Changing trends from inguinal radical orchiectomy to testis-sparing surgery in pediatric testicular tumors

Abstract Aim Pediatric testicular tumors are rare entities accounting for only 1–2% of all pediatric solid tumors. We aimed to present the experiences of a tertiary pediatric hospital on testicular tumors and to reveal the changing surgical treatment trends over the years. Methods The patients who underwent surgery for scrotal tumors between 1992 and 2022 were reviewed retrospectively. The patients' demographic data, laboratory, radiologic, histopathological, and surgical findings, and postoperative follow-up were evaluated. The patients were evaluated as prepubertal, postpubertal, and in 10-year periods according to the operation time. Results A total of 47 children were identified. The median age was 6.2 years. Twenty-eight (59.6%) patients had left, 14 (29.8%) right, and 5 (10.6%) bilateral testicular tumors. The size of the tumor varied between 1 and 6 cm. Thirty-two (68%) patients were prepubertal. Twenty-four of them were germ-cell tumors, and 79.2% of these patients were prepubertal. The most common germ cell tumors were the yolk sac tumor ( n = 9) and mature cystic teratoma ( n = 7). Paratesticular rhabdomyosarcoma ( n = 6) was the most common paratesticular malignancy. Radical inguinal orchiectomy was performed in 21 and testis-sparing surgery was performed in 11 cases for primary testicular tumors. Testicular biopsy was performed in 9 cases for testicular involvement of Leukemia and Lymphoma. No recurrence was detected with a median follow-up of 6.5 years. Conclusion Radical inguinal orchiectomy is still the standard surgical treatment for malignant testicular tumors. With the support of imaging methods, tumor markers, and intraoperative frozen examination, testis-sparing surgery should be preferred in prepubertal and some carefully selected postpubertal benign testicular tumors.