Carefully selected intratesticular lesions can be safely managed with serial ultrasonography.
OBJECTIVE
To evaluate a policy of conservative non-operative management for incidental, impalpable, < 1 cm, intratesticular pathology.


METHODS
We retrospectively reviewed all scrotal ultrasonograms within an 8-year period to identify all radiological lesions of < 1 cm within the testis. All palpable lesions and those accompanied by elevated tumour markers or disseminated malignancy were managed surgically. The remaining incidentally detected lesions were followed with a protocol of serial ultrasonography (US).


RESULTS
Of 1544 scans reviewed, 12 (0.8%) lesions suitable for observational management were identified. The mean (range) age of the patients was 54 (34-76) years. The indication for US was suspected epididymitis in five, contralateral epididymal cyst in five and infertility in two patients. The mean (range) size of the lesion was 4.9 (1.5-9.8) mm. Three anechoic lesions were consistent with intratesticular cysts, and each was followed with no change to a mean (range) follow-up of 26 (12-48) months. Eight hypoechoic lesions were followed to a mean of 34 (4-72) months, and only one showed growth on repeat US after an interval of 4 months, and was diagnosed as a 1.0-cm seminoma after orchidectomy. One hyperechoic lesion remains unchanged at 6 months of follow-up.


CONCLUSIONS
Supported by previous reports suggesting that most testis lesions of < 1 cm are benign, we managed a series of carefully selected intratesticular lesions conservatively, the behaviour in most being in keeping with benign pathology.
Connolly
Stephen S
SS
Department of Urology, University College Hospital Galway, National University of Ireland, Galway, Ireland. steconolly@rcsi.ie
D'Arcy
Frank T
FT
Gough
Niall
N
McCarthy
Peter
P
Bredin
Hugh C
HC
Corcoran
Michael O
MO
D000328:Adult; D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D013736:Testicular Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D014463:Ultrasonography