Innovative Technique Preserves the Potential for Fertility in Men with Testicular Tumors
Dec 19, 2002
A new surgical technique, developed and pioneered by a NewYork-Presbyterian Hospital Weill Cornell urologist, prevents the unnecessary removal of testes for some men with testicular tumors, ultimately preserving their fertility. Hidden testicular tumors can now be correctly identified and safely removed by ultrasound guided needle localization aided by an operative microscope. Weill Cornell was the first in the world to perform the procedure and demonstrate its efficacy.
The new technique is discussed in a recently published issue of the Journal of Urology, and was presented earlier this year at the annual meeting of the American Urological Association.
"Traditionally, when a man is discovered to have a hidden testicular tumor, the recommendation is radical orchiectomy, the removal of the testicle," said Dr. Marc Goldstein, Professor of Reproductive Medicine and Urology at Weill Cornell Medical College, and Surgeon-in-Chief of Male Reproductive Medicine and Surgery at NewYork-Presbyterian Hospital Weill Cornell Medical Center.
"We now know, by using guided needle localization, that half of all these tumors are benign. Therefore, as many as half of men diagnosed with impalpable testis tumors may have a testis removed unnecessarily. This is particularly devastating for men with only one testis to start with. Our new technique makes correct diagnosis possible."
From the participating study group of 65 men undergoing fertility evaluation between January 1995 and December 2001, five percent were discovered to have testicular masses that were not detected by physical examination. In half of these cases, pathological findings were benign.
The new technique also makes possible, for the first time, the safe removal of these tumors while preserving the testicle. This is particularly useful to men with a single testicle who otherwise would be castrated. "Without testicles, a man will need hormone replacement therapy for the rest of his life, and he will have no chance for fertility," said Dr. Goldstein.
The study, authored by Dr. Goldstein and Dr. Carin V. Hopps, Fellow in the Department of Urology and The Cornell Institute for Reproductive Medicine at Weill Cornell Medical College, is also the first to document the use of an operating microscope for the removal of impalpable testicular tumors.
Ultrasound guided needle localization, a technique used for many years for breast cancer, is an outpatient procedure requiring general or regional anesthesia. The procedure involves the precise insertion of a surgical needle into the testicle with the aid of ultrasound visualization and an operating microscope, which together make possible the safe discovery and extraction of the testicular tumor. After extraction of the patient's irregular tissue mass, tissue pathology is determined by a frozen section analysis. Following the procedure, patients are able to return to work in three days.
Nearly half of infertility cases are male-based. And men with infertility are 38 times more likely to have testicular cancer. For this reason, Dr. Goldstein strongly urges routine scrotal ultrasound for all men who are undergoing infertility evaluation or those with a history of undescended testes. "Additionally, all men ages 15 to 45 should perform self-examinations for palpable masses."