[Contralateral testicular biopsy in patients with germ cell tumors: practice patterns in Germany 2014]

Contralateral testicular biopsy is a tool for early diagnosis of contralateral tumors in patients with testicular germ cell tumor (GCT). Though based on a high level of evidence, international guidelines do not unanimously recommend biopsies. We enquired the acceptance of contralateral biopsies among clinical urologists in Germany.

A total of 326 urologic departments were asked by a questionnaire whether they perform contralateral biopsy in all cases with GCT, in most, in select cases, or never. In addition we enquired for type and size of the department as well as the annual volume of GCT patients. To specify the hospital geographically, we noted the ZIP code. The data were analyzed with descriptive statistical methods.

The response rate was 86.5%. Of the departments, 52.1, 17, 27.3, and 3.5% do the biopsy in all cases, in most of them, in select patients, and never, respectively. University departments have significantly lower acceptance of the procedure than general hospitals (50% versus 72.6%), even after adjusting for other hospital characteristics by multivariate analysis. There was no association of acceptance rate with hospital size and annual GCT volume. The biopsy is highly used in the northern parts of Germany and considerably under-used in southern regions.

Contralateral testicular biopsy is well-established and widely accepted among clinical urologists in Germany. In other countries, biopsies remain controversial. Only in Denmark is it routinely employed. In Sweden, Austria, and Switzerland biopsies are done in selected patients. In view of the multination treatment consensus of GCT, explanations for the dissimilar biopsy rates in various countries remain elusive. Peculiar findings are the inferior acceptance rates in university departments and the north-south gradient within Germany.