Radical inguinal orchidectomy: the gold standard for initial management of testicular cancer

Koschel, Samantha; Wong, Lih‐Ming

doi:10.21037/tau.2019.12.20

Cited by 18 publications

(18 citation statements)

References 37 publications

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“…Identify the gubernaculum and then clamp, divide, and ligate. Confirm the diagnosis with inspection [5]. Intravaginal torsion of the left testis was found to be rotated three times.…”

mentioning

confidence: 68%

“…the skin 2 cm superior and parallel to the inguinal ligament, following the line connecting the internal and external rings. Continue the incision through the subcutaneous fat and the Camper and Scarpa fasciae [5]. Identify the external oblique fibers and external inguinal ring.…”

mentioning

confidence: 99%

“…Inspect the wound and especially the scrotum for adequate hemostasis. Close the external oblique fascia and external ring in a running fashion, appose Scarpa fascia in an interrupted fashion, and close the skin [5].…”

mentioning

confidence: 99%

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Late Presentation of Testicular Torsion : A Case Report

Kalangi

Ardiyansyah²,

Andre³

2022

AANHS-J

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Introduction: Testicular torsion is a twisting of the spermatic cord, which results in impaired blood flow to the testicle. This urological emergency occurs 3.8 per 100,000 males annually, most often observed younger than 18 years. The left testis is more frequently involved. Bilateral cases report for 2% of all torsions. We describe a male with a late presentation of more than 24 hours of acute testicular pain. Patients hesitate to seek advice from doctors for testicular pain because of unawareness. Case Reports: A 16-year-old man arrived at the Emergency Room with more than 24 hours history of sudden severe left testicular pain after taking up two gas cylinders, but he was not aware. After more than 24 hours, he came to the emergency room with worsening testicular pain. The physical examination found tender, slightly swollen, and high-riding left testes. Phren test and cremaster reflex were negative on the left testes. TWIST score of the patient was 7 (high risk for testicular torsion). We made quick order for ultrasound, which shows left testicular torsion. Emergency exploration of testes was done, found the necrotic left testes with rotation more than three times. After complete derotation of the cord, the testes were still necrotic, and we decided to do left side orchidectomy after enough observation. Conclusion: Late presentation to the hospital is one of the causes of delay in treatment and mostly leads to orchidectomy in testicular torsion. Every case of testicular pain should be treated as testicular torsion until proven otherwise. Keyword: Emergency, Late presentation, Orchidectomy, Testicular torsion.

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“…Identify the gubernaculum and then clamp, divide, and ligate. Confirm the diagnosis with inspection [5]. Intravaginal torsion of the left testis was found to be rotated three times.…”

mentioning

confidence: 68%

mentioning

confidence: 99%

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Late Presentation of Testicular Torsion : A Case Report

Kalangi

Ardiyansyah²,

Andre³

2022

AANHS-J

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“…Radical inguinal orchiectomy is the standard surgical approach for testicular tumours 18 . We suggest that scrotal exploration following trauma may be inappropriate if a patient has a testicular tumour.…”

Section: Discussionmentioning

confidence: 98%

Unmasking the unexpected: Testicular tumour uncovered as a result of scrotal trauma

