H. ABBOUDI ET AL. 285
more, if a man wishes to father children, adjuvant radio-
therapy after testis-sparing surgery can be deferred until
this has occurred, although close ultrasonic surveillance
of the remnant testis is required.
5. Conclusion
In conclusion, our series confirms previous results show-
ing that the majority of non-palpable testicular masses
less than 2 cm in diameter are benign lesions. In view of
the possible significant risk of malignancy, however, we
recommend that all such lesions are managed surgically,
with excision biopsy, frozen-section analysis and testis-
sparing surgery the optimal approach. If the lesion proves
to be benign, the patient is spared the overtreatment of
orchidectomy with its negative impact on endocrine and
exocrine function and psychosocial well-being. It is im-
portant that this approach be undertaken in centres with
specialist histopathological and surgical expertise. In pa-
tients over the age of 50 without any risk factors for
germ-cell tumours, the risk of malignancy appears low
and a more conservative approach could be taken. In any
case, patients should be counselled that radical orchidec-
tomy remains the standard of care for oncological control,
and if the testis-sparing approach is undertaken then
close surveillance will be required for many years.
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