Our objective was to perform a long-term evaluation of conservative surgical treatment of Leydig cell tumors. A multicenter retrospective clinical study was performed at 6 European centers. Case files of all patients diagnosed with Leydig cell tumor and treated with conservative surgery were examined. Patients underwent physical examination, hormone and tumor marker assays, scrotal and abdominal ultrasonography, chest radiography, and endocrinologic examination. From 1987 to 2006, 22 patients with Leydig cell tumor underwent conservative surgery. Mean patient age was 35 years (range, 5-61 years). Mean follow-up was 180 months (range, 77-290 months). No local recurrence or metastasis was observed. Patients presented with a palpable testicular nodule (3 patients [13.7%]), a nodule diagnosed by ultrasonography (15 patients [68.2%]), gynecomastia (2 patients [9.1%]), precocious pseudopuberty (1 patient [4.5%]), or scrotal pain (1 patient [4.5%]). Diagnosis after frozen section examination was Leydig cell tumor in 20 of 22 patients (91%). Mean histologic size of the nodule was 1.11 cm. Follow-up was conducted for all patients every 3 to 6 months, with physical examination, tumor marker assays, scrotal and abdominal ultrasonography, chest radiography, and computed tomography (CT). No local recurrences or metastases were observed. One hundred percent of patients are still alive with a 100% disease-free survival. When diagnosed and treated early, long-term favorable outcomes are seen at follow-up in Leydig cell tumors, even with its potential metastatic behavior. In these patients, testicle-sparing surgery proved to be a feasible and safe choice and could be regarded as the first line of therapy. Copyright © 2013 Elsevier Inc. All rights reserved.