{"id":52972,"date":"2022-09-07T16:42:48","date_gmt":"2022-09-07T13:42:48","guid":{"rendered":"https:\/\/serhatdonmezer.com\/?p=52972"},"modified":"2023-09-27T13:54:32","modified_gmt":"2023-09-27T10:54:32","slug":"testicular-tumors-and-surgical-treatment","status":"publish","type":"post","link":"https:\/\/serhatdonmezer.com\/en\/testis-tumorleri-ve-cerrahi-tedavi\/","title":{"rendered":"Testicular Tumors and Surgical Treatment"},"content":{"rendered":"<p>Tumors that form in the testicles of men change over time depending on some factors. This is what happens <strong>testicular tumors<\/strong> It can be benign or malignant. As a result of urological examination and tests, it is determined that the tumor in the patient is benign or malignant. Depending on the course of the disease, it is decided whether surgical treatment will be applied or not. Factors such as swelling in the testicles, fluid formation, pain in the groin or lower abdomen <strong>testicular tumors<\/strong> may be an indicator. In this case, it is necessary to consult a Urologist.<\/p>\n<p><img decoding=\"async\" class=\"wp-image-52977 aligncenter\" src=\"https:\/\/serhatdonmezer.com\/wp-content\/uploads\/2022\/09\/testis-tumoru-400x211.jpg\" alt=\"testicular tumor\" width=\"627\" height=\"331\" title=\"\" srcset=\"https:\/\/serhatdonmezer.com\/wp-content\/uploads\/2022\/09\/testis-tumoru-400x211.jpg 400w, https:\/\/serhatdonmezer.com\/wp-content\/uploads\/2022\/09\/testis-tumoru-768x404.jpg 768w, https:\/\/serhatdonmezer.com\/wp-content\/uploads\/2022\/09\/testis-tumoru.jpg 870w\" sizes=\"(max-width: 627px) 100vw, 627px\" \/><\/p>\n<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_82_2 counter-hierarchy ez-toc-counter ez-toc-light-blue ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">Yaz\u0131 \u0130\u00e7eri\u011fi<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewbox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewbox=\"0 0 24 24\" version=\"1.2\" baseprofile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/serhatdonmezer.com\/en\/testis-tumorleri-ve-cerrahi-tedavi\/#Testis_Tumoru_Olusumu\" >Testicular Tumor Formation<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/serhatdonmezer.com\/en\/testis-tumorleri-ve-cerrahi-tedavi\/#Testis_Tumorleri_Inguinal_Orsiyektomi\" >Testicular Tumors Inguinal Orchiectomy<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/serhatdonmezer.com\/en\/testis-tumorleri-ve-cerrahi-tedavi\/#Gecikmis_Inguinal_Orsiyektomi\" >Delayed Inguinal Orchiectomy<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/serhatdonmezer.com\/en\/testis-tumorleri-ve-cerrahi-tedavi\/#Organ_Koruyucu_Cerrahi\" >Organ Preserving Surgery<\/a><ul class='ez-toc-list-level-4' ><li class='ez-toc-heading-level-4'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/serhatdonmezer.com\/en\/testis-tumorleri-ve-cerrahi-tedavi\/#Kanser_Kontrolu_Fertilite_ve_Endokrin_Fonksiyon\" >Cancer Control, Fertility and Endocrine Function<\/a><\/li><\/ul><\/li><\/ul><\/li><\/ul><\/nav><\/div>\n<h2><span class=\"ez-toc-section\" id=\"Testis_Tumoru_Olusumu\"><\/span>Testicular Tumor Formation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>It constitutes %1 of male malignant neoplasms. However, they are the most common solid tumors in men between the ages of 15-35, and there has been a significant increase in the incidence of the disease in the last 30 years. Pathologies such as cryptoorchidism, testicular atrophy, inguinal hernia and infertility constitute risk factors for testicular tumor development. <strong>testicular tumors <\/strong>Since it is seen especially in the young male population, possible delays or deficiencies in diagnosis and treatment lead to unnecessary morbidity and mortality. Today, the treatment of testicular tumors is <strong>surgical treatment<\/strong>, kemoterapi, radyoterapi gibi parametrelerin bir ya da birka\u00e7\u0131n\u0131 kombine olarak i\u00e7erdi\u011finden tedavide multidisipliner yakla\u015f\u0131m gerekmektedir. \u00d6zellikle 1960\u2019l\u0131 y\u0131llarda tesis t\u00fcm\u00f6rlerinde %60-65 olan sa\u011fkal\u0131m oran\u0131n\u0131n, 2000\u2019li y\u0131llara gelindi\u011finde %90\u2019lar\u0131n \u00fczerine \u00e7\u0131kmas\u0131 solid t\u00fcm\u00f6rlerde ba\u015far\u0131l\u0131 multidisipliner yakla\u015f\u0131m\u0131n \u00f6nemini bir kez daha ortaya koymu\u015ftur. G\u00fcn\u00fcm\u00fczde testis t\u00fcm\u00f6rlerinin cerrahi tedavisinde inguinal or\u015fiyektomi (alt\u0131n standart), testis korucu cerrahiler, retroperitoneal lenf nodu diseksiyonu (RPLND) gibi prosed\u00fcrler uygulanmaktad\u0131r.