Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 32  |  Issue : 3  |  Page : 132-134

Partial orchiectomy: Experience of four cases in a secondary hospital of greece


Department of Urology, Ygeias Melathron Hospital, Athens, Greece

Date of Submission22-Dec-2020
Date of Decision23-Dec-2020
Date of Acceptance24-Dec-2020
Date of Web Publication22-Feb-2021

Correspondence Address:
Jason Kyriazis
Department of Urology, Ygeias Melathron Hospital, 4-6 Thereianou Street, 114 73 Athens
Greece
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/HUAJ.HUAJ_16_20

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  Abstract 


Aim of the Study: The aim of this study is to review our collective experience with partial orchectomy due to testicular tumors in a secondary hospital of Greece. Materials and Methods: In total four young patients with relative indications for a partial orchectomy (single testis and/or tumors <2 cm in diameter, patient consent for a close follow-up, negative tumor markers) underwent partial orchiectomy in our institution. All operations were performed under clamping of the spermatic cord, and postoperative period was uneventful. Results: Pathology examination revealed one case of Sertoli cell only tumor, one patient with testicular cancer of mixed pathology (embryonal and teratoma), one case of organized hematoma, and one case with focal atypical inflammation. Patients underwent a close follow-up protocol. The patient with the mixed tumor was subjected to adjuvant chemotherapy with BEP (bleomycin, etoposide, cisplatin). The patient with atypical inflammation had a single testis due to a history of contralateral seminoma. During follow-up, he developed local tumor recurrence and underwent orchiectomy that revealed the presence of seminoma. The patient was set under testosterone replacement therapy. Conclusions: Partial orchiectomy represents a safe treatment option in the management of small testicular tumors. A benign pathology in up to 50% of cases should be expected. In case of both malignant and benign pathologies, a close follow-up is deemed necessary for the timely recognition of local recurrences in case of insufficient cancer eradication.

Keywords: Partial orchiectomy, surgical treatment, testicular cancer


How to cite this article:
Kyriazis J, Dimitriou D, Karavitakis M, Thanos A. Partial orchiectomy: Experience of four cases in a secondary hospital of greece. Hellenic Urology 2020;32:132-4

How to cite this URL:
Kyriazis J, Dimitriou D, Karavitakis M, Thanos A. Partial orchiectomy: Experience of four cases in a secondary hospital of greece. Hellenic Urology [serial online] 2020 [cited 2021 May 8];32:132-4. Available from: http://www.hellenicurologyjournal.com/text.asp?2020/32/3/132/310045




  Introduction Top


Radical orchiectomy represents the state of the art treatment in the management of testicular tumors. Partial orchiectomy is an organ sparing alternative treatment option that according to European Association of Urology guidelines can be employed in special cases such as in the case of synchronous bilateral tumors, metachronous contralateral tumors, or with a lesion in solitary testis, provided that the tumor volume is <30% of testicular volume and surgical rules are respected.[1] We herein present our experience with four cases subjected to this organ preserving procedure.


  Materials and Methods Top


In total four patients with a mean age of 34 years were subjected to partial orchiectomy in the department of Urology of Ygeias Melathron Clinic, TYPET. All cases had testicular masses <2 cm in size and were sized <30% of total testicular volume. All patients were assessed through scrotal ultrasonography and abdominal and scrotal magnetic resonance imaging [Figure 1]. None had elevated tumor markers (alpha fetoprotein, beta chorionic gonadotropin, and lactate dehydrogenase) or indications of a systemic disease (normal chest X-ray and no retroperitoneal lymph node enlargement in abdominal MRI imaging). One had a single testis, due to a history of contralateral seminoma and one had a history of an old testicular injury. All cases consented to a close postoperative follow-up and were informed on the high risk of concomitant treatment in case germ cell tumors would be revealed including orchiectomy and adjuvant chemotherapy.
Figure 1: Magnetic resonance imaging of Sertoli cell only testicular tumor

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Surgical technique

Under general anesthesia, an inguinal incision was performed, and spermatic cord was identified at the level of its entrance into the inguinal canal. The cord was clamped using a soft vascular clamp, and the ipsilateral testis was retrieved from the scrotum and externalized though the inguinal incision. The tunica albuginea overlying the palpable tumor was incised, and the tumor was retrieved and separated from the surrounding seminiferous tubules respecting a surgical margin of 5 mm. Punctual coagulation of bleeding tubules was performed using bipolar forceps, and the tunical defect was sutured using interrupted 3-O Vicryl sutures [Figure 2]. Testis was then placed again in the scrotum, and the spermatic cord was unclamped followed by careful hemostasis and closure of skin incision.
Figure 2: Operative technique of partial orchiectomy. Under clamping of the spermatic cord using a vascular clamp, testicular capsule is incised over the tumor, and testicular mass is identified and locally excised. Single 3-0 Vicryl sutures are placed to close capsular defect

