Department of Urology, Princess Alexandra Hospital, Harlow.
U-merge Ltd. (Urology for emerging countries), London, UK; Consultant Urologist, Bahrain Specialist Hospital.
Arch Ital Urol Androl. 2021 Sep 30;93(3):296-300. doi: 10.4081/aiua.2021.3.296.
The widespread use of ultrasonography for the investigation of common urological conditions, such as infertility or pain, has resulted in an increased incidence of incidental non-palpable testicular masses. The majority of these are expected to be benign therefore a conservative approach, either active monitoring or organsparing approach, is recommended. However, there are no clinical or radiological parameters which define the exact nature of such lesions and optimal patient selection criteria are lacking. In this comprehensive review we discuss the significance of incidental, small testicular masses (STMs) and the role of organ-sparing approach in the management of these lesions.
A non-systematic search was performed using PubMed to identify articles that covered the following topics; clinical implications at diagnosis, role of imaging in identifying the malignant capabilities of a lesion, role of surgery and the final pathology.
Incidental STMs are routinely identified following ultrasound examination of infertile men. STMs usually measure a few millimeters in size and the majority of these are benign. Therefore, strict follow up or an organ-sparing approach, with utilisation of frozen section analysis (FSA), is favored for STMs. FSA has a high correlation with final pathology and prevents unnecessary orchidectomies. Advances in imaging, namely ultrasound and magnetic resonance imaging may provide enhanced assessment of STMs and guidance intraoperatively.
The optimal approach is not well defined and there is no specific clinical parameter that can predict the nature of STMs. The increasing incidence of small, benign testicular masses has resulted in the development of organ-sparing surgery to investigate and manage these lesions. Organ-sparing surgery has been shown to be practical and carries excellent oncological outcomes.
由于超声检查在不孕或疼痛等常见泌尿科疾病中的广泛应用，偶然发现的无触诊睾丸肿块的发生率有所增加。这些肿块大多数预期为良性，因此建议采取保守方法，无论是主动监测还是保留器官的方法。然而，目前没有临床或影像学参数可以确定这些病变的确切性质，也缺乏最佳的患者选择标准。在本次全面综述中，我们讨论了偶然发现的小睾丸肿块（STMs）的意义，以及保留器官的方法在这些病变管理中的作用。
我们使用 PubMed 进行了非系统性搜索，以确定涵盖以下主题的文章：诊断时的临床意义、影像学在确定病变恶性能力中的作用、手术的作用以及最终的病理学。
在对不育男性进行超声检查后，通常会偶然发现 STMs。STMs 通常大小为数毫米，其中大多数为良性。因此，对于 STMs，严格随访或保留器官的方法，利用冷冻切片分析（FSA），是首选。FSA 与最终病理学具有高度相关性，可以避免不必要的睾丸切除术。成像技术的进步，即超声和磁共振成像，可能会提供对 STMs 的更全面评估，并在手术中提供指导。
最佳方法尚未明确，也没有特定的临床参数可以预测 STMs 的性质。小的良性睾丸肿块发生率的增加导致了保留器官手术的发展，以调查和管理这些病变。保留器官的手术已被证明是实用的，并且具有出色的肿瘤学结果。