<\/p>\n<h3><img decoding=\"async\" class=\"wp-image-52975 size-full alignleft\" src=\"https:\/\/serhatdonmezer.com\/wp-content\/uploads\/2022\/09\/testis-tumorleri.png\" alt=\"Testicular Tumors\" width=\"270\" height=\"227\" title=\"\"><\/h3>\n<h3><span class=\"ez-toc-section\" id=\"Testis_Tumorleri_Inguinal_Orsiyektomi\"><\/span><strong>T<\/strong><strong style=\"font-size: 16px;\">est<\/strong><strong style=\"font-size: 16px;\">Work Tumors Inguinal Orchiectomy<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>The presence of an intrascrotal mass that cannot be localized anywhere other than the testicle is a sufficient indication for a surgical intervention performed through the inguinal approach. All masses detected within the testicle should be considered malignant until proven otherwise and should be treated surgically.<\/p>\n<p>Radical orchiectomy combined with high ligation of the spermatic cord at the level of the internal inguinal ring constitutes the first step of treatment in patients with suspected testicular neoplasm. In this way, delay in diagnosis of the disease is prevented and local control is achieved with minimal morbidity, and appropriate treatment planning can be carried out by staging and categorizing the tumor.<\/p>\n<p>Radical orchiectomy can be performed under local anesthesia, regional anesthesia such as spinal anesthesia, or under general anesthesia. The recommended method in cases without additional disease is surgery under general anesthesia. <strong>surgical treatment<\/strong> are applications. In this way, visceral pain that may develop due to manipulation of the spermatic cord is also controlled.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"Gecikmis_Inguinal_Orsiyektomi\"><\/span>Delayed Inguinal Orchiectomy<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>There are different opinions about performing inguinal orchiectomy in advanced stage testicular tumors. While some researchers argue that inguinal orchiectomy should be performed as soon as a testicular tumor is detected, regardless of its stage, some authors argue that orchiectomy should be postponed so that chemotherapy can be started as soon as possible.<\/p>\n<p>Or\u015fiyektominin ertelenmesini savunan ara\u015ft\u0131rmac\u0131lar\u0131n temel dayana\u011f\u0131; or\u015fiyektomi sonras\u0131 nadir de olsa geli\u015febilecek komplikasyonlar\u0131n kemoterapi ba\u015flanmas\u0131n\u0131 geciktirebilece\u011fi d\u00fc\u015f\u00fcncesidir. Sistemik kemoterapi sonras\u0131 gecikmi\u015f or\u015fiyektomi yap\u0131lan 160 hastal\u0131k bir seride hastalar\u0131n %25\u2019inin testisinde anlaml\u0131 kanser ve %31\u2019inde ise teratom saptanm\u0131\u015ft\u0131r. Buna kar\u015f\u0131n or\u015fiyektomi yap\u0131lmas\u0131n\u0131 savunan ar\u015ft\u0131rmac\u0131lar; kemoterapi esnas\u0131nda testisin neoplazi kayna\u011f\u0131 olmaya devam edece\u011fi, kemoterap\u00f6tik ajanlar\u0131n (\u00f6zellikle bleomisin) pulmoner toksisiteye neden olarak anesteziye ba\u011fl\u0131 komorbiditeyi art\u0131rabilece\u011fi g\u00f6r\u00fc\u015f\u00fcn\u00fc ileri s\u00fcrmektedirler.