Who is the doctor specializing in testicular health. When should you consult a urologist for testicular issues. What are the signs of testicular cancer that require immediate medical attention. How often should men undergo testicular self-examinations. What are the treatment options for testicular pain and discomfort.

Understanding the Role of a Urologist in Men’s Health

A urologist is the medical professional specializing in diagnosing and treating conditions related to the male reproductive system, including the testicles. These highly trained physicians are equipped to handle a wide range of urological issues, from testicular pain to cancer screening.

Men often hesitate to seek medical attention for testicular concerns due to embarrassment or the misconception that their symptoms aren’t serious. However, early intervention can be crucial in preventing and treating potentially life-threatening conditions.

Why Timely Consultations Matter

Dr. Jonathan Bingham, a urologic surgeon at Coordinated Health, part of Lehigh Valley Health Network, notes that on average, men wait about six months before seeking medical help for testicular masses or tumors. This delay can significantly impact treatment outcomes and overall health.

Key Indicators for Seeking Urological Care

Recognizing the signs that warrant a visit to a urologist is essential for maintaining optimal reproductive health. Here are some critical indicators:

• Persistent testicular pain
• Lumps or swelling in the testicles
• Changes in testicular size or texture
• Discomfort or heaviness in the scrotum
• Sudden fluid buildup in the scrotum

Is testicular pain always a sign of cancer? Not necessarily. While pain can be a symptom of testicular cancer, it’s more commonly associated with other conditions such as infections, injuries, or varicoceles. However, any persistent discomfort should be evaluated by a urologist to rule out serious issues.

Prostate Health and Urological Care

While testicular health is a primary concern, urologists also play a crucial role in managing prostate health. Prostate cancer is one of the most common cancers among men, and early detection is key to successful treatment.

Recognizing Prostate Cancer Symptoms

Prostate cancer often develops without noticeable symptoms in its early stages. However, as the disease progresses, men may experience:

• Frequent urination, especially at night
• Difficulty starting or stopping urination
• Weak or interrupted urine flow
• Blood in urine or semen
• Erectile dysfunction

How often should men undergo prostate cancer screenings? The American Cancer Society recommends that men at average risk begin discussing screenings with their healthcare provider at age 50. Those with higher risk factors may need to start earlier.

Erectile Dysfunction: More Than Just a Sexual Issue

Erectile dysfunction (ED) is a common condition that affects millions of men worldwide. While it’s often associated with aging, ED can also be an indicator of underlying health problems.

Can erectile dysfunction be a sign of heart disease? Yes, ED can be an early warning sign of cardiovascular issues. The blood vessels in the penis are smaller than those in the heart, so problems with blood flow may manifest in sexual function before affecting the heart.

Treatment Options for Erectile Dysfunction

Urologists offer various treatments for ED, including:

1. Oral medications (e.g., Viagra, Cialis)
2. Penile injections
3. Vacuum erection devices
4. Penile implants
5. Lifestyle modifications

Urinary Issues: When to Consult a Specialist

Urinary problems can significantly impact quality of life and may indicate underlying health conditions. Common urinary issues that warrant a urologist’s attention include:

• Frequent urination
• Urgency to urinate
• Difficulty starting or stopping urination
• Weak urine stream
• Incomplete bladder emptying

Are urinary issues always related to the prostate? While an enlarged prostate (benign prostatic hyperplasia) is a common cause of urinary symptoms in older men, other factors such as bladder conditions, neurological disorders, or medications can also contribute to urinary problems.

Blood in Urine: A Red Flag for Urological Conditions

The presence of blood in urine, known medically as hematuria, is always a cause for concern and requires prompt medical evaluation. Potential causes of hematuria include:

• Urinary tract infections
• Kidney or bladder stones
• Enlarged prostate
• Kidney disease
• Bladder or kidney cancer

Does blood in urine always indicate cancer? No, blood in urine can have many causes, ranging from benign to serious. However, it’s essential to have any instance of hematuria evaluated by a urologist to rule out potentially life-threatening conditions.

