Testicular Biopsy: Overview, Techniques & Healing Process

Understanding Testicular Biopsy

A testicular biopsy involves extracting a small tissue sample from the testicle for detailed laboratory examination.

The testicles are key male reproductive organs responsible for producing sperm and testosterone, housed within the scrotum—a skin-covered sac beneath the penis.

This biopsy procedure serves multiple purposes:

• Identifying the nature and position of lumps within the testicles
• Investigating reasons behind male infertility
• Harvesting sperm for assisted reproductive techniques like in vitro fertilization (IVF)

There are two primary biopsy approaches.

Percutaneous Biopsy

This minimally invasive method uses a slender needle inserted through the skin to collect tissue samples. It requires no incision or stitches and is often called a fine needle biopsy.

A variation, the core needle biopsy, employs a hollow, spring-loaded needle to retrieve a larger cylindrical tissue segment, known as a core sample.

Open Biopsy

Also referred to as a surgical biopsy, this technique involves making incisions in both the skin and testicle to extract a small tissue piece, followed by suturing to close the wounds.

Diagnostic Role of Testicular Biopsy

Testicular biopsies are vital in diagnosing male infertility but are typically performed after initial assessments, including medical history review, blood tests, and semen analysis.

Semen analysis evaluates sperm count and quality, usually obtained through masturbation.

Common issues detected through semen analysis include:

• Low sperm count
• Poor sperm quality
• Azoospermia (absence of sperm)

When blood and hormone tests do not clarify low sperm levels, a biopsy may be necessary.

Biopsies can help:

• Determine if sperm production issues stem from blockages
• Retrieve sperm for IVF when sperm are produced but absent in semen
• Diagnose testicular cancer
• Identify causes of testicular lumps

Preparing for a Testicular Biopsy

Preparation is straightforward.

Inform your healthcare provider about all medications you take, including over-the-counter drugs, to assess any risks during the procedure.

Medications affecting blood clotting, such as:

• Blood thinners (anticoagulants)
• NSAIDs like aspirin or ibuprofen
• Other clotting-affecting drugs

may require temporary discontinuation.

If general anesthesia is planned, fasting for at least eight hours before the biopsy is necessary. Sedatives given prior to the procedure mean you should arrange transportation, as driving is unsafe.

Conducting the Testicular Biopsy

Usually performed on an outpatient basis, biopsies take place in a clinic or hospital and last around 15 to 20 minutes.

A sedative or general anesthesia may be administered to ensure comfort and immobility during the procedure.

The scrotal area is cleaned, and local anesthesia is injected to numb the skin, which may cause a brief stinging sensation.

Open Biopsy Procedure

1. A small skin incision is made.
2. A tiny tissue sample, about the size of a pea, is removed.
3. Pressure or mild discomfort may be felt, but significant pain is uncommon.
4. Absorbable stitches close the testicle and skin; no stitch removal is needed.
5. The procedure is repeated on the other testicle.

Percutaneous Biopsy Procedure

• A needle is inserted through the scrotal skin to access the testicle.
• Core needle biopsies produce a clicking sound during tissue extraction.
• Fine needle biopsies use a syringe to draw tissue.
• The second testicle undergoes the same process.

Testicular Cancer Diagnosis

Biopsies are seldom the first choice for diagnosing testicular cancer due to the risk of cancer cell spread.

Ultrasound imaging and surgical removal of the testicle (radical inguinal orchiectomy) are preferred diagnostic methods.

Radical inguinal orchiectomy steps include:

1. An incision in the groin area.
2. Removal and examination of the testicle.
3. Sampling suspicious tissue for immediate pathological analysis.
4. If benign, the testicle is replaced; if malignant, the testicle and spermatic cord are removed to prevent cancer spread.

Post-Biopsy Recovery

Recovery instructions vary based on biopsy type but generally include:

• Avoiding sexual activity for 1-2 weeks
• Wearing supportive underwear for several days
• Keeping the biopsy area dry and refraining from washing it initially
• Steering clear of aspirin for at least a week
• Using acetaminophen to manage discomfort

Swelling, bruising, mild discomfort, and minor bleeding are normal and usually resolve within days.

Potential Risks

While testicular biopsies are generally safe and do not affect erectile function or fertility, rare complications include prolonged bleeding and infection.

Seek medical attention if you experience:

• Excessive bleeding soaking through bandages
• Hematoma formation under the skin
• Severe scrotal pain or swelling
• Fever or chills

Internal injury to the testicles or nearby structures is uncommon.

Understanding Biopsy Results

Microscopic analysis reveals sperm production status and possible abnormalities.

Normal sperm development in someone with low or absent sperm count may indicate a blockage causing infertility.

Blockages often occur in the vas deferens, the sperm transport tube, and may be surgically corrected.

Other abnormal findings could include:

• Spermatocele: fluid-filled cysts on testicular ducts
• Orchitis: testicular inflammation due to infection
• Testicular cancer

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