Some urologists advocate for testis-sparing surgery even for men with germ cell tumors of the testicle. While some evidence indicates that this can be done safely in some patients, it is not a proven or well-established technique. Before undergoing testis-sparing surgery, an extensive consultation should occur with the patient and their family regarding expectations and possible outcomes in the operating room.
The beginning portion of a testis-sparing surgery is identical to a radical orchiectomy. Once the testicle is “delivered,” the testis-sparing portion should begin. Intraoperative ultrasound should be used to identify the mass, rule out other masses and create a surgical plan. The outer layer of the testicle (the tunica albuginea, which houses the tubules of the testicle) is opened and the mass is removed, often with a small margin of normal testicular tissue. The mass will go to pathology for frozen analysis — an expert genitourinary pathologist should evaluate the mass when possible.
If the patient has a normal contralateral testicle and cancer is confirmed in the mass, a completion radical orchiectomy should be performed.
If the patient has (or had) cancer in the contralateral testicle, the pathologist should confirm negative margins before leaving the remainder of the testicle. If there is any suspicion of residual cancer, the testicle should be removed. Once again, the standard of care is bilateral orchiectomy, and testosterone can easily be replaced.
In the case of most surgeries, infection is a possibility when undergoing a micro-dissection sperm retrieval procedure. Following the surgery, patients will feel soreness, swelling, and possible bruising to the scrotum.
Patients may take over the counter painkillers during the recovery process. In addition, applying ice to reduce the swelling can provide pain relief. Men who undergo the micro-dissection sperm retrieval procedure should speak with their doctor about possible pain relief medication.
Men should refrain from any physical work or activities following a micro-dissection sperm retrieval procedure. Participating in physical work or activities can cause further injury and issues to the groin area.