Biopsy and histology of the testis

In the guidelines of the "European Association of Urology" (EAU), the following indications for testicular biopsy determined:
  A therapeutic testicular biopsy for testicular sperm extraction (TESE) in the case of obstructive azoospermia (OA) in normal testis volume and FSH level (<7 IU / l) and low markers of epididymal (α-glucosidase, l-carnitine) or seminal vesicle (fructose ) indicated no chance of a surgical reconstruction, for example in congenital bilateral aplasia of the vas deferens. Alternatively, a microsurgical epididymal sperm aspiration (MESA) are performed. In the case of a microsurgical refertilization (vaso-Vasostomie, vaso-Tubulostomie) after vasectomy helps a diagnostic testicular biopsy to exclude a Spermatogeneseschaden. In both cases, allows the use of cryopreservation of sperm obtained by MESA or TESE for intracytoplasmic sperm injection (ICSI), when a microsurgical refertilization not possible or is not successful.


  A therapeutic biopsy is indicated in case of nichtobstruktiven azoospermia (NOA), either normogonadotrop (FSH <7 IU / l) or hypergonatrop (FSH> 7 IU / l). A hypergonadotropic azoospermia has a focally damaged spermatogenesis, eg associated with focal or complete Sertoli cell-only syndrome (SCO), to. In these cases, a TESE of focal areas with at least qualitatively intact spermatogenesis in combination with IVF and ICSI, the only rational therapy (Bergmann et al 1994;. Zitzmann et al 2006.). The testicular tissue for later use with assisted reproductive technologies always cryopreserved (EAU Guidelines 2007).

  A diagnostic testicular biopsy is indicated to rule out preinvasive testicular intraepithelial neoplasia (TIN) in the case of an inhomogeneous ultrasonographic finding (microlithiasis) (von Eckardstein et al 2001,.. De Gouveia Brazao et al 2004). The biopsy of the contralateral testis double is indicated in clinically overt germ cell tumor, because a contralateral TIN had a testicular tumor in patients with a prevalence of 5-6% (Kliesch et al 2003,.. Dieckmann et al 2007). Also found in 2-4% of all adult men with cryptorchidism, a TIN (Rφrth et al. 2000).

  A therapeutic testicular biopsy is also indicated for patients with Klinefelter's syndrome who have at least a small proportion of a focal spermatogenesis, which allows therapy with TESE and ICSI (Lanfranco et al 2004,.. Schiff et al 2005).