PERCUTANEOUS TESTIS BIOPSY - AN ALTERNATIVE TO OPEN TESTICULAR BIOPSYIN THE EVALUATION OF THE SUBFERTILE MAN

Purpose: We evaluated the safety and efficacy of percutaneous testis b iopsy by comparing the ultrasound appearance and histological status o f testicular parenchyma obtained to those noted after open testis biop sy. Materials and Methods: A total of 51 consecutive infertile men wit h azoospermia or severely impaired semen quality, in whom ductal obstr uction was suspected, underwent percutaneous (31) or open (20) testis biopsy, with 58 and 34 procedures performed, respectively. Scrotal ult rasound was performed preoperatively, and at 2 weeks and 1, 3 and 6 mo nths after biopsy. In addition, immunoglobulins G and A antisperm anti body assays were obtained preoperatively and postoperatively. Two biop sy specimens were obtained from each testis for formal histological ev aluation. A touch preparation was also performed and examined immediat ely for mature spermatozoa using phase contrast microscopy. Results: A ll biopsies yielded adequate tissue for diagnosis and morphometric ana lysis. Of 58 percutaneous biopsies 4 (7%) demonstrated sonographic evi dence of intratesticular bleeding, characterized by a hypoechoic regio n within the testicular parenchyma, which resolved by 6 months postope ratively. In contrast, 10 of 34 open biopsies (29%) showed evidence of intratesticular bleeding or a new area of increased echogenicity at 1 month after the procedure (intraparenchymatous scar). All intraparenc hymatous scars persisted to 6 months postoperatively. No patient under going percutaneous or open testis biopsy had antisperm antibodies in t he seminal fluid or serum (azoospermia cases) or on sperm postoperativ ely. Of the 32 and 20 patients undergoing percutaneous and open testis biopsy 3 (9%) and 14 (70%), respectively, required narcotic analgesia . All patients returned to routine activities within 24 hours after pe rcutaneous testis biopsy. No postoperative infections or extratesticul ar hematomas were noted. Pathological study was diagnostic in all spec imens. Conclusions: Percutaneous testis biopsy is well tolerated by th e patient, with fewer apparent complications than and diagnostic value equal to open testis biopsy. Percutaneous testis biopsy should be con sidered an alternative to open biopsy.