1
|
Xia Q, Kuang T, Lin X, Zhang H. Testicular tumor arising from an intra-abdominal undescended testis in a 1-year-old child: a case report and literature review. Front Pediatr 2023; 11:1142157. [PMID: 37266534 PMCID: PMC10229765 DOI: 10.3389/fped.2023.1142157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/17/2023] [Indexed: 06/03/2023] Open
Abstract
Objectives Testicular tumors in the intra-abdominal undescended testis are rare in children, and their management remains challenging. The aim was to present a case report and review of the literature about diagnosis and treatment of testicular tumors arising from undescended intra-abdominal testis in children. Methods In this study, we retrospectively analyzed the clinical records of a 1-year-old male patient admitted to pediatric surgery in March 2022 with a testicular tumor originating in the intra-abdominal undescended testis. Furthermore, medical literature published in English during the last three decades was systematically searched through the databases of Medline, PubMed, and Google Scholar. Results The patient underwent laparoscopic orchiopexy and tumor excision. The operation was uneventful, and the patient recovered well without complications. An 8-month follow-up showed no recurrence of the teratoma after postoperative pathology. The literature search resulted in the retrieval of 16 non-duplicate articles, and 16 patients were included in this review. The cases included six cases of left cryptorchidism and 10 cases of right cryptorchidism, with an average age of 15.3 months. The largest transverse diameter of the tumors ranged from 1.8 to 12.5 cm, with an average tumor length of 6.7 cm. All patients underwent surgical treatment, including three cases of laparoscopic orchiectomy, a sole case of a conversion of inguinal incision to laparotomy and orchiectomy, and 12 cases of laparotomy and orchiectomy. Postoperative pathology revealed 12 cases of mature teratoma, two cases of immature teratoma, one case of yolk sac tumor, and a single case of embryonic carcinoma combined with yolk sac tumor. 11 patients were followed up, and one of them recurred. Conclusion Abdominal ultrasound (US) or abdominal computer tomography (CT) should be performed in cases of undescended testis suspected to have testicular tumors on clinical findings. The most common type of intra-abdominal testicular tumor is mature teratomas. Early diagnosis and prompt surgical intervention resulted in an excellent outcome.
Collapse
Affiliation(s)
- Qiongzhang Xia
- Department of Pediatric Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Tongshuai Kuang
- Department of Pediatric Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaokun Lin
- Department of Pediatric Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Wenzhou Key Laboratory of Children Genitourinary Diseases, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hua Zhang
- Department of Pediatric Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| |
Collapse
|
2
|
Zhao W, Sun P, Xie J, Sun J, Zhou W, Yang Z, Fan Y, Yin J, Xu Q, Zhang Y, Zhou G, Jiang J, Li S. Anatomical laparoscopic orchiopexy and hybrid transcrotal orchiopexy for high inguinal undescended testis: A novel and interfascial technique. J Endourol 2022; 36:1199-1205. [PMID: 35509258 DOI: 10.1089/end.2021.0744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In traditional laparoscopic orchiopexy for inguinal undescended testis (UDT) surgery, the testicles are pulled back into the abdominal cavity by grasping and cephalad retracting the testicle and the cord. If this fails, a subsequent open inguinal incision is made to complete orchiopexy. To improve the orchiolysis and avoid extra open inguinal incision, we describe our early experience with and illustrate the surgical procedure of a novel anatomical laparoscopic orchiopexy (ALO) and hybrid transscrotal orchiopexy as required in high palpable UDT. METHODS From March 2018 to April 2020, ALO was performed in 140 consecutive patients (158 testes) with high inguinal UDT. After blunt and bloodless dissection of the inter-tunica vaginalis-cremasteric fascia plane, tunica vaginalis enveloping the testis was brought into the abdominal cavity as a whole. When the tunica vaginalis was unable to be brought into the abdominal cavity, given that the orchiolysis had already been partially carried out, the testis could be brought out of the external ring and descended when converting to transscrotal surgery. RESULTS The mean age in this study was 1.88 years (SD±1.95). The position of the testis assessed at surgery was peeping (58, 36.7%) and canalicular (100, 63.3%). In 128 testes (81.1%), ALO successfully brought the UDT into the abdominal cavity; the remaining 30 testes (18.9%) required a hybrid transscrotal technique. All testes were successfully descended without conversion to open inguinal procedure. The mean operative time was 43.99.2 minutes. All patients had follow-up within a median of 17.8 months, with satisfactory results in relation to viability and location of the testis. CONCLUSIONS ALO was shown to be not only safe, feasible, and effective for high inguinal UDT but also facilitated subsequent hybrid transscrotal orchiopexy; when the testis failed to be pulled into the abdominal cavity, the conversion to open inguinal orchiopexy could be obviated.
