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Department of Urology

Testicular Mapping

Overview

Azoospermia  is  the complete absence of sperm in a man’s ejaculate.  In many men, azoospermia  results from inadequate production of sperm within the testicles.  Despite not having sperm in the ejaculate, some men may harbor small pockets of sperm within the testes.  If identified, these sperm may be surgically extracted and used to fertilize an egg using in vitro fertilization with intracytoplasmic sperm injection.

Fine needle aspiration biopsy (FNA) of the testes (or Testicular Mapping) is a non-surgical, minimally invasive method that can accurately diagnose and classify the severity of disease in men with azoospermia or severe oligospermia. Cytological analysis with FNA has a high correlation with histological specimens from open testicular biopsies. In some men, FNA may be more sensitive at detecting very small quantities of sperm that are present in a heterogeneous pattern within the testes. In addition to these important diagnostic considerations, it also has much lower morbidity than does an open biopsy. Testicular biopsies require a scrotal and testicular incision followed by removal of testicular tissue. FNA is less invasive as it utilizes a series of biopsies with a fine needle (23 to 25 gauge). In general, men experience minimal post-procedural discomfort with the FNA approach, and the diagnostic yield is greater.

Description

Prior to the day of the procedure, please shave the hair from the scrotum.  The procedure is performed with a local anesthetic and typically takes 45 minute to one hour.  The scrotal area will be cleansed with warm solution.  Both testicles will be numbed with a long-acting anesthetic.  Each testis will be sampled at 9 to 12 locations with a small gauge needle.  No incisions are required.  When sampling is complete, a compressive dressing will be placed to help prevent  bruising or swelling.

Preoperative Considerations

Importantly, testicular mapping is only a diagnostic procedure to determine the presence, density and location of sperm. If sperm are identified, they must be extracted at a later time using the appropriate type of sperm retrieval procedure (see sperm retrieval).

Postoperative Care

Remove the dressing from inside the athletic supporter in 24 hours; continue with the scrotal support for 2 days and then return to your normal underwear. You can shower once the dressings are removed.

Apply frequent ice packs to the scrotum the night of surgery and the next morning. Do this by placing a thin towel on the scrotum (or scrotal support) and lay the ice (a bag of frozen peas works well) on top of the towel. Keep the scrotum cool, NOT cold, by rotating 20min on and 20min off. After 24 hours, discontinue the ice. You can apply moist heat (a warm bath) to the scrotum after 5 days.

Prescribed pain medication can be taken as directed.  Ibuprofen can also be taken, one or two pills every 6 hours as needed.  There are no sutures to remove. Scrotal swelling will peak in 24-48 hours and may take several days to weeks to resolve after that.

Each aspirated sample is individually examined by an expert in sperm morphology from the Male Fertility Laboratory.  This process is detailed and very time consuming.  As a consequence, results may not be available for two to three weeks.

Long Term Care

After confirming the results, Dr. Walsh will discuss the testicular map with you and your partner.  Although results may be discussed preliminarily by phone, a face to face consultation is generally the best approach.  Together, you will formulate a plan for addressing azoospermia.