Management of nonpalpable incidental testicular masses

Purpose: We report on 4 patients who presented with nonpalpable testicular masses discovered on scrotal ultrasound, and offer treatment recommendations based on our experience and a review of the literature. Materials and Methods: Four patients underwent intraoperative ultrasound guided localization and excisional biopsy of nonpalpable testicular parenchymal masses. Radical orchiectomy was performed in 2 patients because of testicular cancer. Patient age, clinical presentation, ultrasound results, frozen section and permanent pathology results are reported. Results: During a 3-year period 1,040 scrotal ultrasounds were performed for indications other than retroperitoneal mass at a single institution, and nonpalpable testicular parenchymal masses were discovered in 4 patients with an age range of 22 to 31 years. Testis mass size ranged from 5 to 6 min in maximum diameter and serum tumor markers were negative in all patients. Frozen section pathology indicated benign lesions in all patients and permanent pathology revealed seminoma in 2 of the patients who underwent delayed radical orchiectomy. Permanent pathology of orchiectomy specimens did not reveal residual invasive tumor. Conclusions: Intraoperative ultrasound guided localization and excisional biopsy is a reasonable treatment option for patients with nonpalpable incidental testicular masses. Excisional biopsy with margins that show normal testicular tissue is essential in testis sparing surgery and patients must be cautioned that final pathology may indicate the need for delayed radical orchiectomy.