1928 SMALL INCIDENTALLY DISCOVERED TESTICULAR MASSES IN INFERTILE MEN: IS ACTIVE SURVEILLANCE THE NEW STANDARD OF CARE?

Abstract

You have accessJournal of UrologyInfertility: Therapy/Evaluation1 Apr 20101928 SMALL INCIDENTALLY DISCOVERED TESTICULAR MASSES IN INFERTILE MEN: IS ACTIVE SURVEILLANCE THE NEW STANDARD OF CARE? Paul Toren, Matthew Roberts, Irene Lecker, Ethan Grober, Keith Jarvi, and Kirk Lo Paul TorenPaul Toren More articles by this author , Matthew RobertsMatthew Roberts More articles by this author , Irene LeckerIrene Lecker More articles by this author , Ethan GroberEthan Grober More articles by this author , Keith JarviKeith Jarvi More articles by this author , and Kirk LoKirk Lo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1896AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES With the widespread use of scrotal ultrasound in the evaluation of male infertility, the incidence of small, incidentally detected testicular masses is increasing. Traditionally, treatment has been surgical removal due to concerns about malignancy. Ultrasound follow-up has been proposed as an alternative to surgery. We present the largest series to date of small, non-palpable, incidentally detected testes masses, and document the natural history of these lesions. METHODS We reviewed the records of patients seen at the Mount Sinai Hospital Fertility Clinic from 2001-2008. Patients with one or more testicular lesions fitting all of the following criteria were included in the study: intratesticular, hypoechoic, diameter < 1cm, non-palpable. We assessed patient age and semen parameters, the size and growth of the lesion(s) on serial ultrasounds, need for surgery, and pathologic diagnosis. RESULTS Of 4418 patients evaluated, 46 (1%) met the inclusion criteria. Mean age was 35. Thirty-nine(85%) presented with infertility. Semen analysis showed azoospermia, oligospermia, and normospermia in 15, 18, and 7 patients respectively, and was unavailable in 6 patients. Mean ultrasound follow-up interval was 253 days, and mean number of ultrasounds was 2.8. Mean lesion diameter was 4.3 mm (range 1-10mm). Thirty-eight patients had serial ultrasound follow-up only, with a mean growth of 0.5mm/yr(95% CI: -2.2 - 3.3mm/yr). Three had immediate surgery, and 5 had surgery following a period of ultrasound follow-up. Indications for surgery were interval growth in 2 and patient choice in 6. Larger size(p=0.02) and presence of vascular flow(p<0.01) were associated with intervention. One patient had radical orchiectomy for pure seminoma identified due to interval growth from 3mm to 6mm at 3 months; he remains recurrence free. The other 7 masses excised by partial orchiectomy were benign. CONCLUSIONS The vast majority of small, non-palpable testicular masses were safely followed with serial ultrasound and did not show significant growth or require surgical removal. Serial ultrasound follow-up of small, non-palpable, hypoechoic testicular masses detected incidentally during work-up for infertility appears to be a safe alternative to immediate surgical removal. Toronto, Canada© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e749 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Paul Toren More articles by this author Matthew Roberts More articles by this author Irene Lecker More articles by this author Ethan Grober More articles by this author Keith Jarvi More articles by this author Kirk Lo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...