All about Testicular Biopsy – Types, Procedure, Precautions, Risks & More

Along with the penis and scrotum, the male reproductive system incorporates two testicles. These testicles are situated in your scrotum, a pouch-like sac of skin behind and under your penis. The testicles create sperm and the male sex hormone testosterone.

There are multiple reasons why some men need to undergo testicular biopsy. Before moving forward to why the testicular biopsy is done, let’s understand what it is and its types.

What is Testicular Biopsy?

Testicular biopsy is a surgical procedure of taking a sample of tissue from one or both testicles for examination. The sample goes under microscopic examination to inspect for any proof of disease or complications in the testes.

Types of Testicular Biopsy:

The two different types of procedures to perform testicular biopsy are:

Open Biopsy  Open biopsy, also known as surgical biopsy, refers to a method where doctors make a surgical incision in your scrotum to get a sample of testicular tissue. Once the sample is taken, the incisions are closed using the stitches.

Percutaneous Biopsy A percutaneous biopsy does not require any incisions or stitches. Here, a needle is inserted through the scrotum skin into the testicles. In the end, the needle has its syringe, which collects the sample of testicular tissue. The percutaneous biopsy can also be referred to as fine needle biopsy.

A core needle biopsy is a variation to a percutaneous biopsy. In this procedure, a spring-loaded needle is used to pull a cylinder of cells, which is known as a core sample. You can get a greater sample of tissues in core needle biopsy in comparison to open biopsy.

Why is a Testicular Biopsy Performed?

Here are some reasons why a testicular biopsy is performed:

Testicular biopsy in male infertility: A testicular biopsy is performed to know the cause of male infertility. However, testicular biopsy is not the first step to identifying male infertility – blood tests and other tests like semen analysis are done before it.

Obstructive Azoospermia: In this, the testes do produce sperm, but they cannot reach the semen and ejaculate because of the blockage. So, a testicular biopsy is performed to confirm the occurrence of obstructive azoospermia.

Recover Sperms for IVF Purpose: For men whose testes produce sperm but the sperms do not emerge in semen even if there is no blockage, the testicular biopsy is conducted to extract sperms for in vitro fertilization (IVF).

Diagnosis: A testicular biopsy can be used to diagnose testicular cancer, know the cause of a lump on the testis, and evaluate risks for men having testes located in an abnormal location in a scrotum or any previous testicular malignancy.

What is the Process for a Testicular Biopsy?

Preparation before the Testicular Biopsy:

There isn’t much a patient has to do before the testicular biopsy. The patient needs to inform his doctor about any regular or over-the-counter medicines that he is taking.

Some medications like blood thinners, nonsteroidal anti-inflammatory drugs such as aspirin or ibuprofen, and any medicines that affect blood clotting can be a risk for the process.

You must fast for at least eight hours prior to your test if you are going to get general anaesthesia. You will not be able to drive yourself to the biopsy if you are given a sedative to take at home before the procedure, so avoid doing so.

The Surgical Procedure for Testicular Biopsy:

  • Generally, a testicular biopsy is an outpatient process and is performed at the doctor’s office or hospital.
  • A testicular biopsy is usually a process of 15-20 minutes.
  • The patient is asked to lie on his back, and then the scrotum is cleaned to remove the bacteria.
  • The skin of the scrotum will be numbed with a local anaesthetic injection.
  • To assist you to relax in the process, you may be given a sedative. Some doctors choose to use general anaesthetic instead since you must remain still. However, the biopsy procedure remains the same, regardless of the medicines.

If you are having an open biopsy:

  • The doctor will make a tiny incision through your skin and remove a pea-sized amount of your testicular tissue.
  • While the process goes on, you will not experience any pain but might feel a little discomfort.
  • The incision made on the testicles and scrotum is stitched using an absorbable material so that you do not have to get your stitches removed.
  • The same procedure may be performed on the second testicle. After completion, the testicles are bandaged.

If you are having a percutaneous biopsy:

  • Your doctor will either use a fine needle or a core needle for the process.
  • In both scenarios, the needle is inserted via the skin of the testicle.
  • If it’s a fine needle biopsy, the sample of testicle tissue will be extracted with a syringe.
  • If it’s a core needle biopsy, you will hear a loud popping sound when the sample is extracted.
  • The same procedure is repeated on the second testicle.

Precautions One Must Take After Testicular Biopsy:

Some of the precautions patients need to take post the testicular biopsy to fasten the healing process are:
  • Avoid taking aspirin for a few weeks
  • Abstain any kind of sexual activity for two weeks
  • Wear an athletic supporter for some days
  • Keep the area of biopsy dry and do not wash the area for some days
  • Take acetaminophen for pain, discomfort or soreness
You may feel mild swelling, discomfort or discolouration for a few days.  

Risks Associated with Testicular Biopsy:

  • Sometimes the bleeding after a biopsy can be severe and may lead to a small risk of orchitis infection.
  • If the testicular biopsy is performed when the patient has testicular cancer, it grows the risk of spread. However, this is rare.
  • Bleeding that stains most of your dressing
  • High fever or chills
  • Severe pain or swelling
Before you decide to undergo a testicular biopsy, Dr Banker advises you to get a basic evaluation and workup. At Banker IVF, we ensure that you receive appropriate guidance and treatments for your concerns. Also Read: Sperm Count Test- Semen Analysis for Infertility 
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