Diagnostic utility of WT-1, AR and Ki-67 in Sertoli cells and germ cells for testicular biopsy / 临床与实验病理学杂志

Purpose To explore the specific diagnostic markers of Sertoli cells and germ cells for testicular biopsy. Methods Normal testis from 3 patients who suffered from carcinoma of the prostate and treated with testis castration, and 15 testicular biopsy tissues were stained by EnVision two steps with WT-1, AR and Ki-67. Results The expression of WT-1 and AR protein were found in Sertoli cells from the 3 normal testis and 15 testis biopsy, the positive rate were all 100%, and non was positive in germ cells. The germ cell was positive for Ki-67, and the positive rate was 100%. Conclusions WT-1, AR and Ki-67 may be the specific diagnostic markers of Sertoli cells and germ cells for testicular biopsy, which may contribute to the diagnosis of testicular biopsy.

Update in the evaluation of the azoospermic male

Approximately 1% of all men in the general population suffer from azoospermia, and azoospermic men constitute approximately 10 to 15% of all infertile men. Thus, this group of patients represents a significant population in the field of male infertility. A thorough medical history, physical examination and hormonal profile are essential in the evaluation of azoospermic males. Imaging studies, a genetic workup and a testicular biopsy (with cryopreservation) may augment the workup and evaluation. Men with nonobstructive azoospermia should be offered genetic counseling before their spermatozoa are used for assisted reproductive techniques. This article provides a contemporary review of the evaluation of the azoospermic male.

Laboratory processing and intracytoplasmic sperm injection using epididymal and testicular spermatozoa: what can be done to improve outcomes?

There are two main reasons why sperm may be absent from semen. Obstructive azoospermia is the result of a blockage in the male reproductive tract; in this case, sperm are produced in the testicle but are trapped in the epididymis. Non-obstructive azoospermia is the result of severely impaired or non-existent sperm production. There are three different sperm-harvesting procedures that obstructive azoospermic males can undergo, namely MESA (microsurgical epididymal sperm aspiration), PESA (percutaneous epididymal sperm aspiration), and TESA (testicular sperm aspiration). These three procedures are performed by fine-gauge needle aspiration of epididymal fluid that is examined by an embryologist. Additionally, one technique, called TESE (testicular sperm extraction), is offered for males with non-obstructive azoospermia. In this procedure, a urologist extracts a piece of tissue from the testis. Then, an embryologist minces the tissue and uses a microscope to locate sperm. Finding sperm in the testicular tissue can be a laborious 2- to 3-hour process depending on the degree of sperm production and the etiology of testicular failure. Sperm are freed from within the seminiferous tubules and then dissected from the surrounding testicular tissue. It is specifically these situations that require advanced reproductive techniques, such as ICSI, to establish a pregnancy. This review describes eight different lab processing techniques that an embryologist can use to harvest sperm. Additionally, sperm cryopreservation, which allows patients to undergo multiple ICSI cycles without the need for additional surgeries, will also be discussed.

Fertilization and Pregnancy Rate after Intracytoplasmic Sperm Injection with Spermatozoa Extracted from the Testicle Biopsy / 대한비뇨기과학회지

In case requiring microsurgical epididymal sperm aspiration(MESA) for congenital absence of the vas deferens or unreconstructable obstructive azoospermia, spermatozoa sometimes could not be retrieved from the epididymis or were necro and teratozoospermia. We studied whether testicular biopsy sperm extraction (TESE) in such cases could yield spermatozoa that would result in successful fertilization and pregnancy using intracytoplasmic sperm injection(ICSI) from November, 1994 to April, 1995. Thirty cycles were treated with TESE-ICSI. The mean age of husbands was 34 years(range 25 to 42 years). A total of 426 oocytes were collected and 333 were subsequently microinjected. Normal fertilization occurred in 234 oocytes(70.3%). Thirty cases underwent embryo transfer, with a total of 176 embryos(75.2%) transferred. Twelve cases conceived with a clinical pregnancy rate of 40. O% per transfer and all of whom are ongoing normal pregnancy. Conclusively, when epididymal spermatozoa can not be retrieved TESE Would be final resort that is also very effective with most patients obtaining high fertilization and pregnancy rates. It appears that all cases of obstructive azoospermia can now be successfully treated.

