Article

Safety and effectiveness of a new saline filled testicular prosthesis

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Abstract

Testicular prostheses have been used for 50 years to replace missing or removed testes. In 1995 the manufacture of the silicone gel filled testis prosthesis in the United States was discontinued because of concern about the safety profiles of other implants. We assessed the safety and effectiveness of a new, saline filled implant for testicular replacement. This open label, multicenter, prospective, case controlled clinical trial was done at 18 American tertiary referral centers. Adult and pediatric male patients missing 1 or 2 testes and without evidence of active malignancy or rheumatological disease were enrolled. All patients underwent formal rheumatological and urological evaluation prior to and after prosthesis placement. Main outcome measures were prosthesis safety assessed by adverse events and effectiveness assessed by changes in testis dimension. Secondary outcome measures were quality of life assessments with 3 validated instruments. All patients were followed a minimum of 1 year in this 5-year study. Postoperative adverse events observed in 19% of 149 patients included device related discomfort or pain in 3%, scrotal edema in 1.3%, infection in 1.3%, extrusion in 2.6%, deflation in 0.7% and pulmonary emboli in 0.7%. No patient reported rheumatological symptoms at 1 year. Testis dimensions were significantly increased in patients missing a testis at baseline (p <0.001). Subjective assessment of testicular appearance was significantly improved (p <0.001) and scores were stable or significantly improved in 2 of 3 quality of life instruments. At short-term followup a new, saline filled testis prosthesis appears safe and well tolerated. Importantly validated self-esteem measures also suggest improvement in quality of life after prosthesis placement.

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... [20] Travmatik nedenler veya zamanla silikon jelin özelliğini kaybetmesi ve çevre dokulara sızabilmesi nedeniyle silikon jel ile doldurulmuş silikon elastomer kaplı protezlerin kullanılma yaygınlığı azalmış ve farklı dolgu maddeleri kullanılan testis protezlerinin yaygınlığı artmıştır. [21] Turek ve ark. [21] içi tuzlu su (serum fizyolojik) ile doldurulmuş dışı silikon elastomerden yapılmış testis protezlerini 1997'de geniş bir olgu grubunda kullanmış ve sonuçlarını yayınlandıktan sonra Amerikan İlaç Kurumu (FDA) onay vermiştir. ...
... [21] Turek ve ark. [21] içi tuzlu su (serum fizyolojik) ile doldurulmuş dışı silikon elastomerden yapılmış testis protezlerini 1997'de geniş bir olgu grubunda kullanmış ve sonuçlarını yayınlandıktan sonra Amerikan İlaç Kurumu (FDA) onay vermiştir. ...
... Tüm protez cerrahilerinde olduğu gibi testis protez implantasyonun da en önemli komplikasyonu infeksiyondur. [2,4,21,38] İnfeksiyon riskini azaltmak için Tablo 2'deki önlemler yararlı olabilir. [2,4] Sistemik antibiyotik gram-negatif, gram-pozitif ve anaerob bakterilere etkili geniş spektrumlu bir antibiyotik olmalıdır. ...
Article
Full-text available
Absence of one or two testicle due to congenital or acquired reasons creates not only physiological complications, but also cosmetic and psychological problems for males of all ages. These problems can be effectively solved by implantation of testicular prostheses. Current implants in use are made out of a silicone elastomer envelope filled either with saline, silicone gel or solid silicone elastomer. A Pubmed search was carried out for all articles on testicular prosthesis published between 1963 and 2010 for this review. The history and development of testicular prostheses, types of implants, timing of implantation, the surgical techniques and complications, and benefits of implantation of testicular prosthesis were reviewed.
... [20] Travmatik nedenler veya zamanla silikon jelin özelliğini kaybetmesi ve çevre dokulara sızabilmesi nedeniyle silikon jel ile doldurulmuş silikon elastomer kaplı protezlerin kullanılma yaygınlığı azalmış ve farklı dolgu maddeleri kullanılan testis protezlerinin yaygınlığı artmıştır. [21] Turek ve ark. [21] içi tuzlu su (serum fizyolojik) ile doldurulmuş dışı silikon elastomerden yapılmış testis protezlerini 1997'de geniş bir olgu grubunda kullanmış ve sonuçlarını yayınlandıktan sonra Amerikan İlaç Kurumu (FDA) onay vermiştir. ...
