Outcomes of testes-sparing surgery for the treatment of testicular masses: A multi-centre study
Treatment of testicular masses by inguinal orchidectomy (IO) can have psychological and functional morbidity, particularly in men with a solitary testis or bilateral tumours. Testes-Sparing Surgery (TSS) may offer a more desirable treatment option, allowing preservation of testicular tissue. This study aimed to evaluate the outcomes for patients selected to undergo TSS for the treatment of testicular lesions.
Between January 2007 and May 2017, 90 cases of TSS were performed with Frozen section analysis (FSA) in 85 men, 25 of whom had a solitary testis or bilateral tumours. All patients had discrete or focal lesions. Patients with testicular cancer, were followed up post-operatively with regular ultrasound (US) surveillance. Data was retrospectively collected and analysed from 3 tertiary referral centres.
Mean patient age was 34 years (range 17-76). Of the 90 specimens from TSS, 54 were benign and 36 were malignant on FSA. Of the 54 benign lesions, 47 (87.0%) were effectively managed with TSS only, and 7 (13.0%) underwent delayed IO due to incidental finding of intratubular germ cell neoplasia or the development of chronic orchalgia. Mean tumour size on US was 9.13mm (1.9-33.0) for benign lesions and 13.2mm (3.7-44.0) for malignant lesions. FSA gave an unclear diagnosis in 2 cases of TSS. Overall, mean follow-up was 20 months (range 0-86). Of the 36 malignancies, 17 (47.2%) were managed with TSS only, in patients with a solitary testis, bilateral tumours or those refusing an IO. 19 (52.8%) malignancies were managed with an additional IO. There was recurrence of 4 (23.5%) malignancies in the group managed by TSS alone. The mean time until recurrence was 31 months (range 2-72 months). All recurrent cancers were safely managed by either IO or repeated TSS. Overall, the testis-sparing rate was 87% for benign pathologies and 38.9% for malignancies.
TSS is an effective treatment option for benign indeterminate testicular lesions with high rates of testis preservation. It may also be offered to manage testicular cancers in selected cases; however, a vigorous post-operative US screening programme must be followed due to the relatively high rates of recurrence.