Surgical Decision Making

When can a testis-sparing procedure be considered?

In prepubertal boys with normal serum markers (AFP) in whom US demonstrates a well-circumscribed begin-appearing lesion, partial orchiectomy (testis-sparing) can be considered. An adequate amount of residual testicular parenchyma must be left after resection. Common histologies for which this approach might be possible include mature teratoma, epidermoid cyst, and stromal tumors. The initial approach is the same as for radical orchiectomy: early control of the spermatic cord at the internal inguinal ring via an inguinal incision, and enucleation. Intraoperative US may be needed on occasion.

Radical orchiectomy via an inguinal approach is the standard for the surgical management of testicular malignancy.