What Is a Testicular Biopsy?

Testicular biopsy (referred to as testicular biopsy) is a clinical technique with dual functions of diagnosis and treatment. It is a simple surgical method to remove a small piece of living testicular tissue and perform pathological section histological observation to understand testicular spermatogenesis. The condition is used to diagnose testicular disease and assess the prognosis. At present, the test methods to understand the testicular spermatogenesis function are hormone test and biochemical test. Compared with testicular biopsy, these test methods can not accurately reflect the testicular spermatogenesis function. Because testicular biopsy is a direct examination of the seminiferous tubules of the testis, and endocrine and biochemical tests are an indirect understanding of spermatogenic function. Testicular biopsy is currently the gold standard for diagnosing testicular spermatogenic function, so this test should be done for patients with azoospermia.

Testicular biopsy

testis

Testicular biopsy observations can directly estimate the testicular spermatogenic function and the degree of spermatogenic disorders, as well as the ability of the testes to synthesize steroid hormones. It is an important test method for male infertility. It estimates fertility and provides intuitive information The choice of treatment and prognosis are also an important basis.

In recent years, drug treatment and obstructive

1) Clinical examination of testicular volume and hormone levels to determine normal infertility patients.

2) The semen test is oligozoospermia, and the follicle stimulating hormone is within the normal range. The spermatogenic function can be judged by biopsy.

3) Oligospermia caused by varicocele, biopsy can help diagnose the degree of influence of varicocele on the spermatogenic function of the testis.

4) For cryptorchidism in puberty or late development, preoperative biopsy can evaluate spermatogenic function and exclude the possibility of malignant changes.

5) The combination of testicular biopsy and endocrine examination can determine whether the testicular dysfunction is primary or secondary.

6) Vasectomy shows that the vas deferens is blocked. Biopsy can help diagnose the spermatogenic function of the testis. Vasectomy is the choice.

7) Efficacy evaluation before and after hormone therapy.

8) Biopsy can assist early diagnosis of germ cell tumors. Before testicular biopsy, first perform a microscopic examination of the centrifuged semen to see if sperm are present; if the amount of semen is less than normal, take a urine test after ejaculation to exclude retrograde ejaculation; measure the fructose in the semen to understand whether the seminal vesicles Presence and obstruction of the vas deferens; in addition, vas deferens and epididymis should be palpated, and bilateral absence is a good explanation for azoospermia. Testicular biopsy is not necessary in patients with moderate or severe spermatozoa with significant increase in small testes and FSH.

Although the testicular biopsy is less invasive, care should be taken to minimize the patient's physical and mental pain, and usually only a side testicular biopsy is needed, because for most people, the testes on both sides have similar tissue structures. However, in some cases, bilateral testicular biopsies are required; for example, suspected obstructive azoospermia, cryptorchidism, and varicocele infertility.

(1) Normal testicular structure: the pre-pubertal convoluted seminiferous tubules are small, there is no basement membrane, there are only primitive germ cells and support cells, and interstitial cells are not obvious. Spermatogenic epithelium can be seen in the seminiferous tubules after puberty. Spermatogenic cells (spermatogonia, spermatocytes, spermatids) and supporting cells are present at all levels. There are many spermatozoa on the lumen surface. . The reproductive and pathological changes of testis mainly occur in seminiferous seminiferous epithelium and seminiferous tubule basement membrane.

(2) Spermatogenic function is low: spermatogenesis occurs, but the spermatogenic epithelium becomes thinner, and the number of spermatogenic cells at all levels decreases.

(3) Spermatogenesis stagnation: Spermatogenesis occurs at a certain cell stage, but sperm cannot be formed. It is more common in the spermatocyte stage, followed by the sperm cell stage, and less in the spermatogonia stage.

(4) Spermatogenic cells fall off and arrange disorderly: Immature spermatogenic cells, spermatocytes, spermatids, etc. fall off in clumps of seminiferous tubules, blocking the lumen, and failing to drain. Often accompanied by disordered spermatogenic cell arrangement.

