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Oncological and functional outcomes of testis sparing surgery in small testicular mass: a systematic review
Vincenzo Favilla1, Rossella Cannarella2, Antonio Tumminaro3
1Section of Urology, Gaetano Barresi Department of Human and Pediatric Pathology, University of Messina, Messina, Italy.
Introduction:
The prevalence of testicular tumor is constantly increasing, with an estimated incidence rate of about 3-10 new cases per 100,000 males/per year. Radical orchiectomy or testis sparing surgery (TSS) are recognized therapeutic approaches in these cases. However, the risk for hypogonadism and infertility is higher with the former compared with the latter. The aim of this systematic review is to evaluate the oncological outcome and testicular function (endocrine and reproductive aspects) in patients who had undergone TSS for small testicular lesions.
Evidence Acquisition:
To accomplish this, 684 articles were retrieved and screened; 24 retrospective and two prospective studies were selected and finally included in this systematic review.
Evidence Synthesis:
Overall the TSS attempts were 1096 but TSS was definitively performed in 603 cases (55%). Frozen section examination was performed in 996 TSS attempts (22 out of the 26 studies selected) and showed a benign histology in 37-100% of cases, a malignant histology in 0-63%, and an inconclusive result in 0-16%, respectively. Five studies reported that a total of 22 patients were able to father after conservative surgery. None of these studies reported cases of hypotestosteronemia after surgery and a low prevalence (1.66%) of complications was associated with this type of surgery.
Conclusions:
In conclusion, TSS showed to be safe and practicable if used according to the specific guidelines. It can be safely performed to treat recurrence eventually associated to local adjuvant radiotherapy when an intra-tubular neoplasia is present. Urologists can therefore consider TSS as an important means against testicular tumor in selected and well-informed patients.
Insights
Testis sparing surgery (TSS) is a safe and effective treatment for small testicular tumors, preserving testicular function and fertility. This approach offers a viable alternative to radical orchiectomy, with a low complication rate.
Area of Science:
- Urology
- Oncology
- Reproductive Medicine
Background:
- Testicular tumors are increasing in incidence, with radical orchiectomy and testis sparing surgery (TSS) as primary treatments.
- Radical orchiectomy carries a higher risk of hypogonadism and infertility compared to TSS.
- Evaluating oncological outcomes and testicular function after TSS for small testicular lesions is crucial.
Purpose of the Study:
- To systematically review the oncological outcomes of testis sparing surgery (TSS).
- To assess the impact of TSS on testicular function, including endocrine and reproductive aspects.
- To evaluate the safety and efficacy of TSS for small testicular lesions.
Main Methods:
- A systematic review of 684 retrieved articles.
- Inclusion of 24 retrospective and 2 prospective studies.
- Analysis of 1096 TSS attempts, with definitive surgery in 603 cases.
Main Results:
- Frozen section examination during TSS showed benign histology in 37-100% of cases.
- Fertility was preserved in 22 patients after conservative surgery.
- Low prevalence of complications (1.66%) and no reported cases of hypotestosteronemia post-TSS.
Conclusions:
- Testis sparing surgery (TSS) is a safe and practicable option for selected patients with small testicular tumors.
- TSS can be safely performed for recurrence, potentially with adjuvant radiotherapy for intra-tubular neoplasia.
- Urologists can consider TSS as a valuable treatment for testicular tumors in well-informed patients.
