It’s our great honour to get the response from Dr. Guragac et al to our article, “Experiences and outcomes of organ-sparing surgery for testicular tumour with benign tendency.”1 They give our study pertinent evaluations and suggestions. In their recent study, they also show their experience with testis-sparing surgery (TSS) for small testicular masses not suspected to be malignant.2
According to European Association of Urology (EAU) guidelines, TSS can be attempted in synchronous bilateral testicular tumours, metachronous contralateral tumours, or in a tumour in a solitary testis with normal preoperative testosterone levels, when tumour volume is <30% of the testicular volume and surgical rules are respected.3 The inguinal incision is generally adopted for spermatic cord occlusion during TSS.2,4
In our study, the patients are young, unmarried, or sexually active. The comprehensive preoperative examinations suggest the benign tendency of the testicular mass. The vertical scrotal incision is made to avoid possible damage to the spermatic cord. During the surgery, the mass is gently isolated and resected with surrounding 2 mm tissue. These techniques can efficiently avoid squeezing the tumour and completely excise the lesion. Like partial nephrectomy, appropriate procedure should not increase the risk of tumour spread. However, the suitable incision and surgical approach for TSS need more studies and data. For suspicious cases, inguinal incision and temporary cord occlusion should be performed during TSS.
Organ-sparing surgery is more widely carried out to treat tumours in recent years. Testicular cancer is the most common tumour in young men.3,5 TSS for maximal organ retention is beneficial to young patients’ physical and mental health. We believe that TSS will get more and more attention. TSS, combined with other methods — new tumour markers, intraoperative ultra-sonography, and needle biopsy — will increase the diagnostic and therapeutic safety and efficacy.
Footnotes
Competing interests: The authors declare no competing financial or personal interests.
References
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