<\/p>\n<p><img decoding=\"async\" class=\"size-medium wp-image-52976 alignright\" src=\"https:\/\/serhatdonmezer.com\/wp-content\/uploads\/2022\/09\/cerrahi-tedavi-320x240.jpg\" alt=\"surgical treatment\" width=\"320\" height=\"240\" title=\"\" srcset=\"https:\/\/serhatdonmezer.com\/wp-content\/uploads\/2022\/09\/cerrahi-tedavi-320x240.jpg 320w, https:\/\/serhatdonmezer.com\/wp-content\/uploads\/2022\/09\/cerrahi-tedavi-768x576.jpg 768w, https:\/\/serhatdonmezer.com\/wp-content\/uploads\/2022\/09\/cerrahi-tedavi.jpg 880w\" sizes=\"(max-width: 320px) 100vw, 320px\" \/><br \/>\nComplications The most important complication in inguinal orchiectomy <strong>surgical treatment<\/strong> intrascrotal hematoma development. In order to prevent this complication from developing, bleeding control must be done carefully during the operation. Since the scrotum is an expandable structure, possible bleeding may not stop with the development of tamponade and may reach large sizes. The growth of the hematoma can be prevented by applying a compressive scrotal dressing, and the hematoma often resorbs spontaneously with conservative follow-up. If the sutures connecting the spermatic cord become loose, retroperitoneal hematoma may develop. These retroperitoneal hematomas may be confused with lymphadenopathy in tomography scans performed for postoperative staging.<\/p>\n<p>Another complication that may develop in patients undergoing inguinal orchiectomy is scrotal injury. The risk of local recurrence is very low in scrotal injuries that occur without tumor contamination. In the past, when there was a scrotal injury, hemiscrotumectomy, inguinal lymphadenectomy or scrotal radiotherapy was recommended.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"Organ_Koruyucu_Cerrahi\"><\/span>Organ Preserving Surgery<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>Organ-preserving surgery has become one of the treatment alternatives for many urological tumors and with this procedure; While providing a permanent cure, it is aimed to prevent unnecessary aggressive treatment in lesions that are likely to be benign and to preserve organ functions. In %1-5 cases with testicular tumor, a tumor also develops in the opposite testicle. Since gonads are not vital organs, they are bilateral. <strong>testicular tumors<\/strong>\u00a0The main treatment should be bilateral orchiectomy.<\/p>\n<p>However, bilateral orchiectomy; It has been shown that organ-sparing surgery may be a good option in well-selected cases, as it will bring about psychological problems such as infertility, lifelong androgen replacement, and castration at a young age. Organ-preserving surgery, or partial orchiectomy, in testicular tumors is generally performed in the presence of bilateral germ cell tumors, in the presence of tumor in cases with solitary testicles, in cases where the opposite testicle is severely atrophic, in the presence of benign lesions such as epidermoid cysts and simple cysts, in testicular masses detected in childhood (prepubertal). It is an exceptional method that is appropriate to perform (since the majority of tumors are benign).<\/p>\n<p>The surgeon who will perform organ-sparing surgery must have sufficient experience in this field and know the vascular anatomy of the testicle well. In this way, complications such as testicular atrophy can be minimized. After the inguinal incision is made, the spermatic cord is accessed. Since Sertoli cells are damaged within 30 minutes in warm ischemia, the testicle is cooled by wrapping it with ice cubes for approximately 5 minutes before the spermatic cord is occluded with a penrous drain.<\/p>\n<p>After the testicle is delivered to the operation field, the intratesticular mass is palpated, and with the help of intraoperative ultrasonography, both the localization of small-sized tumors and the detection of vascular structures can be achieved. <strong>Testicular Tumors<\/strong> After determining the location and wrapping ice around the cord and testicle, the tunica albuginea is incised at the point closest to the tumor under cold ischemia, then the area around the pseudocapsule of the tumor is dissected and enucleated to include 1-2 mm of normal parenchyma tissue. Bipolar electrocautery can be used to control bleeding. After enucleation, the specimen is immediately sent for frozen section and if the result is malignant, 4 biopsies are taken from the tumor bed and sent for frozen evaluation again. Surgical resection can be extended according to frozen results. Samples should be taken from the intact parenchyma and placed in Bouin&#039;s solution and sent for pathological examination to investigate the possible presence of TIN. At the end of the procedure, the tunica albuginea is closed continuously with 5\/0 monocryl sutures.