Advertisement

The Role of Intraoperative Ultrasound for Testicular Masses

  • Michele BertolottoEmail author
  • Nicola Pavan
  • Massimo Valentino
  • Giovanni Liguori
  • Stefano Bucci
  • Libero Barozzi
  • Lorenzo E. Derchi
Chapter

Abstract

In the clinical practice, there is an increasing incidence of small, non-palpable testicular lesions identified with an ultrasonographic investigation performed for other purposes. Many of these lesions are benign tumours or non-neoplastic conditions. In this context, the old axiom that every testicular mass should be considered a malignant tumour and the testis must be removed is no longer valid. Lesions can either undergo active surveillance or testis-sparing surgery, which allows maximal preservation of testicular parenchyma and its vasculature. To provide for the possibility of testis-sparing surgery for non-palpable nodules, precise intraoperative ultrasonographic localisation of the lesion is necessary. Our technique includes ultrasonographic localisation of the nodule within the exposed testicle and placement of a localising needle while the patient is on the operating table.

Keywords

Intraoperative ultrasonography, testis Testis, tumour enucleation Testis, organ-sparing surgery 

Supplementary material

Video 44.1

Insertion of a 30G needle into the nodule to guide enucleation. (MP4 522 kb)

References

  1. 1.
    Carmignani L, Gadda F, Gazzano G, Nerva F, Mancini M, Ferruti M, Bulfamante G, Bosari S, Coggi G, Rocco F, Colpi GM (2003) High incidence of benign testicular neoplasms diagnosed by ultrasound. J Urol 170(5):1783–1786. doi: 10.1097/01.ju.0000092066.01699.90 CrossRefPubMedGoogle Scholar
  2. 2.
    Avci A, Erol B, Eken C, Ozgok Y (2008) Nine cases of nonpalpable testicular mass: an incidental finding in a large scale ultrasonography survey. Int J Urol Off J Jpn Urol Assoc 15(9):833–836. doi: 10.1111/j.1442-2042.2008.02120.x Google Scholar
  3. 3.
    Powell TM, Tarter TH (2006) Management of nonpalpable incidental testicular masses. J Urol 176(1):96–98. doi: 10.1016/S0022-5347(06)00496-4; discussion 99CrossRefPubMedGoogle Scholar
  4. 4.
    Toren PJ, Roberts M, Lecker I, Grober ED, Jarvi K, Lo KC (2010) Small incidentally discovered testicular masses in infertile men – is active surveillance the new standard of care? J Urol 183(4):1373–1377. doi: 10.1016/j.juro.2009.12.012 CrossRefPubMedGoogle Scholar
  5. 5.
    Carmignani L, Gadda F, Mancini M, Gazzano G, Nerva F, Rocco F, Colpi GM (2004) Detection of testicular ultrasonographic lesions in severe male infertility. J Urol 172(3):1045–1047. doi: 10.1097/01.ju.0000134892.10525.39 CrossRefPubMedGoogle Scholar
  6. 6.
    Eifler JB Jr, King P, Schlegel PN (2008) Incidental testicular lesions found during infertility evaluation are usually benign and may be managed conservatively. J Urol 180(1):261–264. doi: 10.1016/j.juro.2008.03.021; discussion 265CrossRefPubMedGoogle Scholar
  7. 7.
    Isidori AM, Pozza C, Gianfrilli D, Giannetta E, Lemma A, Pofi R, Barbagallo F, Manganaro L, Martino G, Lombardo F, Cantisani V, Franco G, Lenzi A (2014) Differential diagnosis of nonpalpable testicular lesions: qualitative and quantitative contrast-enhanced US of benign and malignant testicular tumors. Radiology 273(2):606–618. doi: 10.1148/radiol.14132718 CrossRefPubMedGoogle Scholar
  8. 8.
    Rocher L, Ramchandani P, Belfield J, Bertolotto M, Derchi LE, Correas JM, Oyen R, Tsili AC, Turgut AT, Dogra V, Fizazi K, Freeman S, Richenberg J (2015) Incidentally detected non-palpable testicular tumours in adults at scrotal ultrasound: impact of radiological findings on management Radiologic review and recommendations of the ESUR scrotal imaging subcommittee. Eur Radiol 26:2268–78. doi: 10.1007/s00330-015-4059-7 CrossRefPubMedGoogle Scholar