An Analysis of Testicular Biopsy in 85 Infertile Men / 대한비뇨기과학회지

We analyzed testicular biopsies in eighty five infertile men with seventy eight azoospermia and seven severe oligospermia (< 1000000/ml) at our hospital from January 1989 to July 1993. The testicular volume was average 15.7ml (10 to 20ml). The most frequent histopathological finding was Sertoli cell only syndrome with 25 cases (29.4%). The second prevalent finding was sloughing and disorganization of germ cells with 22 cases (25.9%) and followed by maturation arrest with 19 cases (22.4%) and hypospermatogenesis with 19 cases (22.4%), in order. In the Sertoli cell only syndrome, sloughing and disorganization of germ cells and maturation arrest, nearly all showed azoospermia in the sperm count comparing to the hypospermatogenesis. Leydig cell abnormalities were hyperplasia in 32 cases (37.6%) and hypoplasia in 4 cases (4.7%). On the aspect of feedback, in Sertoli cell only syndrome and maturation arrest, serum FSH was increased in 21 cases (84.0%) and 7 cases (36.8%), respectively, but in the majority of sloughing and disorganization of germ cells and hypospermatogenesis, not increased. Plasma LH, prolactin, testosterone and estradiol were not correlated with germ cell morphology. Therefore, the testicular biopsy is especially important for aid in the diagnosis and prognosis in the infertile men, and further more to evaluate the testicular paracrinology.

An Experimental Study of Testicular Fixation and Histopathologic Changes of Testis after Testicular Fixation in Rats / 대한비뇨기과학회지

Orchiopexy is the generally recommended procedure to treat and to prevent intravaginal testicular torsion. But recurrent torsion of the previously fixed testis has been reported infrequently. Failure of orchiopexy leading to recurrent torsion has been attributed by some to use of absorbable suture material and as a result nonabsorbable sutures often has been recommended. To determine whether there were differences between absorbable and nonabsorbable sutures, and also to study various surgical and chemical methods to produce fixation between the testis and scrotal wall, we used rats as an experimental model of orchiopexy. Eversion of the tunica vaginalis with absorbable and nonabsorbable suture to dartos muscle produced excellent scarification. Eversion of the tunica vaginalis without suture also produced good scarification but less than above method. Absorbable and nonabsorbable sutures between tunica albuginea and tunica vaginalis produced only minor degree of inflammation. Tetracycline instillation similarly failed to produce a significant inflammation. Histopathologic changes of testis after orchiopexy were also studied. The main histopathologic changes were inflammatory reaction, interference of local blood flow and obstruction of seminiferous tubules. So it can be suggested that testicular injury after orchiopexy can be developed.

Effects of testicular biopsy in rat testis: comparison of open surgical percutaneous needle and biopsy gun biopsy technique / 대한비뇨기과학회지

Testicular biopsy has been known as useful diagnostic tool for the male infertility. Open biopsy and percutaneous needle biopsy have been widely used. Recently. Biopty gun method has been applied in the testicular biopsy. These three different biopsy methods were performed in rats to compare the diagnostic accuracy and effects on spermatogenesis. Diagnostic accuracy was not compromised owing to different biopsy methods but the seminiferous tubules obtained by testicular biopsy were most abundant in the open biopsy and sparse in the Biopty gun biopsy. Using the spermatogenesis index, such as sperm head count and repopulation index, all biopsy techniques were not harmful to spermatogenesis. These results demonstrate that needle biopsy of the testis with Biopty gun system is rapid, effective an8 safe way to obtain a testicular biopsy.

Clinical Significance of Testicular Biopsy in Patient of Spermatic Cord Torsion / 대한비뇨기과학회지

Torsion of the testis is a common urological emergency. We treated 28 cases of spermatic cord torsion during the period from March. 1978 to November, 1988. Detorsion with orchiopexy was performed in 19 cases, remaining cases underwent orchiectomy. Follow up was made in 13 cases who underwent detorsion with orchiopexy, and 11 cases of them under went testicular biopsy at same operation field. histopathologic findings of testicular biopsies were compared with clinical characteristics and courses of patients. The results were as follows : 1. Among the group of biopsy, testicular atrophy occurred in 5 cases and normal testis was palpable in 6 cases 2. Testicular salvage is closely related with duration of symptoms. 3. Histopathologic findings of atrophic testis group showed marked hemorrhagic necrosis of seminiferous tubule and interstitial tissue, but normally palpable testis group showed mild to moderate congestive and hemorrhagic changes of seminiferous tubule and interstitial tissue. 4. histopathologic changes were more deteriorative in the group of patients more delayed managed. 5. We could predict fate of testis after orchiopexy by biopsy findings.

