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Evaluation of the decision-making process in the conservative approach to small testicular masses

Abstract

Introduction

We evaluate the clinical outcome of patients treated with conservative approach for small testicular masses (STMs). We analyzed the steps who brought to the selection of the therapeutic approach: starting from clinical presentation, through imaging and lab studies.

Methods

We considered 18 patients who underwent an organ-sparing approach for STMs from 2005 until 2014. The selection criteria were dimension of the mass and absence of clinical, laboratory and/or radiological malignancy suspicion. Preoperative scrotal ultrasound (US) was carried out in all the patients by the same radiologist. The postoperative fertility profile was evaluated in patients younger than 40 years.

Results

We performed 13 enucleations, one partial orchiectomy (PO) and four active surveillances. During surgery, a frozen section examination (FSE) was always requested and no discrepancies were noted between its results and the definitive histology. Only one seminomatous tumor was identified, while the remaining masses were four necrosis, four epidermoid cysts, three Leydig tumors, one Sertoli tumor and one chronic orchitis. After a mean follow-up of 41.6 ± 24.7 months, all the patients resulted free of disease and hypogonadism and five of them reached the fatherhood after surgery.

Conclusions

The clinical and instrumental evaluation consented an accurate selection of patients eligible for the organ-preserving approach. We believe that testis-sparing surgery leads good functional and aesthetic results in patients with benign lesions; it is a safe option for STMs with a reliable pathologist performing FSE and is an important goal in young patients with fatherhood desire.

Urologia 2017; 84(2): 83 - 87

Article Type: ORIGINAL RESEARCH ARTICLE

DOI:10.5301/uro.5000219

Authors

Andrea Benelli, Virginia Varca, Lorenzo Derchi, Andrea Gregori, Giorgio Carmignani, Alchiede Simonato

Article History

Disclosures

Financial support: The authors have not received any funding for this study.
Conflict of interest: None of the contributing authors have any conflict of interest, including specific financial interests or relationships and affiliations relevant to the subject matter or materials discussed in the manuscript.

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Authors

Affiliations

  • Department of Urology, ASST Rohdense, G. Salvini Hospital, Garbagnate Milanese, Milan - Italy
  • Department of Radiology, San Martino Hospital, University of Genova, Genova - Italy
  • Department of Urology “L. Giuliani”, San Martino Hospital, University of Genova, Genova - Italy

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