Search

Objective:We aimed to determine the predictive value of additional parameters for differentiating benign-malign tumors and to identify optimal patients for partial orchiectomy in unilateral, small (≤2 cm) testicular masses.Methods:The data of 31 patients who underwent radical orchiectomy between January 2010 and December 2017 due to unilateral and small testicular masses were retrospectively analyzed. Demographic data, histopathological tumor types, serum tumor markers, neutrophil/lymphocyte ratio (NLR), monocyte/ lymphocyte ratio (MLR), platelet/lymphocyte ratio (PLR), mean platelet volume (MPV), red cell distribution width (RDW), the presence of testicular dysgenesis syndrome (TDS) and its components, postoperative follow-up outcomes were recorded. Patients were divided into two groups as benign and malignant.Results:There was no significant difference between groups in terms of AFP (p=0.116), β-hCG (p=0.205), LDH (p=0.606), MPV (p=0.087) and RDW (p=0.266); while MLR (p=0.001), NLR (p=0.036) and PLR (p=0.001) were significantly higher in malignant group. The presences of testicular microlithiasis (p=0.719), undescended testis (p=0.254), hypospadias (p=0.645), atrophic testis (p=0.409) were not different between groups; while the rate of disorders of semen parameters (p=0.043) and presence of TDS (p=0.043) were significantly higher in malignant cases. In multivariate analysis, MLR and PLR were found as predictive factors for benign-malign distinction of small testicular masses.Conclusion:In the patients in whom preoperative malignancy suspicion could not be excluded, we think that PLR, MLR, NLR, disorders of semen parameters and presence of TDS may have high predictive value for benign-malign distinction. Partial orchiectomy may be recommended in patients with suspicion of benign lesions according to these parameters.

Introduction We present our experience with patients who had suspected testicular masses, managed by a frozen section assessment and testicular sparing surgery. Material and methods We performed a retrospective review of all patients over the last 5 years, who underwent a frozen section assessment and testicular sparing surgery for small testicular lesions. The frozen section assessment was compared with the final histology. Results Twelve patients were identified. The mean age of patients was 40 years (22-58 years). The mean lesion size was 9.8 mm (3-18 mm). Presentations varied: a testicular lump was palpable in 7 patients and 3 patients were referred due to infertility with a subsequent ultrasound, which showed incidental testicular lesions. Two patients presented with testicular pain. Tumour marker levels were within the normal limits in all patients.The frozen section assessment correctly determined 10 out of 12 (83%) lesions, showing 1 (8%) lymphoma, 2 (17%) seminomas, 3 (25%) fibrosis, 3 (25%) low-grade Leydig cell tumours and 1 (8%) adenomatous tumour. The frozen section reported a benign epidermal cyst in 1 case, whilst the final histology showed a pre-pubertal type teratoma, a rare and low risk tumour. One patient (8%) had an indeterminate lesion, which proved to be a benign adenomatous tumour on final histology. All malignant cases were correctly identified.There was no malignancy in 9 out of 12 (75%) patients therefore they had testicular sparing surgery. Three patients had orchidectomy, two due to a seminoma and one due to an indeterminate lesion. One patient developed a postoperative haematoma requiring antibiotics but there were no other complications. Conclusions Our findings demonstrate that partial orchidectomy with a frozen section assessment is useful in small testicular masses and testicular sparing surgery can be considered in order to prevent a radical orchidectomy in selected patients.

Introduction: we present oncological and functional outcomes of patients who underwent testis-sparing surgery (TSS). Methods: overall, 13 patients were included. Mean patient age was 29.9 +/- 12.5 years. In five patients, TSS was performed for sequential bilateral testicular tumours. One patient underwent concurrent left radical orchiectomy and right TSS. In eight patients with normal contralateral testis, seven underwent left and one underwent right TSS. Results: mean pathological tumour size was 14.6 +/- 12.5 mm. lntraoperative frozen section evaluation of the mass was performed in eight patients that revealed benign lesions. No intraoperative tumour bed biopsies were taken in this patient group. Regarding the remaining five patients, intraoperative tumour bed biopsies were taken and testicular intraepithelial neoplasia (TIN) was reported in two (40%) patients; no local testicular radiotherapy was given postoperatively. Tumour pathology was malignant in all but one lesion, including Leydig cell tumour (n=1), seminoma(n=2), embryonal carcinoma (n=1), and adenomatoid tumour (n=1). During 47.2 +/- 22.5 months of followup, local recurrence was detected in one patient who underwent radical orchiectomy. No additional local recurrence or systemic metastasis was identified in other patients with malignant lesions. For patients with malignant tumours, of the three patients with a normal preoperative testosterone levels, testosterone level was normal in one patient (with no erectile dysfunction [ED]) and was decreased in two patients (with ED) following TSS. No ED was reported in the nine patients with benign lesions. Conclusions: in carefully selected cases, TSS appears to be a safe, feasible procedure with adequate cancer control that could preserve sexual function., NA

OBJECTIVE To retrospectively evaluate the clinical outcomes of 20 patients diagnosed with a nonpalpable or small testicular mass (2 cm) at 2 academic urological department. Testis-sparing surgery (TSS) is currently performed routinely for the management of nonpalpable testicular masses. High reliability of frozen section examination (FSE) and high-frequency ultrasound (US) and the adoption of microsurgical techniques improved safety and feasibility of this technique.METHODS From January 2004 to March 2011, 23 patients underwent microsurgical TSS. An inguinal approach was performed in 22 cases and a suprapubic incision in one bilateral case. All procedures were performed with an operating microscope, with warm ischemia in 21 cases and cold ischemia in 2 cases. Intraoperative US was performed before opening the albuginea. Mean operative time was 89 minutes.RESULTS After mass excision, FSE was performed; only 2 seminomatous tumors were identified, and the remaining masses were benign lesions. After a mean follow-up >12 months, all patients are free of disease; no hypogonadism developed.CONCLUSIONS TSS performed using an operating microscope allowed the preservation of testes for 21 patients diagnosed with small testicular and/or nonpalpable mass (