Histopathologic Changes of Testis after Experimental Testicular Biopsy in Rabbit / 대한비뇨기과학회지

Testicular biopsy to have been utilized as a diagnostic tool in male infertility were underwent experimentally to observe the effects on the morphology and the physiology of post-biopsied testis of 17 male rabbits. Bilateral orchiectomy was done at third day, 1st week, 2nd week and 4th week after open testicular biopsy, and biopsied testes were compared with contralateral control in histopathological views. The results were summarized as follows : 1. In seminiferous tubules of sham-operated tests, there was no significant pathologic changes. 2. The inflammatory reaction was most severe at third day after biopsy and completely disappeared at 4th week. 3. Increased thickness of tunica albuginea and fibrotic reaction were observed near the biopsy site. 4. Spermatogenesis did not only decrease near the biopsy site with atrophy of the seminiferous tubules but also mildly decreased on the far area, that all began to recover at 4th week. 5. No evidence of immunologic reaction and hyperplasia of Leydig cell were demonstrated. It was suggested that testicular injury after biopsy was developed by interference of local blood flow, obstruction of seminiferous tubules and inflammatory reaction, so that could be minimized by application of open testicular biopsy only to definitively indicated cases.

Testicular Biopsy in Infertile Men with Azoospermia / 대한비뇨기과학회지

Testicular biopsy is an important tool in the diagnosis and management of male infertility. The increasing use of this procedure has permitted a rational classification of the testicular lesion responsible for infertility and provide an intelligent basis for the institution of corrective measures or the withholding of therapy in cases in which the biopsy indicates a hopeless prognosis for fertility. The testicular biopsy findings of 48 azoospermia cases were evaluated in aspects of testicular size and past history. The following results were obtained. 1. The biopsy findings of 8 cases with normal sized testes and no nodules of both epididymimides and vasa deferens were normal in 4 cases, germinal aplasia in 2 cases, maturation arrest in 1 case and hypospermatogenesis in 1 case. 2. The biopsy findings of 23 cases with small sized testes and no nodules of both epididymides and vasa deferens were germinal aplasia in 13 cases, generalized fibrosis in 6 cases, maturation arrest in 3 cases and hypospermatogenesis in 1 case. 3. The past history of 17 cases with normal sized testes and bilateral induration of epididymides of vasa deferens revealed nonspecific epididymitis in 6 cases, tuberculous epididymides in 6 cases, tuberculous epididymitis in 5 cases, vasectomy in 5 cases and trauma of scrotum in 1 case. The biopsy findings of these cases were normal in 10 cases, hypospermatogenesis in 3 cases, testicular blockage in 3 cases and atrophy in 1 case.

Testicular Biopsy in the Study of Male Infertility / 대한비뇨기과학회지

The slides of testicular biopsy were reviewed of 29 cases of infertile men admitted to the Department of Urology, Keimyung University School of Medicine during the period from 1974 through 1982. Among the 29 cases, seminovesiculograms were made of 25 cases, The results obtained were as follows: 1. In testicular biopsy findings, 10 cases (34.5%) of hypospermatogenesis, 7 cases (24.1%) of germ cell aplasia, 6 cases (20.7%) of normal spermatogenesis, 2 cases of maturation arrest, 2 cases of tubular hyalinization, 1 case of generalized fibrosis and 1 case of incomplete spermatocytic arrest were observed. 2. In aspect of past history, 3 cases of epididymal tuberculosis showed normal spermatogenesis. 1 case of epididymal tuberculosis, scrotal trauma and retrograde ejaculation showed hypospermatogenesis. and 1 case of irradiation and heat showed maturation arrest. 3. 69% of all the cases of male infertility in the present series belonged to the testicular category and 31% were posttesticular causes, but pretesticular causes were excluded in this report. 4. Among the 5 cases who showed obstruction on seminovesiculograms, 3 cases of normal spermatogenesis and 2 cases hypospermatogenesis were observed. In the past history 3 cases had epididymal tuberculosis and 2 cases had either scrotal trauma or scrotal abscess.

