V09-12: Testicular conservative surgery in small testicular mass treatment
Radical orchiectomy (RO) is considered the treatment of choice for malignant germ cell tumors, which represent the majority of palpable testicular masses. In patients with small testicular masses, conservative testicular surgery (CTS) could be an alternative treatment to RO.
We present the case of a 42-year-old man who consulted for left testicular pain of two months of evolution. Doppler ultrasound was performed, showing a 7 mm lesion in the upper third of the right testicle; hypoechoic, discretely heterogeneous with regular borders. There was no clear vascularization in the Doppler US, but when contrast was administered it behaved as a vascularized lesion. It was accompanied by microcalcifications and was not palpable. Tumor markers were negative. Given the location and small size of the lesion, it was decided to perform inguinal exploration of the testicle, with the intention of performing a CTS if easible. To prevent tumor spread, the spermatic cord was isolated and fixed with a tourniquet. Then, exposure of the superior pole of the testicle was carried out, we could not define the tumor, so we performed intraoperative evaluation of the lesion. After scoring the area, the tunica albuginea was opened and the lesion was resected, sending the sample intraoperatively to check the total resection of the tumor with adequate margins. Subsequently, the testicular pulp was reconstructed, applying a Tachoseal® haemostatic patch over it and suturing the tunica albuginea over it with a 4/0 resorbable continuous suture.
There were no intraoperative complications with 25-minute ischemia time. Hospital stay was 24 hours. Postoperative ultrasound revealed good vascularization in the right testicle. The pathological report was compatible with a Leydig cell tumor. The patient is free of recurrence after 12 months.
CTS should be considered as a treatment option in the management of small testicular masses, with the support of ultrasound and intraoperative biopsy to safely determine tumor resection.