Hook Wire Localization for Testis Sparing Surgery

Objective To describe a novel technique for localizing small testicular mass during testicular-sparing surgery (TSS). Methods and Results A 20-year-old man presented with bilateral testicular masses. Both alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (BHCG) levels were raised. Clinical and imaging studies revealed a 2.7 cm and 0.7 cm mass in the right and left testis, respectively. No metastatic disease was detected on staging scans. Right inguinal total orchiectomy was performed. For the left testis, the inguinal approach was used to deliver the testis to the surgical wound. Vascular clamping and cooling of the testis were performed. A hook wire (Ghiatas Beaded Breast Localization Wire, 20G) was then inserted through the small testicular tumor with the aid of on-table ultrasound imaging. Testicular-sparing surgery (TSS) was easily performed with the aid of the hook wire. Postoperative recovery was uneventful. The histology report revealed a mixed germ cell tumor with clear margin. Tumor markers returned to normal after surgery. Serum testosterone level was also within normal range. Follow-up ultrasound scan showed a viable left testis with normal vascularity. Conclusion Hook wire localization of a small testicular mass under ultrasound guidance is an easy-to-perform technique that facilitates TSS in selected patients. This technique allows TSS to be performed in a more controlled and confident manner.