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

Abstract

Background Radical orchidectomy in patients who are subsequently diagnosed with benign testicular tumours represents an overtreatment due to the deleterious effects on endogenous testosterone, fertility and body image. For these reasons, the option of partial orchidectomy (PO) should be considered in certain groups of patients. Patients with bilateral tumours (synchronous or metachronous) or a solitary testis where the lesion is no greater than 30% of the volume of the testis could be considered for a PO. Evidence has shown that PO is effective for small testicular masses with excellent survival and recurrence rates. Objectives Highlight the feasibility of maintaining post‐operative fertility or normal semen parameters and endocrine function following PO. Materials and Methods Data for this review were obtained through a search of the PubMed database. Papers were required to be in English and focus on adult human males. Results Eligible and relevant papers were assessed for data regarding fertility, semen parameters and endocrine function following PO for a small testicular mass (STM). Conclusion It is possible to preserve both fertility and endocrine function after PO. Although patients may still require adjuvant radiotherapy for concomitant intratubular germ cell neoplasia (ITGCN) which results in subfertility, endocrine function is still conserved. However, it is possible to postpone radiotherapy and continue with clinical surveillance for the purposes of fertility preservation.

Outcomes of organ‐sparing surgery for adult testicular tumors: A systematic review of the literature

“…Conference abstracts were included in Embase, Scopus, and Web of Science searches. We also reviewed the studies included in two systematic reviews on related topics 15,16 . No language, date, or other limits were applied.…”

Organ Sparing Surgery in Testicular Cancer

“…However, there are concerns regarding the oncological outcomes of this surgery, due to the presence of residual CIS. The data is promising, as survival rates of OSS for testicular cancer are reported in the literature between 80-100%, with the vast majority being 100%, and recurrence rates between 0-15.9% (25).…”

“…The tumor and additional samples taken from the tumor bed, should be sent for frozen section examination to identify histology, presence of CIS and surgical margin positivity (24). If the histology shows a benign lesion, the incision site in the testis should be irrigated and then the tunica albuginea can be closed with a running suture and the testis replaced in the scrotum (25).…”

“…Patients who undergo OSS have different risks and complications from those undergoing a radical orchidectomy. There can be concerns regarding the viability of the testis after OSS and reported rates of postoperative testicular atrophy can occur in 3-5% of patients (25). This can consequently affect the endocrine function of the testes and account for late onset hypogonadism (25); however, the cases reported in the literature are attributed to poor selection of patients and unfavorable surgical technique (11).…”

“…There can be concerns regarding the viability of the testis after OSS and reported rates of postoperative testicular atrophy can occur in 3-5% of patients (25). This can consequently affect the endocrine function of the testes and account for late onset hypogonadism (25); however, the cases reported in the literature are attributed to poor selection of patients and unfavorable surgical technique (11). There is also some suggestion that handling of the vas deferens can lead to inflammation and chronic obstruction of the vas, which can contribute subfertility (22).…”