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Testis-sparing surgery for small testicular masses: Functional and oncological outcomes
Oğuzhan Kahraman1, Bülent Akdoğan1
1Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye.
Purpose:
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.
Materials And Methods:
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.
Results:
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.
Conclusions:
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.
Insights
Testis-sparing surgery (TSS) is a viable option for select small testicular masses (STMs), preserving endocrine function. Careful patient selection and follow-up are crucial, especially for germ cell tumors and cases with a normal contralateral testis.
Area of Science:
- Urology
- Surgical Oncology
- Endocrinology
Background:
- Testicular masses require careful management to balance oncological control and functional preservation.
- Radical orchiectomy is the standard treatment, but may lead to overtreatment and endocrine dysfunction.
Purpose of the Study:
- To evaluate functional and oncological outcomes of testis-sparing surgery (TSS) for small testicular masses (STMs).
- To assess the feasibility of TSS in patients with a normal contralateral testis and germ cell tumors.
Main Methods:
- Retrospective review of 37 TSS procedures (36 patients) between 2001 and 2020.
- Analysis of clinical, radiological, and pathological data, including ultrasonography, tumor markers, testosterone levels, and frozen-section examination.
Main Results:
- Median follow-up was 65 months for a median tumor size of 1.2 cm.
- Oncological events occurred in 13.5% of cases, all germ cell tumors; no significant changes in testosterone levels were observed.
- Positive surgical margins were noted in 4 cases, all without frozen-section examination.
Conclusions:
- TSS is a feasible alternative to radical orchiectomy for carefully selected STMs, potentially reducing overtreatment and preserving endocrine function.
- Close patient selection, counseling, and follow-up are essential due to recurrence risks in germ cell tumors and nonstandard indications.
