Partial Orchiectomy Treatment & Management

Updated: Mar 04, 2014
  • Author: Samuel G Deem, DO; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Treatment

Medical Therapy

Primary therapy for any testicular mass includes radical or partial orchiectomy. This is followed by complete metastatic workup including CT of the abdomen and pelvis and chest radiography with serum levels of tumor markers. No further testing is necessary in routine cases.

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Surgical Therapy

Surgical therapy consists of partial orchiectomy (excisional biopsy) under ultrasound and needle guidance. Frozen-section analysis results dictate whether radical or partial orchiectomy is indicated.

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Preoperative Details

Candidates for partial orchiectomy must have negative findings on serum marker studies, abdominal CT scanning, and chest radiography. The patient must be counseled that a negative frozen-section result followed by a positive pathology result on final pathologic diagnosis would require delayed radical orchiectomy. In addition, sperm banking must be offered, if applicable. Testicular sperm extraction at the time of partial orchiectomy can also be offered to patients with azoospermia.

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Intraoperative Details

Open excisional biopsy is similar to radical inguinal orchiectomy in many ways. The authors' treatment algorithm is as follows:

  1. An inguinal incision is made to deliver the testis and spermatic cord.
  2. Towels are placed over the incision.
  3. The testis is manipulated on a towel away from the incision.
  4. Intraoperative ultrasonography is used to locate the mass.
  5. A needle can be passed into the mass for localization if desired.
  6. The mass is excised with a margin of normal parenchyma. Cold ischemia can be used.
  7. Postexcisional ultrasonography is performed to evaluate for a hypoechoic lesion.
  8. The specimen is sent for frozen-section pathological analysis.
  9. If the frozen analysis result is benign, the testis is placed into the scrotum and the wound is closed.
  10. If the frozen analysis result shows viable tumor, radical orchiectomy should be considered.
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Postoperative Details

A scrotal support is applied, and the patient is instructed to avoid strenuous activity for 2-3 weeks postoperatively.

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Follow-up

Follow-up ultrasonography 1-2 months after surgery is recommended to ensure the patient has no residual mass. Routine follow-up of the testicular cancer is performed based on pathologic staging.

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Complications

Complications of partial orchiectomy include the following:

  • False-negative frozen-section analysis result
  • Tumor spillage
  • Incomplete incision of the tumor mass
  • Bleeding
  • Infection
  • Testicular infarction
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Outcome and Prognosis

Outcomes and prognosis following partial orchiectomy are typically favorable, with at least half of the patients in some small series without evidence of tumor on final pathology. Most cancerous testicular masses are composed of pure seminoma, which carries a favorable prognosis and is highly radiosensitive.

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