Kidney Stones: Prevention and Treatment

Kidney stones are solid masses formed from crystals that separate from urine. They can cause severe pain and potentially lead to serious complications if left untreated.

Symptoms of Kidney Stones

Common signs of kidney stones include:

• Severe pain in the side, back, or lower abdomen
• Pain or burning sensation during urination
• Frequent urination
• Nausea and vomiting
• Blood in urine

How can kidney stones be prevented? Increasing fluid intake, particularly water, is one of the most effective ways to prevent kidney stones. Additionally, dietary modifications and certain medications may be recommended based on the type of stones a person is prone to developing.

The Importance of Regular Testicular Self-Examinations

Regular testicular self-examinations are crucial for early detection of testicular cancer and other abnormalities. Men should perform these checks monthly, ideally after a warm shower when the scrotum is relaxed.

Steps for Performing a Testicular Self-Exam

1. Examine each testicle separately using both hands
2. Gently roll the testicle between your fingers
3. Check for any lumps, bumps, or changes in size or texture
4. Feel for the epididymis, a tube-like structure on the back of each testicle
5. Note any changes or abnormalities and report them to your healthcare provider

How quickly can testicular cancer develop? Testicular cancer can progress rapidly, with some tumors doubling in size within just 10 to 30 days. This underscores the importance of regular self-examinations and prompt medical attention for any concerning changes.

Breaking the Stigma: Encouraging Open Dialogue About Men’s Health

Many men feel embarrassed or uncomfortable discussing testicular health issues, even with medical professionals. This reluctance can lead to delayed diagnoses and potentially worse outcomes. It’s crucial to foster an environment where men feel comfortable seeking medical attention for reproductive health concerns.

Strategies for Promoting Men’s Health Awareness

• Educate men about the importance of regular check-ups and self-examinations
• Encourage open conversations about men’s health issues
• Promote awareness campaigns like Movember
• Provide accessible information about common urological conditions
• Emphasize the role of preventive care in maintaining overall health

Can lifestyle changes improve urological health? Absolutely. A healthy diet, regular exercise, stress management, and avoiding tobacco and excessive alcohol consumption can significantly impact urological health and reduce the risk of many common conditions.

Advancements in Urological Treatments and Diagnostics

The field of urology has seen significant advancements in recent years, leading to improved diagnostic techniques and treatment options for various conditions.

Innovative Diagnostic Tools

• High-resolution ultrasound imaging
• Multiparametric MRI for prostate cancer detection
• Genetic testing for inherited urological conditions
• Advanced urodynamic studies for bladder function assessment
• PET scans for cancer staging and recurrence monitoring

Cutting-Edge Treatment Options

Modern urological treatments offer less invasive options with faster recovery times and improved outcomes:

• Robotic-assisted surgical procedures
• Focal therapy for prostate cancer
• Shockwave lithotripsy for kidney stones
• Neuromodulation for overactive bladder
• Minimally invasive treatments for enlarged prostate

How have these advancements improved patient outcomes? These innovations have led to more precise diagnoses, targeted treatments, and reduced complications. Patients often experience shorter hospital stays, less post-operative pain, and quicker returns to normal activities.

The Multidisciplinary Approach to Urological Care

Effective urological care often involves collaboration between various medical specialists. This comprehensive approach ensures that patients receive holistic treatment that addresses all aspects of their health.

Key Players in Urological Care

• Urologists: Specialists in the urinary tract and male reproductive system
• Oncologists: Cancer specialists for cases involving urological malignancies
• Radiologists: Experts in medical imaging for diagnostic purposes
• Pathologists: Specialists who analyze tissue samples for accurate diagnosis
• Physiotherapists: Professionals who can assist with pelvic floor rehabilitation

Why is a multidisciplinary approach beneficial for urological patients? This collaborative method ensures that patients receive comprehensive care that addresses all aspects of their condition, from diagnosis to treatment and follow-up care. It also allows for the integration of various expert opinions to determine the most effective treatment plan.