(5) Sertoli cell syndrome only: there are only sertoli cells in the seminiferous tubules, but no spermatogenic cells. The tube diameter is reduced, the boundary membrane is thickened, and the interstitial hyperplasia. This is a congenital anomaly with no sperm and fertility, but normal secondary sexual characteristics.

(6) Mixed lesions: A variety of abnormalities can be seen in the seminiferous tubules, such as various types and degrees of spermatogenic disorders: spermatogenic stagnation, shedding disorders; boundary membrane hyperplasia or hyaline degeneration.

(7) Immature testis: The testicular development of adults still stops before puberty, the diameter of seminiferous tubules is small, the lumen has not appeared, and there is no spermatogenesis.

(8) The degeneration of seminiferous seminiferous tubules: rapid development, progressive, manifested by the thickening of the limiting membrane of seminiferous seminiferous tubules, showing a hyaline degeneration, and expanding to the lumen and interstitium, causing the lumen to shrink. With varying degrees of spermatogenic disorders. In severe cases, all kinds of cells in the tubules disappeared, leaving only the shadow of shrinking seminiferous tubules.

Dissection biopsy

After scrotal skin disinfection, apply local anesthesia, fix the testicles under examination with hands, tighten the surface of the scrotal skin, select a site with few blood vessels, and make an incision of about 1 to 2 cm. The incision passes vertically through the skin, intima, and sheath. The testicular alveolar membrane was made into a -shaped incision with a length of about 0.5cm. The testicles were gently squeezed to expose the parenchyma of the testicles. A little testicular tissue was taken as a specimen and sent to pathology for pathological examination. Strict disinfection and careful operation during the operation usually do not cause infection, hematoma or pain. In a few patients, sperm counts decrease in the short term after taking testicular tissue, and it takes about 4 months to gradually recover.

The skin and testes are cut open, and the seminiferous tubules in the testes are taken out in this way. The collection is very complete and can accurately reflect the spermatogenic function of the testicles without the errors of the test. The results are reliable. However, this test method is very traumatic and requires skin and testicular incision, and sutures and sutures are required after surgery, which brings more pain and inconvenience to patients. Although this test method is accurate, it is not convenient for clinical practice because of the pain and the patient's fear of surgery.

Puncture

Use a needle and needle for puncture. After routine disinfection of the skin and anesthesia, puncture the puncture needle through the scrotal skin and pierce the testicles, withdraw the needle core, aspirate the needle tube to obtain a little testicular tissue, and then pull out the puncture needle. Too little, you can aspirate multiple times in different parts, bandage the puncture site after the end, and send testicular tissue for examination.

Compared with the incision method, this method has less damage, less pain, and does not require sutures. Its disadvantage is that only a few tissue cells can be obtained by needle aspiration cytology, and the overall structure of the tissue cannot be seen, so it cannot accurately reflect the testicular spermatogenic function. There are errors in false positives and false negatives, and the results of the tests are unreliable and easily misdiagnosed.

Testis biopsy

First sterilize the skin with 1 Xinjieer, then sperm cord with 2% or 1% procaine

The main diagnosis of testicular biopsy, so far, is mainly the evaluation of spermatogenic function and the diagnosis of testicular carcinoma in situ. To this end, it is necessary to master the normal histology of the testis and the main functions of various components and the age of the patient. Only with clinical expertise can an objective and comprehensive diagnosis be made.

(A) testicular tissue in normal adult men

It consists of finely curved tubules and interstitial.

Spermicular tubules: contain spermatogenic cells (spermatogonia, spermatocytes, spermatids, spermatozoa, etc.) and support cells (Sertoli cells) at all levels.

Before testicular biopsy, first perform a microscopic examination of the centrifuged semen to see if sperm are present; if the amount of semen is less than normal, take a urine test after ejaculation to exclude retrograde ejaculation; measure the fructose in the semen to understand whether the sperm Presence and obstruction of the vas deferens; in addition, vas deferens and epididymis should be palpated, and bilateral absence is a good explanation for azoospermia. Testicular biopsy is not necessary in patients with moderate or severe spermatozoa with significant increase in small testes and FSH.