Carefully selected intratesticular lesions can be safely managed with serial ultrasonography

OBJECTIVE: To evaluate a policy of conservative non-operative management for incidental, impalpable, < 1 cm, intratesticular pathology. PATIENTS AND METHODS: We retrospectively reviewed all scrotal ultrasonograms within an 8-year period to identify all radiological lesions of < 1 cm within the testis. All palpable lesions and those accompanied by elevated tumour markers or disseminated malignancy were managed surgically. The remaining incidentally detected lesions were followed with a protocol of serial ultrasonography (US). RESULTS: Of 1544 scans reviewed, 12 (0.8%) lesions suitable for observational management were identified. The mean (range) age of the patients was 54 (34-76) years. The indication for US was suspected epididymitis in five, contralateral epididymal cyst in five and infertility in two patients. The mean (range) size of the lesion was 4.9 (1.5-9.8) mm. Three anechoic lesions were consistent with intratesticular cysts, and each was followed with no change to a mean (range) follow-up of 26 (12-48) months. Eight hypoechoic lesions were followed to a mean of 34 (4-72) months, and only one showed growth on repeat US after an interval of 4 months, and was diagnosed as a 1.0-cm seminoma after orchidectomy. One hyperechoic lesion remains unchanged at 6 months of follow-up. CONCLUSION: Supported by previous reports suggesting that most testis lesions of < 1 cm are benign, we managed a series of carefully selected intratesticular lesions conservatively, the behaviour in most being in keeping with benign pathology.