Biopsies testiculaires percutanees dans l’exploration des infertilites masculines

Abstract

Between February 1989 and March 1991, eight patients (mean age 32 years) presenting with azoospermia or severe oligozoospermia underwent a testicular biopsy to investigate their secretory or excretory origin. A bilaterial testicular biopsy was performed percutaneously using an automatic biopsy gun with a Tru-cut 14 gauge needle. General anaesthesia was used for seven patients although one man had a painless biopsy following spermatic cord anaesthesia. Satisfactory specimens were obtained in seven patients (more than 30 spermatogenic tubules visible in each biopsy), and the differential diagnosis of excretory (three cases) or secretory origin (four cases) of the infertility was possible. In six patients a testicular ultrasonographic examination was performed after the biopsy. Results were normal in five men while the sixth showed a haematocoele, although the fluid was removed percutaneously. In 7/8 patients no haemorrhagic or infectious complications were noted. To investigate possible immediate complications of this type of procedure, 25 patients presenting with prostatic carcinoma underwent percutaneous testicular biopsy just before their orchidectomy. In all patients a haematic infiltration of the testicular parenchyma along the needle’s path was observed. Among these 25 men, eight biopsies were performed under local spermatic cord anaesthesia: the procedure was painless in six cases but slightly painful in two. Consequently, percunateous testicular biopsy using an automatic gun is an interesting option compared to the traditional open surgical approach used to investigate spermatogenesis in certain types of male sterility. Furthermore, this procedure can be performed under local anaesthesia in the consulting room, making this altermative approach even more attractive

Resume

Une biopsie testiculaire percutanée bilatérale a été réalisée chez 8 hommes explorés pour azoospermie ou oligospermie sévère. Celle-ci s’effectue au pistolet automatique à l’aiguille 14 gauge de type Tru-cut. Les prélèvements ont été suffisants par le diagnostic chez 7 patient. Un patient a présenté une hématocèle unilatérale traitée par simple ponction. Ce geste simple, rapide et peu agressif peut s’effectuer sous anesthésie, locale et constitue une alternative intéressante à la biopsie chirurgicale classique.