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Is Testis Sparing Surgery Safe in Patients with Incidental Small Testicular Lesions Referring to a Fertility Center? A Retrospective Analysis Reporting Factors Correlated to Malignancy and Long-Term Oncological Outcomes - Beyond the Abstract

As you may recall from your experience and read in our recently published article, small testicular lesions (STL) are a rather frequent finding during fertility workup, especially in centers where physicians perform routinely ultrasonography.1 Our article offers an overview of the possible treatments (or “not-treatments”, such as active surveillance) that can be used by both general urologists and urologists specialized in fertility management. Aiming to preserve testicular functions while being ontologically safe (i.e., all patients had negative markers and were widely followed up), we show the findings from a conservative approach based on a testis sparing surgery for STL in a cohort of patients referring for infertility evaluation, eventually with a subsequent radical orchiectomy.

In our center, fertility center urologists are also experts in general urology and manage patients with STL based on both cancer and fertility outcomes. From our experience, we appreciate that there is not this sharing of knowledge in all centers, and fertility urologists may not be the ones treating patients affected by STL found during infertility workup. In this setting, we hope that also general urologists would find our article pleasing, bringing to them some interesting insights on possible approaches.

One aspect that our research tried to stress, is that the indication to the surgical treatment plays a pivotal role. The most widespread diagnostic tool in testicular lesions workup is ultrasound imaging, therefore the most relevant features from this exam should be thoroughly assessed. We found ourselves surprised to appreciate that ultrasonographic features, other than lesion dimension, are seldom reported. To steer the patient towards the best surgical management, hopefully preserving as much testicular parenchyma as possible, we believe that the ultrasonographic features of STL should be better disclosed in future research on the topic. In this regard, thanks to the ultrasonographic skills of the urologists in our fertility center, we analyzed some intriguing associations with the definitive histological report in our sample of sub-fertile men.

Considering the extremely important role that ultrasound holds, in the hope of giving some solid evidence to the ultrasonographic assessment of STL we highly encourage researchers to include in their results the detailed ultrasonographic appearance or to begin a more accurate reporting in the next future.

Written by: Andrea Gobbo, MD,1 Vittorio Fasulo, MD,1 Luciano Negri, MD,2 Nicolò Maria Buffi, MD,1 Paolo Levi Setti, MD,3

  1. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
  2. Department of Gynecology, Division of Gynecology and Reproductive Medicine-Fertility Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
  3. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Department of Gynecology, Division of Gynecology and Reproductive Medicine-Fertility Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.

References:

  1. Gobbo A, Negri L, Casale P, Fasulo V, Lughezzani G, Saitta C, et al. Is testis sparing surgery safe in patients with incidental small testicular lesions referring to a fertility center? A retrospective analysis reporting factors correlated to malignancy and long-term oncological outcomes. Urol Oncol Semin Orig Investig 2022;000:1–8. https://doi.org/10.1016/j.urolonc.2022.08.002.

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