Testicular biopsy and histology

Abstract

Indications for testicular biopsy are summarized in Table 11.1. According to the European Association of Urology (EAU) guidelines, a therapeutic testicular biopsy (for testicular sperm extraction, TESE) is indicated (1) in the case of obstructive aszoospermia (OA), indicated by normal testicular volume, normal FSH (<7 IU/l), and low levels of epididymal (α-glucosidase, L-carnitine) or seminal vesicle (fructose) markers with no chance for surgical reconstruction (e.g., congenital bilateral aplasia of the vas deferens). Alternatively, microsurgical epididymal sperm aspiration (MESA) can be applied. However, sperm obtained by TESE show better fertilization rates. In the case of microsur-gical refertilization (vasovasostomy, vasotubulostomy), after vasectomy a diagnostic biopsy helps to exclude impairment of seminiferous epithelium. In both cases, cryopreservation allows the use of extracted sperm (TESE, MESA) in combination with intracytoplasmic sperm injection (ICSI), if microsurgical refertilization techniques are not applicable or fail. © 2010 Springer-Verlag Berlin Heidelberg.