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Testis-sparing Surgery: A Single Institution Experience

Published:October 30, 2020DOI:https://doi.org/10.1016/j.urology.2020.10.031

      Abstract

      Objective

      To demonstrate the safety and efficacy of testis-sparing surgery (TSS) in 2 specific circumstances: small, nonpalpable masses suspected to be benign and masses suspicious for germ cell tumor in a solitary or functionally solitary testicle or bilateral disease.

      Methods

      Our institutional review board-approved testicular cancer registry was reviewed for men who underwent inguinal exploration with intent for TSS (2013-2020). The attempted TSS and completed TSS groups were evaluated for differences using Student's t test for normally-distributed variables, chi-squared and Fisher's exact tests for proportions, and Wilcoxon rank-sum test for nonparametric variables.

      Results

      TSS was attempted in 28 patients and completed in 14. TSS was completed only if intraoperative frozen section demonstrated benign disease, except for 1 patient with stage I seminoma and solitary testicle. Sensitivity and specificity of frozen section analysis was 100% and 93%, respectively. There were no significant differences in demographics between attempted vs completed TSS cohorts. Median tumor size was significantly smaller in the completed TSS cohort (1.0 cm vs 1.7 cm, P = .03). In patients with unilateral masses without history of testis cancer, the testis was successfully spared in 9 of 22 cases (41%). In patients with bilateral disease or germ cell tumor in solitary testis, the testis was spared in 5 of 6 cases (83%). At a median follow up of 12.2 months, all patients were alive, and 27 of 28 had no evidence of disease (96%).

      Conclusion

      TSS is safe and effective for small, benign masses and in the setting of bilateral disease or tumor in a solitary testis.
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      References