Collapse
Affiliation(s)
- Weiguang Zhao
- Shenzhen Children's Hospital, 85113, Urology, Shenzhen, China;
| | - Peng Sun
- Shenzhen Children's Hospital, 85113, Urology, Shenzhen, Guangdong, China;
| | - Jinjin Xie
- Shenzhen Children's Hospital, 85113, Urology, Shenzhen, Guangdong, China;
| | - Junjie Sun
- Shenzhen Children's Hospital, 85113, Urology, Shenzhen, Guangdong, China;
| | - Wei Zhou
- Shenzhen Children's Hospital, 85113, Urology, Shenzhen, Guangdong, China;
| | - Zhilin Yang
- Shenzhen Children's Hospital, 85113, Urology, Shenzhen, China;
| | - Yibin Fan
- Shenzhen Children's Hospital, 85113, Urology, Shenzhen, Guangdong, China;
| | - Jianchun Yin
- Shenzhen Children's Hospital, 85113, Urology, Shenzhen, Guangdong, China;
| | - Qitao Xu
- Shenzhen Children's Hospital, 85113, Urology, Shenzhen, Guangdong, China;
| | - Yingtian Zhang
- Shenzhen Children's Hospital, 85113, Urology, Shenzhen, Guangdong, China;
| | - Guanglun Zhou
- Shenzhen Children's Hospital, 85113, Urology, Shenzhen, Guangdong, China;
| | - Junhai Jiang
- Shenzhen Children's Hospital, 85113, Urology, Shenzhen, Guangdong, China;
| | - Shoulin Li
- Shenzhen Children's Hospital, 85113, Urology, Shenzhen, Guangdong, China;
| |
Collapse
|
3
|
Undescended Testes and Laparoscopy: Experience from the Developing World. Adv Urol 2018; 2018:1620470. [PMID: 30473708 PMCID: PMC6220417 DOI: 10.1155/2018/1620470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 09/23/2018] [Indexed: 02/02/2023] Open
Abstract
Background Cryptorchidism or undescended testes is the most common disorder of the male endocrine glands in children. With the advancements in laparoscopic techniques and instruments, laparoscopic orchidopexy has become the standard procedure in the management of nonpalpable undescended testes. Aim To evaluate and determine the therapeutic role, sensitivity, and specificity of laparoscopy in localizing nonpalpable testes and the mean operative time, the conversion rate (and reasons thereof), postoperative wound infection, postoperative stay, and time taken for return to daily activities following laparoscopic orchidopexy or orchidectomy. Materials and Methods This was a prospective study carried out in the Postgraduate Department of Surgery, Government Medical College, Srinagar, J&K, India, from May 2008 to August 2011. All patients who presented to the outpatient department with complaints of absent testes were examined, and the ones with nonpalpable testes were included in the study. Results The mean operative time for bilateral and unilateral nonpalpable testis was 102.76 and 53.67 minutes, respectively. Minor postoperative wound infections were noted in 4 of our patients. Mean duration of hospital stay was 14.23 hrs for unilateral cases and 16.27 hrs for bilateral cases. Patients who underwent laparoscopic orchidopexy resumed their normal activities within 4 ± 1 days. Conclusion Laparoscopy clearly demonstrates the anatomy and provides visual information upon which a definitive decision can be made for further management of the undescended nonpalpable testis.
Collapse
|
4
|
Arena S, Impellizzeri P, Perrone P, Scalfari G, Centorrino A, Turiaco N, Parisi S, Antonuccio P, Romeo C. Is inguinal orchidopexy still a current procedure in the treatment of intraabdominal testis in the era of laparoscopic surgery? J Pediatr Surg 2017; 52:650-652. [PMID: 27629799 DOI: 10.1016/j.jpedsurg.2016.08.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/12/2016] [Accepted: 08/31/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE To report our experience in surgical management of nonpalpable intraabdominal testis (NPIT) by inguinal orchidopexy without division of the spermatic vessels. METHODS We reviewed the records of NPIT patients who underwent orchidopexy between 2012 and 2015. All patients were evaluated ultrasonographically. When the testis was not detected ultrasonographically, a laparoscopic exploration was performed. If the testis was found on laparoscopy, surgery was resumed through an inguinal incision. A follow-up was performed at 1week, 1, 3 and 6months. RESULTS Twenty-one NPIT patients were treated, mean age 21.0±11.7months. Ultrasound identified 15 cases of NPIT (71%); diagnostic laparoscopy was performed in 6 (29%). All patients underwent an inguinal orchidopexy. At 1week, four testes were in a high scrotal position. At 6months follow-up, one testis was in a high scrotal position and one retracted up to the external inguinal ring. No atrophy was recorded. CONCLUSIONS Despite several attempts to find a surgical technique without any significant complications, all described procedures failed to meet the target. In our experience, inguinal orchidopexy is a safe, reliable and successful surgical procedure for the management of NPIT. It should be preferred to a technique requiring vascular division, burdened with a higher incidence of atrophy. TYPE OF STUDY Treatment study. LEVELS OF EVIDENCE Case series with no comparison group.