... [21] Turek ve ark. [21] içi tuzlu su (serum fizyolojik) ile doldurulmuş dışı silikon elastomerden yapılmış testis protezlerini 1997'de geniş bir olgu grubunda kullanmış ve sonuçlarını yayınlandıktan sonra Amerikan İlaç Kurumu (FDA) onay vermiştir. ...
... Tüm protez cerrahilerinde olduğu gibi testis protez implantasyonun da en önemli komplikasyonu infeksiyondur. [2,4,21,38] İnfeksiyon riskini azaltmak için Tablo 2'deki önlemler yararlı olabilir. [2,4] Sistemik antibiyotik gram-negatif, gram-pozitif ve anaerob bakterilere etkili geniş spektrumlu bir antibiyotik olmalıdır. ...
Article
Full-text available
Absence of one or two testicle due to congenital or acquired reasons creates not only physiological complications , but also cosmetic and psychological problems for males of all ages. These problems can be effectively solved by implantation of testicular prostheses. Current implants in use are made out of a silicone elastomer envelope filled either with saline, silicone gel or solid silicone elastomer. A Pubmed search was carried out for all articles on testicular prosthesis published between 1963 and 2010 for this review. The history and development of testicular prostheses, types of implants, timing of implantation, the surgical techniques and complications, and benefits of implantation of testicular prosthesis were reviewed.
... [6] Implantation of the prosthesis in childhood and adolescence is considered safe if the proper implant size is selected, the correct surgical access is used, and adequate post-operative treatment is provided. [7][8][9][10] A good cosmetic result has a positive impact on the psycho-sexual development of young boys and those in puberty. [5,[9][10][11][12][13] There are no widely accepted standards for the appropriate age for prosthesis implantation or the time between the excision of a testis and insertion of an implant. ...
... [7][8][9][10] A good cosmetic result has a positive impact on the psycho-sexual development of young boys and those in puberty. [5,[9][10][11][12][13] There are no widely accepted standards for the appropriate age for prosthesis implantation or the time between the excision of a testis and insertion of an implant. However, early implantation is generally considered beneficial. ...
... [5,21] Other prostheses were made of solid silicone, silicone sheath with normal saline filling, or polyurethane sheath with silicone gel filling. [5,10] Martín-Crespo Izquierdo et al proposed multiple injections of hyaluronic acid gel inside a scrotal sac, which played the role of an expander. [17] We used prostheses made of silicone sheath with liquid silicone filling. ...
Article
Full-text available
Lack of the testis is an important factor in psycho-sexual development of the boys, and implantation of the prosthesis plays a very essential role in the treatment of that group of patients. Currently there are no standards regarding when prosthesis should be implanted, and which access is connected with minimal rates of complications. We present our experience of primary prosthesis implantations in boys treated in our department.From 2000 to 2014, primary implantation of the testicular prosthesis was performed in 290 boys. The early and late post-operative complications and long-term therapeutic results were analyzed, considering age at the time of implantation, the time between the initial operation and implantation of the prosthesis, and the surgical approach.Best results were observed in 267 patients and bad outcome in 23 patients. Prosthesis implantation in young boys operated within the first three years of life or during the first year after primary surgery was connected with statistically fewer complications (P = .002 and P < .05, respectively). Supra-scrotal access was connected with the lowest rate of complications (P = .01).Long-term therapeutic results in boys with testicular prostheses were good in the majority of cases. Implantation of the first prosthesis should be performed early between 1 and 3 years of life in boys with lack of the testis. Implantation of a prosthesis should also be performed within 1 year after removing of testis or during orchiectomy. Supra-scrotal access should be chosen for testicular prosthesis implantation due to the best long-term results.
... Чепурной (2002) предложили использовать в качестве импланта-наполнителя стерильный гидрогель ПААГ 6-й степени плотности [10]. Существует и имеет некоторое практическое значение метод протезирования с использованием резервуара, заполненного солевым раствором [11]. Ранее предлагавшиеся методики с использованием парафина, поролоновой губки, пластмассы АКР-10 на сегодняшний день имеют только историческое значение; • силиконовые импланты, имеющие определенную форму. ...
... 2). Так, риск отторжения импланта и инфекции области оперативного вмешательства достоверно выше при использовании мошоночного доступа, так как при нем всегда сохраняется негерметичность швов и контакт протеза с внешней средой [11]. Отдельные авторы представили случаи деструкции силиконового импланта [13]. ...
