What is a Testicular Biopsy?
A testicular biopsy takes a tissue sample from your testicle for laboratory analysis.
The two testicles are the male reproductive organs. They produce sperm and the male sex hormone testosterone. Your testicles are located in your scrotum, which is the fleshy pouch of tissue that hangs under your penis.
A testicular biopsy can be used to:
- diagnose the location and condition of a lump in the testes
- diagnose causes of male infertility
- obtain sperm for in vitro fertilization (IVF)
There are two different procedures for a testicular biopsy.
With percutaneous biopsy, a thin biopsy needle is inserted through the skin. The needle has a syringe on the end to collect the testicular tissue. This procedure does not require an incision or stitches. It also is called a fine needle biopsy.
A core needle biopsy is a variation on this technique. It uses a hollow, spring-loaded needle to extract a cylinder of cells. This is called a core sample. A core sample is a larger specimen than one from a fine needle biopsy.
An open biopsy is also called a surgical biopsy. Your doctor starts by making a cut in the skin. A cut also is made in the testicle. Then a small tissue sample is taken from the opening and stitches are used to close the cuts.
A testicular biopsy is an important tool in diagnosing male infertility. However, it is not the first step. For the initial phase in a fertility evaluation, your doctor will take a health history and order blood tests and a semen analysis.
Semen analysis looks at the quantity and quality of your sperm. The initial semen sample is usually obtained by masturbation.
Semen analysis can identify the following problems:
- abnormally low levels of sperm
- poor quality of sperm
- azoospermia (absence of sperm)
Blood and hormone tests often can identify the causes of low sperm levels. However, when these tests are not conclusive, you may need a testicular biopsy.
A testicular biopsy may be used to:
- determine whether sperm production problems are caused by a blockage
- retrieve sperm for use in IVF. This is done if sperm are being made in the testicles but are not present in the semen.
- diagnose testicular cancer
- determine the cause of a lump in the testicles
The preparations required for this test are minimal.
Tell your physician about any prescription or over-the-counter medications you are taking. Discuss whether these medications should be used before and during the test.
Certain drugs may pose a special risk during the procedure. These include:
- anticoagulants (blood thinners)
- nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin or ibuprofen
- any medications that affect blood clotting
If you are receiving general anesthesia, you will need to fast from food and drink for at least eight hours before your test. If you are given a sedative to take at home before the biopsy, you will not be able to drive yourself to the procedure.
A testicular biopsy is usually an outpatient procedure. It may be performed at your doctor’s office or a hospital.
The biopsy typically takes about 15 to 20 minutes. It is performed by a doctor or another trained health professional.
You may be offered a sedative to help you relax for the test. Since you have to stay completely still, some doctors prefer to use general anesthesia instead. With either medication, the biopsy technique remains the same.
You will be asked to lie on your back and the scrotum will be cleaned to remove bacteria. An injection of local anesthesia will numb the skin of the scrotum. You may feel a slight sting.
If you are having an open biopsy, the following procedure is typical:
- Your physician will make a small incision through the skin.
- A tiny, pea-sized amount of testicular tissue is removed.
- When the biopsy is taken, you will feel pressure or minor discomfort. You should not feel pain.
- Typically, one absorbable stitch closes the cut in the testicle. Another stitch closes your skin. Stitch removal is not necessary.
- The same technique is done on the second testicle.
The procedure for a percutaneous biopsy will depend on the type of needle used — a core needle or a fine needle.
- In both cases, a needle is inserted through the skin of the testicle.
- If you are having a core needle biopsy, you will hear a loud clicking or popping sound when the tissue sample is being extracted.
- If you are having a fine needle biopsy, the tissue sample will be drawn out with a syringe.
- The same technique is done on the second testicle.
Testicular biopsy is rarely used to diagnose testicular cancer. Typically, it is performed when the diagnosis is uncertain. This is because a biopsy, unfortunately, increases the likelihood the cancer will spread.
Your physician is more likely to use ultrasound for cancer diagnosis. Your testicle can also be examined and removed through open surgery. This is called a radical inguinal orchiectomy.
A radical inguinal orchiectomy to diagnose cancer includes the following steps:
- Your physician will make a cut in your groin.
- The testicles will be removed from the scrotum and examined.
- If abnormal tissue is found, a small portion will be taken for analysis.
- A pathologist will examine the tissue. This will be done immediately, while you wait.
- If the tissue sample is benign (noncancerous), the testicle will be returned to the scrotum.
- If the tissue sample is malignant (cancerous), the testicle will be removed. The spermatic cord will be removed as well. This prevents the spread of cancer cells to the rest of the body.
After your testicular biopsy, you will receive special instructions to help you heal and remain comfortable. Instructions will vary depending on the type of biopsy.
You may be advised to:
- refrain from sexual activity for one to two weeks
- wear an athletic supporter for several days
- keep the site of the biopsy dry, and avoid washing it for several days
- avoid aspirin for one week
- use acetaminophen for soreness
It is normal to have swelling, discoloration, and discomfort for a few days. A small amount of bleeding is also common. Your doctor may also warn you about other routine side effects that are procedure dependent.
A testicular biopsy can help your doctor resolve your infertility problems. It does not carry a risk of erection or fertility problems after the procedure.
Prolonged bleeding and post-procedure infection are two potentially serious risks. However, they are rare. Contact your physician if you experience:
- bleeding that soaks the bandage at the biopsy site
- hematoma (a collection of blood under the skin)
- severe pain or swelling of the scrotum
- fever or chills
Another possible risk is internal damage to the testicles or nearby areas. This is rare.
Your tissue sample will be analyzed under a microscope. The pathologist will identify any defects in sperm production or development.
Your results may show normal sperm development. If you previously had a low or zero sperm count, an obstruction may be the cause of your infertility.
Blockages in the vas deferens have been shown to cause this type of infertility. The vas deferens is the tube that carries sperm from the testicles to the urethra. Surgery may be able to correct the problem.
Additional causes of abnormal results include:
- spermatocele: a fluid-filled cyst on the ducts of the testicles
- orchitis: a swelling of the testicles caused by an infection
- testicular cancer