Collapse
Affiliation(s)
- Salvatore Arena
- Department of human pathology in adult and developmental age "Gaetano Barresi", Unit of Pediatric Surgery, University of Messina, Italy.
| | - Pietro Impellizzeri
- Department of human pathology in adult and developmental age "Gaetano Barresi", Unit of Pediatric Surgery, University of Messina, Italy
| | - Patrizia Perrone
- Department of human pathology in adult and developmental age "Gaetano Barresi", Unit of Pediatric Surgery, University of Messina, Italy
| | - Gianfranco Scalfari
- Department of human pathology in adult and developmental age "Gaetano Barresi", Unit of Pediatric Surgery, University of Messina, Italy
| | - Antonio Centorrino
- Department of human pathology in adult and developmental age "Gaetano Barresi", Unit of Pediatric Surgery, University of Messina, Italy
| | - Nunzio Turiaco
- Department of human pathology in adult and developmental age "Gaetano Barresi", Unit of Pediatric Surgery, University of Messina, Italy
| | - Saveria Parisi
- Department of human pathology in adult and developmental age "Gaetano Barresi", Unit of Pediatric Surgery, University of Messina, Italy
| | - Pietro Antonuccio
- Department of human pathology in adult and developmental age "Gaetano Barresi", Unit of Pediatric Surgery, University of Messina, Italy
| | - Carmelo Romeo
- Department of human pathology in adult and developmental age "Gaetano Barresi", Unit of Pediatric Surgery, University of Messina, Italy
| |
Collapse
|
5
|
Abstract
Recently, a new platform of abdominal access, called single-port surgery, has emerged in human and veterinary laparoscopy. The single-port platform enables all laparoscopic instruments, including the telescope, to pass individually through the same abdominal incision. Recently, there have been several published reports documenting the efficacy and safety of single-port procedures in veterinary patients. This article discusses the common single-port devices and instrumentation, as well as procedures now routinely offered in veterinary minimally invasive surgery.
Collapse
|
6
|
Talabi AO, Adisa AO, Adefehinti O, Sowande OA, Etonyeaku AC, Adejuyigbe O. Early experience with laparoscopic surgery in children in Ile-Ife, Nigeria. Afr J Paediatr Surg 2015; 12:29-32. [PMID: 25659546 PMCID: PMC4955486 DOI: 10.4103/0189-6725.150947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Laparoscopy is not yet routinely employed in many Paediatric Surgical Units in Nigeria despite the advantages it offers. This study describes the preliminary experience with laparoscopic procedures in a single centre. PATIENTS AND METHODS A retrospective analysis of all children who had laparoscopic surgery between January 2009 and December 2013 at the Paediatric Surgical Unit of Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife was carried out. Their sociodemographic, preoperative and intraoperative data along with postoperative records were subjected to descriptive analysis. RESULTS Eleven (44%) diagnostic and 14 (56%) therapeutic procedures were performed on 25 children whose age ranged from 5 months to 15 years (Median: 84 months, Mean: 103 ± 64.1 months), including eight (32%) females and 17 (68%) males. Indications included acute appendicitis in 12 (48%), intra-abdominal masses in six (24%), three (12%) disorders of sexual differentiation, two (8%) ventriculoperitoneal shunt malfunctions and impalpable undescended testes in two (8%) children. The procedures lasted 15-90 minutes (Mean = 54 (±21.6) minutes). Conversion rate was 17% for two patients who had ruptured retrocaecal appendices. No intra operative complications were recorded while three (12%) patients had superficial port site infections post-operatively. All diagnostic (11) and two therapeutic procedures were done as day case surgery. The mean duration of hospital stay was 3.1 (±3.3) days for those who had appendectomies. CONCLUSION Laparoscopic surgery in children is safe and feasible in our hospital. We advocate increased use of laparoscopy in paediatric surgical practice in Nigeria and similar developing settings.