Testicular Biopsy in the Study of Male Infertility / 대한비뇨기과학회지

The slides of testicular biopsy were reviewed of 29 cases of infertile men admitted to the Department of Urology, Keimyung University School of Medicine during the period from 1974 through 1982. Among the 29 cases, seminovesiculograms were made of 25 cases, The results obtained were as follows: 1. In testicular biopsy findings, 10 cases (34.5%) of hypospermatogenesis, 7 cases (24.1%) of germ cell aplasia, 6 cases (20.7%) of normal spermatogenesis, 2 cases of maturation arrest, 2 cases of tubular hyalinization, 1 case of generalized fibrosis and 1 case of incomplete spermatocytic arrest were observed. 2. In aspect of past history, 3 cases of epididymal tuberculosis showed normal spermatogenesis. 1 case of epididymal tuberculosis, scrotal trauma and retrograde ejaculation showed hypospermatogenesis. and 1 case of irradiation and heat showed maturation arrest. 3. 69% of all the cases of male infertility in the present series belonged to the testicular category and 31% were posttesticular causes, but pretesticular causes were excluded in this report. 4. Among the 5 cases who showed obstruction on seminovesiculograms, 3 cases of normal spermatogenesis and 2 cases hypospermatogenesis were observed. In the past history 3 cases had epididymal tuberculosis and 2 cases had either scrotal trauma or scrotal abscess.

Testicular Biopsy in Infertile Men / 대한비뇨기과학회지

Testicular biopsy is an important tool in the diagnosis and management of male infertility. Other types of analysis such as plasma hormonal assay, chromosomal studies and biochemical determination of ejaculate components have also a role in characterizing male infertility. There were 53 infertile males who received testicular biopsy in our department during the period from January, 1972 to June, 1982. A clinical investigation was undertaken in aspect of testicular size, past history, testicular biopsy findings and plasma hormonal level. The following results were obtained: 1. On semen analysis, oligospermia was found in 5 cases, azoospermia in 48 cases and the most common age group was 4th decade. 2. The biopsy findings of 41 cases with normal size testis were normal in 20 cases. hypospermatogenesis in 8 cases, peritubular fibrosis with reduced spermatogenesis in 4 cases. maturation arrest in 4 cases germinal aplasia in 4 cases, hyalinized seminiferous tubule with Leydig cell hyperplasia in 1 case. 3. The biopsy findings of 12 cases with small size testis were hypospermatogenesis in 3 cases. hyalinized seminiferous tubule with Leydig cell hyperplasia in 6 cases, peritubular fibrosis with reduced spermatogenesis in 1 case, maturation arrest in 1 case, germinal aplasia in 1 case. 4. There were 20 cases which had induration on epididymis or vas deferens. On their past history, gonorrheal urethritis in 7 cases, nonspecific epididymitis in 4 cases, tuberculous epididymitis in 3 cases, undetermined cause in 6 cases were observed. 5. The biopsy findings of 20 cases with indurated epididymis or vas deferens were normal in 13 cases, peritubularfibrosis with reduced spermatogenesis in 4 cases, hypospermatogenesis in 3 cases. 6. The plasma hormonal assay (FSH, LH, Testosterone) was performed in 8 cases.

Testicular Biopsies in 36 Cases of Varicocele / 대한비뇨기과학회지

We have performed bilateral testicular biopsies on 36 patients with varicocele and discussed the relation between histologic findings and semenogram. The results obtained in the study are as follows. 1. The volume of the semen increased more than 4.0 ml in our series by 19. 5%, and decreased below 1.5ml by 8.3%. The sperm count, motility and morphology were seen to depend on the size of varicocele 2. Testicular histology showed germinal cell hypoplasia and premature sloughing of immature cells into the lumen of the tubules, which seems to be impaired spermatogenesis. These cells are similar to those seen in the ejaculate, including tapering forms and spermatids. In most of the cases the tubular thickening was found in variable degree, and this is considered as a possible prognostic factor. Our study showed on preferential influence on testicular histology in relation to right or left side, except a few cases. The size of varicocele is no concerned with the histologic change of the testicle. 3. In comparing the histologic change of the left testicle with the semenogram, the sperm morphology was thought to be correlated with the histologic change but the count and motility were not so.