V08-04: Partial Orchiectomy for Testicular Mass in a Pediatric Patient: Technique and Outcomes

Katherine Fischer*, Ruchika Talwar, Karl Godlewski, Alice Xiang, Aseem Shukla, Arun Srinivasan, Christopher Long, Thomas Kolon, Sameer Mittal, Philadelphia, PA

Introduction: Testis-sparing surgery is included in the 2019 AUA guidelines as an option for adults with masses less than 2cm and (1) equivocal ultrasound (US) and exam findings and negative tumor markers (2) mass in a solitary testis or (3) bilateral synchronous tumors. The role of partial orchiectomy (PO) in pre-pubertal pediatric patients is well described, but the ideal treatment for adolescents is unclear.  We present our technique for PO in an adolescent patient and our outcomes.

Methods: We retrospectively identified patients less than 18 years planned for PO at our institution from 2013-2020. Data on successful completion of PO, final pathology and oncologic outcomes were aggregated.

In this case, our patient was 16 years and pre-operative US showed a well-demarcated 1.6 cm left testicular mass without vascularity. Tumor markers were negative and CT abdomen/ pelvis showed no evidence of metastatic disease. Based on this he was planned for PO.

A left inguinal approach was used to isolate the spermatic cord. With the testis delivered, radiology provided intra-operative US guidance confirming the mass to be poorly vascularized and abutting the epididymis. The tunica albuginea was opened 5 mm superior to demarcation of normal testis and tumor and blunt dissection was used to enucleate the entire mass. Frozen sections of the mass and adjacent margins were negative for tumor and suggestive of epidermoid cyst. The tunica albuginea was closed and the testis returned to the scrotum.

Results: Final pathology showed epidermoid cyst and all margins were benign. The patient was discharged home same day and his post-operative course has been uncomplicated. He is scheduled to follow up in 3 months with a repeat US.

In reviewing our institutional experience, we identified 21 patients, median age 8.2 years (IQR=2-13.2), planned for PO, 2 of which were converted to radical intraoperatively. One of these was for suspected teratoma in a post-pubertal patient (mature teratoma on final pathology) and the other for suspected yolk sac tumor (juvenile granulosa cell and Sertoli cell tumor). Of the 19 patients who had PO, 14 had benign pathology, 3 mature teratoma and 2 Leydig cell tumor. None of the patients had recurrence or required further oncologic treatment.

Conclusions: PO has been shown to be a safe and potentially beneficial option in children and adolescents with non-germ cell tumor pathology. The same technique can be used as an alternative to radical orchiectomy in the properly selected adult. Here we demonstrate our technique for PO without sacrificing oncologic control should a mass prove to be malignant on pathology.

Source of Funding: This work was supported in part by the 2021-2022 Urology Care Foundation Research Scholar Award Program (KF).