OBJECTIVE To report our experience in the management of patients with non-palpable lesions of the testis with a review of published studies. Even though radical orchiectomy remains the golden standard treatment for solid testicular masses there is an increasing role for testes-sparing surgery in a select group of patients with non-palpable tumors. METHODS Between April 2000 and October 2004, a non-palpable testicular lesion was discovered on ultrasonography in six patients. Ultrasonography was performed for infertility in two patients, for testicular pain in three patients, and in one case for previous history of seminoma in the contra-lateral testis. RESULTS Radical orchiectomy was performed in two patients, testis-sparing surgery with microsurgical excision and frozen-section examination (FSE) in two patients, and a conservative watchful waiting attitude was adopted in two patients. CONCLUSIONS In a select group of patients, testis-sparing surgery with microsurgical dissection and FSE or a watchful waiting attitude can be safely adopted as an alternative to radical orchiectomy in the presence of incidentally discovered non-palpable testicular lesion.