Retroperitoneal block dissection in the treatment of nonseminomatous tumors of the testis

Fifteen patients with nonseminomatous tumors of the testis, stages I and II, underwent a retroperitoneal block dissection as part of their treatment regimen. Nonseminomatous germ cell and paratesticular tumours were reported. The preoperative measures and operative technique of the anterior transabdominal approach are described. There were no deaths or major postoperative complications encountered, in spite of the magnitude of the surgery involved. In two patients the tumor had occurred in an undescended testis. No patient had normal ejaculatory function after the operation. Special attention is drawn to the proper management of patients having undergone a transscrotal biopsy or orchiectomy. Five patients with a relatively long-term follow-up, are free of disease and doing well.

Testicular tumors in undescended testes

Twelve cases of malignant tumors in undescended testes were studied. Early diagnosis of these tumors was usually difficult as the testes were intrabdominal and the symptoms vague. Sixty percent of the seminoma cases were of the anaplastic aggressive variant. Early treatment of undescended testes included either orchiopexy or orchidectomy in early childhood. Exploratory laparotomy and frozen section examination of the abdominal nodes, followed by silver clip application, aided in better staging and the planning of further treatment.