Microsurgery has recently been introduced into the field of urology and offers highly successful results. Using the magnification power of the surgical microscope the veins are more accurately visualized and easily controlled, while other vital structures are carefully preserved including the arteries and lymphatic vessels (lymphatic vessels are vascular channels draining fluids from the testis and hence their inadvertent ligation may lead to a condition called ‘Hydrocele’ which is collection of watery fluid around the testis).
MTESE is a surgical procedure that involves opening the testis and using the magnification offered by the surgical microscope, the seminiferous tubules are carefully studied. The surgeon will search for and retrieve the best-looking and healthiest tissues avoiding the removal of unnecessary testicular fragments and hence preserving the volume of the testis. Retrieved tissues are then sent for analysis and exploration for the presence of sperms to be used ultimately by assisted reproduction. This technique may result in higher success rates compared to other forms of testicular biopsy. Improved results are attributed to the magnification power offered by the surgical microscope that significantly improved sperm retrieval rates.
TESA/PESA is the simplest form of testicular biopsy, done as an outpatient procedure. It is performed using a needle that is connected to a syringe for aspiration, the surgeon will initially inject small dose of local anaesthetic into the skin overlying the testis and then insert a needle directly into the testis, and while the syringe is on the aspiration mode, tissues from within the testis are sucked through the needle. Tissue fragments aspirated from the testis are then pulled and collected in specific tubes for analysis. This is usually done at a facility where immediate examination of the tissues is possible.
