Large-needle percutaneous aspiration biopsy of the testicle in men with nonobstructive azoospermia

Controversies in the management of nonobstructive azoospermia

“…With local anesthesia, the same procedure as for FNAB is performed except more vigorously in the case of LNAB. In >100 men with NOA, the technique safely obtained testicular fragments larger than those of other percutaneous LNCB techniques and similar to those of open surgical techniques (70). The mean number of seminiferous tubules was 52, with a section length of 0.2 Â 0.3 Â 0.6 cm and a weight of 385 mg (70).…”

“…In >100 men with NOA, the technique safely obtained testicular fragments larger than those of other percutaneous LNCB techniques and similar to those of open surgical techniques (70). The mean number of seminiferous tubules was 52, with a section length of 0.2 Â 0.3 Â 0.6 cm and a weight of 385 mg (70). A recent study (71) described how LNAB obtains relatively large biopsy specimens in a safe manner.…”

“…In addition, a cytologic finding of spermatozoa, obtained with fine needle aspiration biopsy (FNAB), can be correlated with testicular biopsy histology (40,41) and with the presence of spermatozoa in surgical or percutaneous biopsy of the same testicle (41,42). Moreover, some authors have reported that FNAB cytology was more sensitive than surgical or percutaneous biopsy histology for sperm detection (41)(42)(43). FNAB for the selection of testicles containing sperm can be easily performed in an ambulatory setting with one or two percutaneous punctures (43).…”

“…The size of the biopsy tissue fragment was evaluated by the number of seminiferous tubules per histologic section (43). The mean value was reported to vary from 14 to 38.9 (41,43,(64)(65)(66)(67), being slightly higher when performed with scrotal incision than without (26 vs. 18.7, respectively) (66). The biopty-gun succeeded in collecting sperm for subsequent IVF/ICSI in six of ten patients with NOA (63).…”

“…Percutaneous LNAB is a technique that has been used for evaluation of palpable thyroid nodules and now to obtain testis tissue (68)(69)(70). It does not require a skin incision or sterile environment and uses a commonly available disposable 18-, 20-, or rarely 22-gauge needle (67) attached to a 20-30-mL syringe placed in the usual ''pistol.''…”