title: Organ-sparing microsurgical resection of incidental testicular tumors plus microdissection for sperm extraction and cryopreservation in azoospermic patients: surgical aspects and technical refinements.
abstract: BACKGROUND
  The management of nonpalpable testicular masses is a challenging task, and coexisting infertility can further complicate the treatment decisions. We present our technique for microsurgical organ-sparing resection of incidental nonpalpable testicular nodules combined with microdissection for testicular sperm extraction and tissue cryopreservation in azoospermic patients.
  
  
  METHODS
  Five infertile patients with azoospermia presented with nonpalpable hypoechoic testicular masses that were detected by ultrasonography and underwent organ-sparing surgery. The testis was delivered through an inguinal incision, and the blood circulation was interrupted with a vascular clamp placed on the spermatic cord. Sludged ice was used to prevent warm ischemia, and a temperature probe was used to control the temperature at 12 degrees-15 degrees C. Real-time reflex ultrasonography was used to locate the tumor, and a stereotaxic hook-shaped needle was inserted under ultrasound guidance. The needle was placed adjacent to the tumor to guide the microsurgical resection. The tunica albuginea was incised over the tumor, which was dissected and removed, along with the adjoining parenchymal tissue. Frozen section studies were performed and, if malignancy was confirmed, biopsies of the tumor cavity margins and remaining parenchyma were obtained to ensure the absence of residual tumor. Microdissection was performed for excision of selected enlarged tubules that were processed and cryopreserved.
  
  
  CONCLUSIONS
  We present a technique for microsurgical organ-sparing resection of testicular tumor and sperm extraction that can be used in selected infertile patients with azoospermia in whom incidental masses have been diagnosed by ultrasonography. This conservative approach should be especially considered for patients with a solitary testis or bilateral tumors.
authors.affiliation: Department of Urology, University of São Paulo, São Paulo, São Paulo, Brazil. hallakj@androscience.com.br
authors.forename: Jorge
authors.initials: J
authors.lastname: Hallak
authors.forename: Marcello
authors.initials: M
authors.lastname: Cocuzza
authors.forename: Alvaro S
authors.initials: AS
authors.lastname: Sarkis
authors.forename: Kelly S
authors.initials: KS
authors.lastname: Athayde
authors.forename: Giovanni G
authors.initials: GG
authors.lastname: Cerri
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
mesh_terms: D000328:Adult; D053713:Azoospermia / Q000150:complications / Q000601:surgery*; D015925:Cryopreservation; D006801:Humans; D008297:Male; D008866:Microsurgery; D013736:Testicular Neoplasms / Q000150:complications / Q000601:surgery*; D020858:Tissue and Organ Harvesting; D013521:Urologic Surgical Procedures, Male / Q000379:methods