Prepubertal testicular tumors: Clinical characteristics and indications for testis-sparing surgery in a multicenter retrospective study

Objectives: We aimed to clarify the characteristics of prepubertal testicular tumors and evaluate the suitability of testis-sparing surgery (TSS) for benign prepubertal testicular tumors, with a focus on clinical outcomes and tumor-specific factors that influence treatment decisions. Methods: A retrospective study was conducted involving 34 patients under 14 years of age who were treated for testicular tumors at five institutions from 2001 to 2021. Clinical parameters were compared between benign and malignant groups, and additional parameters, such as testicular volume, tumor volume, and tumor volume ratio, were analyzed within the benign group. Results: There were 18 cases in the benign group and 16 in the malignant group. The maximal tumor diameter was significantly larger in the malignant group (2.0 cm vs. 3.5 cm, p = 0.006). In the benign group, all cases in the TSS group had a tumor volume ratio < 70 % and a maximal tumor diameter < 2 cm (p = 0.006). No cases of testicular atrophy or recurrence were observed during a median follow-up of 60 months in the benign group. Conclusions: TSS is a feasible option for benign prepubertal testicular tumors with favorable preoperative evaluation results, offering preservation of testicular function without compromising oncological safety. Parameters such as a maximal tumor diameter < 2 cm and a tumor volume ratio < 70 % may help determine the suitability of TSS and support clinical decision-making in pediatric testicular surgery.