after a biopsy and the possibility of conducting in an outpatient setting.

Cons: high risk of bleeding from the vessels of the scrotum during puncture and low efficiency( small amount of material obtained by puncture).

TESE( Testicular Sperm Extraction) - extraction of spermatozoa

An open biopsy is performed under anesthesia. During the procedure, the doctor dissects the skin of the scrotum, carefully bandages the damaged vessels, reducing the risk of bleeding. The tissue of the testicle is dissected, after which the surgeon takes the necessary amount of material for examination and further procedures. After the biopsy is completed, stitches are applied. The duration of the procedure is from 15 to 30 minutes.

Pros: the ability to take a large amount of ovarian tissue, low risk of bleeding.

Cons: the need for a cut, a longer recovery period after the procedure.

A type of open biopsy is micro-TESE - extraction of spermatozoa using microscopic techniques. During manipulation, the doctor examines the tissue of the testicle under a microscope, which helps him to obtain the most suitable material. The advantages of micro-TESE are obvious:

• is an opportunity to take small areas of testicular tissue with a large concentration of sperm;
• has a lower risk of bleeding.

Follow-up after biopsy

Testicular biopsy is performed on an outpatient or inpatient basis. After completion of the procedure, the patient is kept in the postoperative ward for an hour under the supervision of a doctor. If you feel well, the patient can go home after 1.5-2 hours. Further treatment will depend on the results of the biopsy.

In the first day after a testicular biopsy, it is recommended:

1. Refuse to drive and perform any work requiring increased attention and reaction speed.
2. Wear underwear made of quality cotton fabric.
3. Do not overheat the genitals.
4. Take medications prescribed by a doctor.

After an aspiration biopsy, there is no need for special skin care for the scrotum. The sutures are not superimposed, and a small puncture heals independently. It is necessary only to keep the skin of the external genital organs clean and dry for the next 3-5 days.

After an open biopsy, the wound requires special care:

• Treatment of the skin around the joint with antiseptics 2 times a day for 7 days.
• Use of sterile wipes. Press the napkin to the skin of the scrotum with dense cotton panties or wear special post-operative linen.
• Visual control of skin condition and postoperative suture.

During the first three days, do not take a shower and wet the area of ​​the suture on the scrotum. Remove the seams do not need: the threads dissolve themselves. When there is severe itching, burning, pus or blood in the seam area, you should always see a doctor.

Sexual life is prohibited for 14 days after a testicular biopsy. The procedure without complications does not affect the sexual function of a man in the future.

Complications of

When conducting a testicular biopsy, the development of such complications is possible:

• bleeding into the skin of the scrotum and formation of a hematoma;
• infection and development of orchitis( inflammation of the testicle).

Disturbing symptoms indicative of complications:

• severe pain in scrotal area;
• swelling and redness of the scrotum skin for three or more days after a biopsy;
• appearance of extensive hematoma around the external genitalia;
• fever.

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