Application Of Different Testicular Biopsy Methods In Male Infertility Patients

Male infertility is a kind of urology diseases which morbidity isincreased year by year.And the testicular biopsy plays a critical role in thediagnosis and treatment of the male infertility. According to the testicularbiopsy, we can observe the physiology of the testis, evaluate the degree ofdyszoospermia of the testicular and react the fertility of patientsdirectly.The birth of biopsy gun provides a more safety and scientific wayfor testicular biopsy. Biopsy gun is consist of three parts: circumscribedcasing, grooved needle core and controlling handle. When pulling theupper bolt, the circumscribed casing can be loaded, pulling the lower bolt,the grooved needle core can be loaded. Put the pre-primed biopsy needleclose to testicular tissue, press the firing button, the needle core willpuncture the testicular tissue for a high speed, then the circumscribedcasing accurately cut the tissue immediately, obtain a standard biopsiesof10mm×2mm in the needle groove. Since of its little trauma, littlepostoperative complication, easy and simple to carry out, patientswell-obedience, biopsy gun is widely used in urinary surgery and othersurgery clinical field. By means of the theory of biopsy gun, we madetesticular biopsy needle.Through clinical trials and postoperative analysis,we can not only lower the cost but also get the same qualified rate andreach the test goal by this kind of needling technology. Objective：Evaluate the different biopsy methods used in the testicular biopsy.Methods: Since2010to2013, collecting300cases of male infertilitypatients in our hospital who is marriaged and cohabited for more than3years, and all is function well, his wife has the ability to have children，22~39years old，average29years old, volume of the testis is10~26ml，length1.6~3.7cm，width1.2~3.4cm，thickness1.1~1.9cm, seeing no sperms after5times of routine examination of semen. Detailed announcethe risks and the possible complications of the biopsy to the patients andfamilies, and signed the informed consent. The300samples were dividedrandomly and averagely into A, B, C three groups: Group A (group ofbiopsy gun), group B (group of self-made biopsy needle), group C (groupof open biopsy). Using3.5%iodophor disinfected the operation area afterconventional drapping.4%lidocaine local anesthesia then start thefollowing operation. Group A: Put the left thumb, forefinger and middlefinger, three fingers fixed to the scrotal skin,avoiding sliding (Processshould be evenly and cause no testicular pain). Cut a length about2~3mm incision in the anesthesia position in scrotal with a sharp knife, piercethe tunica albuginea then with right hand holding biopsy gun biopsy,make the needle through the scrotal skin incision, close to the tunicaalbuginea, pressing the firing button and pull the biopsy gun out. Nosuture, only hemostasis by compression with gauze2min thencompression bandage. The whole process is about3~5min. Group B ofconventional steps as above, the biopsy needle is adapted by20ml and50ml injector for medical purpose. Use a hemostatic clip clamping the5ml syringe needle and bending slowly, making a shape if "hook", checkthe needle without fracture as qualified. The5ml syringe needle isarranged in the20ml injector body. Assistant fixed testis as group Aconventionally and operator holded the needle with left hand puncturing,the acupuncture point and puncture direction should be far away from theepididymis, slowly pull into the needle, you would have a sense of emptywhen breaking the tunica albuginea, and then deeper into the1~2cmdepth. His left hand piston fixed in10ml negative pressure for5seconds,then rotate the needle core180°~360°, maintain10ml negative pressurefor5seconds again, pull out of the needle core,you will see testiculartissue at the "fishhook",Covered with gauze after puncturing. The whole process is about3.5~5.5min.Group C disinfected rountely, draped,andchoice a suitable region of testicular. Cut a length about1~2cm incisionwith a sharp knife, then cut the scrotum and testis, take a small piece oftesticular tissue in vivo using sharp scissors for testing organization.Sutured with4-0lines which can be absorbed and bandaged using gauze.The whole process is about30~45min. Group A, and B with no specialtreatment after operation however, Group C should change dressingsregularly. Results:1. The age, height,weight and the intraoperativetransfusion of the patients in the three groups has no statisticallysignificant difference and is comparable.2. There was no statisticallysignificant difference about the surgical specimen qualified rate in thepatients of three groups and is comparable.3. All surgical patients arecompleted by the same doctor, comparable.4. In the group of cutting,self-made biopsy needle and biopsy gun, the AsAb positive raterespectively is26.0%(26/100),4%(4/100) and3%(3/100), whichshows that cutting method has the highest positive rate, and thencompared the positive rate in the other two groups, there was nosignificant difference (P≥0.05).5.In the group of cutting, self-madebiopsy needle and biopsy gun, the incidence rate of complication was10%(10/100),3%(3/100),2%(2/100), the method of cutting has thehighest positive rate, and there was no significant difference in the othertwo groups (P≥.05).6. The averaged operating time in the group ofcutting, the self-made biopsy needle and biopsy gun group is40min and4.5min and3.7min, the later two groups have significant difference withcutting group in time. Conclusion:1.The influence caused by biopsyneedle and biopsy gun is small in the changes of serum antispermantibody level and is superior to cutting biopsy.2. The biopsy needle andbiopsy gun caused fewer complications, and is suitable for clinicalapplication.3. Testicular biopsy operation time shortened significantly with the biopsy needle biopsy gun.4. Hospitalized days in patients withthe biopsy needle and biopsy gun group was obviously less than incisionbiopsy group.