Although surgical therapy for testicular tumors (TT) is often radical orchidectomy, tumor resection with preservation of healthy testicular parenchyma has been proposed. This study herein reports a 20 year single center experience applying testicular sparing surgery (TSS) as a primary operative strategy in pediatric patients. A systematic literature review summarizes the utility and outcomes of TSS in appropriately selected patients.
Pediatric patients with TT who underwent TSS between 1997 and 2018 were studied. TSS was indicated if patients presented evidence of adequately spared healthy testicular parenchyma on preoperative ultrasound and negative serum tumor markers. A systematic review of the literature was also performed.
12 cases met full inclusion criteria with 10 of 12 subjects in the prepubertal age group. Follow-up was 73 months (range 18–278 months). Only a single male patient (GSCCT) presented with early recurrence and orchidectomy was then performed. No cases of postoperative testicular atrophy were identified. Sexual maturation (Tanner stage) expected for age in each patient was documented. Review of the literature identified 34 published studies including 269 patients (94% prepubertal). Pathologic lesions here were mainly mature teratoma(s)—(62%) with a follow-up period of 4 years. Recurrent tumors were observed in only three patients (1.1%) notably two Leydig Cell Tumors and one Teratoma. Testicular atrophy reportedly occurred in only one single case (0.37%).
TSS is a feasible alternative to radical orchidectomy in pediatric male patients with localized TT and negative tumor markers. Long term follow-up is essential to monitor testicular growth, puberty with sexual development and psychological male health.
This is a preview of subscription content, access via your institution.
We’re sorry, something doesn't seem to be working properly.
Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.
Testicular sparing surgery
Giant Sertoli cell calcifying tumor
Vagni R (2016) Tumores testiculares, PRONACIP (ACACIP), Unidad didáctica 1, Año 7
Galosi AB, Fulvi P, Fabiani A, Servi L et al (2016) Testicular sparing surgery in small testis masses: a multi institutional experience. Arch Ital Urol Androl 88(4):320–324
Borghesi M, Brunocilla E, Schiavina R, Gentile G et al (2015) Role of testis sparing surgery in the conservative management of small testicular masses: oncological and functional perspectives. Actas Urol Esp 39(1):57–62
Albers P, Albrecht B, Ferran AlgabaCarsten CB et al (2011) EAU guidelines on testicular cancer: 2011 update. Eur Urol 60:304–319
Escalante Cateriano J, Ruiz E, de Badiola F, Puigdevall JC et al (2003) Cirugía conservadora en el tratamiento de los tumores benignos de testículo en la infancia. Arch Arg Pediatr 101(3):193
Shaikh F, Murray MJ, Amatruda JF, Coleman N, Nicholson JC, Hale JP, et al (2018) Paediatric extracranial germ-cell tumours. Lancet Oncol. 2016; 17(4): e149-e162. https://doi.org/10.1016/S1470-2045(15)00545-8. Erratum in: Lancet Oncol. 2018; 19(2): e78
Zu’bi F, Koyle M, Rickard M, Beaiti M et al (2019) Testis-sparing surgery for pediatric Leydig cell tumors: evidence of favorable outcomes irrespective of surgical margins. Urology 134:203–208
Hisamatsu E, Takagi S, Nakagawa Y, Sugita Y et al (2010) Prepubertal testicular tumors: a 20-year experience with 40 cases. Int J Urol 17:956–959
Steiner H, Höltl L, Maneschg C, Berger AP et al (2003) Frozen section analysis-guided organ-sparing approach in testicular tumors: technique, feasibility, and long-term results. Urology 62(3):508–513
Mother D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151(4):264–270
