Open Testicular Biopsy Without a Surgical Assistant Using a Scrotal Rumel Tourniquet

Purpose

The main current indication for open testicular biopsy is the extraction of sperm cells for intracytoplasmic sperm injection in patients with azoospermia. Usually the surgical assistant or operator holds the testicle with the nondominant hand throughout the operation. We propose using a scrotal device in the shape of a Rumel tourniquet to maintain the testicle fixed and tight against the scrotal wall all the time with no need to be held by the hand.

Materials and Methods

The Rumel tourniquet is made of a Penrose-type rubber drain and a piece of plastic tube. It is placed at the base of the scrotum to include the 2 testicles, while tension is adjusted until the skin becomes tense and the scrotal wall is held tightly against the testicles. Placing the eyelid retractor is unnecessary since the various scrotal wall layers become spontaneously separated.

Results

We have used this device in 20 consecutive testicular biopsies in patients with obstructive azoospermia and for histopathological diagnosis. It was useful in all cases. No device related complications were observed.

Conclusions

This straightforward scrotal device simplifies the procedure since no surgical assistant is required, the surgeon can use 2 hands during the operation and testicular biopsy is achievable through a small incision.

Key Words:  testis , sperm injections , intracytoplasmic , tourniquets , scrotum , biopsy