Role of testis sparing surgery in the conservative management of small testicular masses: oncological and functional perspectives.

INTRODUCTION: Radical orchiectomy (RO) is still considered the standard of care for malignant germ cell tumours, which represent the vast majority of the palpable testicular masses. In those patients diagnosed with small testicular masses (STMs), testis-sparing surgery (TSS) could be an alternative treatment to RO. The aim of this updated review is to evaluate the current indications for TSS, and discuss the oncological and functional results of patients who had undergone organ-sparing surgery for STMs. EVIDENCE ACQUISITION: A non-systematic review of the Literature using the Medline database has been performed, including a free-text protocol using the terms "testis-sparing surgery", "testicular sparing surgery", "partial orchiectomy", "testis tumour", "sex cord tumour", and "testis function". Other significant studies cited in the reference lists of the selected papers were also evaluated. EVIDENCE SYNTHESIS: No randomized controlled trials comparing TSS with radical orchiectomy have been reported yet. In those patients with normal contra-lateral testis, the use of TSS is still controversial. In selected cases of gonadal masses < 2 cm, TSS seems to be a safe and feasible treatment option. Frozen section examination allows us to discriminate between benign and malignant neoplasms during TSS. Intermediate and long-term follow-up results showed no significant risk of local and distant recurrences in the main series reported in the literature. CONCLUSIONS: TSS is an effective treatment for STMs in selected patients, limiting the unnecessary surgical over-treatments, without compromising the oncological and functional outcomes. Further studies are needed in order to confirm the oncological safety.

Warm ischemia time and postoperative complications after partial nephrectomy for renal cell carcinoma.

OBJECTIVE: To evaluate the correlations between PADUA and RENAL scores, WIT and postoperative complications in a cohort of patients who underwent elective open or minimally invasive nephron sparing surgery for renal cell carcinoma. MATERIAL AND METHODS: We analyzed 96 consecutive patients who underwent partial nephrectomy for renal cell carcinoma between 2004 and 2013 at our Institution. The Spearman test was used to compare categorical variables. For all statistical analyses, a two-sided P < .05 was considered statistically significant. RESULTS: The median (IQR) PADUA score was 7 (7-8) and the median (IQR) RENAL score was 7 (6-8). The median (IQR) warm ischemia time was 14 min (8-20). Low grade and high grade postoperative complications were found in 27 (28.1%) and 6 (6.3%) patients, respectively. PADUA risk group categories significantly correlated with WIT > 20 minutes and high grade postoperative complications, respectively (P = .04), regardless of the surgical approach. RENAL risk group categories significantly predicted longer hilar clamping time in our cohort (P = .04), but no statistically significant correlations with high grade postoperative complications were found. CONCLUSIONS: In our retrospective series nephrometric scores demonstrated to significantly predict longer warm ischemia time and higher postoperative complications, especially in those patients with more challenging and complex renal tumors. Therefore, when planning to perform partial nephrectomy, urologists should widely use these comprehensive tools.

Survival, Continence and Potency (SCP) recovery after radical retropubic prostatectomy: a long-term combined evaluation of surgical outcomes.

OBJECTIVE: To offer a comprehensive account of surgical outcomes on a defined series of patients treated with radical retropubic prostatectomy (RRP) for prostate cancer in a single European Center after 5-year minimum follow-up according to the Survival, Continence and Potency (SCP) system. MATERIAL AND METHODS: We evaluated our Institutional database of patients who underwent RRP from November 1995 to September 2008. Oncological and functional outcomes were reported according to the recently proposed SCP system. RESULTS: The 5- and 10-year biochemical recurrence-free survival rates were 80.1% and 55.8%, respectively. At the end of follow-up, 611 (78.5%) patients were fully continent (C0), 107 (13.8%) used 1 pad for security (C1) and 60 (7.7%) patients were incontinent (C2). Of the 112 patients who underwent nerve-sparing RRP, 22 (19.6%) were fully potent without aids (P0), 13 (11.6%) were potent with assumption of PDE-5 inhibitors (P1) and 77 (68.8%) experienced erectile dysfunction (P2). The combined SCP outcomes were reported together only in 95 (12.2%) evaluable patients. In patients preoperatively continent and potent, who received a nerve-sparing and did not require adjuvant therapy, oncological and functional success was attained by 29 (30.5%) patients. In the subgroup of 508 patients not evaluable for potency recovery, oncological and continence outcomes were obtained in 357 patients (70.3%). CONCLUSION: Survival, Continence and Potency (SCP) classification offer a comprehensive report of surgical results, even in those patients who do not represent the best category, thus allowing to provide a much more accurate evaluation of outcomes after RP.

Papel de la cirugía conservadora testicular en el manejo conservador de masas testiculares pequeñas: perspectivas oncológicas y funcionales / Role of testis sparing surgery in the conservative management of small testicular masses: oncological and functional perspectives

