Testicular Biopsies in Adolescent and Adult Andrological Patients: The EAA Clinical Guidelines.
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BACKGROUND: Histological evaluation of testicular tissue is central to the assessment of infertile men, particularly those at an increased risk of testicular germ cell tumors (TGCT). Traditionally, testicular biopsies have been used primarily for diagnostic purposes, such as the detection of germ cell neoplasia in situ (GCNIS). With advances in assisted reproductive technologies, testicular biopsies may also serve a therapeutic role, including testicular sperm extraction (TESE or microsurgical TESE) in men with nonobstructive azoospermia (NOA). OBJECTIVE: To provide clinical practice guidelines on the indications for testicular biopsies for diagnostic and combined therapeutic-diagnostic purposes, including surgical aspects, tissue preparation and staining, and interpretation of histological findings. METHODS: Evidence-based recommendations were developed following a systematic literature search of English-language publications and graded using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. The suggestions and recommendations were thoroughly discussed by the guidelines' authors, who are experienced in testicular biopsies in a clinical andrology setting. Subsequently, the guidelines were approved by the Directors of 29 andrological centers accredited by the European Academy of Andrology (EAA). RESULTS: A total of 34 recommendations were formulated. CONCLUSION: Testicular biopsies remain an essential tool for both the diagnostic evaluation of men at risk of TGCT and therapeutic sperm retrieval in NOA. Careful patient selection, appropriate preoperative evaluation, and follow-up of reproductive hormones are crucial to optimize outcomes and minimize risks.