Section of Urology, Gaetano Barresi Department of Human and Pediatric Pathology, University of Messina, Messina, Italy.
Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy -
Minerva Urol Nephrol. 2021 Aug;73(4):431-441. doi: 10.23736/S2724-6051.21.04330-5. Epub 2021 May 5.
The prevalence of testicular tumor is constantly increasing, with an estimated incidence rate of about 3-10 new cases per 100,000 males/per year. Radical orchiectomy or testis sparing surgery (TSS) are recognized therapeutic approaches in these cases. However, the risk for hypogonadism and infertility is higher with the former compared with the latter. The aim of this systematic review is to evaluate the oncological outcome and testicular function (endocrine and reproductive aspects) in patients who had undergone TSS for small testicular lesions.
To accomplish this, 684 articles were retrieved and screened; 24 retrospective and two prospective studies were selected and finally included in this systematic review.
Overall the TSS attempts were 1096 but TSS was definitively performed in 603 cases (55%). Frozen section examination was performed in 996 TSS attempts (22 out of the 26 studies selected) and showed a benign histology in 37-100% of cases, a malignant histology in 0-63%, and an inconclusive result in 0-16%, respectively. Five studies reported that a total of 22 patients were able to father after conservative surgery. None of these studies reported cases of hypotestosteronemia after surgery and a low prevalence (1.66%) of complications was associated with this type of surgery.
In conclusion, TSS showed to be safe and practicable if used according to the specific guidelines. It can be safely performed to treat recurrence eventually associated to local adjuvant radiotherapy when an intra-tubular neoplasia is present. Urologists can therefore consider TSS as an important means against testicular tumor in selected and well-informed patients.
睾丸肿瘤的发病率不断上升，估计每 10 万男性/年约有 3-10 例新发病例。根治性睾丸切除术或保留睾丸手术（TSS）是这些病例的公认治疗方法。然而，前者发生性腺功能减退和不育症的风险高于后者。本系统评价的目的是评估因小睾丸病变而行 TSS 的患者的肿瘤学结果和睾丸功能（内分泌和生殖方面）。
为了实现这一目标，共检索到 684 篇文章并进行了筛选；选择了 24 项回顾性研究和 2 项前瞻性研究，最终纳入本系统评价。
总的来说，TSS 尝试了 1096 次，但在 603 例（55%）中确实进行了 TSS。在 996 次 TSS 尝试中进行了冰冻切片检查（从 26 项研究中选择了 22 项），分别有 37-100%、0-63%和 0-16%的病例显示良性组织学、恶性组织学和不确定结果。五项研究报告称，共有 22 名患者在保守手术后能够生育。这些研究均未报告手术后出现低睾酮血症的病例，并且与这种手术相关的并发症发生率低（1.66%）。
总之，如果按照特定指南使用，TSS 显示出安全且可行。如果存在管内肿瘤，可以安全地进行 TSS 以治疗局部辅助放疗后可能出现的复发。因此，泌尿科医生可以考虑将 TSS 作为治疗选定和知情患者睾丸肿瘤的重要手段。