Navigating Insurance and Healthcare Systems for Urological Care

Understanding how to navigate healthcare systems and insurance coverage is crucial for patients seeking urological care. This knowledge can help reduce financial stress and ensure access to necessary treatments.

Tips for Maximizing Insurance Coverage

1. Understand your policy’s coverage for specialist visits and procedures
2. Check if your urologist is in-network with your insurance provider
3. Inquire about pre-authorization requirements for specific tests or treatments
4. Discuss potential out-of-pocket costs with your healthcare provider
5. Explore financial assistance programs or payment plans if needed

Are all urological procedures covered by insurance? Coverage varies depending on the insurance plan and the specific procedure. Preventive care and medically necessary treatments are more likely to be covered, while elective procedures may require out-of-pocket payment.

The Future of Urological Care: Emerging Trends and Technologies

The field of urology continues to evolve, with new technologies and treatment approaches on the horizon. These innovations promise to further improve patient outcomes and quality of life.

Promising Developments in Urology

• Artificial intelligence for more accurate disease prediction and treatment planning
• Gene therapy for inherited urological disorders
• 3D-printed organs and tissues for transplantation
• Nanotechnology for targeted drug delivery
• Telemedicine platforms for improved access to urological care

How will these advancements impact patient care? These emerging technologies have the potential to revolutionize urological care by offering more personalized treatment options, improving diagnostic accuracy, and expanding access to specialized care, particularly in underserved areas.

Maintaining Urological Health Throughout Life

Urological health is an important aspect of overall well-being at every stage of life. Adopting healthy habits and staying vigilant about potential issues can help prevent many common urological problems.

Lifestyle Recommendations for Optimal Urological Health

1. Stay hydrated by drinking plenty of water throughout the day
2. Maintain a balanced diet rich in fruits, vegetables, and whole grains
3. Exercise regularly to promote circulation and maintain a healthy weight
4. Practice good hygiene to prevent urinary tract infections
5. Avoid smoking and limit alcohol consumption
6. Manage stress through relaxation techniques or mindfulness practices
7. Perform regular self-examinations and attend scheduled check-ups

Can lifestyle changes reverse existing urological conditions? While some conditions may require medical intervention, many urological issues can be improved or managed through lifestyle modifications. Consult with a urologist to determine the most appropriate approach for your specific situation.

When Should You See a Urologist? – What to Know

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When it comes to health problems, men are most likely to endure their symptoms longer before going to the doctor than women. Sometimes, it may be because they don’t feel like their condition is serious enough, and other times, they may find it embarrassing to have certain parts of their body checked.

The latter is the case when it comes to testicular issues. According to Urologic surgeon, Dr. Jonatahan Bingham, it takes the average man around six months to see a doctor after symptoms of testicular mass or tumor appear. Dr. Bingham is from Coordinated Health, which is part of Lehigh Valley Health Network.

Here’s when it’s time to visit your urologist:

Signs of prostate cancer

Your symptoms could mean you have prostate cancer, which is one of the most common cancers among men. Prostate cancer does not show noticeable symptoms at an early stage and can only be identified by having prostate cancer screenings. Having said that, you should highly consider going to the urologist if you feel worried about this condition.

Spotting early symptoms of prostate cancer makes it easier to cure. However, this means that you shouldn’t skip your appointments with your urologist to see symptoms and prevent them from becoming more serious.

Testicular pain

When you start to feel constant mild pains in your testicular area, it’s time to consult a urologist. If something doesn’t feel right, you need to have it checked right away to prevent any serious conditions. The urologist can also give you remedies and treatments to alleviate the pain.

Erectile dysfunction

Erectile dysfunction is common, particularly among older men. However, it is also typically tied to other medical issues that can be medical or psychological. When you observe that you have erectile dysfunction, consult the urologist right away to have any possible conditions treated.

Urinary issues

Issues like slowing of the urinary stream, painful urination, frequent urination, and sudden start and stop of the urinary stream are common among men as they grow older. That said, such issues could also be tied to the growth of the prostate gland.

It’s important to address these issues because they can lead to serious problems in the kidney or the bladder in the long run.

