Testicular Biopsy

A testicular biopsy is a test to remove a small sample of tissue from one or both testicles and examined under a microscope to evaluate a man's ability to father a child.

The testicles (testes) are oval-shaped glands that hang in the scrotum beneath the base of the penis. The testicles produce sperm (necessary for reproduction) and male hormones, such as testosterone.

A testicular biopsy may, on rare occasions, be done to help determine the cause of male infertility. Testicular biopsy may be done if both of the following are present:

• The man's semen has an abnormal sperm count.
• Hormone test results are within the normal range.

Testicular biopsy is not usually used to detect testicular cancer. When cancer is suspected, an open surgical procedure (orchiectomy) is done to confirm the diagnosis.

Before having a testicular biopsy, be sure to tell your doctor if you:

• Have had any bleeding problems.
• Are allergic to any medications, including anesthetics.
• Take any medications regularly. Be sure your doctor knows the names and doses of all your medications.
• Are taking any blood-thinning medications, such as warfarin (Coumadin), heparin, enoxaparin (Lovenox), aspirin, ibuprofen, or other nonsteroidal anti-inflammatory drugs (NSAIDs).

You will need to sign a consent form that says you understand the risks of a testicular biopsy and agree to have the biopsy. Talk to your health professional about any concerns you have regarding the need for the biopsy, any alternative methods for the biopsy, its risks, how it will be done, or what the results will indicate. To help you understand the importance of the biopsy, fill out the medical test information form(What is a PDF document?).

If a testicular biopsy is done under local anesthesia, no other special preparation is needed.

If the biopsy is done under general anesthesia, do not eat or drink anything for 8 to 12 hours before the biopsy. During preparation for the biopsy, an intravenous line (IV) is inserted in your arm, and a sedative medication is given about an hour before the biopsy.

This biopsy is done by a surgeon or a doctor who specializes in men's sexual problems (urologist) in the doctor's office, a day surgery clinic, or a hospital operating room.

You will lie on your back on an examining table. The skin over your testicle is cleaned with an antiseptic solution, and the area around it is covered with sterile cloth. Your doctor will wear sterile gloves. It is very important that you do not touch this sterile area.

A local anesthetic will be injected into the skin of the scrotum to numb (anesthetize) the area. Then a small incision is made through the skin, and a tiny piece of testicular tissue is removed with small scissors. A single stitch is used to close the incision in the testicle, and another stitch is used to close the incision in the skin. (Absorbable sutures are used so the stitches do not need to be removed.) The procedure is usually repeated on the other testicle. The scrotal area is then bandaged. You will be asked to wear an athletic supporter for several days after the procedure to help support the testicles while the incisions heal.

If a general anesthetic is used, you will be asleep during the procedure but the same method will be used.

The biopsy usually takes 15 to 20 minutes. You will probably be advised to refrain from sexual activity for 1 to 2 weeks after the biopsy. You should avoid washing the area for several days.

You will feel a brief sting when the IV line is inserted or when the local anesthetic is injected. Other than that, the procedure should be painless.

Your scrotum and testicles may be somewhat sore for 3 to 4 days after the biopsy and some bruising may be present. You may also notice a small amount of bleeding through the bandage, which is normal. Talk to your doctor about how much bleeding to expect.

There is a slight risk of prolonged bleeding or infection from this procedure. There is no risk of erection problems or infertility as a result of this biopsy. If general anesthesia is used, there is a small risk of complications from anesthesia.

After the biopsy

Call your doctor immediately if you have:

• Severe pain in your scrotum. Some mild discomfort is normal.
• Severe swelling of your scrotum. Some mild swelling is normal.
• A fever higher than 100°F (38°C).
• Excessive bleeding through the bandage.

A testicular biopsy is a test in which a small sample of tissue is taken from one or both testicles and examined under a microscope to evaluate a man's ability to father a child. Results are usually available in 2 to 4 days.

A pathologist examines the biopsy sample through a microscope for any abnormalities in sperm production or maturation. If sperm development appears normal yet a semen analysis test shows reduced or absent sperm, a blockage of the tube (vas deferens) from the testes to the urethra is suspected. A blocked vas deferens can sometimes be repaired by surgery.

It is important to remain completely still while a biopsy is done under local anesthesia. If this is not possible, general anesthesia may be needed.

Testicular cancer is more likely to spread when a testicular biopsy is done. For this reason, a biopsy usually is not done if testicular cancer is suspected. A testicular ultrasound is generally done to help diagnose suspected testicular cancer. For more information, see the medical test Testicular Ultrasound. When cancer is suspected, an open surgical procedure (orchiectomy) is done to confirm the diagnosis.

Other Works Consulted

• Chernecky CC, Berger BJ, eds. (2004). Laboratory Tests and Diagnostic Procedures, 4th ed. Philadelphia: Saunders.

• Goldstein M (2002). Surgical management of male infertility and other scrotal disorders. In PC Walsh et al., eds., Campbell's Urology, 8th ed., vol. 2, pp. 1532–1587. Philadelphia: W.B. Saunders.