Benelli Andrea, Varca Virginia, Derchi Lorenzo, Gregori Andrea, Carmignani Giorgio, Simonato Alchiede
Department of Urology, ASST Rohdense, G. Salvini Hospital, Garbagnate Milanese, Milan - Italy.
Department of Radiology, San Martino Hospital, University of Genova, Genova - Italy.
Urologia. 2017 Apr 28;84(2):83-87. doi: 10.5301/uro.5000219. Epub 2017 Mar 15.
We evaluate the clinical outcome of patients treated with conservative approach for small testicular masses (STMs). We analyzed the steps who brought to the selection of the therapeutic approach: starting from clinical presentation, through imaging and lab studies.
We considered 18 patients who underwent an organ-sparing approach for STMs from 2005 until 2014. The selection criteria were dimension of the mass and absence of clinical, laboratory and/or radiological malignancy suspicion. Preoperative scrotal ultrasound (US) was carried out in all the patients by the same radiologist. The postoperative fertility profile was evaluated in patients younger than 40 years.
We performed 13 enucleations, one partial orchiectomy (PO) and four active surveillances. During surgery, a frozen section examination (FSE) was always requested and no discrepancies were noted between its results and the definitive histology. Only one seminomatous tumor was identified, while the remaining masses were four necrosis, four epidermoid cysts, three Leydig tumors, one Sertoli tumor and one chronic orchitis. After a mean follow-up of 41.6 ± 24.7 months, all the patients resulted free of disease and hypogonadism and five of them reached the fatherhood after surgery.
The clinical and instrumental evaluation consented an accurate selection of patients eligible for the organ-preserving approach. We believe that testis-sparing surgery leads good functional and aesthetic results in patients with benign lesions; it is a safe option for STMs with a reliable pathologist performing FSE and is an important goal in young patients with fatherhood desire.
我们评估了采用保守方法治疗小睾丸肿块（STM）患者的临床结果。我们分析了促成治疗方法选择的各个步骤：从临床表现开始，经过影像学和实验室检查。
我们纳入了2005年至2014年间接受STM保留器官治疗的18例患者。选择标准为肿块大小以及无临床、实验室和/或影像学恶性怀疑。所有患者均由同一位放射科医生进行术前阴囊超声（US）检查。对年龄小于40岁的患者评估术后生育情况。
我们进行了13例肿物剜除术、1例部分睾丸切除术（PO）和4例主动监测。手术期间，总是要求进行冰冻切片检查（FSE），其结果与最终组织学检查结果之间未发现差异。仅发现1例精原细胞瘤，其余肿块为4例坏死、4例表皮样囊肿、3例Leydig细胞瘤、1例Sertoli细胞瘤和1例慢性睾丸炎。平均随访41.6±24.7个月后，所有患者均无疾病且无性腺功能减退，其中5例术后成为父亲。
临床和器械评估有助于准确选择适合保留器官方法的患者。我们认为，保留睾丸手术对良性病变患者可带来良好的功能和美学效果；对于有可靠病理学家进行FSE的STM患者，这是一种安全的选择，并且对于有生育愿望的年轻患者来说是一个重要目标。
