Testis-sparing surgery for testicular masses: current perspectives.

Abstract

INTRODUCTION:

Males who present with a palpable testis nodule are likely to have malignant germ cell tumor in >90% of cases. Therefore radical orchiectomy remains the standard of care for intratesticular tumors. However, due to the recent developments of high-frequency probes in ultrasonography, the incidence of detecting a small non-palpable testis tumor is higher and higher. These lesions are thought to be benign in more than 60-80% of cases, thus a radical orchiectomy should be considered an overtreatment. In addition to that, radical orchiectomy might cause infertility, psychological issues and endocrine disorders, hence an organ-sparing procedure in such cases should be pursued.

EVIDENCE ACQUISITION:

Only fourteen reliable retrospective studies met the inclusion criteria. No prospective randomized trials have appeared in Medline database.

EVIDENCE SYNTHESIS:

This review of the current literature has confirmed the safety and efficacy of testicular-sparing surgery in selected patients: 1) monorchid patients; 2) bilateral testis masses; 3) normal patients with a small, non-palpable masses detected with US, as long as the dimension of the lesion is up to 3 cm and not greater that 30% of the total volume of the organ.

CONCLUSIONS:

According to the literature, testis sparing surgery is a safe and feasible procedure for patients presenting a benign small testis mass. The enthusiasm found in the literature should however be tempered as the small number of patients reported in the studies coupled with the absence of a prospective trial represent important limits that need to be overtaken. Therefore more robust and well-designed studies are needed.

• Authors: Roberto La Rocca, Marco Capece, Lorenzo Spirito, Marcus K Cumberbatch, Massimiliano Creta, Vincenzo Altieri, Giorgio Franco, Simone Albisinni, Vincenzo Mirone, Francesco Esperto, EAU-ESRU (European Associations of Urology-European Society of Residents Urologist)
• Journal: Minerva urologica e nefrologica = The Italian journal of urology and nephrology (Minerva Urol Nefrol) Vol. 71 Issue 4 Pg. 359-364 (Aug 2019) ISSN: 1827-1758 [Electronic] Italy
• PMID: 30957472 (Publication Type: Journal Article, Review)

Topics

• Humans
• Male
• Neoplasms, Germ Cell and Embryonal (surgery)
• Orchiectomy
• Organ Sparing Treatments (methods)
• Testicular Neoplasms (surgery)
• Testis (surgery)