Article
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Aim. The aim of this study was to optimize indications and techniques and to develop the optimal timing for testicular prosthesis following inversion in adolescence considering the assessment of quality of life of patients at different times following the surgery. Materials and methods. We observed 70 patients with gonadal loss following critical ischemia (torsion) at ages 11-18 years (average, 15.5 ± 2.3 years). In total, 49 patients underwent joint replacement after orchiectomy due to torsion. In 21 patients, prosthetics were preceded by orchiectomy for testicular atrophy as a result of twisting. The interval from an acute episode to joint replacement ranged from 6 months to 15 years. Three techniques for testicular prosthesis implantation were applied: prosthetics with inguinal access without suturing the scrotal entrance (n = 14); prosthetics with inguinal access with suturing the scrotal entrance by the originally developed technique (n = 34); and a prosthetic scrotum (n = 22). Patient satisfaction was assessed based on the different outcomes of testicular inversion according to the originally developed questionnaire. Results. Suturing the scrotal entrance reduces the risk of implant migration in the proximal direction due to anatomical prerequisites. Scrotal access does not have this drawback but increases the risk of inflammatory complications. The esthetic result of prosthetics depends on patient’s age during orchiectomy. Older patients tend to have better cosmetic results. The most favorable results of prosthetics are noted at the time that has passed since the turn - no more than 3 years; all unsatisfactory results are noted at the time of more than 5 years since the twist. Testicular prosthesis increases social adaptation of patients after gonadal loss and improves their quality of life. Conclusions. 1. Testicular prosthesis is an essential stage of patient rehabilitation after an orchiectomy for inversion. 2. Prosthetic inguinal access by the originally developed technique is optimal from a technical perspective and provides the most physiological standing of the implant. 3. Prosthetics results directly depend on the period following the initial operation. 4. Testicular prosthesis complications can be minimized with the accumulation of knowledge and surgical experience and their rational prevention. 5. Assessment of patients’ quality of life illustrates the necessity of gonadal prosthetics for cosmetic compensation of organ loss and psycho-emotional and social rehabilitation. (For citation: Shormanov IS, Shchedrov DN. Medical and social rehabilitation following testicular prosthesis in post-orchiectomy patients. Urologicheskie vedomosti. 2018;8(2):43-52. doi: 10.17816/uroved8243-52).
... There are theoretical risks associated with silicone and liquid-filled implants, including connective tissue diseases, auto-immune disorders, and implant failure due to rupture. While these risks remain very low, there is a market push toward an alternative for silicone use in soft prosthetic implant design (1)(2)(3). ...
... This unit cell was chosen because of its simplicity and known analytical relationships. The relative density can be adjusted using Equation (1) and the E-modulus (related to firmness, hardness and feel) can be adjusted using Equation (2). ...
Article
Full-text available
Patients often opt for implantation of testicular prostheses following orchidectomy for cancer or torsion. Recipients of testicular prostheses report issues regarding firmness, shape, size, and position, aspects of which relate to current limitations of silicone materials used and manufacturing methods for soft prostheses. We aim to create a 3D printable testicular prosthesis which mimics the natural shape and stiffness of a human testicle using a lattice infill structure. Porous testicular prostheses were engineered with relative densities from 0.1 to 0.9 using a repeating cubic unit cell lattice inside an anatomically accurate testicle 3D model. These models were printed using a multi-jetting process with an elastomeric material and compared with current market prostheses using shore hardness tests. Additionally, standard sized porous specimens were printed for compression testing to verify and match the stiffness to human testicle elastic modulus (E-modulus) values from literature. The resulting 3D printed testicular prosthesis of relative density between 0.3 and 0.4 successfully achieved a reduction of its bulk compressive E-modulus from 360 KPa to a human testicle at 28 Kpa. Additionally, this is the first study to quantitatively show that current commercial testicular prostheses are too firm compared to native tissue. 3D printing allows us to create metamaterials that match the properties of human tissue to create customisable patient specific prostheses. This method expands the use cases for existing biomaterials by tuning their properties and could be applied to other implants mimicking native tissues.
... Lattimer and Puranik introduced a testicular prosthesis with a silicone sheath and silicone gel filling elastomer in 1973 [3••]. Though initially popular, silicone-filled testicular implants were withdrawn from the US market in 1995 in response to concerns about gel bleed and development of connective tissue disease in patients who received silicone breast implants [4,6]. Since that time, the testicular implant market shifted towards salinefilled silicone implants [1••,4]. ...
