Microsurgical testis biopsy: A novel technique for retrieval of testiculartissue

Purpose: In vitro fertilization with intracytoplasmic sperm injection has r esulted in a dramatic increase in the need for diagnostic and therapeutic t estis biopsies. We developed a microsurgical testis biopsy technique which allows identification of testicular vessels and individual seminiferous tub ules. We compare the results of this technique to our prier series of nonmi croscopic biopsies. Materials and Methods: A retrospective study of 226 consecutive patients wh o had undergone open testes biopsy with or without an operating microscope was performed. Between 1988 and 1994 standard open testis biopsy was perfor med without a microscope in 119 patients and a single sample of testicular tissue was taken. After 1994 microsurgical biopsy was performed under 6 to 25x magnification in 107 patients, nearly half of whom had multiple biopsie s of each testis. The complication rates of the 2 procedures were compared. Results: Scrotal hematoma required surgical drainage in 3 of the 119 standa rd testis biopsy cases and testis atrophy was noted in 1, for a total compl ication rate of 3.4%. There were no episodes of clinically detectable testi cular atrophy or scrotal hematoma requiring surgical drainage in the 107 mi crosurgical biopsy cases (p <0.05). In 2 men the microscope allowed identif ication of larger tubules that contained sperm. Conclusions: Use of the operating microscope for testicular biopsy allows i dentification and avoidance of testicular vessels, minimizing complications . It also may allow selection of seminiferous tubules more likely to contai n sperm.