Tröbs R-B et al (2007) Surgery in infants and children with testicular and paratesticular tumors: a single centre experience over a 25-year-period. Klin Pädiatr 219:146–151
Ye Y, He Q, Zheng F, Guo S et al (2017) Trends of testis-sparing surgery for pediatric testicular tumors in South China. BMC Surg 17:31
Nonomura K, Koyama T, Kakizaki H, Murakumo M, Shinohara N, Koyanagi T (2001) Testicular-sparing surgery for the prepubertal testicular tumor experience of two cases with large cell calcifying Sertoli cell tumors. Eur Urol 40:699–704
Antón L, Pérez-Etchepare E, Soriano D, Gómez M, Barrientos G, Tracchia R (2010) Testicular tumors: wide spectrum in our short casuistics. Cir Pediatr 23(4):222–224
Tallen G et al (2011) High reliability of scrotal ultrasonography in the management of childhood primary testicular neoplasms. Klin Padiatr 223:131–137
Bujons A, Caffaratti J, Pascual M, Angerri O, Villavicencio J (2011) Tumores testiculares en la infancia. Actas Urol Esp 35(2):93–98
Ciftci A, Bingo M, Tanyel F, Bu N (2001) Testicular tumors in children. J Pediatr Surg 36(12):1796–1801
Murcia-Pascual FJ, Gracia-Rodríguez R, Vázquez-Rueda F (2016) Testicular and paratesticular tumors in children. Arch Esp Urol 69(10):691–697
Gomez Traverso RE. et al (2000) Neoplasias testiculares en la infancia. Rev Cir Infantil 10 (4)
Ross JH (2009) Prepubertal testicular tumors. Urology 74(1):94–99
Metcalfe PD, Farivar-Mohseni H, Farhad W, McLorie G et al (2003) Pediatric testicular tumors: contemporary incidence and efficacy of testicular preserving surgery. J Urol 170:2412–2416
Hoag N, Afshar K, Youssef D, Masterson J, Murphy J, Macneily A (2013) Cystic intratesticular lesions in pediatric patients. J Pediatr Surg 48(8):1773–1777
Patel AS, Coley BD, Jayanthi VR (2007) Ultrasonography underestimates the volume of normal parenchyma in benign testicular masses. J Urol 178:1730–1732
Slaughenhoupt B, Klauber G (1995) Simple testicular cyst in the neonate. J Ped Surg 30(4):636–637
Emre S, Ozcan R, Elicevik M, Emir H (2016) Testis sparing surgery for Leydig cell pathologies in children. J Pediatr Urol 13(1):8–11
Sávio LF, Prakash N, Clavijo R, Kryvenko O et al (2017) Microsurgical identification and excision of an intratesticular mass. Fertil Steril 107:e16
Cecchetto G, Alaggio R, Bisogno G, Virgone C, Dall P, Terenziani M et al (2010) Sex cord-stromal tumors of the testis in children. A clinicopathologic report from the Italian TREP project. J Pediatr Surg 45(9):1868–1873
Caballero Mora FJ, Muñoz Calvo MT, García RM, Rodríguez de Alarcón J et al (2013) Tumores testiculares y paratesticulares en la infancia y adolescencia. An Pediatr (Barc) 78:6–13
Article O (2007) Surgery in infants and children with testicular and paratesticular tumors: a single centre experience over a 25-year-period. Klin Padiatr 219:146–151
Koski M, Thomas J (2009) Successful bilateral testicular sparing surgery for benign teratoma. J Pediatr Urol 5(1):72–74
Shukla AR, Woodar C, Carr M, Huff D (2004) Experience with sparing testis surgery for testicular teratoma. J Urol 171:161–163
Wu D, Shen N, Lin X, Chen X (2018) Prepubertal testicular tumors in China: a 10-year experience with 67 cases. Pediatr Surg Int 34(12):1339–1343
Sugita Y et al (1999) Testicular and paratesticular tumors in children: 30 years’ experience. Aust N Z J Surg 69:505–508
Canda AE, Atmaca AF, Ozdemir AT, Akbulut Z et al (2009) Testis sparing surgery for sequential bilateral testicular tumors. Can J Urol 16(3):4677–4681
Docal I, Pardo A, Alonso P (2001) Epidermoid cyst of the testis: a case report. Pediatr Radiol 31(5):365–367
Kay R (1993) Prepubertal testicular tumor registry. J Urol 150(2 Pt 2):671–674
Tapper D, Lack EE (1983) Teratomas in infancy and childhood: a 54-year experience at the Children‘s Hospital Medical Center. Ann Surg 198:398–410
