Hallak Jorge, Cocuzza Marcello, Sarkis Alvaro S, Athayde Kelly S, Cerri Giovanni G, Srougi Miguel
Department of Urology, University of São Paulo, São Paulo, São Paulo, Brazil.
Urology. 2009 Apr;73(4):887-91; discussion 891-2. doi: 10.1016/j.urology.2008.08.510. Epub 2009 Feb 8.
The management of nonpalpable testicular masses is a challenging task, and coexisting infertility can further complicate the treatment decisions. We present our technique for microsurgical organ-sparing resection of incidental nonpalpable testicular nodules combined with microdissection for testicular sperm extraction and tissue cryopreservation in azoospermic patients.
Five infertile patients with azoospermia presented with nonpalpable hypoechoic testicular masses that were detected by ultrasonography and underwent organ-sparing surgery. The testis was delivered through an inguinal incision, and the blood circulation was interrupted with a vascular clamp placed on the spermatic cord. Sludged ice was used to prevent warm ischemia, and a temperature probe was used to control the temperature at 12 degrees-15 degrees C. Real-time reflex ultrasonography was used to locate the tumor, and a stereotaxic hook-shaped needle was inserted under ultrasound guidance. The needle was placed adjacent to the tumor to guide the microsurgical resection. The tunica albuginea was incised over the tumor, which was dissected and removed, along with the adjoining parenchymal tissue. Frozen section studies were performed and, if malignancy was confirmed, biopsies of the tumor cavity margins and remaining parenchyma were obtained to ensure the absence of residual tumor. Microdissection was performed for excision of selected enlarged tubules that were processed and cryopreserved.
We present a technique for microsurgical organ-sparing resection of testicular tumor and sperm extraction that can be used in selected infertile patients with azoospermia in whom incidental masses have been diagnosed by ultrasonography. This conservative approach should be especially considered for patients with a solitary testis or bilateral tumors.
处理不可触及的睾丸肿块是一项具有挑战性的任务，而同时存在的不育症会使治疗决策更加复杂。我们介绍了一种针对偶然发现的不可触及睾丸结节进行显微外科保留器官切除术的技术，该技术还结合了显微解剖以进行无精子症患者的睾丸精子提取和组织冷冻保存。
五例无精子症的不育患者出现了通过超声检查发现的不可触及的低回声睾丸肿块，并接受了保留器官手术。通过腹股沟切口将睾丸取出，用血管夹夹闭精索以中断血液循环。使用淤浆冰预防热缺血，并用温度探头将温度控制在12摄氏度至15摄氏度。使用实时反射超声定位肿瘤，并在超声引导下插入立体定向钩形针。将针放置在肿瘤附近以指导显微外科切除。在肿瘤上方切开白膜，连同相邻的实质组织一起将肿瘤解剖并切除。进行冰冻切片研究，如果确诊为恶性肿瘤，则获取肿瘤腔边缘和剩余实质的活检样本以确保无残留肿瘤。进行显微解剖以切除选定的扩大的曲细精管，这些曲细精管经过处理后进行冷冻保存。
我们介绍了一种用于睾丸肿瘤显微外科保留器官切除和精子提取的技术，该技术可用于经超声检查诊断出偶然肿块的特定无精子症不育患者。对于单睾或双侧肿瘤患者，应特别考虑这种保守方法。