Blood in the urine

When you start to see blood in your urine, don’t delay testing and visit your urologist right away. Blood in the urine can signify prostate enlargement, kidney stones, or tumors in the kidney or bladder.

Kidney stones

Kidney stones may not be painful early on, but over time, it can cause excruciating pain and severe health conditions. Prolonging your treatment can lead to serious kidney issues that can be deadly. When you spot these symptoms, visit your urologist to prevent your condition from getting worse.

Conclusion

Men should not be ashamed or embarrassed to talk about testicular issues, especially if it’s for medical concerns. Visiting the urologist when symptoms first appear is essential to avoid any serious condition. More importantly, doing so will help relieve pain and stop issues that can be worrisome from appearing again.

We care about your health! Our team of expert urologists in New Jersey is more than willing to address your concerns. Request an appointment with us today!

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What Kind of Doctor Should I See For Testicular Pain?

Ball pain. Nuts aching. Sac is hurtin’. Regardless of what you call it, testicular pain is no fun.

You’re not alone. Testicular pain is really common. Unfortunately guys don’t talk about their berries being squeezed in vice grip.

Instead they suffer in silence and walk around like John Wayne just got off of a horse.

Maybe this is something serious though. Testicular torsion (twisted testicle) or epididymitis (bacterial infection) are no joke and require immediate medical attention. I’m certain cancer might be running through your mind as well.

So what kind of doctor should you see for testicular pain? At some point you’ll need a urologist. Maybe you had no idea there was a ball pain specialist. Or maybe you’ve seen 3 of them and no one seems to help.

Let’s get you some help for those achy breaky balls. Because when they’re aching, it’s hard to feel good about anything.

What causes testicular pain?

A good doctor develops a differential diagnosis for every patient complaint. A list of possible medical conditions that could be causing the symptom. For testicular pain this list includes but is not limited to:

Testicular torsion

Testicular torsion is fancy doctor speak for a twisted testicle. No blood is going to the testicle and this is not good.

It is usually seen in kids and young adults. It is exceedingly rare after age 40. It will cause severe, drop you to your knees pain with nausea or vomiting. Unless you get your ball “untwisted” with surgery in 4 hours or less, the testicle unfortunately dies due to lack of blood flow.

Although intermittent torsion can occur, this is pretty rare. If you’ve been aching for weeks to months then torsion is very unlikely.

Epididymo-orchitis

An infection of the testicle or epididymis typically presents with an acute onset (fast) of one-sided pain and swelling. An examination will clearly show swelling and tenderness. Usually this is caused by a urinary tract infection or sexually transmitted disease.

Varicocele

Swollen veins draining the testicle are seen in up to 15% of men. Sometimes visible as a “bag of worms in the sac”, varicoceles are more common on the left side. They can cause a heavy, dull ache that’s usually worse with standing throughout the day.

The veins will not “burst” but they can cause male infertility in addition to chronic pain. A surgical repair by a micro-surgical specialist will fix this issue for good.

Inguinal hernia

A hernia is a weakness of the abdominal wall. Bulging and pain can occur at this site of weakness as your “insides” are “poking out.” When this bulging occurs in the groin area we call this an inguinal hernia.

An inguinal hernia can extend into the scrotum leading to ball pain and swelling. This is usually obvious on a physical examination but at times can be subtle. This is treated with surgery to repair the weakened tissues.

Hydrocele

Another cause of a painful “big sac” is an accumulation of fluid around the testicle. A hydrocele most often occurs for no good reason. It can be a consequence of a trauma, infection or even cancer. An ultrasound of the scrotum will confirm the diagnosis.

Sometimes a hydrocele will go away on it’s own. If it doesn’t then surgery does the trick.

Epididymal cyst

Speaking of swelling of the sac you can also have lumps next to the testicle. The epididymis sits behind the testicle and carries sperm. Cysts can develop leading to a “third nut” as men have told me. These are universally benign and can be cut out if they are causing pain.

