With the advent of modern surgical oncology, multiple areas have incorporated organ preservation, leading to a substantial reduction in treatment- related morbidity without compromising long-term disease-specific survival. The organ-sparing frozen section analysis guided approach to testicular masses represents a promising alternative to orchiectomy in selected patients presenting with bilateral malignant tumors, tumors in a solitary testis, and unilateral or bilateral benign tumors. Tumor enucleation in cold ischemia, biopsy of the tumor bed, frozen section analysis, biopsy of the peripheral parenchyma, postoperative radiation of the remaining testicle, close followup at an experienced center in selected patients can provide long-term disease-specific survival even with preserving fertility.