Collapse
Affiliation(s)
- Ademola Olusegun Talabi
- Department of Surgery, Obafemi Awolowo University and Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State 220005, Nigeria
| | | | | | | | | | | |
Collapse
|
7
|
Sangrasi AK, Laghari AA, Abbasi MR, Bhatti S. Laparoscopic-assisted management of impalpable testis in patients older than 10 years. JSLS 2010; 14:251-5. [PMID: 20932378 PMCID: PMC3043577 DOI: 10.4293/108680810x12785289144449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Laparoscopic-assisted single-stage orchiopexy appears to be a safe, effective procedure for intraabdominal testis in adolescent and older patients. Objective: Cryptorchidism affects 1% of male births. The majority of patients with undescended testis are identified and treated in childhood, but a significant proportion of them especially in third-world countries are neglected and present late. Herein, we present our initial experience of managing impalpable testis in older children and adults with laparoscopic assistance. Patients and Methods: This study was conducted from 2003 through 2008 at LUMHS Jamshoro. Thirty-two patients with 40 impalpable testes were included in this study. Diagnostic laparoscopy was performed in 32 anesthetized patients. Laparoscopic-assisted orchiopexy or orchiectomy was performed in patients with intraabdominal testis. Testicular vessels and vas deferens were mobilized and after obtaining sufficient length were brought through the posterior wall of the inguinal canal by creating a neo-inguinal ring medial to the epigastric vessels after a small inguinal incision. Results: Of 40 impalpable testis, ultrasound localized 16 (40%) of them, and on laparoscopy, 36 (90%) were localized, 30 (75%) as intraabdominal and in 6 (15%) cases vas and vessels were entering into the internal inguinal ring (intracanalicular). The remaining 4 patients were diagnosed as having vanishing testis (anorchia). Laparoscopic orchiectomy was performed in 14 (35%) of these testes, while single-stage laparoscopic-assisted orchiopexy using Prentiss' maneuver was performed in 16 (40%) testis. No major complications occurred. Seven testes were associated with ipsilateral hernias and were simultaneously repaired laparoscopically. Conclusion: Laparoscopic-assisted single-stage orchiopexy is a safe and successful procedure for intraabdominal testis in adolescents and older patients. The additional benefit of shortening the usual course of spermatic cord was beneficial to fix the testis in the scrotum without tension.
Collapse
|
8
|
Ang CW, Forrest J. Diagnostic laparoscopy and management of the impalpable testis--a review of 10 years' practice at a non-paediatric specialist centre. J Pediatr Urol 2008; 4:214-7. [PMID: 18631929 DOI: 10.1016/j.jpurol.2007.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2007] [Accepted: 11/09/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Laparoscopy is used for the diagnosis and treatment of impalpable testes. We reviewed practice and outcomes in our unit over the last 10 years. METHODS Retrospective case-note review of patients undergoing laparoscopy with or without orchidopexy for impalpable testes. RESULTS Eighty-three patients underwent laparoscopy. Twelve patients had bilateral impalpable testes; 25.3% of testes were identified intra-abdominally, 21% in the internal ring, and 29.5% of cases had vas and vessels entering the deep ring. A 76.5% success rate was achieved following diagnostic laparoscopy and standard open orchidopexy for testes in the region of the internal ring, compared to a 40.0% success rate following one-stage laparoscopic orchidopexy for 'low' intra-abdominal testes. CONCLUSION Laparoscopy is useful in managing patients with an impalpable testis from both a diagnostic and therapeutic standpoint. The success rate following laparoscopic orchidopexy in our non-paediatric specialist centre is lower than in most reports from paediatric specialist centres. This suggests the importance of centralization of such complicated, less frequently performed surgical procedures to a specialist centre.
Collapse
Affiliation(s)
- Chin Wee Ang
- General Surgical Department, University Hospital of North Staffordshire, City General Hospital, Stoke-On-Trent, UK.