Testicular cancer

Testicular cancer most often presents with a painless firm mass of the testicle itself. I’ve included it because cancer should always be considered in a differential diagnosis. The good news is that cancer rarely causes pain and is easily ruled out with an exam and ultrasound.

Kidney stone

Kidney stones are bad enough but ball pain as well? When a kidney stone is traveling down the urine tube (the ureter) it can cause a referred pain to the testicle. If you have associated back or abdominal pain, nausea/vomiting or a history of kidney stones, evaluation with CT scan should be considered.

Post-vasectomy pain syndrome

This rare condition (1/500 vasectomies) is distinguished by the start of pain shortly after a vasectomy. We are not certain why it happens but it is not fun. Local anesthesia blocks of the spermatic cord can temporarily relieve the pain.

When necessary, microscopic denervation procedures can be performed with success rates up to 85%. Sometimes men even elect to have the vasectomy reversed (vasovasostomy) to re-hook the plumbing pipes. This releases the back pressure and solves the post-vasectomy pain as well.

Musculoskeletal cause

The testicle is connected to the spermatic cord. An anatomic structure containing blood vessels, nerves, the vas deferens and muscles running to the testicle. The muscles are known as the cremaster muscles.

The reason your balls hug tight to the body in cold water is the cremaster muscle contracting to keep your berries warm. This muscle is a continuation of the internal oblique muscle; a series of muscles fibers that make up your core abdominal wall.

When you suffer from low back pain, are hanging on to 40 extra pounds of belly fluff, or lifting heavy objects all day, you are straining your core abdominal muscles. Since these muscles are connected to the cremaster muscle, your testicle hurts.

Musculoskeletal strain is probably the cause of 95% of testicular pain seen by a urologist. If you’ve had normal exams, ultrasounds, urine tests and no one has been able to help you yet, then this is probably what’s going on. As a urologist, it’s not unusual to see 5-10 men per week for a 2nd opinion on ball pain.

Testicular pain evaluation

Regardless of the kind of doctor you see for testicular pain, every evaluation starts with a good history. Bilateral (both sides) or alternating pain eliminates almost all of the above conditions with the exceptions of post-vasectomy pain syndrome and musculoskeletal causes.

A physical exam can detect masses, lumps and swellings. Tenderness with an otherwise normal exam is seen with many of these conditions. Some doctors you see for testicular pain may be experienced (urologist) or inexperienced (pretty much everyone else) with performed a thorough and accurate exam for testicular pain.

When necessary imaging can be performed. A CT scan should be considered for suspected kidney stones. A scrotal ultrasound will confirm findings on a physical exam.

Sometimes a scrotal ultrasound will show incidental findings that are not felt on an exam (small hydrocele or cyst). If a doctor can’t feel it then it’s not the source of the pain.

Treatment for Testicular Pain

I’m going to assume that you’ve had a normal exam, imaging tests and have never had a vasectomy. This leads us to our diagnosis of chronic testicular pain (also known as orchialgia).

First and foremost, we recommend viewing this condition like headaches and backaches. Most headaches aren’t due to brain cancer. Most backaches don’t require a visit to the spine surgeon. They are musculoskeletal in nature.

When muscles and nerves are irritated, most exams are normal. Unfortunately quick fixes are not always possible.

Here are some options for treating chronic testicular pain:

Improved diet and exercise

It’s amazing how often clean eating and moving our body is the answer to chronic medical conditions. Eating chalupas on the couch never served anybody except the business owners of Taco Bell. The crap we eat causes inflammation. Inflammation causes chronic pain.

When we exercise we release our body’s natural pain killers called endorphins. Strengthening your core and lower back can help testicular pain over time.

As a result of diet and exercise you should start shedding some pounds from your belly. All this extra weight we carry in our midsection strains our back and core muscles. Lose the weight, lose the ball pain.

I’ve had more patients tell me their testicular pain resolved after weight loss than any other thing I’m about to suggest.