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  Results Top


Postoperative course was uneventful with no clinical significant complication being evident in any of the cases. Pathology examination revealed one case of Sertoli cell only tumor, one patient with testicular cancer of mixed pathology (embryonal and teratoma), one case of organized hematoma [Figure 3] and one case with focal atypical inflammation. Patients underwent a close follow-up protocol. The patient with the mixed tumor was subjected to adjuvant chemotherapy with BEP with no evidence of local or distant recurrence during follow-up. The patient with the atypical inflammation has a single testis due to a history of contralateral seminoma. During follow-up, he developed local recurrence and underwent orchiectomy that revealed the presence of seminoma. The patient was set under testosterone replacement therapy with no evidence of local or distant recurrence during follow-up.
Figure 3: Operative photo of the case with a focal organized hematoma

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  Discussion Top


Conventionally, the remaining testis after a unilateral orchiectomy was considered sufficient to maintain normal hormonal and reproductive functions. However, accumulated evidence suggest that the loss of a single testis can be associated with significant deprivation of fertility, long-term exocrine and endocrine deficit as well as with a negative sexual and psychosocial impact.[2],[3] Azoospermia often accompanies unilateral radical orchiectomy in a significant proportion of patients while long-term follow-up of these cases reveals significantly reduced serum testosterone levels as compared to the levels in the general population, and this condition can evolve into severe late-onset hypogonadism even in young patients.[3],[4] The detrimental effects of unilateral testicular loss can be partly prevented by parenchyma preservation following a partial orchiectomy protocol.

While radical orchiectomy remains the gold standard treatment option in the management of testicular tumors, partial orchiectomy has lately gained popularity since numerous studies have documented a benign pathology in a big proportion of small testicular masses. While 90% of palpable lesions >2 cm in size appear to be malignant, 60%–77% of tumors smaller than 2 cm and up to 80% of lesions under 0.5 cm are found to have a benign pathology.[5],[6],[7],[8],[9],[10] A frozen section biopsy is commonly employed during organ sparing orchiectomy as an accurate method of operative assessment of malignant potential with high sensitivity and specificity.[11],[12] In our series, a benign pathology was found in half of our cases, and testis could be preserved in 3 out of 4 cases without any oncological deprivation in the follow-up until today.


  Conclusions Top


Partial orchiectomy represents a safe treatment option in the management of small testicular masses. A benign pathology in up to 50% of cases should be expected. In case of both malignant and benign pathologies, a close follow-up is deemed necessary for the timely recognition of local recurrences in case of insufficient cancer eradication.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Albers P, Albrecht W, Algaba F, Bokemeyer C, Cohn-Cedermark G, Fizazi K, et al. European Association of Urology. EAU guidelines on testicular cancer: 2011 update. Eur Urol 2011;60:304-19.  Back to cited text no. 1
    
2.
Nord C, Bjøro T, Ellingsen D, Mykletun A, Dahl O, Klepp O, et al. Gonadal hormones in long-term survivors 10 years after treatment for unilateral testicular cancer. Eur Urol. 2003;44:322-8.  Back to cited text no. 2
    
3.
Huddart RA, Norman A, Moynihan C, Horwich A, Parker C, Nicholls E, et al. Fertility, gonadal and sexual function in survivors of testicular cancer. Br J Cancer 2005;93:200-7.  Back to cited text no. 3
    
4.
Jacobsen KD, Theodorsen L, Fossa SD. Spermatogenesis after unilateral orchiectomy for testicular cancer in patients following surveillance policy. J Urol 2001;165:93-6.  Back to cited text no. 4
    
5.
Heidenreich A, Weissbach L, Höltl W, Albers P, Kliesch S, Köhrmann KU, et al. German testicular cancer study group: Organ sparing surgery for malignant germ cell tumor of the testis. J Urol 2001;166:2161-5.  Back to cited text no. 5
    
6.
Steiner H, Höltl L, Maneschg C, Berger AP, Rogatsch H, Bartsch G, et al. Frozen section analysis-guided organ-sparing approach in testicular tumors: Technique, feasibility, and longterm results. Urology 2003;62:508-13.  Back to cited text no. 6
    
7.
Müller T, Gozzi C, Akkad T, Pallwein L, Bartsch G, Steiner H. Management of incidental impalpable intratesticular masses of ≤5 mm in diameter. BJU Int 2006;98:1001-4.  Back to cited text no. 7
    
8.
Horstman WG, Haluszka MM, Burkhard TK. Management of testicular masses incidentally discovered by ultrasound. J Urol 1994;151:1263-5.  Back to cited text no. 8
    
9.
Comiter CV, Benson CJ, Capelouto CC, Kantoff P, Shulman L, Richie JP, et al. Nonpalpable intratesticular masses detected sonographically. J Urol 1995;154:1367-9.  Back to cited text no. 9
    
10.
Yossepowitch O, Baniel J. Role of organ-sparing surgery in germ cell tumors of the testis. Urology 2004;63:421-7.  Back to cited text no. 10
    
11.
Elert A, Olbert P, Hegele A, Barth P, Hofmann R, Heidenreich A. Accuracy of frozen section examination of testicular tumors of uncertain origin. Eur Urol 2002;41:290-3.  Back to cited text no. 11
    
12.
Leroy X, Rigot JM, Aubert S, Ballereau C, Gosselin B. Value of frozen section examination for the management of nonpalpable incidental testicular tumors. Eur Urol 2003;44:458-60.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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