Testicular sparing surgery in small testis masses: A multinstitutional experience

Area of Science:

• Urology
• Oncology
• Surgical Pathology

Background:

• Increasing incidence of benign testicular tumors, particularly small incidental scrotal ultrasonography findings.
• Need for effective diagnostic and therapeutic strategies for small testicular masses.

Purpose of the Study:

• To evaluate the efficacy of a diagnostic-therapeutic pathway for small testicular lesions.
• To assess the safety and reliability of testis-sparing surgery for benign testicular lesions.

Main Methods:

• Multicenter study of patients with single testicular lesions < 15 mm.
• Application of a pathway including tumor markers, repeated scrotal ultrasound, and surgical exploration with intraoperative pathology.
• Definitive histology reviewed by a dedicated uro-pathologist.

Main Results:

• 28 patients completed the pathway; mean lesion size 9.3 mm.
• 39.3% (11/28) underwent radical orchiectomy, 60.7% (17/28) had testis-sparing surgery.
• 6 malignant (seminoma) and 22 benign/non-neoplastic lesions were diagnosed; high concordance between frozen section and definitive histology.

Conclusions:

• Orchiectomy is often an overtreatment for small testicular lesions given the high incidence of benign findings (60%).
• Testis-sparing surgery is a safe and effective option for small testicular nodules (< 15 mm) when managed with a standardized pathway.
• The evaluated diagnostic-therapeutic pathway demonstrates good reliability and safety for multicenter management of small scrotal masses.