<\/p>\n<h4><span class=\"ez-toc-section\" id=\"Kanser_Kontrolu_Fertilite_ve_Endokrin_Fonksiyon\"><\/span>Cancer Control, Fertility and Endocrine Function<span class=\"ez-toc-section-end\"><\/span><\/h4>\n<p>T\u00fcm kanser olgular\u0131nda oldu\u011fu gibi testis kanserinde de \u00f6ncelikle uzun sa\u011fkal\u0131m ama\u00e7lanmaktad\u0131r. Testis koruyucu cerrahide temel avantaj endokrin fonksiyonlar\u0131n korunuyor olmas\u0131d\u0131r. Burada en \u00f6nemli sorun t\u00fcm\u00f6re kom\u015fu testis dokusunda % 85\u2019lere varan oranlarda T\u0130N g\u00f6r\u00fclmesi ve bu odaklar\u0131n 5 y\u0131l i\u00e7ersinde %50\u2019ye varan oranlarda invaziv kansere d\u00f6n\u00fc\u015fme riskinin bulunmas\u0131d\u0131r.<\/p>\n<p>Therefore, when TIN is detected in the ipsilateral intact testicular parenchyma, 18-20 Gy radiotherapy is recommended to prevent local recurrence. The local recurrence rate is reported as %5.4 by the German Working Group, and it is reported that all cases with local recurrence are due to the presence of TIN adjacent to the tumor and that radiotherapy cannot be applied for various reasons. <strong>\u00a0<\/strong><\/p>\n<p>Leydig cell dysfunction and hypogonadism may develop in patients after radiotherapy. In addition, keeping the spermatic cord clamped for a long time during testicle-sparing surgery may lead to Leydig cell dysfunction by causing warm ischemia. For this reason, patients whose serum testosterone levels are observed to be normal at the 3rd month follow-up after testicle-sparing surgery should be informed that radiotherapy will inevitably result in infertility and should be sent for radiotherapy.<\/p>\n<p>In patients who want to have children, radiotherapy can be postponed until plans are made regarding fertility. Despite all these harmful effects, testicle protective <strong>surgical treatment<\/strong> adjuvan radyoterapi alan hastalar\u0131n %85\u2019inde serum testosteron seviyelerinin normal oldu\u011funu bildiren \u00e7al\u0131\u015fmalar vard\u0131r. Bu bilgiler \u0131\u015f\u0131\u011f\u0131nda testis koruyucu cerrahi ile ilgili daha \u00e7ok say\u0131da kontroll\u00fc \u00e7al\u0131\u015fmalar yap\u0131l\u0131ncaya kadar bilateral testis t\u00fcm\u00f6rl\u00fc olgularda parsiyel or\u015fiyektomiye temkinli bir \u015fekilde yakla\u015fmak gerekmektedir.<\/p>","protected":false},"excerpt":{"rendered":"<p>Tumors that form in the testicles of men change over time depending on some factors. These testicular tumors can be benign or malignant. As a result of urological examination and tests, it is determined that the tumor in the patient is benign or malignant. Depending on the course of the disease, it is decided whether surgical treatment will be applied or not. Swelling in the testicles, fluid formation, in the groin or lower abdomen [\u2026]<\/p>","protected":false},"author":1,"featured_media":52976,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[323],"tags":[],"class_list":["post-52972","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-testis-kanseri"],"acf":[],"_links":{"self":[{"href":"https:\/\/serhatdonmezer.com\/en\/wp-json\/wp\/v2\/posts\/52972","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/serhatdonmezer.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/serhatdonmezer.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/serhatdonmezer.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/serhatdonmezer.com\/en\/wp-json\/wp\/v2\/comments?post=52972"}],"version-history":[{"count":0,"href":"https:\/\/serhatdonmezer.com\/en\/wp-json\/wp\/v2\/posts\/52972\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/serhatdonmezer.com\/en\/wp-json\/wp\/v2\/media\/52976"}],"wp:attachment":[{"href":"https:\/\/serhatdonmezer.com\/en\/wp-json\/wp\/v2\/media?parent=52972"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/serhatdonmezer.com\/en\/wp-json\/wp\/v2\/categories?post=52972"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/serhatdonmezer.com\/en\/wp-json\/wp\/v2\/tags?post=52972"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}