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Organ erhaltende Hodentumorchirurgie

Organ-sparing surgery for testicular tumors

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An Erratum to this article was published on 25 October 2008

Zusammenfassung

Gutartige Läsionen des Hodens (Stromatumoren, Dermoid- und Epidermoidzysten sowie präpuberale Teratome) werden mit dem Ziel entfernt, die Spermiogenese und die Hormonbildung zu erhalten, auch wenn beide Hoden vorhanden sind. Deuten Palpation, Sonographie und Marker auf einen malignen Tumor, so ist bei Fehlen oder Erkrankung des kontralateralen Organs die Enukleationsresektion gerechtfertigt, wenn die präoperativen Werte für Plasmatestosteron und LH im Normbereich liegen. Die Nachbestrahlung der obligatorisch vorhandenen testikulären intraepithelialen Neoplasie (TIN) mit 20 Gy sichert die dokumentierten guten Ergebnisse. Bei Kinderwunsch kann unter sorgfältiger Kontrolle die Bestrahlung bis zum Eintreten der Schwangerschaft aufgeschoben werden. Die richtige Indikation und eine ausgefeilte Technik führen zu einer Überlegenheit der Enukleationsresektion gegenüber nichtoperativen Verfahren (HIFU, Chemotherapie und Bestrahlung bei Seminom).

Abstract

Benign lesions of the testicles (stromal tumors, dermoid and epidermoid cysts as well as teratomas) are excised with the objective of preserving spermiogenesis and hormone production even though both testicles are present. If palpation, sonography and markers suggest a malignant tumor and the contralateral organ is affected by disease or has been ablated because of previous disease history, then enucleation resection is justified when the preoperative levels of plasma testosterone and LH are within the normal range. Postoperative irradiation of the unavoidable testicular intraepithelial neoplasia (TIN) with 20 Gy ensures the well-documented good results. If a child is desired, irradiation can be postponed with careful monitoring until pregnancy has ensued. Accurate indication and sophisticated technology result in a superiority of enucleation resection in comparison to non-surgical procedures (HIFU, chemotherapy, and irradiation for seminoma).

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Mitglied der Steuerungsgruppe zur Erstellung der S3-PCA-Leitlinie, Mitglied des urologischen Advisory Boards der Fa. Novartis und Mitglied des urologischen Advisory Boards der Fa. AstraZeneca. Trotz des möglichen Interessenkonflikts ist der Beitrag unabhängig und produktneutral.

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Authors and Affiliations

  1. Privatärztliche Praxis und Belegabteilung für Urologie, EuromedClinic, Europa-Allee 1, 90763, Fürth, Deutschland

    L. Weißbach & C. Schaefer

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  1. L. Weißbach
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  2. C. Schaefer
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Correspondence to L. Weißbach.

Additional information

Ein Erratum zu diesem Beitrag ist zu finden unter http://dx.doi.org/10.1007/s00120-008-1889-9.

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Weißbach, L., Schaefer, C. Organ erhaltende Hodentumorchirurgie. Urologe 47, 809–817 (2008). https://doi.org/10.1007/s00120-008-1711-8

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