title: Microsurgical testis-sparing surgery in small testicular masses: seven years retrospective management and results.
abstract: OBJECTIVE
  To retrospectively evaluate the clinical outcomes of 20 patients diagnosed with a nonpalpable or small testicular mass (2 cm) at 2 academic urological department. Testis-sparing surgery (TSS) is currently performed routinely for the management of nonpalpable testicular masses. High reliability of frozen section examination (FSE) and high-frequency ultrasound (US) and the adoption of microsurgical techniques improved safety and feasibility of this technique.
  
  
  METHODS
  From January 2004 to March 2011, 23 patients underwent microsurgical TSS. An inguinal approach was performed in 22 cases and a suprapubic incision in one bilateral case. All procedures were performed with an operating microscope, with warm ischemia in 21 cases and cold ischemia in 2 cases. Intraoperative US was performed before opening the albuginea. Mean operative time was 89 minutes.
  
  
  RESULTS
  After mass excision, FSE was performed; only 2 seminomatous tumors were identified, and the remaining masses were benign lesions. After a mean follow-up >12 months, all patients are free of disease; no hypogonadism developed.
  
  
  CONCLUSIONS
  TSS performed using an operating microscope allowed the preservation of testes for 21 patients diagnosed with small testicular and/or nonpalpable mass (<2 cm), without evidence of disease recurrence or de novo onset. This approach could be mandatory in the treatment of bilateral tumors or in solitary testis. Maintaining fertility is not the main goal of TSS because a great number of patients affected by testicular tumors are already infertile. Esthetic outcomes and sparing hormonal function are the main reasons for TSS.
authors.affiliation: Department of Urology, Modena University Hospital, University of Modena and Reggio Emilia, Italy.
authors.forename: Stefani
authors.initials: S
authors.lastname: De Stefani
authors.forename: Gianmarco
authors.initials: G
authors.lastname: Isgrò
authors.forename: Virginia
authors.initials: V
authors.lastname: Varca
authors.forename: Annarita
authors.initials: A
authors.lastname: Pecchi
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Bianchi
authors.forename: Giorgio
authors.initials: G
authors.lastname: Carmignani
authors.forename: Lorenzo E
authors.initials: LE
authors.lastname: Derchi
authors.forename: Salvatore
authors.initials: S
authors.lastname: Micali
authors.forename: Livia
authors.initials: L
authors.lastname: Maccio
authors.forename: Alchiede
authors.initials: A
authors.lastname: Simonato
mesh_terms: D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D012189:Retrospective Studies; D018239:Seminoma / Q000601:surgery; D013736:Testicular Neoplasms / Q000601:surgery*; D013737:Testis / Q000098:blood supply; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male / Q000379:methods*