Role of testis-sparing surgery in the conservative management of small testicular masses: Oncological and functional perspectives

Introduction Radical orchiectomy (RO) is still considered the standard of care for malignant germ cell tumours, which represent the vast majority of the palpable testicular masses. In those patients diagnosed with small testicular masses (STMs), testis-sparing surgery (TSS) could be an alternative treatment to RO. The aim of this updated review is to evaluate the current indications for TSS, and discuss the oncological and functional results of patients who had undergone organ-sparing surgery for STMs. Evidence acquisition A non-systematic review of the Literature using the Medline database has been performed, including a free-text protocol using the terms “testis-sparing surgery”, “testicular sparing surgery”, “partial orchiectomy”, “testis tumour”, “sex cord tumour”, and “testis function”. Other significant studies cited in the reference lists of the selected papers were also evaluated. Evidence synthesis No randomized controlled trials comparing TSS with radical orchiectomy have been reported yet. In those patients with normal contra-lateral testis, the use of TSS is still controversial. In selected cases of gonadal masses Conclusions TSS is an effective treatment for STMs in selected patients, limiting the unnecessary surgical over-treatments, without compromising the oncological and functional outcomes. Further studies are needed in order to confirm the oncological safety.