Two testes are better than one: results of a large multicentric retrospective study on testis sparing surgery

Introduction & Objectives: Radical Orchiectomy (RO) represents the standard treatment for patients (pts) with suspicious testicular masses and normal contralateral testis. Since a considerable amount of small testicular masses (STM) are benign lesions, this practice expose to a substantial risk of overtreatment with possible medical-legal consequences. In addiction, after RO men report more sexual dysfunction than do men in an agematched group with other forms of cancer, probably because of the effect of the procedure on body image. Aim of this study is to report the results of testis sparing surgery (TSS) in the treatment of STM (< 2cm) and to identify an updated treatment strategy. Materials & methods: We retrospectively reviewed clinical history of pts treated with TSS for STM < 2cm in five Italian tertiary referral centres. Demographics, pathological features and postoperative follow-up (FU) data were recorded and analysed. Results: Between Jan 2009 and Jan 2017, 147 pts have undergone TSS for STM < 2 cm at diagnostic evaluation. Mean pts age was 33 (28-41) years. All diagnoses of STM were based on ultrasound scan (US), performed for pain in 25 pts, palpable testicular mass in 20, varicocele in 15, infertility in 45 and other reasons in 42. No pts had elevated serum tumour markers. In all cases diagnosis of benign or malignant nature was achieved with frozen section examination (FSE) followed by definitive histology. Pts with benign lesions at FSE underwent TSS. Pts with malignant lesions at FSE underwent immediate RO. No complications were reported. 21 pts (14,3%) harboured malignant tumours while 126 (85,7%) benign lesions. In only two cases FSE was not confirmed by definitive pathological examination. FU has been scheduled according to EAU guidelines. Median FU of pts with malignant lesion was (24 months). No tumour recurrences or diffusion were reported. ROC analysis demonstrated that benign conditions were present in 92.6% of STM < 1cm and in 73,1% of STM from 1 to 2 cm (p<0,001). In pts with malignancies, during follow-up no recurrences or tumour spreading were observed when RO was preceded by TSS. Conclusions: TSS for STM is a safe and feasible procedure. It allowed preservation of testis in the majority of pts and therefore should be considered the procedure of choice, particularly in nodules < 1cm. TSS should be offered to all men with STM, in order to avoid overtreatment and improve pt satisfaction