The safety of ultrasonically guided testis aspiration biopsies and efficacy of use to predict varicocelectomy outcome

• Published in: Human reproduction (Oxford) Vol. 20; no. 8; pp. 2279 - 2288
• Main Authors: Marmar, Joel L., Benoff, Susan
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.08.2005; Oxford Publishing Limited (England)
• Subjects: Biological and medical sciences; Biomarkers; biopsy; Biopsy, Needle - adverse effects; Biopsy, Needle - methods; Cadmium - metabolism; Calcium Channels, L-Type - genetics; Gynecology. Andrology. Obstetrics; Humans; Infertility, Male - diagnostic imaging; Infertility, Male - pathology; Infertility, Male - surgery; Male; Medical sciences; percutaneous aspiration; Postoperative Complications; Predictive Value of Tests; RNA, Messenger - analysis; Sperm Count; testis; Testis - diagnostic imaging; Testis - metabolism; Testis - pathology; Treatment Outcome; Ultrasonography; ultrasound; varicocele; Varicocele - diagnostic imaging; Varicocele - pathology; Varicocele - surgery; biopsy; percutaneous aspiration; testis; ultrasound; varicocele; Sonography; Varicocele; Prognosis; Aspiration; biopsy/percutaneous aspiration/testis/ultrasound/varicocele; Male genital system; Percutaneous route; Vertebrata; Mammalia; Biopsy; Surgery; Safety; Male genital diseases; Ultrasound; Testicular diseases
• ISSN: 0268-1161; 1460-2350
• DOI: 10.1093/humrep/dei027

BACKGROUND: We hypothesized that infertile men with varicoceles have molecular/genetic defects that interact with varicoceles to induce infertility. Studies directly on testis tissue appeared to be a way to link histology, markers for molecular/genetic defects and spermatogenesis, but testis biopsies may induce morbidity. In this report, we present safety and efficacy data on ultrasonically guided, single stick, percutaneous aspiration. METHODS: Biopsies were performed on 115 infertile men with varicoceles and five men with obstructive azoospermia. Morbidity was examined by pre- and post-biopsy ultrasound, efficacy by ability of two markers to predict >50% increase in sperm density post-operatively. All patients had three pre- and three post-operative semen analyses. RESULTS: 78.3% of patients had no ultrasonic testicular defects immediately post-biopsy. By 2 months, 100% had no defects. Biopsy markers [testicular cadmium (<0.453 ng/mg tissue) and an intact calcium channel mRNA sequence] predicted >50% increase in sperm density with 82.9 and 90.5% accuracy, respectively. CONCLUSIONS: Ultrasonically controlled, percutaneous aspiration testis biopsies are safe. Specimens so acquired can assist study of molecular/genetic markers associated with spermatogenesis in infertile men with varicoceles. Tissue cadmium level, calcium channel sequence and other markers may predict outcome of varicocele surgery.