  9. 9.
    Valentino M, Bertolotto M, Martino P, Barozzi L, Pavlica P (2014) Incidentally detection of non-palpable testicular nodules at scrotal ultrasound: what is new? Archivio Ialiano Di Urologia Andrologia Organo Ufficiale [di] Societa Italiana Di Ecografia Urologica e Nefrologica/Associazione Ricerche Urologia 86(4):378–382. doi: 10.4081/aiua.2014.4.378 CrossRefGoogle Scholar
  10. 10.
    Patel K, Sellars ME, Clarke JL, Sidhu PS (2012) Features of testicular epidermoid cysts on contrast-enhanced sonography and real-time tissue elastography. J Ultrasound Med Off J Am Inst Ultrasound Med 31(1):115–122Google Scholar
  11. 11.
    Valentino M, Bertolotto M, Derchi L, Bertaccini A, Pavlica P, Martorana G, Barozzi L (2011) Role of contrast enhanced ultrasound in acute scrotal diseases. Eur Radiol 21(9):1831–1840. doi: 10.1007/s00330-010-2039-5 CrossRefPubMedGoogle Scholar
  12. 12.
    Bertolotto M, Derchi LE, Sidhu PS, Serafini G, Valentino M, Grenier N, Cova MA (2011) Acute segmental testicular infarction at contrast-enhanced ultrasound: early features and changes during follow-up. AJR Am J Roentgenol 196(4):834–841. doi: 10.2214/AJR.10.4821 CrossRefPubMedGoogle Scholar
  13. 13.
    Huang DY, Sidhu PS (2012) Focal testicular lesions: colour Doppler ultrasound, contrast-enhanced ultrasound and tissue elastography as adjuvants to the diagnosis. Br J Radiol 85 Spec No 1:S41–S53. doi: 10.1259/bjr/30029741
  14. 14.
    Connolly SS, D’Arcy FT, Gough N, McCarthy P, Bredin HC, Corcoran MO (2006) Carefully selected intratesticular lesions can be safely managed with serial ultrasonography. BJU Int 98(5):1005–1007. doi: 10.1111/j.1464-410X.2006.06451.x; discussion 1007CrossRefPubMedGoogle Scholar
  15. 15.
    Kirkham AP, Kumar P, Minhas S, Freeman AA, Ralph DJ, Muneer A, Allen C (2009) Targeted testicular excision biopsy: when and how should we try to avoid radical orchidectomy? Clin Radiol 64(12):1158–1165. doi: 10.1016/j.crad.2009.06.008 CrossRefPubMedGoogle Scholar
  16. 16.
    Hopps CV, Goldstein M (2002) Ultrasound guided needle localization and microsurgical exploration for incidental nonpalpable testicular tumors. J Urol 168(3):1084–1087. doi: 10.1097/01.ju.0000025141.88860.0d CrossRefPubMedGoogle Scholar
  17. 17.
    Browne RF, Jeffers M, McDermott T, Grainger R, Mulvin D, Gibney RG, Torreggiani WC (2003) Technical report. Intra-operative ultrasound-guided needle localization for impalpable testicular lesions. Clin Radiol 58(7):566–569CrossRefPubMedGoogle Scholar
  18. 18.
    Kravets FG, Cohen HL, Sheynkin Y, Sukkarieh T (2006) Intraoperative sonographically guided needle localization of nonpalpable testicular tumors. AJR Am J Roentgenol 186(1):141–143. doi: 10.2214/AJR.04.1687 CrossRefPubMedGoogle Scholar
  19. 19.
    Attieh A, Benelli A, Bertolotto M, Simonato A, Carmignani G, Derchi LE (2015) Sonographic appearances of the postoperative testis. J Clin Ultrasound 44:12–16. doi: 10.1002/jcu.22304 CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Michele Bertolotto
    • 1
    Email author
  • Nicola Pavan
    • 1
  • Massimo Valentino
    • 2
  • Giovanni Liguori
    • 1
  • Stefano Bucci
    • 1
  • Libero Barozzi
    • 3
  • Lorenzo E. Derchi
    • 4
  1. 1.Department of RadiologyUniversity of Trieste, Ospedale di CattinaraTriesteItaly
  2. 2.S.O.C. Radiologia ASS 3 FVG, Ospedale Sant’Antonio AbateTolmezzoItaly
  3. 3.Radiology UnitCasa di Cura Madre Fortunata TonioloBolognaItaly
  4. 4.Department of RadiologyDICMI University of Genova, Ospedale S. MartinoGenoaItaly

Personalised recommendations