Introducción: La orquiectomía radical (OR) se considera todavía la opción estándar de atención para los tumores malignos de células germinales, que representan la gran mayoría de las masas testiculares palpables. En pacientes diagnosticados con pequeñas masas testiculares la cirugía conservadora testicular (CCT) podría ser un tratamiento alternativo a la OR. El objetivo de esta revisión actualizada es evaluar las indicaciones actuales para la CCT y debatir los resultados oncológicos y funcionales de los pacientes sometidos a cirugía conservadora testicular por pequeñas masas testiculares. Adquisición de la evidencia: Se ha llevado a cabo una revisión no sistemática de la literatura empleando la base de datos Medline, que incluyó un protocolo de texto libre utilizando los términos «cirugía conservadora de los testículos», «cirugía conservadora testicular», «orquiectomía parcial», «tumor de testículo», «tumor del cordón sexual» y «función testicular». También se evaluaron otros estudios significativos citados en las listas de referencia de los trabajos seleccionados. Síntesis de la evidencia: Aún no se ha registrado ningún ensayo controlado aleatorizado comparando la CCT con la OR. En aquellos pacientes con testículos contralaterales normales el uso de la CCT todavía resulta controvertido. En casos seleccionados de masas gonadales < 2 cm la CCT parece ser una opción terapéutica segura y viable. El análisis de secciones congeladas permite distinguir entre neoplasias benignas y malignas durante la CCT. Los resultados del seguimiento a medio y largo plazo no mostraron ningún riesgo significativo de recidiva local y a distancia en las principales series de la literatura. Conclusiones: La CCT es un tratamiento efectivo para las pequeñas masas testiculares en pacientes seleccionados, limitando los sobretratamientos quirúrgicos innecesarios, sin comprometer los resultados oncológicos y funcionales. Se requieren más estudios para confirmar la seguridad oncológica

Introduction: Radical orchiectomy (RO) is still considered the standard of care for malignant germ cell tumors, which represent the vast majority of the palpable testicular masses. In those patients diagnosed with small testicular masses (STMs), testis-sparing surgery (TSS) could be an alternative treatment to RO. The aim of this updated review is to evaluate the current indications for TSS, and discuss the oncological and functional results of patients who had undergone organ-sparing surgery for STMs. Evidence acquisition: A non-systematic review of the Literature using the Medline database has been performed, including a free-text protocol using the terms «testis sparing surgery», «testicular sparing surgery», «partial orchiectomy», «testis tumor», «sex cord tumor», and «testis function». Other significant studies cited in the reference lists of the selected papers were also evaluated. Evidence synthesis: No randomized controlled trials comparing TSS with radical orchiectomy have been reported yet. In those patients with normal contra-lateral testis, the use of TSS is still controversial. In selected cases of gonadal masses < 2 cm, TSS seems to be a safe and feasible treatment option. Frozen section examination allows us to discriminate between benign and malignant neoplasms during TSS. Intermediate and long-term follow-up results showed no significant risk of local and distant recurrences in the main series reported in the literature. Conclusions: TSS is an effective treatment for STMs in selected patients, limiting the unnecessary surgical over-treatments, without compromising the oncological and functional outcomes. Further studies are needed in order to confirm the oncological safety

Tiempo de isquemia caliente y complicaciones postoperatorias después de la nefrectomía parcial de carcinoma de células renales / Warm ischemia time and postoperative complications after partial nephrectomy for renal cell carcinoma

Objetivo: Evaluar las correlaciones entre puntuaciones PADUA y RENAL, TIC y complicaciones postoperatorias en una cohorte de pacientes que se sometieron a cirugía de conservación de nefronas por elección abierta o mínimamente invasiva para el carcinoma de células renales. Material y métodos: Analizamos 96 pacientes consecutivos que fueron sometidos a nefrectomía parcial por carcinoma de células renales entre 2004 y 2013 en nuestra institución. La prueba de Spearman se utilizó para comparar variables categóricas. Para todos los análisis estadísticos un valor de p < 0,05 de 2 caras se consideró estadísticamente significativo. Resultados: La mediana de puntuación PADUA (RI) fue de 7 (7-8) y la puntuación RENAL mediana (RI) fue de 7 (6-8). La mediana de tiempo de isquemia caliente (RI) fue de 14 min (8-20). Se encontraron complicaciones postoperatorias de grado bajo y alto en 27 (28,1%) y 6 (6,3%) pacientes, respectivamente. Las categorías de grupos de riesgo de PADUA se correlacionaron significativamente con TIC > 20 min y las complicaciones postoperatorias de alto grado, respectivamente (p = 0,04), independientemente del abordaje quirúrgico. Las categorías de grupos de riesgo RENAL predijeron significativamente más tiempo de pinzamiento hiliar en nuestra cohorte (p = 0,04), pero no se encontraron correlaciones estadísticamente significativas con las complicaciones postoperatorias de alto grado. Conclusiones: En nuestra serie retrospectiva las puntuaciones nefrométricas demostraron predecir significativamente mayor tiempo de isquemia caliente y mayores complicaciones postoperatorias, especialmente en aquellos pacientes con tumores renales más difíciles y complejos. Por lo tanto, al planificar realizar la nefrectomía parcial los urólogos deberían utilizar ampliamente estas herramientas completas

Objective: To evaluate the correlations between PADUA and RENAL scores, WIT and postoperative complications in a cohort of patients who underwent elective open or minimally invasive nephron sparing surgery for renal cell carcinoma. Materials and methods: We analyzed 96 consecutive patients who underwent partial nephrectomy for renal cell carcinoma between 2004 and 2013 at our Institution. The Spearman test was used to compare categorical variables. For all statistical analyses, a two-sided p < 0.05 was considered statistically significant. Results: The median (IQR) PADUA score was 7 (7-8) and the median (IQR) RENAL score was 7 (6-8). The median (IQR) warm ischemia time was 14 min (8-20). Low grade and high grade postoperative complications were found in 27 (28.1%) and 6 (6.3%) patients, respectively. PADUA risk group categories significantly correlated with WIT > 20 min and high grade postoperative complications, respectively (p = 0.04), regardless of the surgical approach. RENAL risk group categories significantly predicted longer hilar clamping time in our cohort (p = 0.04), but no statistically significant correlations with high grade postoperative complications were found. Conclusions: In our retrospective series nephrometric scores demonstrated to significantly predict longer warm ischemia time and higher postoperative complications, especially in those patients with more challenging and complex renal tumors. Therefore, when planning to perform partial nephrectomy, urologists should widely use these comprehensive tools