        • National Cancer Institute
        Cancer stat facts.
        Surveill Epidemiol End Results Progr. 2019; (https://seer.cancer.gov/statfacts/html/testis.html)
        • Stephenson AJ
        • Gilligan TD.
        Neoplasms of the testis..
        Campbell-Walsh Urol. 2012; : 837-870https://doi.org/10.1016/b978-1-4160-6911-9.00031-1
        • Carmignani L
        • Gadda F
        • Gazzano G
        • et al.
        High incidence of benign testicular neoplasms diagnosed by ultrasound.
        J Urol. 2003; 170: 1783-1786https://doi.org/10.1097/01.ju.0000092066.01699.90
        • Haas GP
        • Shumaker BP
        • Cerny JC
        The high incidence of benign testicular tumors.
        J Urol. 1986; 136: 1219-1220https://doi.org/10.1016/S0022-5347(17)45288-8
        • Müller T
        • Gozzi C
        • Akkad T
        • Pallwein L
        • Bartsch G
        • Steiner H
        Management of incidental impalpable intratesticular masses of ≤5 mm in diameter.
        BJU Int. 2006; 98: 1001-1004https://doi.org/10.1111/j.1464-410X.2006.06485.x
        • Shilo Y
        • Zisman A
        • Lindner A
        • et al.
        The predominance of benign histology in small testicular masses.
        Urol Oncol Semin Orig Investig. 2012; 30: 719-722https://doi.org/10.1016/j.urolonc.2010.08.022
        • Fosså SD
        • Chen J
        • Schonfeld SJ
        • et al.
        Risk of contralateral testicular cancer: a population-based study of 29515 U.S. Men.
        J Natl Cancer Inst. 2005; 97: 1056-1066https://doi.org/10.1093/jnci/dji185
        • Laguna M
        • Albers P
        • Albrecht W
        • et al.
        Testicular Cancer 2019 EAU guidelines on testicular cancer: 2019 update.
        Eur Urol. 2019; 60: 304-319https://doi.org/10.1016/j.eururo.2011.05.038
        • Stephenson A
        • Eggener SE
        • Bass EB
        • et al.
        Diagnosis and treatment of early stage testicular cancer: aua guideline.
        J Urol. 2019; https://doi.org/10.1097/JU.0000000000000318
        • Heidenreich A
        • Bonfig R
        • Derschum W
        • et al.
        A conservative approach to bilateral testicular germ cell tumors.
        J Urol. 1995; 153: 10-13https://doi.org/10.1097/00005392-199501000-00005
        • Shilo Y
        • Zisman A
        • Raz O
        • et al.
        Testicular sparing surgery for small masses.
        Urol Oncol Semin Orig Investig. 2012; 30: 188-191https://doi.org/10.1016/j.urolonc.2009.12.021
        • Heidenreich A
        • Weißbach L
        • Höltl W
        • Albers P
        • Kliesch S
        • Köhrmann KU
        Organ sparing surgery for malignant germ cell tumor of the testis.
        J Urol. 2001; 166: 2161-2165https://doi.org/10.1016/S0022-5347(05)65526-7
        • Pfister D
        • Paffenholz P
        • Haidl F
        Testis-sparing surgery in patients with germ cell cancer: indications and clinical outcome.
        Oncol Res Treat. 2018; : 356-358https://doi.org/10.1159/000489346
        • Paffenholz P
        • Held L
        • Loosen SH
        • Pfister D
        • Heidenreich A
        Testis sparing surgery for benign testicular masses: diagnostics and therapeutic approaches.
        J Urol. 2018; 200: 353-360https://doi.org/10.1016/j.juro.2018.03.007
        • Ferretti L
        • Sargos P
        • Gross-Goupil M
        • et al.
        Testicular-sparing surgery for bilateral or monorchide testicular tumours: a multicenter study of long-term oncological and functional results.
        BJU Int. 2014; 114: 860-864https://doi.org/10.1111/bju.12549
        • Galosi AB
        • Fulvi P
        • Fabiani A
        • et al.
        Testicular sparing surgery in small testis masses: a multinstitutional experience.
        Arch Ital di Urol Androl organo Uff [di] Soc Ital di Ecogr Urol e Nefrol. 2016; 88: 320-324https://doi.org/10.4081/aiua.2016.4.320
        • Gentile G
        • Rizzo M
        • Bianchi L
        • et al.
        Testis sparing surgery of small testicular masses: retrospective analysis of a multicenter cohort.
        J Urol. 2019; 203: 760-766https://doi.org/10.1097/ju.0000000000000579
        • Stephenson A
        • Eggener SE
        • Bass EB
        • et al.
        Diagnosis and treatment of early stage testicular cancer: aua guideline.
        J Urol. 2019; 202: 272-281https://doi.org/10.1097/JU.0000000000000318
        • Eifler JB
        • King P
        • Schlegel PN
        Incidental testicular lesions found during infertility evaluation are usually benign and may be managed conservatively.
        J Urol. 2008; 180: 261-265https://doi.org/10.1016/j.juro.2008.03.021
        • Powell TM
        • Tarter TH.
        Management of nonpalpable incidental testicular masses.
        J Urol. 2006; 176: 96-99https://doi.org/10.1016/S0022-5347(06)00496-4
        • Bieniek JM
        • Juvet T
        • Margolis M
        • Grober ED
        • Lo KC
        • Jarvi KA
        Prevalence and management of incidental small testicular masses discovered on ultrasonographic evaluation of male infertility.
        J Urol. 2018; 199: 481-486https://doi.org/10.1016/j.juro.2017.08.004
        • Coret A
        • Leibovitch I
        • Heyman Z
        • Goldwasser B
        • Itzchak Y
        Ultrasonographic evaluation and clinical correlation of intratesticular lesions: a series of 39 cases.
        Br J Urol. 1995; 76: 216-219https://doi.org/10.1111/j.1464-410X.1995.tb07678.x
        • Steiner H
        • Höltl L
        • Maneschg C
        • et al.
        Frozen section analysis-guided organ-sparing approach in testicular tumors: technique, feasibility, and long-term results.
        Urology. 2003; 62 (518-513)https://doi.org/10.1016/S0090-4295(03)00465-5
        • Giannarini G
        • Dieckmann KP
        • Albers P
        • Heidenreich A
        • Pizzocaro G
        Organ-sparing surgery for adult testicular tumours: a systematic review of the literature.
        Eur Urol. 2010; : 780-790https://doi.org/10.1016/j.eururo.2010.01.014
        • Patel HD
        • Gupta M
        • Cheaib JG
        • et al.
        Testis-sparing surgery and scrotal violation for testicular masses suspicious for malignancy: a systematic review and meta-analysis.
        Urol Oncol Semin Orig Investig. 2020; : 344-353https://doi.org/10.1016/j.urolonc.2020.02.023
        • Bojanic N
        • Bumbasirevic U
        • Bojanic G
        • Vukovic I
        • Milojevic B
        • Pekmezovic T
        Testis sparing surgery for treatment of small testicular lesions: is it feasible even in germ cell tumors?.
        J Surg Oncol. 2017; 115: 287-290https://doi.org/10.1002/jso.24502
        • Naughton CK
        • Nadler RB
        • Basler JW
        • Humphrey PA
        Leydig cell hyperplasia.
        Br J Urol. 1998; https://doi.org/10.1046/j.1464-410X.1998.00503.x
        • Bojanic N
        • Bumbasirevic U
        • Vukovic I
        • et al.
        Testis sparing surgery in the treatment of bilateral testicular germ cell tumors and solitary testicle tumors: a single institution experience.
        J Surg Oncol. 2015; 111: 226-230https://doi.org/10.1002/jso.23777
        • Keske M
        • Canda AE
        • Atmaca AF
        • et al.
        Testis-sparing surgery: experience in 13 patients with oncological and functional outcomes.
        Can Urol Assoc J. 2019; : 83-88https://doi.org/10.5489/cuaj.5379
        • Leroy X
        • Rigot JM
        • Aubert S
        • Ballereau C
        • Gosselin B
        • Dieckmann KP
        Value of frozen section examination for the management of nonpalpable incidental testicular tumors.
        Eur Urol. 2003; 44: 458-460https://doi.org/10.1016/S0302-2838(03)00316-6