Heavy balls to keep or cut?

What is a testicular tumor? Testicular tumors are a rare tumor, accounting for only 1%-1.
5% of male tumors, but their incidence is the highest in young men aged 15-34 years
.

Traditionally, most testicular tumors are considered malignant, and radical orchiectomy is generally adopted, that is, the entire diseased testis and the spermatic cord connected to it are removed
.

Most doctors tend to worry that testicular preservation surgery will lead to tumor spread, so testicular sparing surgery is performed less often
.

In fact, for small testicular tumors (<2 cm) in adult men, the proportion of benign tumors is not low
.

Benign testicular tumors are more common, especially in children under 4 years of age
.

Although the removal of unilateral testicles in most patients does not affect male-related functions such as fertility, there are still many patients with testicular-related dysfunctions such as decreased sperm count and decreased sex hormone levels
.

In addition, some studies have also found that the removal of one testicle will also leave corresponding social and psychological trauma to patients, especially children with testicular tumors
.

Based on these realities and the consideration of improving the treatment effect, testicular-sparing surgery came into being
.

Can testicular preservation control tumors? Judging from the research on benign tumors in recent years, the operation of preserving the testis has gradually been recognized by domestic and foreign experts
.

And the results achieved by my center in preserving the testicles are also gratifying
.

In the past 15 years, our center has treated 68 cases of benign testicular tumors, of which 30 cases underwent testicular-sparing surgery.
The median follow-up time was 78 months (6.
5 years), and no tumor recurrence or testicular atrophy was found
.

Among them, 13 children had no significant gap in growth and development with their peers
.

These results let us see that retaining testicles is not a fantasy
.

Cut or save? Where is the key? The most critical part of performing testicular-sparing surgery is to determine which patients may be benign tumors before surgery, and then evaluate whether these patients have enough normal testicular tissue, and finally decide to choose testicular-sparing surgery
.

We can make a final decision whether to perform testicular preservation surgery through intraoperative quick frozen pathological examination
.

If the intraoperative pathological results were considered to be benign, the testicular preservation operation was performed as originally planned; if the pathological results were suspected of being malignant, the testis was excised by radical mastectomy
.

Looking back over the past 15 years, all patients considered to be benign lesions by intraoperative rapid freezing pathological examination in our center were finally diagnosed as benign testicular tumors
.

This 100% result not only depends on the pathological diagnosis made by the pathologists in our center quickly and accurately, but also depends on the surgeon's rich clinical experience and the courage to break the traditional >
.

To achieve testicular preservation surgery for testicular tumors requires the cooperation of multiple disciplines (urology, ultrasound, imaging, pathology, operating room, inspection, etc.
) The normal testicular tissue of tumor patients should avoid missing malignant tumors
.

Through testicular preservation surgery, most normal testicular tissue can be preserved for patients with benign testicular tumors, reducing the chance of male insufficiency
.

Especially for children and young patients with reproductive requirements, it is not only the urgent needs of patients, but also the constant pursuit of doctors in our center to preserve spermatogenesis as much as possible and reduce social and psychological burden
.

Source: Department of Urology, Sun Yat-sen University Cancer Center