title: Microsurgical "testis-sparing" surgery for nonpalpable hypoechoic testicular lesions.
abstract: OBJECTIVE
  With the increased use of trans-scrotal ultrasonography, the unexpected detection of nonpalpable hypoechoic testicular lesions has become more frequent. The different approaches vary from radical orchiectomy to simple ultrasound follow-up, but definitive guidelines do not yet exist about the management of these lesions. We report our series of patients with hypoechoic testicular lesions who underwent surgical exploration with the aid of an operating microscope.
  
  
  METHODS
  A total of 7 patients were considered for microsurgical exploration of a nonpalpable hypoechoic testicular lesion from April 2003 to June 2005. The hospital records and ultrasound and operative reports were reviewed retrospectively.
  
  
  RESULTS
  The side of the lesion was the left testis in 4 patients and the right testis in 3. The mean size of the hypoechoic area was 5.7 +/- 4.6 mm (range 2.5 to 16). The microsurgical technique allowed us to identify and successfully excise the lesion in all patients. Intraoperative frozen section examination revealed a benign lesion in 6 cases and testicular intraepithelial neoplasia in 1. The patient with testicular intraepithelial neoplasia underwent radical orchiectomy. The definitive histologic analysis always confirmed the frozen section examination report. The patients were evaluated clinically and by ultrasonography for a mean follow-up of 15 months. No complications occurred.
  
  
  CONCLUSIONS
  Microsurgical exploration of the testis combined with frozen section examination represents a safe, effective, and reliable technique for evaluation of nonpalpable hypoechoic testicular lesions. This approach has significant advantages and should be considered in particular for patients with a solitary testis or presenting with bilateral lesions and wishing to father a child.
authors.affiliation: Divisione Universitaria di Urologia II, Dipartimento di Discipline Medico-Chirurgiche, Università degli Studi di Torino, Ospedale San Giovanni Battista, Molinette, Torino, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Rolle
authors.forename: Andrea
authors.initials: A
authors.lastname: Tamagnone
authors.forename: Paolo
authors.initials: P
authors.lastname: Destefanis
authors.forename: Andrea
authors.initials: A
authors.lastname: Bosio
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Timpano
authors.forename: Cristian
authors.initials: C
authors.lastname: Fiori
authors.forename: Carlo
authors.initials: C
authors.lastname: Ceruti
authors.forename: Paola
authors.initials: P
authors.lastname: Burlo
authors.forename: Piera
authors.initials: P
authors.lastname: Fauciglietti
authors.forename: Dario
authors.initials: D
authors.lastname: Fontana
mesh_terms: D000328:Adult; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D013733:Testicular Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D013736:Testicular Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D014463:Ultrasonography