Single Testicular Biopsy: Changes in the vascular architecture of the tunica albuginea

Open testicular biopsy is a commonly indicated procedure for diagnosis of testicular histopathology prior to referral to testicular sperm extraction (TESE) or microsurgical testicular sperm extraction (M-TESE) in men with non-obstructive azoospermia (NOA). There are known hematological changes resulting from the rupture of the blood-testis barrier in the TESE and M-TESE procedures, but changes to the microvasculature have not yet been described when the open biopsy is performed prior to spermatozoid collection for intracytoplasmic sperm injection. In this experimental study, open biopsy was performed on testes from adult rabbits. After a 45 days recovery period, the animals underwent a laparotomy for the surgical removal of the aortic patch, both gonadal arteries, the vasa deferentia, and both testicles. The laparotomy was followed by an angiography. The comparative results demonstrate a breakdown in the vascularization of the testicles biopsied relative to the microvasculature pattern of the tunicae albugineae of the intact testicles. The vascular damage resulting from open testicular biopsy reflects one more negative impact on spermatogenic function of previously lesioned testicles besides the known alterations (fibrosis, decrease in testosterone levels, hematological changes). Therefore, we suggest that the M-TESE should be the choice method for sperm retrieval in men with NOA and it should be planned and performed with simultaneous diagnostic and therapeutic objectives in order to increase the patients chances of reproductive success.