Role of testis sparing surgery in the conservative management of small testicular masses: oncological and functional perspectives.
BACKGROUND
Radical orchiectomy (RO) is still considered the standard of care for malignant germ cell tumours, which represent the vast majority of the palpable testicular masses. In those patients diagnosed with small testicular masses (STMs), testis-sparing surgery (TSS) could be an alternative treatment to RO. The aim of this updated review is to evaluate the current indications for TSS, and discuss the oncological and functional results of patients who had undergone organ-sparing surgery for STMs.


METHODS
A non-systematic review of the Literature using the Medline database has been performed, including a free-text protocol using the terms "testis-sparing surgery", "testicular sparing surgery", "partial orchiectomy", "testis tumour", "sex cord tumour", and "testis function". Other significant studies cited in the reference lists of the selected papers were also evaluated.


RESULTS
No randomized controlled trials comparing TSS with radical orchiectomy have been reported yet. In those patients with normal contra-lateral testis, the use of TSS is still controversial. In selected cases of gonadal masses < 2 cm, TSS seems to be a safe and feasible treatment option. Frozen section examination allows us to discriminate between benign and malignant neoplasms during TSS. Intermediate and long-term follow-up results showed no significant risk of local and distant recurrences in the main series reported in the literature.


CONCLUSIONS
TSS is an effective treatment for STMs in selected patients, limiting the unnecessary surgical over-treatments, without compromising the oncological and functional outcomes. Further studies are needed in order to confirm the oncological safety.
Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bolonia, Italia. Electronic address: mark.borghesi@gmail.com.
M
M
Borghesi
Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bolonia, Italia.
E
E
Brunocilla
Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bolonia, Italia.
R
R
Schiavina
Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bolonia, Italia.
G
G
Gentile
Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bolonia, Italia.
H
H
Dababneh
Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bolonia, Italia.
L
L
Della Mora
Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bolonia, Italia.
C
C
del Prete
Andrology Unit, Azienda Ospedaliero-Universitaria di Bologna, Bolonia, Italia.
A
A
Franceschelli
Andrology Unit, Azienda Ospedaliero-Universitaria di Bologna, Bolonia, Italia.
F
F
Colombo
Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bolonia, Italia.
G
G
Martorana
D000072700:Conservative Treatment; D006801:Humans; D008297:Male; D009919:Orchiectomy; D059351:Organ Sparing Treatments / Q000379:methods*; D020127:Recovery of Function; D013736:Testicular Neoplasms / Q000473:pathology / Q000601:surgery*; D013737:Testis; D016896:Treatment Outcome
Cirugía conservadora testicular; Functional outcomes.; Neoplasias testiculares; Oncological outcomes; Orquiectomía radical; Pequeñas masas testiculares; Radical orchiectomy; Resultados funcionales.; Resultados oncológicos; Small testicular masses; Testicular neoplasms; Testis sparing surgery