Routine ultrasonographic screening of the remaining testis in patients following unilateral orchiectomy for testicular germ cell tumors

The incidence of a second primary tumor in the contracterai testis among paiierts fallowing orchiectomy for testicuiar germ cell tumors is significantly higher in comparison to men wjth no previous history of testis cancer. The risk of develooing a second testicuiar tumor following unilateral orchiectomy does not diminish with time thence, long term surveillance of the contralateral testis is mandatory. We evaiuaied the rose of routine scrotal ultrasonographic screening in the surveillance of patients fcllowing orchiectomy for testicuiar germ cell tumors PATIENTS AND METHODS: 82 patients who underwent unilateral orrhiectomy for testicuiar germ cell tumors and are followed with no evidence of recurrent disease and no palpable masses in the remaining testis were included in the current study. None had history of cryptorchidism. In addition to the routine surveillance, these patients were screened prospectiveiy for the presence of impalpable testicuiar lesions by scrotal uitrasonographv usine; Acuson 128 and a 7.5 MHZ linear transducer. Mean age was 36.6 years (range 23-52). Mean duration of follow-up from initial management was 4.4 years (range 1-9). 67% of the tumors were seminorras and 33% nonseminomas. Clinical stage A serninoma patients were managed by radiation to the gbdomen with shielding of the remaining testis. 35% of the patients presented in advanced stage and received systemic chemotherapy. RESULTS: impalpable intra testicuiar mass lesions were detected m 2/82 patients (2.4%). Testicufar calcifications were detected in 4/82 patients (4.8% Incidental varicocele or hydrocele was reported in 8/82 patierrs (9.8%. None of the ultrasonographic examinations demonstrated local recurrence. Tencs in the ipsilateral hemiscrotum. There was no evidence for compensatory growth of the remaining testis following removal of the contralateral tumor Daring teste. CONCLUSIONS. These results support the routine use of seretal ultrasonographic screening to complement tne physical examination in the survetlance of the remaining testis following unilateral orchiectomy for testicular germ cell tumors.