| | | |
Collapse
|
9
|
Radmayr C, Oswald J, Schwentner C, Neururer R, Peschel R, Bartsch G. Long-Term Outcome of Laparoscopically Managed Nonpalpable Testes. J Urol 2003; 170:2409-11. [PMID: 14634439 DOI: 10.1097/01.ju.0000090024.02762.3d] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE We evaluated laparoscopic diagnostic findings in 108 impalpable testes, and analyzed the success rate and long-term outcome of either direct laparoscopic orchiopexy or the 2-stage Fowler-Stephens procedure. MATERIALS AND METHODS A total of 84 children with 108 impalpable testes and a mean age of 1.9 years underwent laparoscopy between 1992 and September 2000. Long-term outcome with regard to viability and location of the testes was evaluated. RESULTS Of the 108 testes 72 were located intra-abdominally, of which 28 were managed by direct laparoscopic orchiopexy, 29 were managed by a 2-stage laparoscopic Fowler-Stephens procedure and 15 were vanishing. The remaining 36 testes were inguinally located during exploration and orchiopexy, except for 5 vanishing testes. In all cases the operation proceeded as planned. After a mean followup of 6.2 years all laparoscopically managed testicles were in a normal scrotal position with normal perfusion as revealed by color flow Doppler sonography. Two testicles became atrophic after a 2-stage Fowler-Stephens procedure. Morbidity was low in all children. CONCLUSIONS The laparoscopic approach allows not only diagnosis, but also adequate therapy regardless of whether direct orchiopexy or a 2-stage procedure is performed. Our long-term results clearly demonstrate that even in the patients undergoing the 2-stage procedure the laparoscopic approach is safe and efficient, and leads to excellent results concerning viability of the affected testicles. Progress and experience gained during recent years are encouraging in continuing laparoscopic procedures in children.
Collapse
|
10
|
Samadi AA, Palmer LS, Franco I. Laparoscopic orchiopexy: report of 203 cases with review of diagnosis, operative technique, and lessons learned. J Endourol 2003; 17:365-8. [PMID: 12965060 DOI: 10.1089/089277903767923128] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Proper management of the nonpalpable testicle requires an accurate diagnosis. Laparoscopic orchiopexy (LO) has become the standard for diagnosis and treatment. We classified the location of nonpalpable testicles, reviewed the technique of LO in detail, and report the results of our series, the largest described to date. PATIENTS AND METHODS We compiled the records of all cryptorchid patients seen between 1994 and 2002. Those with testicles located near the internal inguinal ring and those with nonpalpable testicles underwent laparoscopy and LO in the same session. The 173 patients underwent 203 procedures, all performed by the senior authors. RESULTS The undescended testicles were right-sided in 33% of patients, left-sided in 53%, and bilateral in 14%. Six testicles were excluded because of hypotrophy (N=4) or agenesis of the vas deferens (N=2). At laparoscopy, 58% of the testicles were at the iliac vessels or higher (high intra-abdominal), 22% were between the iliac vessels and the internal ring (low intra-abdominal), 16% were peeping, 3% were intracanicular, and 1% were retrovesical. Standard LO was performed in 70.5% of the patients, with the remainder being treated by laparoscopic Fowler-Stephens orchiopexy. There have been four cases of testicular atrophy, all after Fowler-Stephens procedures. Two were virgin gonads, and the other two had previously been subjected to extensive orchiolysis. Only 3% of the patients required repeat surgery because of an unsatisfactory testicular location. CONCLUSION The reported success rate for LO of intra-abdominal testicles has far exceeded that of open repair (95% v 76%). It is our belief that minimal manipulation of the testicle during dissection, a wider peritoneal window, and sparse use of electrocautery will result in adequate testicular position even for high intra-abdominal gonads with minimal risk of atrophy.
Collapse
Affiliation(s)
- Albert A Samadi
- Division of Pediatric Urology, Department of Urology, New York Medical College, Valhalla, New York, USA
| | | | | |
Collapse
|
11
|
Spermon JR, Debruyne FMJ, Witjes JA. Important factors in the diagnosis and primary staging of testicular tumours. Curr Opin Urol 2002; 12:419-25. [PMID: 12172430 DOI: 10.1097/00042307-200209000-00009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW In the present review we outline the use of different staging methods and highlight future possibilities in the management of testicular germ cell cancer. RECENT FINDINGS The 5-year survival for testicular cancer has improved dramatically over the past 30 years, with cure rates approaching 95%. This success is attributed to the appropriate integration of effective treatments and staging modalities. Staging currently represents the cornerstone on which treatment is based. Because most patients will be cured, attention has shifted toward reducing morbidity of treatment while maintaining high cure rates. This implies that staging must be accurate before any change to the treatment regimen can be instituted. SUMMARY Effective management of testicular germ cell cancer continues to pose a major challenge. Early and accurate diagnosis is very important because it will influence the choice of treatment and thus may impact on prognosis.
Collapse
Affiliation(s)
- J Roan Spermon
- Department of Urology, University Medical Centre Nijmegen, Nijmegen, The Netherlands.
| | | | | |
Collapse
|