Pelvic physical therapy

Muscle tension of the lower abdomen and pelvic floor is associated with chronic testicular pain. An experienced pelvic physical therapist can identify any muscle imbalances, improving chronic pain. It doesn’t work for everybody, but there’s little risk in giving a session a try.

Off-label medications

Sometimes medications designed for another purpose are helpful for seemingly unrelated medical conditions. This is known as an off-label medication. For chronic testicular pain I’ve had success with Tamsulosin (prostate medication), hydroxyzine (anti-histamine) and amitriptyline (anti-depressant).

Every urologist has his or her favorite for helping men get a little relief. It’s really important to avoid narcotics at all costs. This is a chronic condition and the last thing you want is an opioid dependence.

Surgery

Some of the same microsurgical options are available for testicular pain. Referral to a urologist fellowship trained in microsurgery may be your last option for treating unresolved testicular pain. Performed under anesthesia in the office or surgery center, spermatic cord denervation or cryotherapy can have success rates of 70-85%.

Who’s The Best Doctor For Testicular Pain?

If you haven’t had an in-person visit with a doctor then you should start there. This is one of those instances where a physical examination is important. A scrotal ultrasound is not a bad idea either to dot the “I’s” and cross the “T’s. ”

If you’ve already been to a urologist, and are frustrated, then why not consider a second opinion with a VirtuCare specialist. We can review any medical records that you provide and do a deep dive to make certain nothing has been missed.

Our second opinion visits last on average 30 minutes so you know you won’t be rushed for time. We are hear to listen to you.

With our network of colleagues, we’d be happy to make a referral to a microsurgical expert if that’s what it takes to cure your testicular pain.

Unfortunately there are certain medical conditions that can’t be cured. But you at least deserve care from an expert who will listen and do everything they can to help.

Your family jewels deserve the best. 

Testicular cancer (testicular cancer) 3 stages: doctors, clinics, prices

Prognosis and survival

Tumors in testicular cancer occur in 2 varieties: seminoma and nonseminoma. They are treated differently. In general, nonseminomas require more complex treatment and are insensitive to radiation.

Metastases appear very early in testicular cancer. Starting from stage II, the lymph nodes of the abdominal cavity are already affected, causing back pain. The lymph nodes closest to the tumor are affected, which complicates the treatment.

Stage III has three additional stages: A, B and C. This depends on the level of tumor markers and on which organs metastases have spread.

• A – metastases enter the lungs, mediastinal lymph nodes
• B – metastases in the lungs, distant lymph nodes are affected
• C – metastases in the brain, liver

The 5-year survival rate at stage III is about 85%, at stage IV the survival rate is 56%. Compared to other cancers, testicular cancer is well treated with modern methods. Without treatment, the average life expectancy is 2-3 years.

What is the treatment for testicular cancer?

Need an operation to remove the testicle called radical orchiectomy . It is psychologically difficult to decide on this operation, but without it there is practically no chance of a cure. Moreover, the decision to go for surgery must be made quickly, some tumors can double in size in two to three weeks. An operation is needed to remove the primary focus and examine the histological type of the tumor in order to prescribe further treatment.

In addition, in the later stages, it is necessary to remove the affected lymph nodes surgically, because chemotherapy drugs are not always effective for the retroperitoneal lymph nodes. The surgery is called retroperitoneal lymphadenectomy . This is especially important for nonseminoma tumors to prevent their further spread. For seminoma tumors, radiation therapy may be used instead of surgery, because the cells of such tumors are sensitive to radiation. After the operation, a mandatory determination of tumor markers is carried out in order to understand whether the tumor has been completely removed or additional treatment is needed.

Testicular cancer is treated with cytostatic drugs. If metastases are up to 3 cm in size, then further surgical intervention may not be necessary, chemotherapy drugs will cope with them. Large lesions may require additional surgery to remove metastases.

Before starting treatment, doctors usually recommend cryopreserving semen . This is justified, since it is impossible to foresee in advance whether a violation of spermatogenesis is possible or not. To eliminate discomfort during removal of the testicle, an implant can be placed. In some cases, this can be done at the same time as the removal operation, in others only after the operation. Complete infertility occurs if both testicles are removed.

