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BACKGROUND: Testicular tumors in prepubertal boys account for 1-2% of all solid pediatric tumors. They have a lower incidence, a different histologic distribution and are more often benign compared to testicular tumors in the adolescent and adult group. This fundamental difference should also lead to a different approach and treatment.OBJECTIVE: To provide a guideline for diagnosis and treatment options in prepubertal boys with a testicular mass.METHOD: A structured literature search and review for testicular tumors in prepubertal boys was performed. All English abstracts up to the end of 2019 were screened, and relevant papers were obtained to create the guideline.RESULTS: A painless scrotal mass is the most common clinical presentation. For evaluation, high resolution ultrasound has a detection rate of almost 100%, alpha-fetoprotein is a tumor marker, however, is age dependent. Human chorionic gonadotropin (HCG) was not a tumor marker for testis tumors in prepubertal boys.CONCLUSION: Based on a summary of the literature on prepubertal testis tumors, the 2021 EAU guidelines on Pediatric Urology recommend a partial orchiectomy as the primary approach in tumors with a favorable preoperative ultrasound diagnosis.

Background Testicular tumors in prepubertal boys account for 1-2% of all solid pediatric tumors. They have a lower incidence, a different histologic distribution and are more often benign compared to testicular tumors in the adolescent and adult group. This fundamental difference should also lead to a different approach and treatment. Objective To provide a guideline for diagnosis and treatment options in prepubertal boys with a testicular mass. Method A structured literature search and review for testicular tumors in prepubertal boys was performed. All English abstracts up to the end of 2019 were screened, and relevant papers were obtained to create the guideline. Results A painless scrotal mass is the most common clinical presentation. For evaluation, high resolution ultrasound has a detection rate of almost 100%, alphafetoprotein is a tumor marker, however, is age dependent. Human chorionic gonadotropin (HCG) was not a tumor marker for testis tumors in prepubertal boys. Conclusion Based on a summary of the literature on prepubertal testis tumors, the 2021 EAU guidelines on Pediatric Urology recommend a partial orchiectomy as the primary approach in tumors with a favorable preoperative ultrasound diagnosis.

Background Whilst there is a trend away from aggressive nonorgan sparing surgical treatments for malignant penile disease, a variety of penile preservation options exist but functional outcomes and patient reported outcomes (PROs) in this area are poorly reported to date. Aim The aim of this study is to report functional outcomes and PROs of total glans resurfacing (TGR) in a consecutive series of patients with lichen sclerosis (LS) or localized penile cancer (PC). Methods From 2004 to 2018 a consecutive series of patients underwent TGR for the management of LS or localized PC in a tertiary referral network. Patient clinical records and operative notes were retrospectively reviewed. Statistical analysis was conducted with Stata 12. Outcomes Urinary and sexual outcomes were recorded utilizing both the International Index of Erectile Function (IIEF) and International Prostate Symptom Score (IPSS) validated questionnaires while PROs were extrapolated from a 5-item “ad hoc” telephone questionnaire administered at 1 year post procedure. RESULTS 37 consecutive patients were enrolled. Histology results demonstrated LS in 16 patients, with the remaining 21 having a diagnosis of PC. The most common reasons for patient presentation were local pain (32.4%), pruritus (37.8%) and bleeding (29.7%). Median follow-up was 22 (IQR 13–77) months. Median age was 62 (IQR 55–68). Neither of the questionnaires assessing urinary and sexual function showed any significant deterioration after surgery. Glans sensitivity was fully maintained in 89.2% of cases. 94.5% of patients reported to be fully satisfied with the aesthetic appearance of the penis and would consider undergoing the same procedure again if necessary. 91.9% of patients would recommend the same procedure to someone else. An overall improvement of the quality of life was reported by 86.4% of patients. Clinical Implications TGR should be considered a treatment of choice for selected cases of benign or malignant penile lesions Strengths and Limitations Our study has some limitations, the first being its retrospective nature. Furthermore, despite being one of the largest series to date, follow-up duration is somewhat limited and a control group is lacking. CONCLUSION TGR represents an excellent surgical option ensuring satisfactory voiding and sexual function, as well as cosmesis for selected cases of penile lesions.

Leydig cell tumor (LCT) is an infrequent stromal neoplasm of the testis with an incidence of less than 3% of all gonadal tumors in the general male population. Only 25% is found in prepubertal children, where Leydig cell tumors are always reported benign. The hospital records of two prepubertal male children, who underwent organ sparing surgery for testicular LCT the last five years, were retrospectively reviewed. In both of them, the lesion was incidentally found during a scrotal ultrasonography for testicular pain. The diagnosis of a benign LCT was based on the pre-operative physical examination and imaging (Ultrasound-US, Magnetic Resonance Imaging-MRI) as well as the negative tumor markers. A testicle-sparing procedure was decided and the pathologic examination of the surgical specimen confirmed the diagnosis. No tumor recurrence was noted on follow-up. Testis-sparing surgery provides the possibility of complete excision of such lesions and should be considered as the treatment of choice.

