What is a Testicular Biopsy?
A testicular biopsy is a procedure that involves the removal of a small amount of tissue from a testicle for lab analysis.
Some reasons a man may need to undergo a testicular biopsy include:
- Determining the nature and location of a lump in the testicles.
- Investigating potential causes of male infertility.
- Extracting sperm for an IVF procedure (in vitro fertilization).
Types of Testicular Biopsies
There are two primary procedures for performing a testicular biopsy: open biopsy and percutaneous biopsy.
Also referred to as a surgical biopsy, an open biopsy involves your doctor making an incision in the both the scrotum and the testicle. A small amount of tissue is then removed through the opening and the incisions are closed using stitches.
Percutaneous Needle Biopsy
A percutaneous needle biopsy is performed by inserting a fine, thin biopsy needle through the skin of the scrotum. The needle has a hollow syringe tip that collects the tissue sample. No incision or stitches are necessary when using this technique.
An alternate version of this procedure is called a core needle biopsy. This method uses a hollow, spring-loaded needle to extract a tiny plug of tissue, called a core sample. A core sample contains a larger amount of tissue compared to a fine needle biopsy.
Reasons For Having a Testicular Biopsy
Reasons for having a testicular biopsy include:
- Determining whether or not problems with sperm production are due to a blockage.
- Retrieval of sperm for use in an IVF procedure, if sperm are being produced in the testicles but are absent in the semen.
- Diagnosing testicular cancer.
- Investigating the cause of a lump in the testicles
Although a testicular biopsy can be a useful diagnostic tool, it is usually one of the last steps taken in determining the source of male infertility. Initially, you will undergo a fertility evaluation, which involves your doctor going over your medical history, ordering blood tests and performing a semen analysis.
A testicular biopsy is not normally used to diagnose testicular cancer. It is usually performed when the diagnosis of testicular cancer is not certain. The reason for this is that a biopsy can actually increase the risk of cancer spreading.
An ultrasound is more commonly used by doctors to diagnose cancer. Open surgery is also an option to remove and examine the testicle. This procedure is referred to as radical inguinal surgery.
Testicular Biopsy Procedure
Normally, a testicular biopsy is performed on an outpatient basis, and may take place at your doctor’s office or a hospital. The average time to complete a biopsy is about 15-20 minutes. A doctor or other qualified health professional will perform the procedure.
Medication may be offered to help you relax during the process. General anesthesia is preferred by some doctors because it is important for the patient to remain completely still.
Next, you will be asked to lie on your back and an anti-bacterial solution will be applied to the scrotum. A local anesthetic is then used to numb the scrotum. The anesthetic is administered by an injection, so you may feel a slight stinging sensation during this step.
The next stages in the procedure depend upon which type of biopsy is being performed.
Open Biopsy Procedure
- The doctor will make a small cut through the skin of the scrotum.
- A small amount of tissue is taken from the testicle.
- While the biopsy is being performed you will likely feel some pressure or slight discomfort. However, you should not experience any pain.
- The cut in the testicle is usually closed with one absorbable stitch, and a second stitch is used to close the incision in the skin. The stitches will dissolve over time and won’t need to be removed.
- The same procedure is performed again on the other testicle.
Percutaneous Needle Biopsy Procedure
The type of needle used for percutaneous biopsy (fine needle or a core needle) will determine the how the procedure is performed.
- In either procedure, the needle is inserted through skin of the scrotum into the testicle.
- The tissue sample from a fine needle biopsy will be extracted using a syringe.
- During a core needle biopsy, you may hear a loud pop or clicking sound when the sample of tissue is being retrieved.
- The same procedure is performed again on the other testicle.
You will be given specific instructions following the procedure, depending on which type of biopsy was performed.
Some common post-biopsy recommendations include:
- Abstaining from sex for 1-2 weeks.
- Wearing athletic support.
- Avoid getting the site of the biopsy wet for a few days.
- Use acetaminophen for any soreness, but avoid using aspirin for one week.
Risks and Side Effects
It is not uncommon to experience some swelling, discomfort, and/or discoloration for several days following the biopsy. You may also notice some minor bleeding.
Other side effects may be mentioned by your doctor that are related to the specific type of biopsy performed.
A testicular biopsy does not pose a risk to fertility or erectile function. However, there are two risks that can potentially be serious: continued bleeding and infection – although these risks rarely occur.
Be sure to contact your doctor if you experience any of the following symptoms:
- Heavy bleeding at the site of the biopsy.
- A formation of a hematoma, where blood collects underneath the skin (blood blister).
- Intense pain or substantial swelling of the scrotum.
- Elevated body temperature.
Although not likely to occur, there is also the possibility of internal damage to the testicles or the surrounding area.
Testicular Biopsy Results
The tissue sample obtained from a biopsy will be examined under a microscope, and a pathologist will look for any abnormalities in sperm formation or development.
Your biopsy results could indicate normal sperm production. For those with a below normal or zero sperm count, this could suggest that your infertility may be caused by an obstruction.
This type of infertility is often caused by blockages in the tube which carries sperm from the testicles during ejaculation (the vas deferens). This condition can often be corrected with surgery.
There are also other causes for abnormal results, including:
- Spermatocele – A fluid-filled sac that forms in the epididymis.
- Orchitis – Swelling of the testicles due to infection.
- Testicular Cancer.