Oncology Microsurgical Testis-sparing Surgery in Small Testicular Masses: Seven Years Retrospective Management and Results Stefani De Stefani, Gianmarco Isgrò, Virginia Varca, Annarita Pecchi, Giampaolo Bianchi, Giorgio Carmignani, Lorenzo E. Derchi, Salvatore Micali, Livia Maccio, and Alchiede Simonato OBJECTIVE To retrospectively evaluate the clinical outcomes of 20 patients diagnosed with a nonpalpable or small testicular mass (2 cm) at 2 academic urological department. Testis-sparing surgery (TSS) is currently performed routinely for the management of nonpalpable testicular masses. High reliability of frozen section examination (FSE) and high-frequency ultrasound (US) and the adoption of microsurgical techniques improved safety and feasibility of this technique. METHODS From January 2004 to March 2011, 23 patients underwent microsurgical TSS. An inguinal approach was performed in 22 cases and a suprapubic incision in one bilateral case. All procedures were performed with an operating microscope, with warm ischemia in 21 cases and cold ischemia in 2 cases. Intraoperative US was performed before opening the albuginea. Mean operative time was 89 minutes. RESULTS After mass excision, FSE was performed; only 2 seminomatous tumors were identified, and the remaining masses were benign lesions. After a mean follow-up 12 months, all patients are free of disease; no hypogonadism developed. CONCLUSIONS TSS performed using an operating microscope allowed the preservation of testes for 21 patients diagnosed with small testicular and/or nonpalpable mass (2 cm), without evidence of disease recurrence or de novo onset. This approach could be mandatory in the treatment of bilateral tumors or in solitary testis. Maintaining fertility is not the main goal of TSS because a great number of patients affected by testicular tumors are already infertile. Esthetic outcomes and sparing hormonal function are the main reasons for TSS. UROLOGY 79: 858 – 862, 2012. © 2012 Elsevier Inc. S ince the pioneering work of Stoll in 1986, testis- sparing surgery (TSS) progressively expanded and is now a well-known technique for the treatment of small testicular masses. 1-3 High-frequency ultrasound (US) and frozen section examination (FSE) increase accuracy and reliability of the procedure, and nowadays some investigators also perform TSS for the treatment of germ cell tumor (GCT) in the presence of a normal functioning contralateral testis. 4-7 This approach is aimed to reduce psychosocial consequences related to radical orchiectomy (RO) and to save endocrinal func- tion. 4 Innovative surgical techniques performed based on the use of the operative microscope and on the knowl- edge acquired during surgery for infertility treatment in- crease the efficacy of operation and the possibility of sparing the healthy tissue. 8-11 We report our experience on TSS for surgical treatment of patients with small testicular nodules using the operative microscope as a guide for detection and removal of such lesions. MATERIAL AND METHODS In the clinical setting, a small testicular mass (STM) is defined as 2-cm diameter, and this definition will be adopted from now on in this paper. 3 Between January 2004 and March 2011, STM was diagnosed sonographically in 23 patients (mean age 30.6  11.10 years). One patient was operated after 5 years on the same testis (right) because ultrasound showed a testicular mass at the lower pole. Therefore, the microsurgical exploration of the testes was performed 24 times in 23 patients. Preoperative US was carried out in all cases: mean standard deviation lesion diameter was 14.3  5.2 mm (range 6-25 mm). Patients were referred to our department in 3 cases for testicular pain; in From the Department of Urology, Modena University Hospital, University of Modena and Reggio Emilia, Italy; Department of Urology “Luciano Giuliani,” S. Martino Hospital, University of Genova, Italy; Department of Radiology, Modena University Hospital, University of Modena and Reggio Emilia, Italy; Department of Radiology, San Martino Hospital, University of Genova, Italy; and Department of Anatomical Pathology and Legal Medicine, Section of Anatomical Pathology, Modena University Hospital, University of Modena and Reggio Emilia, Italy Reprint requests: Dr. Gianmarco Isgrò, University of Modena and Reggio Emilia, Department of Urology, Modena University Hospital, Reggio nell’Emilia, Italy. E-mail: g.isgr@alice.it Submitted: July 21, 2011, accepted (with revisions): December 16, 2011 858 © 2012 Elsevier Inc. 0090-4295/12/$36.00 All Rights Reserved doi:10.1016/j.urology.2011.12.039