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Minerva Urologica e Nefrologica 2019 August;71(4):359-64

DOI: 10.23736/S0393-2249.19.03315-0


lingua: Inglese

Testis-sparing surgery for testicular masses: current perspectives

Roberto LA ROCCA 1, Marco CAPECE 1 , Lorenzo SPIRITO 1, Marcus K. CUMBERBATCH 2, Massimiliano CRETA 1, Vincenzo ALTIERI 3, Giorgio FRANCO 4, Simone ALBISINNI 5, Vincenzo MIRONE 1, Francesco ESPERTO 5, on behalf of EAU-ESRU (European Associations of Urology-European Society of Residents Urologist)

1 Department of Urology, Federico II University, Naples, Italy; 2 Unit of Academic Urology, Department of Urology, University of Sheffield, Sheffield, UK; 3 Department of Urology, Humanitas Gavazzeni Hospital, Bergamo, Italy; 4 Department of Urology, Sapienza University, Rome, Italy; 5 Department of Urology, University Clinics of Brussels, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium

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.

KEY WORDS: Orchiectomy; Testicular neoplasms; Review

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