Yilmaz,

Yildiz,

Sungu

et al. 2024

Int J of Uro Nursing

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We present a case of a 17‐year‐old male with a testicular tumour diagnosed after trauma. A 17‐year‐old male patient came to our clinic with swelling in the right hemiscrotum. The patient had a history of right scrotal blunt trauma 3 weeks before the admission and had no history of urological surgery or chronic disease. The patient doesn't use tobacco, alcohol, or illicit drugs. Genitourinary system examination revealed swelling and tenderness on palpation in the right hemiscrotum. The right testicle was not palpable. The left hemiscrotum was normal. The left testicle had a normal size and shape. Testicular tumour markers were high (AFP:196 μg/L (N: 0–8 μg/L), b‐HCG: 916 mIU/mL (N: <10 mIU/mL), LDH: 364 U/L (N: 0–265 U/L). Scrotal ultrasonography and magnetic resonance imaging revealed that there were areas of 9 × 9 × 11 cm in size of the right scrotal region without viable testis tissue, hematoma area, and areas compatible with necrosis. These findings were related to intratesticular rupture due to trauma. Abdominal tomography revealed lymphadenopathies of approximately 6 × 3 cm in the anterior paracaval area and approximately 4 × 3 cm in the anterior aspect of the psoas muscle. We performed right radical inguinal orchiectomy on the patient. Testicular tumour markers were still high on the 8th postoperative day (AFP:120 μg/L (N: 0–8 μg/L), bHCG: 680 mIU/mL (N: <10 mIU/mL), LDH: 200 U/L (N: 0–265 U/L)). The testicular tumour was diagnosed as mixed germ cell tumour (50% Yolk Sac, 30% Embryonal Carcinoma, 20% Teratoma). The tumour diameter was 9 cm, surgical margins were intact, there was rete testis invasion, and no tumour was detected in the tunica vaginalis. No tumour invasion was seen in the soft tissue around the spermatic cord (pT2). The patient received 3 cycles of chemotherapy with bleomycin, etoposide, and cisplatin. We suggest that patients presenting with scrotal trauma should be carefully evaluated for testicular malignancy, and if malignancy is suspected, radical inguinal orchiectomy should be preferred for the operation.

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“…TSS exhibits a low recurrence rate in some STM 7 , 15 . Studies have reported that 60–70% of nonpalpable masses of less than 2 cm are nonmalignant lesions such as small benign Leydig or Sertoli cell tumors 2 , 3 , 16 – 18 . No difference was demonstrated in the cancer-specific survival between the RO and TSS groups in 5365 patients with tumors of less than or equal to 2 cm from the Surveillance, Epidemiology, and End Results database 18 , 19 .…”

Section: Discussionmentioning

confidence: 99%

SAVE Testis-sparing score: A multicenter retrospective study of a novel predictive tool for quantifying testicular tumors

Liu,

Xie,

Gao

et al. 2023

International Journal of Surgery

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Background: Testis-sparing surgery (TSS) is a safe treatment for patients with benign testicular tumors. Presently, assessments for evaluating the suitability of TSS are poorly standardized, partially because testicular anatomical elements cannot be quantitatively described. Materials and Methods: We developed a scoring method known as SAVE testis-sparing score based on four critical and accessible anatomical features of testicular tumor. The SAVE score ranges from 0 to 8 and is divided into four risk classes (low, medium, high, and extremely high) to evaluate the feasibility of TSS, wherein low risk indicates high feasibility and vice versa. This study included 444 testicular tumor patients from eight centers. Among them, 216 patients (model group: 151 patients, validation group: 65 patients) were included in the modeling analysis, and the other 228 patients from children’s centers were included in the proportion analysis. Using retrospective data, patient characteristics associated with surgical methods were identified. Furthermore, multivariate logistic regression model was built quantify the associations between these characteristics and the surgery method. The receiver operator characteristic curve was used to evaluate the classification efficiency of SAVE. Results: The SAVE testis-sparing score includes size (tumor size as maximal diameter), available testicular tissue volume, volume ratio of the tumor to the testis, and the exophytic/endophytic properties of the tumor. The SAVE scoring system accurately classified the suitability of TSS based on the complexity of benign testicular tumors. Conclusion: The SAVE score is a reproducible and robust tool for quantitatively describing the anatomical characteristics of benign testicular tumors and guide the preoperative evaluation of TSS.

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Radical inguinal orchidectomy: the gold standard for initial management of testicular cancer

Cited by 18 publications

References 37 publications

Late Presentation of Testicular Torsion : A Case Report

Late Presentation of Testicular Torsion : A Case Report

Unmasking the unexpected: Testicular tumour uncovered as a result of scrotal trauma

SAVE Testis-sparing score: A multicenter retrospective study of a novel predictive tool for quantifying testicular tumors

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