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Published on: March 31, 2023
Management of nonpalpable testicular tumors
Yefim R Sheynkin1, Troy Sukkarieh, Michael Lipke
1Department ofUrology, Health Science Center, State University of New York at Stony Brook, Stony Brook, New York 11794-8093, USA.
Objectives:
To report our series of nonpalpable testicular tumors with a review of published studies. Radical orchiectomy remains the reference standard in the treatment of a solid testicular mass. Testis-sparing surgery has recently been advocated for a select group of patients with nonpalpable tumors.
Methods:
Between 1998 and 2002, a nonpalpable testicular mass was discovered in 9 patients. Ultrasonography was performed for infertility evaluation (5 patients), testicular pain (3 patients), and retroperitoneal lymphadenopathy (1 patient).
Results:
Radical orchiectomy was performed in 7 of 9 patients and testis-sparing surgery with microsurgical excision of tumor in 1 patient. One patient decided against surgery. A benign testicular tumor was found in 6 and a malignant tumor in 2 of the 8 patients.
Conclusions:
A high incidence of benign nonpalpable tumor and an advanced microsurgical technique justifies organ-sparing surgery as an alternative for radical orchiectomy in a select group of patients. Testicular preservation in patients with a malignant nonpalpable testicular tumor is a feasible, but still controversial, approach.
Insights
Nonpalpable testicular tumors are often benign, supporting testis-sparing surgery as an alternative to radical orchiectomy. This organ-sparing approach is feasible for malignant nonpalpable testicular tumors but remains controversial.
Area of Science:
- Urology
- Oncology
- Surgical Innovation
Background:
- Nonpalpable testicular masses present diagnostic and therapeutic challenges.
- Radical orchiectomy is the standard treatment for solid testicular masses.
- Testis-sparing surgery is emerging for select nonpalpable tumors.
Purpose of the Study:
- To present a case series of nonpalpable testicular tumors.
- To review existing literature on nonpalpable testicular tumors.
- To evaluate testis-sparing surgery for nonpalpable testicular tumors.
Main Methods:
- Retrospective review of 9 patients with nonpalpable testicular masses (1998-2002).
- Diagnostic workup included ultrasonography for infertility, pain, or lymphadenopathy.
- Surgical interventions included radical orchiectomy and microsurgical testis-sparing surgery.
Main Results:
- 8 patients underwent surgery; 1 declined.
- 6 benign and 2 malignant tumors were identified.
- 7 radical orchiectomies and 1 testis-sparing surgery were performed.
Conclusions:
- High incidence of benign nonpalpable tumors supports organ-sparing surgery.
- Advanced microsurgical techniques make testis-sparing surgery a viable option.
- Testicular preservation for malignant nonpalpable tumors is feasible but debated.
