Advertisement

World Journal of Urology

, Volume 36, Issue 8, pp 1263–1266 | Cite as

Should we rely on Doppler ultrasound for evaluation of testicular solid lesions?

  • Baris Esen
  • Muhiddin Önder Yaman
  • Sümer Baltacı
Original Article

Abstract

Purpose

Colour Doppler ultrasound (CDUS) is the main radiologic tool to evaluate scrotal masses and intratesticular-vascularised solid lesions are mostly considered malign lesions. Objective of this trial is determine ratio of benign lesions in patients with hypervascularised solid intratesticular lesions.

Material and method

Patients who underwent radical orchiectomy due to hypervascularised intratesticular solid lesions detected in CDUS are evaluated retrospectively. Those with previous testicular cancer history and inguinal/scrotal surgeries were excluded from the study. All patients are evaluated for age, preoperative testicular atrophy, multicentricity, echotexture and size of solid lesions, preoperative tumor markers (AFP, bHCG and LDH), and postoperative pathology results. Two tailed p value test was used to evaluate numeric parameters and Fisher’s exact test was used to evaluate non-numeric parameters.

Results

A total of 117 patients with a mean age of 35.9 (5–86) were included to the study. Mean size of solid lesions was 4.39 cm. Seven patients had subcentimeter (subcm) lesions. 101 patients had hypoechoic, ten patients had isoechoic and six patients hyperechoic solid lesions. Preoperatively 60 patients (51.2%) had at least one tumor marker elevated. Postoperative pathology examination resulted to; 21 patients (17.9%) had benign lesions. Elevation of tumor markers, palpability, hypoechoic texture and larger size of the solid lesion were found to be parameters that predict malignancy.

Conclusion

Benign incidence of vascular testicular solid lesions detected with scrotal ultrasound with colour Doppler is greater than expected. In patients with smaller, non-palpable lesions without elevated tumor markers, treatment options other than radical orchiectomy such as testicular sparing surgery should be considered.

Keywords

Colour Doppler ultrasound Small testicular lesions Scrotal masses Testicular sparing surgery Testicular biopsy Testicular cancer 

Notes

Author contribution

BE Manuscript writing, Data Collection. MÖY Data collection, Data analysis, Project development. SB Project development, Manuscript writing and editing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Human and animal participants

No research involving human participants or animals was performed.

Informed consent

For this type of study, formal consent is not required.

References

  1. 1.
    Bieniek JM, Juvet T, Margolis M, Grober ED, Lo KC, Jarvi KA (2018) Prevalence and management of incidental small testicular masses discovered on ultrasonographic evaluation of male infertility. J Urol 199(2):481–486.  https://doi.org/10.1016/j.juro.2017.08.004 CrossRefPubMedGoogle Scholar
  2. 2.
    Carmignani L, Gadda F, Gazzano G, Nerva F, Mancini M, Ferruti M et al (2003) High incidence of benign testicular neoplasms diagnosed by ultrasound. J Urol 170(5):1783–1786CrossRefPubMedGoogle Scholar
  3. 3.
    Eifler JB Jr, King P, Schlegel PN (2008) Incidental testicular lesions found during infertility evaluation are usually benign and may be managed conservatively. J Urol 180(1):261–264.  https://doi.org/10.1016/j.juro.2008.03.021 CrossRefPubMedGoogle Scholar
  4. 4.
    Toren PJ, Roberts M, Lecker I, Grober ED, Jarvi K, Lo KC (2010) Small incidentally discovered testicular masses in infertile men—is active surveillance the new standard of care? J Urol 183(4):1373–1377.  https://doi.org/10.1016/j.juro.2009.12.012 CrossRefPubMedGoogle Scholar
  5. 5.
    Horstman WG, Melson GL, Middleton WD, Andriole GL (1992) Testicular tumors: findings with color Doppler US. Radiology 185(3):733–737CrossRefPubMedGoogle Scholar
  6. 6.
    Muglia V, Tucci S Jr, Elias J Jr, Trad CS, Bilbey J, Cooperberg PL (2002) Magnetic resonance imaging of scrotal diseases: when it makes the difference. Urology 59(3):419–423CrossRefPubMedGoogle Scholar
  7. 7.
    Capelouto CC, Clark PE, Ransil BJ, Loughlin KR (1995) A review of scrotal violation in testicular cancer: is adjuvant local therapy necessary? J Urol 153(3 Pt 2):981–985PubMedGoogle Scholar
  8. 8.
    Soh E, Berman LH, Grant JW, Bullock N, Williams MV (2008) Ultrasound-guided core-needle biopsy of the testis for focal indeterminate intratesticular lesions. Eur Radiol 18(12):2990–2996.  https://doi.org/10.1007/s00330-008-1072-0 CrossRefPubMedGoogle Scholar
  9. 9.
    Albers P, Albrecht W, Algaba F, Bokemeyer C, Cohn-Cedermark G, Fizazi K et al (2015) Guidelines on testicular cancer: 2015 update. Eur Urol 68(6):1054–1068CrossRefPubMedGoogle Scholar
  10. 10.
    Bojanic N, Bumbasirevic U, Bojanic G, Vukovic I, Milojevic B, Pekmezovic T (2017) Testis sparing surgery for treatment of small testicular lesions: is it feasible even in germ cell tumors? J Surg Oncol 115(3):287–290.  https://doi.org/10.1016/j.eururo.2015.07.044 CrossRefPubMedGoogle Scholar
  11. 11.
    Liu B, Su H, Cheng G, Li P, Hua L, Song N et al (2015) Experiences and outcomes of organ-sparing surgery for testicular tumour with benign tendency. Can Urol Assoc J 9(11–12):E785–788.  https://doi.org/10.5489/cuaj.2972 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Basal S, Malkoc E, Aydur E, Yildirim I, Kibar Y, Kurt B et al (2014) Fibrous pseudotumors of the testis: the balance between sparing the testis and preoperative diagnostic difficulty. Turk J Urol 40(3):125–129.  https://doi.org/10.5152/tud.2014.21284 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Baris Esen
    • 1
  • Muhiddin Önder Yaman
    • 1
  • Sümer Baltacı
    • 1
  1. 1.Department of Urology, Medical FacultyAnkara UniversityAnkaraTurkey

Personalised recommendations