title: Carefully selected intratesticular lesions can be safely managed with serial ultrasonography.
abstract: 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.
authors.affiliation: Department of Urology, University College Hospital Galway, National University of Ireland, Galway, Ireland. steconolly@rcsi.ie
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Connolly
authors.forename: Frank T
authors.initials: FT
authors.lastname: D'Arcy
authors.forename: Niall
authors.initials: N
authors.lastname: Gough
authors.forename: Peter
authors.initials: P
authors.lastname: McCarthy
authors.forename: Hugh C
authors.initials: HC
authors.lastname: Bredin
authors.forename: Michael O
authors.initials: MO
authors.lastname: Corcoran
mesh_terms: 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