Testicular biopsy and vasography in the evaluation of male infertility

Testicular biopsy is performed mainly to differentiate primary testicular failure from obstructive ductal lesions (usually occurring in the epididymis in azoospermic patients who have normal serum gonadotropins). Testicular biopsy may be performed easily on an outpatient basis with excision of a small piece of seminiferous tissue using a "no-touch" technique. Needle core biopsy and needle aspiration biopsy may become more widely used in the future. The role of flow cytometry for purposes of interpreting testicular specimens may be expanded in the future. Vasography should be performed only at the time of planned definitive correction of obstructive lesions of the genital duct system. Various techniques of performing vasography are discussed. Emphasis is placed on deferring vasography until the time that definitive surgery is performed to correct the patient's ductal obstruction. In that regard, vasography therefore generally is not performed as an isolated outpatient procedure.