Abstract

Until the late 1980s, it was considered that any testicular mass, if suspicious, should be removed totally by radical orchiectomy, however, a marked increase in incidental testicular mass diagnosis, the high accuracy of diagnosis obtained from frozen section examinations, and evidence showing the potential advantages of testis‐sparing surgery, threw into question the need to sacrifice the entire testis even when a normal contralateral testis was present. We present a 23‐year‐old patient who was asymptomatic at diagnosis of a non‐palpable testicular mass with a size of approximately 7.5 mm and negative for tumor markers. He underwent a Testis‐sparing surgery guided by ultrasound with frozen section examination, however, with the suspicious of Germ cell tumor, it was decided to complete the orchiectomy. The final histological results were Leydig cell tumor. Given the high likelihood of non‐palpable and small testicular lesions being benign (80%), the negative impact of radical orchiectomy on spermatogenesis, cosmetic aspects, and endocrine function, impossible to ignore, Testis‐sparing surgery is a procedure that although it is not a standard procedure must be employed as the first approach in selected cases and specialized reference centers.

Abstract

Malignant germ cell tumors represent the majority of testicular masses, according to current knowledge, radical orchiectomy remains the standard of care in the management of this type of cancer. However, testis‐sparing surgery (TSS) can be an alternative to radical surgery in selected cases, particularly in patients with small testicular masses (STM). The authors conducted a review of the current indications for performing testicular sparing surgery as well as functional and oncological results of it. We conducted a literature search in Medline database (PubMed) using the keywords: “testis sparing surgery”, “partial orchiectomy”, ‘testis tumor’, ‘small testicular mass/tumor’. The search was limited to article in English language, published from 2010 to the current date. randomized controlled trials/studies with high level of evidence that compare TSS with radical orchiectomy were not found. Indications for TSS are still controversial, particularly in patients with normal contralateral testis. The organ sparing surgery seems a viable therapeutic option for patients with small non‐palpable testicular mass (with < 20 mm major axis), bilateral tumors or single testicle. The frozen section examination plays a decisive role in the technique, since it allows the distinction between malignant and benign neoplasms, as well as assessing the status of surgical margins. The medium and long follow‐up results of the analyzed retrospective studies revealed no significant risk of local and/or distant relapses. Regarding the testis, the organ‐sparing surgery can be adopted safely in the treatment of selected cases. Prospective multicentric and high level of evidence studies are needed in order for TSS become a real alternative to radical surgery, as well to evaluate the oncological safety and real functional benefits of preserving the testis.