Testis-sparing surgery for small testicular masses: Functional and oncological outcomes

To evaluate functional and oncological outcomes of testis-sparing surgery (TSS), particularly in selected patients with small testicular masses (STMs), including those with a normal contralateral testis and germ cell tumors.

Patients with STMs treated with TSS between January/2001 and January/2020 were retrospectively reviewed. Clinical, radiological, and pathological data, including ultrasonography (US) findings, tumor markers, serum testosterone levels, frozen-section examination (FSE), and final pathology results were analyzed.

Overall, 37 TSSs (36 patients) were included in the study. Mean patient age was 28.6 ± 9.8 years. Median follow-up was 65 (8-228) months. Median tumor size was 1.2 (0.4-2.5) cm. Contralateral testis was normal in 26 (70.3%) cases and in 4 (36.4%) germ cell tumor cases. Positive surgical margins were reported in 4 cases, all without FSE. Oncological events were observed in 5 (13.5%) cases, all involving germ cell tumors, with a median time to event of 6 (3-36) months. No significant difference was found between pre- and postoperative testosterone levels, and no patient required testosterone replacement therapy. Secondary surgeries were required in 6 (16.2%) cases. One patient with bilateral synchronous tumors died during follow-up because of systemic progression.

In carefully selected patients with STMs, TSS may represent a feasible alternative to radical orchiectomy, potentially reducing overtreatment while preserving endocrine function. However, given the risk of recurrence in germ cell tumors and the nonstandard role of TSS in patients with a normal contralateral testis, careful patient selection, counseling, and close follow-up remain essential.