title: The safety of ultrasonically guided testis aspiration biopsies and efficacy of use to predict varicocelectomy outcome.
abstract: BACKGROUND
  We hypothesized that infertile men with varicoceles have molecular/genetic defects that interact with varicoceles to induce infertility. Studies directly on testis tissue appeared to be a way to link histology, markers for molecular/genetic defects and spermatogenesis, but testis biopsies may induce morbidity. In this report, we present safety and efficacy data on ultrasonically guided, single stick, percutaneous aspiration.
  
  
  METHODS
  Biopsies were performed on 115 infertile men with varicoceles and five men with obstructive azoospermia. Morbidity was examined by pre- and post-biopsy ultrasound, efficacy by ability of two markers to predict >50% increase in sperm density post-operatively. All patients had three pre- and three post-operative semen analyses.
  
  
  RESULTS
  78.3% of patients had no ultrasonic testicular defects immediately post-biopsy. By 2 months, 100% had no defects. Biopsy markers [testicular cadmium (<0.453 ng/mg tissue) and an intact calcium channel mRNA sequence] predicted >50% increase in sperm density with 82.9 and 90.5% accuracy, respectively.
  
  
  CONCLUSIONS
  Ultrasonically controlled, percutaneous aspiration testis biopsies are safe. Specimens so acquired can assist study of molecular/genetic markers associated with spermatogenesis in infertile men with varicoceles. Tissue cadmium level, calcium channel sequence and other markers may predict outcome of varicocele surgery.
authors.affiliation: Division of Urology, Robert Wood Johnson Medical School, Camden, New Jersey, USA.
authors.forename: Joel L
authors.initials: JL
authors.lastname: Marmar
authors.forename: Susan
authors.initials: S
authors.lastname: Benoff
mesh_terms: D015415:Biomarkers; D001707:Biopsy, Needle / Q000009:adverse effects / Q000379:methods*; D002104:Cadmium / Q000378:metabolism; D020746:Calcium Channels, L-Type / Q000235:genetics; D006801:Humans; D007248:Infertility, Male / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008297:Male; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D012333:RNA, Messenger / Q000032:analysis; D013076:Sperm Count; D013737:Testis / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology*; D016896:Treatment Outcome; D014463:Ultrasonography; D014646:Varicocele / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*
chemical_list: D015415:Biomarkers; D020746:Calcium Channels, L-Type; D012333:RNA, Messenger; D002104:Cadmium