Penile cancer has a high incidence in developing countries. The gold standard treatment is penectomy, however, due to its mutilating nature, organ-preserving techniques such as Mohs' micrography have been developed. This is indicated in small and low-grade invasive tumors, as well as in situ neoplasia. In this regard, we report the case of a young patient with a neoplastic injury in the glans, who had undergone Mohs' micrographic surgery and who achieved satisfactory aesthetic, functional, and oncological results. Despite the recurrence, he had a new surgery by the same method with good outcomes.

Objective: to assess the effectiveness of segmental-selective partial nephrectomy as the method of organ sparing surgery for terminal stages treatment of congenital hydronephrosis in children. Material and methods. Since 1987 and up to date, 32 children with terminal stages of congenital hydronephrosis aged from 1 to 17 years (the average age was 4 years and 2 months) have been treated at the clinic of paediatric surgery in Zaporizhzhia; there were 13 boys (40.63%) and 19 girls (59.37%). The patients were evaluated according to a four&score system: score «excellent' had 8 (25%) patients, «good» — 10 (31.25%), «satisfactory» — 11 (34.375%) patients, and «unsatisfactory» was observed in 1 case. Long-term results were evaluated during the period of 5 to 20 years. An unsatisfactory outcome was observed in one child who had primary nephrectomy on the basis of intraoperative data. X-ray, ultrasound, urodynamic studies were carried out. Results. The conducted study confirmed irregularity, lesion locality of renal structures due to segmental renal dysplasia, differences in blood supply of particular areas of the kidney, heterochronicity of the kidney segments. Even in the advanced stages of hydronephrosis, the areas of normally functioning renal structures are preserved in children that allow developing and performing their functions. The proposed technique allows restoring the passage of urine and pre-serves the kidney. A positive result was achieved in 31 (96.88%) patients. Conclusions. The proposed technique is an alternative to nephrectomy, allows significantly reducing the number of unsatisfactory outcomes of surgical treatment in children with the advanced stages of the disease. The functional capacity of the operated kidney is largely determined by the adaptive process severity in the operated organ and the organism as a whole.

ResumoIntroduçãoA vasta maioria das massas testiculares são tumores malignos de células germinativas. O tratamento standard deste tipo de neoplasias é a orquidectomia radical. No entanto, a cirurgia conservadora do testículo (CCT) pode constituir uma alternativa à cirurgia radical em casos selecionados, nomeadamente em doentes com pequenas massas testiculares (PMT), sem compromisso oncológico e com melhores resultados funcionais.ObjetivoOs autores efetuaram uma revisão das indicações atuais para realização de cirurgia testicular conservadora de órgão, bem como dos resultados funcionais e oncológicos da mesma.Material e métodosProcedeu‐se a uma pesquisa bibliográfica na base de dados Medline (PubMed) utilizando as palavras‐chave: «testis sparing surgery», «partial orchiectomy», «testis tumor», «small testicular mass/tumor». A pesquisa foi limitada a artigos em inglês, publicados entre 2010‐2015. A bibliografia dos artigos selecionados, assim como as diretrizes das principais associações médicas de urologia e oncologia sobre tumor do testículo foram também analisadas.ResultadosNão foram encontrados ensaios randomizados e controlados, ou com elevado nível de evidência, que comparassem a CCT com a orquidectomia radical. As indicações para a CCT são controversas, particularmente em doentes com testículo contralateral normal. Atualmente, a cirurgia conservadora é uma opção terapêutica em doentes com PMT (com

Objectives To assess the feasibility and the safety of conservative surgery to treat spermatic cord leiomyosarcoma. Methods Patients undergoing inguinoscrotal exploration in 10 different Urological Centers with diagnosis of leiomyosarcoma were enrolled. Preoperative evaluation included physical examination, Scrotal US, Abdominal CT and Scrotal MRI in selected cases. Patients underwent organ sparing surgery or orchiectomy in case of intraoperative FSE was positive for a local infiltration. Data collected were: age, presence of infiltration, length of the lesion, number of lesions, definitive histological outcome, pre and postoperative testosterone level. Follow up was performed with abdomen CT scan and scrotal US. Results From January 2007 to December 2013, 23 patients (mean age: 64.7 yrs) were diagnosed with spermatic cord leiomyosarcoma. Each patients underwent scrotal US. 10 patients underwent radical orchiectomy and 13 patients underwent conservative surgery. Mean follow up was 36.5 months. 5 patients (21.7%) developed a recurrent disease, 18 patients (78.3%) had a negative follow up (mean time: 40.8 months). Statistical analysis reveals that there is a significant correlation between number of lesions, length of the lesions and recurrent disease. Conclusions Spermatic cord leiomyosarcoma is a rare disease. Conservative surgical treatment of spermatic cord leiomyosarcoma is a feasible therapeutic option for small, single and not infiltrating lesion.

