title: Can testis-sparing surgery for small testicular masses be considered a valid alternative to radical orchiectomy? A prospective single-center study.
abstract: BACKGROUND
  The aim of this study was to evaluate the incidence of malignancy in small testicular masses (STMs) treated with testis-sparing surgery (TSS) with intraoperative frozen section analysis and to assess the safety of this surgical procedure.
  
  
  METHODS
  From January 2009 to January 2013, 15 consecutive patients underwent TSS for STMs in a third-referral academic institution. Every patient was preoperatively evaluated with clinical examination and scrotal ultrasonography (US) performed by the same radiologist. Tumor markers were assessed in all cases. All the procedures were performed through inguinal access; the small mass was identified by straight palpation of the testis or with intraoperative ultrasonography (IUS). Frozen-section examination (FSE) was performed in all patients in association with multiple biopsies of the surrounding tissue. Follow-up was carried out in all patients with an ultrasonographic exploration at 6 and 12 months.
  
  
  RESULTS
  Preoperative tumor markers were normal in all patients. The mean operative time was 90 ± 31 minutes. The warm ischemia time was 18 ± 3 minutes. The mean size on US was 9.5 ± 4.4 mm. FSE results were confirmed by the final pathologic analysis in 14 patients. At final pathologic analysis, 6 patients (40%) were found not to have tumors, another 7 patients (46.7%) had benign neoplasms, and malignant tumor was found in only 2 patients (13.3%). There was no disease recurrence after a mean follow-up of 19.2 ± 11.5 months.
  
  
  CONCLUSIONS
  Our experience shows that TSS performed for STMs may represent a safe procedure with optimal results in terms of functional and oncologic end points.
authors.affiliation: Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy. Electronic address: dr.giorgio.gentile@gmail.com.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Gentile
authors.forename: Eugenio
authors.initials: E
authors.lastname: Brunocilla
authors.forename: Alessandro
authors.initials: A
authors.lastname: Franceschelli
authors.forename: Riccardo
authors.initials: R
authors.lastname: Schiavina
authors.forename: Cristian
authors.initials: C
authors.lastname: Pultrone
authors.forename: Marco
authors.initials: M
authors.lastname: Borghesi
authors.forename: Daniele
authors.initials: D
authors.lastname: Romagnoli
authors.forename: Matteo
authors.initials: M
authors.lastname: Cevenini
authors.forename: Hussam
authors.initials: H
authors.lastname: Dababneh
authors.forename: Beniamino
authors.initials: B
authors.lastname: Corcioni
authors.forename: Caterina
authors.initials: C
authors.lastname: Gaudiano
authors.forename: Mauro
authors.initials: M
authors.lastname: Gacci
authors.forename: Rita
authors.initials: R
authors.lastname: Golfieri
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Martorana
authors.forename: Fulvio
authors.initials: F
authors.lastname: Colombo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor; D006801:Humans; D008297:Male; D008875:Middle Aged; D009919:Orchiectomy / Q000379:methods; D011446:Prospective Studies; D011859:Radiography; D013736:Testicular Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D013737:Testis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor
keywords: Intraoperative scrotal ultrasonography; Small testicular masses; Stromal testicular neoplasm; Testicular frozen section; Testis-sparing surgery