Efficacy of ultrasound-guided testicle-sparing surgery for small testicular masses

Abstract

Purpose The aim of the present study was to evaluate evolution of conservative echo-guided surgery for testicular tumours B1.5 cm and to assess the safety of this surgical procedure. Methods 49 consecutive patients diagnosed with ultrasonography testicular lesions (mono or bilateral) B1.5 cm and treated with conservative echo-guided testicular surgery were examined. The parameters considered in this retrospective analysis included case history, physical examination, scrotal and abdominal ultrasonography, computed tomography scan, size of the nodule (maximum diameter), tumour markers, chest radiography, frozen section examination, histologic size of the tumour, overall survival (OS) and findings on follow-up. Results Mean age of patients was 33 years (range 18-62). Patients who presented with a palpable testicular nodule were 32.7 %, gynecomastia 10.2 %, precocious pseudopuberty 4 %, and scrotal pain 12.2 %. Permanent section examination confirmed the FSE data in all cases of certainty malignant lesion and definitive histological types were: 22 seminoma, 13 non-seminomatous or mixed germ cell tumours, 4 Leydig tumours, 2 hamartoma, 1 epidermoid cyst, 2 sertoli cell tumours, and 5 fibrous pseudotumour. No complications intra-and postoperative were observed. Overall survival was 100 % and scrotal US showed evidence of local tumour recurrence in 6 patients (12.2 %) after a mean follow-up of 34.7 months. ConclusionThe OS, the low rate of local recurrence, and absence of complications, tend to demonstrate the safety of the procedure. The benefits to testicular-sparing surgery include improving the patient's overall quality of life, fertility, endocrine function and negative cosmetic effects of radical orchiectomy.Keywords Testicular tumour Á Ultrasound Á Testiclesparing surgery Á Small testicular mass Á Non-palpable Riassunto Scopo del lavoro Lo scopo del presente studio è stato quello di valutare il ruolo della terapia chirurgia ecoguidata conservativa nel trattamento dei tumori testicolari B1.5 cm e valutarne la sicurezza ed efficacia. Metodi Furono esaminati 49 pazienti con diagnosi ecografica di lesione testicolare (mono o bilaterale) B1.5 cm e sottoposti a chirurgia testicolare conservativa ecoguidata. I parametri presi in considerazione in questo studio retrospettivo furono la storia clinica del paziente, l'esame obiettivo, l'ecografia scrotale ed addominale, la TAC, le dimensioni della lesione, i marcatori tumorali, la radiografia del torace, l'esame istologico estemporaneo e definitivo della lesione, il tasso di sopravvivenza globale e i risultati del follow-up. Risultati L'età media dei pazienti è stata di 33 anni (range 18-62). Il 32.7 % dei pazienti presentavano un nodulo testicolare apprezzabile palpatoriamente, il 10.2 % ginecomastia, il 4 % pseudopubertà precoce, mentre il 12.2 % dolore scrotale. In tutti i casi l'esame istologico definitivo delle lesioni tumorali aveva confermato i risultati riscontrati all'esame istologico estemporaneo. Gli istotipi definitivi furono: 22 tumori seminomatosi, 13...

The role of partial orchidectomy in the management of small testicular tumours: Fertility and endocrine function

“…This was similar to the results of Dell’Atti et al and Ferretti et al in which only 1/18 and 1/30 patients, respectively, undergoing TSS were able to father a child after their surgery and subsequent chemotherapy 37,41 . Furthermore, Dell’Atti et al found that patients with residual testicular tissue following surgery did not require testosterone supplementation and had an average serum testosterone level of 4.0 ng/mL 41 . In an attempt to combat this, it has been suggested that delaying radiotherapy could be used to facilitate attempts at fathering children, with the caveat that they remain under close observation for recurrence of disease (Heidenreich et al, 2001).…”

“…Only 1 patient had normal semen analysis 4 . This was similar to the results of Dell’Atti et al and Ferretti et al in which only 1/18 and 1/30 patients, respectively, undergoing TSS were able to father a child after their surgery and subsequent chemotherapy 37,41 . Furthermore, Dell’Atti et al found that patients with residual testicular tissue following surgery did not require testosterone supplementation and had an average serum testosterone level of 4.0 ng/mL 41 .…”

Papillary Cystadenoma of the Epididymis: A Case Report and Review of the Literature

“…[4,[8][9][10]22,23] This allows the examiner to distinguish benign from malignant lesions as well as identify intratesticular from extratesticular pathologic conditions. [4,[23][24][25] Malignant masses characteristically include larger diameters, volume, and increased vascularity. [10] US imaging is the preferred modality for imaging palpable testicular lesions, especially for children younger than 16 years, to avoid exposure to radiation or contrast media.…”

Successful management of an asymptomatic bilateral synchronous testicular carcinoid tumor with a testicular-sparing surgery

“…Until a short time ago, all testicular tumors were virtually treated with radical orchiectomy; however, testicle-sparing surgery is now advocated especially for bilateral and/or multiple lesions or in monorchid patients 9. The benefits of testicle-sparing surgery include the improvement of the patient's overall quality of life, fertility, endocrine function, and the avoidance of the negative cosmetic effects of radical orchiectomy 10. However, the role of the uropathologist is to establish the diagnosis of malignancy and resection margins of the tumor in FSE, taking into consideration the clinical information, tumor markers, and ultrasonographic results.…”

“… 9 The benefits of testicle-sparing surgery include the improvement of the patient's overall quality of life, fertility, endocrine function, and the avoidance of the negative cosmetic effects of radical orchiectomy. 10 However, the role of the uropathologist is to establish the diagnosis of malignancy and resection margins of the tumor in FSE, taking into consideration the clinical information, tumor markers, and ultrasonographic results. In this case report, a close collaboration between pathologist and urologist was possible conservative management without compromise oncological efficacy in the treatment of these tumors.…”