Caldwell BT, Saltzman AF, Maccini MA, Cost NG (2018) Appropriateness for testis-sparing surgery based on the testicular tumor size in a pediatric and adolescent population. J Pediatr Urol 15:70.e1-70.e6
Akgor FM, Canda T (1997) Testis sparing surgery for epidermoid cyst of the testis: a case report. Int Urol Nephrol 29(5):587–589
Çakıroğlu B, Sönmez N, Sinanoğlu O, Ateş L, Hilmi S (2015) Testicular epidermoid cyst. Afr J Paediatr Surg 12(1):89–91
Ceylan H, Ortaç R, Karaca I, Sari I, Brah I (2004) Case report simple testicular cyst: a rare cause of scrotal swelling. Int J Urol 11(5):352–354
Friend J, Barker A, Khosa J, Samnakay N (2016) Benign scrotal masses in children—some new lessons learned. J Pediatr Surg 51(10):1737–1742
Romo Munoz I, Mu R, Nú V, Dore M, Sánchez A, González-peramato P et al (2017) Tumores testiculares en la edad pediátrica: indicaciones de la cirugía conservadora. An Pediatr (Barc) 88(5):253–258
Kao C, Cornejo K, Ulbright T, Young R (2015) Juvenile granulosa cell tumors of the testis: a clinicopathologic study of 70 cases with emphasis on its wide morphologic spectrum. Am J Surg Pathol 39(9):1159–1169
Liu P, Li W, Song H, Jiao L, Zhang W, Sun N (2018) Characteristics, treatment decisions and outcomes of prepubertal testicular germ cell tumor: a descriptive analysis from a large Chinese center. J Pediatr Urol 14(5):443.e1-443.e7
Marte A, Pintozzi L, Cretì G, Lelli P, Dacia C, Renzo D et al (2017) Long-term follow-up of testicular microlithiasis in children and adolescents: multicenter prospective cohort study of the italian society of pediatric urology. Eur J Pediatr Surg 27(2):155–160
Pearse I, Glick RD, Abramson S, Gerald W, Shamberger R, La Quaglia M (1999) Surgery for benign testicular tumors. J Pediatr Surg 34(6):1000–1003
Tracey AJ, Cerwinka WH (2017) Benign large-cell calcifying sertoli tumor of the testis in a 13-year-old male patient treated with partial orchiectomy. Urology 107:226–228
Garrett J, Cartwright P, Snow B, Coffin C (2000) Cystic testicular lesions in the pediatric population. J Urol 163(3):928–936
Brown B, Ram A, Clayton P, Humphrey G (2007) Conservative management of bilateral Sertoli cell tumors of the testicle in association with the Carney complex: a case report. J Pediatr Surg 42:E13–E15
Rushton HG et al (1990) Testicular sparing surgery for prepubertal teratoma of the testis; a clinical and pathological study. J Urol 144:726–730
Lev R et al (2002) Epidermoid cyst of the testis in an adolescent: case report and review of the evolution of the surgical management. J Pediatr Surg 37(1):121–123
Otguner M et al (1997) Testis sparing surgery for epidermoid cyst of the testis: a case report. Int Urol Nephrol 29(5):587–589
Conflict of interest
The authors declare that they have no conflict of interest.
This retrospective study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) approved this study.
Consent to publish
Participants have consented to the submission of the study series to the journal.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
((‘testis sparing surgery’/exp OR ‘partial orchiectomy’:ti,ad OR ‘parenchymal surgery’:ti,ab) AND (‘testis tumor’/exp OR ‘testicular tumor’:ti,ab)) AND ([adolescent]/lim OR [child]/lim OR [infant]/lim OR [preschool]/lim OR [school]/lim)
About this article
Cite this article
Bois, J.I., Vagni, R.L., de Badiola, F.I. et al. Testis-sparing surgery for testicular tumors in children: a 20 year single center experience and systematic review of the literature. Pediatr Surg Int (2021). https://doi.org/10.1007/s00383-020-04850-6
- Testicular tumor
- Testis-sparing surgery
- Pediatric tumors
- Germ cell tumors