Where can I find a testicular cancer clinic?

While the patient and his family are trying to understand their disease and understand what treatment is needed, the tumor can move to a later stage. Therefore, treatment even in the later stages should not be postponed. You need to find a doctor who will prescribe the right treatment.

On the RussianHospitals portal you can find doctors and clinics specializing in the treatment of testicular cancer. In order to contact the clinic, you need to take 3 simple steps:

1. Choose a clinic at RussianHospitals
2. Fill out the application form and upload your medical documents
3. Get an answer from the clinic

Testicular biopsy – articles from the specialists of the clinic “Mother and Child”

Ryzhkov Alexey Igorevich

Urologist, Andrologist

Clinic “Mother and Child” Yaroslavl

Testicular biopsy – surgical removal of spermatozoa from the testicle and its epididymis. This approach is mainly used in obstructive and non-obstructive azoospermia to obtain spermatozoa for their subsequent use in the IVF/ICSI procedure.

The choice of biopsy method depends on the cause of azoospermia. If the absence of spermatozoa in the semen is due to impaired patency of the vas deferens (obstructive form), the probability of the presence of germ cells (gametes) in the gonads is high, the preferred method is microsurgical open biopsy of the epididymis (MESE). As an alternative, it is possible and often practiced to use puncture techniques (PESA, TESA).

Percutaneous Epididymal Needle Biopsy (PESA)

A butterfly needle is passed through the skin of the scrotum into the head of the appendage, aspiration (absorption) of the liquid is performed, from which gametes are subsequently extracted. If no motile spermatozoa are found during the examination of the obtained material, the procedure is repeated, puncturing another part of the epididymis.

Percutaneous Needle Testicular Biopsy (TESA)

A needle is passed through the skin into the testicle, aspiration (suction) of the testicular tissue is performed, from which spermatozoa are then removed. This technique is used if during PESA it was not possible to detect germ cells of adequate quality for ICSI, or for special indications. For example, with high DNA fragmentation of spermatozoa that cannot be corrected, testicular spermatozoa obtained as a result of TESE, which contain intact DNA, are used for ICSI.

Microsurgical open epididymal biopsy (MESE)

An open operation, during which the testicle is accessed through a 2–3 cm transverse incision in the scrotum. Under an operating microscope with a 15-20-fold magnification, the epididymal membrane is dissected and the widest part of the tubule is found, its lumen is opened and the liquid contained in it is aspirated. If, according to the results of the study of the obtained material, the quantity and quality of spermatozoa is insufficient, the procedure is repeated on another part of the epididymis. MESE is a much more efficient procedure than PESE, it allows obtaining sperm of better quality and in greater quantity, often enough not only for ICSI, but also for cryopreservation for use in subsequent procedures.

In case of non-obstructive azoospermia (absence of germ cells in the semen, due to a violation of the process of their creation by the gonads), when the probability of detecting spermatozoa in the testicles is lower than in the obstructive form, the most effective procedure is microsurgical testicular biopsy (microTESE). Classical open testicular biopsy (TESE) is also used.

Open testicular biopsy (TESE)

A small (1.5–2 cm) incision is made in the skin of the scrotum, the surface of the testicle is exposed, and its membrane is dissected over a short distance (3 mm). A small piece of tissue is taken from the resulting incision, the incision is sutured, and the resulting material is examined for the presence of germ cells. Both monofocal (from one site) and multifocal (from 2–3 cuts) biopsy are used. The average probability of finding sperm in non-obstructive azoospermia for TESE is 40–50%.

Microsurgical testicular biopsy (microTESE)

Through a transverse incision of the scrotum 2–3 cm, access to the testicle is made. The albuginea is dissected transversely in the middle part (equatorial zone), the parenchyma (the main functional tissue) is widely exposed. The parenchyma is examined under an operating microscope with a 16-25x magnification in order to search for and isolate dilated seminiferous tubules in which spermatogenesis occurs and are more likely to contain spermatozoa compared to non-dilated or collapsed ones.