Testis-sparing surgery for testicular masses: current perspectives

Minerva Urol Nefrol. 2019 Aug;71(4):359-364. doi: 10.23736/S0393-2249.19.03315-0. Epub 2019 Apr 5.


Introduction: Males who present with a palpable testis nodule are likely to have malignant germ cell tumor in >90% of cases. Therefore radical orchiectomy remains the standard of care for intratesticular tumors. However, due to the recent developments of high-frequency probes in ultrasonography, the incidence of detecting a small non-palpable testis tumor is higher and higher. These lesions are thought to be benign in more than 60-80% of cases, thus a radical orchiectomy should be considered an overtreatment. In addition to that, radical orchiectomy might cause infertility, psychological issues and endocrine disorders, hence an organ-sparing procedure in such cases should be pursued.

Evidence acquisition: Only fourteen reliable retrospective studies met the inclusion criteria. No prospective randomized trials have appeared in Medline database.

Evidence synthesis: This review of the current literature has confirmed the safety and efficacy of testicular-sparing surgery in selected patients: 1) monorchid patients; 2) bilateral testis masses; 3) normal patients with a small, non-palpable masses detected with US, as long as the dimension of the lesion is up to 3 cm and not greater that 30% of the total volume of the organ.

Conclusions: According to the literature, testis sparing surgery is a safe and feasible procedure for patients presenting a benign small testis mass. The enthusiasm found in the literature should however be tempered as the small number of patients reported in the studies coupled with the absence of a prospective trial represent important limits that need to be overtaken. Therefore more robust and well-designed studies are needed.

Publication types

  • Review

MeSH terms

  • Humans
  • Male
  • Neoplasms, Germ Cell and Embryonal / surgery*
  • Orchiectomy
  • Organ Sparing Treatments / methods*
  • Testicular Neoplasms / surgery*
  • Testis / surgery*