Background:
Radical orchiectomy is the standard treatment in patients with clear features of malignancy and a normal contralateral testis. However, given the high incidence of benign tumors in small testicular masses (
Objectives:
To evaluate perioperative results, safety profile, functional and oncological outcomes of TSS at our institution.
Methods and Materials:
Records of all patients treated with TSS at our center will be analyzed. Patients with a solitary testicular lesion with a diameter of 2 cm or less at preoperative ultrasound will be included in the study.
Patients with multiple lesions or a solitary testis will be excluded.
Outcome measurements and statistical analysis:
Primary end-point of the study is to evaluate the accuracy of frozen section histology in the diagnosis of benign versus malignant masses. Secondary end-points include perioperative results, intra- and post-operative morbidity, functional (fertility, endocrine function) and oncological outcomes (recurrence-free, cancer-specific and overall survival at last follow-up).
Categorical variables are reported as frequency and percentage, and continuous variables as median and interquartile range (IQR) or mean and standard deviation. Kaplan¿Meier methods are used to estimate tumour recurrence and survival after TSS.
TSS is certainly an innovative procedure, from both surgeon's and patient's perspectives. The old dogma that equaled diagnosis of any testicular mass to immediate RO has been confuted by the clinical experience accumulated in the last decade. Similar to what has happened for other cancers and conditions in urology, the management of tumors of the testis has evolved in the last decade in favor of an organ-sparing approach in selected cases. Until the late '80s the axiom existed according to which testes bearing any suspicious mass had to be removed, based on the historically reported very low prevalence of lesions of benign nature and the belief that intraoperative biopsies in presence of malignancy would have invariably led to tumor seeding and disease progression.
However, no randomized controlled trials supporting the use of TSS versus RO for testicular tumors are available and probably will ever be conducted. As such, prospective studies with high number of patients are required since they are clinically relevant for both patients and physicians. In light of this, the present study can significantly contribute to body of knowledge in this field.