A 30-year-old man underwent a left high orchiectomy because of stage I testicular tumor in December, 2006. A palpable nodule was noticed in the contralateral testicle in March, 2008. No tumor marker was elevated. Imaging studies including ultrasonography and magnetic resonance imaging showed a 13 mm tumor consisting of both a solid portion and a hemorrhagic cyst. A malignant tumor could not be ruled out completely based on examinations and his medical history. Tumor resection with partial orchiectomy was planned after informed consent. Preoperative serum concentration of free testosterone was 8.4 pg/ml, and motile sperm were found in the semen analysis. The tumor was resected while the spermatic cord was clamped transiently. The pathological diagnosis of frozen sections confirmed no malignancy, and the final pathological result was mature teratoma, no evidence of malignancy. No androgen substitution has been required. Furthermore, a few normal motile sperm were detected in the ejaculated semen after the surgery. Organ-sparing surgery for the contralateral testicular tumor following orchiectomy, can be considered to avoid infertility and hormonal substitutions.

25歳未婚男.左精巣腫瘍に高位精巣摘除術を施行され, 約3年後に右陰嚢内に腫瘤を認めた.超音波断層検査上右精巣内にlow echoic lesionを認め, MRIではT2強調画像で径2cmのlow intensityに強調される部位を認めた.CTでは後腹膜等にリンパ節転移は認めなかった.以上から右精巣腫瘍と診断し, 精巣機能の温存を強く希望されたため, 精液を冷凍保存した上で, 右精巣部分切除を施行した.摘出標本の病理結果はseminomaであり, 生検組織中にCarcinoma in situを認めなかった.術後の精液検査の結果は無精子症であったが, 術後1年6ヵ月経過で再発は認めず, 超音波断層検査上, 残存精巣は径3cmであった.testosterone値は術後1台後半から2台前半と低値であるが, 補充療法は必要ないと考えられる.なお, リビドーや勃起能・射精能に関しては術後も維持されている.本邦で部分切除術を施行した報告は調べ得た限りでは3症例のみで, 全例再発を認めておらず, 両側精巣腫瘍に対する温存手術は治療の選択肢の1つとして十分に考慮に値する治療法であると考えられた, A 25-year-old single man presented with a mass in the right testis. He had a history of left radical orchiectomy for testicular cancer. Magnetic resonance imaging (MRI) and ultrasonography demonstrated a tumor (2 cm in diameter) within the right tests. The patient underwent right partial orchiectomy. Histological examination revealed typical seminoma of the right testis. He is alive with no evidence of disease recurrence at 18 months after surgery, and did not need androgen substitution.

A 30-year-old man underwent a left high orchiectomy because of stage I testicular tumor in December, 2006. A palpable nodule was noticed in the contralateral testicle in March, 2008. No tumor marker was elevated. Imaging studies including ultrasonography and magnetic resonance imaging showed a 13 mm tumor consisting of both a solid portion and a hemorrhagic cyst. A malignant tumor could not be ruled out completely based on examinations and his medical history. Tumor resection with partial orchiectomy was planned after informed consent. Preoperative serum concentration of free testosterone was 8.4 pg/ml, and motile sperm were found in the semen analysis. The tumor was resected while the spermatic cord was clamped transiently. The pathological diagnosis of frozen sections confirmed no malignancy, and the final pathological result was mature teratoma, no evidence of malignancy. No androgen substitution has been required. Furthermore, a few normal motile sperm were detected in the ejaculated semen after the surgery. Organ-sparing surgery for the contralateral testicular tumor following orchiectomy, can be considered to avoid infertility and hormonal substitutions.

PubMed ID: 25659561, Epidermoid cyst of the testis is a benign, non-teratomatous tumour. It is often possible to make the diagnosis pre-operatively, combining typical sonographic features with normal biochemical tumour markers. The accurate pre-operative diagnosis will allow for testis-sparing surgery and prevent unnecessary orchiectomy. An 11-year-old boy with testicular epidermoid cyst who presented with pain in testis was presented in this report.

A 25-year-old single man presented with a mass in the right testis. He had a history of left radical orchiectomy for testicular cancer. Magnetic resonance imaging (MRI) and ultrasonography demonstrated a tumor (2 cm in diameter) within the right tests. The patient underwent right partial orchiectomy. Histological examination revealed typical seminoma of the right testis. He is alive with no evidence of disease recurrence at 18 months after surgery, and did not need androgen substitution.