... Testicular implants are safe in pediatric and adult populations with low complication rates [6, 12••]. Though overall complication rate varies based on placement indication, the most frequent complications of testicular prostheses include pain (9%), allergic reaction (5%), scrotal edema (3%), extrusion (2%), and infection (1.3%) (Table 1) [6]. To prevent infection, the skin should be carefully clipped or shaved with a safety razor and prepped with chlorahexadine and/ or isopropyl alcohol. ...
Article
Full-text available
Purpose of Review Placement of a testicular implant may restore cosmesis and improve quality of life after testicular loss. This review will discuss contemporary indications for testicular prosthesis, considerations for patient selection, surgical techniques, and future directions for research. Recent Findings Immediate testicular prosthesis placement at the time of orchiectomy does not appear to compromise outcomes compared with delayed placement. Additionally, patients with a history of scrotal irradiation or chemotherapy appear to have prosthetic outcomes comparable to baseline. Recent quality-of-life studies reinforce the importance of patient counseling pre-operatively and demonstrate positive long-term effects of testicular implants on patient satisfaction and self-image. Active research in the field focuses on improving the prosthetic tactile feel and possibly producing hormonally active implants. Summary Testicular prosthetic placement at the time of orchiectomy is safe and should be offered to patients prior to surgery. Testicular implants produce high patient satisfaction with low complication rates.
... [11] The spread of silicone to inguinal lymph nodes is also documented in a case report [12] but, as mentioned previously, there is no evidence of autoimmune disease or malignancy developing following testicular prosthesis implantation. Turek at el [13] also reviewed their series of testicular prosthesis for complication and noted a complication rate as shown in table1. In current practice, the most common postoperative complaints concern body image, namely that ...
... Observed complications with testicular prosthesis ComplicationMarshal et al[10] Turek et al[13] ...
Article
Full-text available
Prosthesis is an artificial material used as a replacement for its natural counterpart. Use of testicular prosthesis in paediatric urology is limited and indications are well defined. In this review we tried to find out and summarize the current indications and available options in paediatric urology for these prostheses.
... Turek et al. found improved body and self-esteem in a monorchid cohort (n Z 73; mean age 12.8 years, range 0e17) surveyed 1 year after prosthesis implantation [51]. However, baseline body and self-esteem scores of the patients (i.e. ...
... Testicular prosthesis placement is not a harmless procedure. The aforementioned study by Turek et al. reported a 14.5% complication rate directly related to the prosthesis; a similar study in a pediatric cohort reported a 10.5% complication rate [51,53]. Complications from the procedure included extrusion and implant migration. ...
Article
Testicular torsion remains the most frequent cause of testicular ischemia, especially in adolescents and young adults. Timely diagnosis and intervention are keys to saving the affected testicle. This review presents current trends in the diagnosis and treatment of torsion, potential pitfalls and consequent outcomes. Additionally, other salient issues surrounding testicular torsion are also discussed, including: pathogenesis of injury, legal ramifications, fertility outcomes, novel management techniques, and recent advances in diagnostic technology.
... Gel-filled implants were replaced by saline-filled prostheses in 1995 as a precautionary measure after discovery that many silicone breast implants had leaked into surrounding connective tissues, causing harm (Robinson, Bradley, Wilson, & Fisher, 1995). Following the transition to saline-filled prosthesis, TPP cemented itself as a safe and effective reconstructive option after testicular removal (Turek & Master, 2004). ...
... Patients should be counseled that TPP is considered a safe and effective intervention, with low complication rates over the last 50 years (Lakshmanan & Docimo, 1997). Furthermore, Turek and Master demonstrated that modern saline-filled prostheses are safe, well tolerated, and improve quality of life (Turek & Master, 2004). Additionally despite these risks, a 2014 study of 904 men who underwent radical orchiectomy demonstrated that 236 received a prosthesis and only 1 out of 236 (0.4%) required a prosthesis removal (Robinson, Tait, Clarke, & Ramani 2016). ...
Article
Full-text available
Orchiectomy is the standard of care for many testicular conditions. Testicular prosthesis placement (TPP) can mitigate psychosocial burden, restore self-image, and improve quality of life for patients requiring orchiectomy. Limited data exist regarding patient attitudes and counseling on TPP in the United States. The objective of this study was to characterize patient experiences after TPP, rationale for pursuing/declining TPP, and satisfaction levels. Patients with a history of urologic conditions warranting orchiectomy were identified and sent an anonymous survey addressing demographics, pre/post counseling, attitudes toward TPP, satisfaction rates, and postoperative complications. Sixteen percent (76/480) of patients completed the survey. Of these, 50.8% (32/63) undergoing orchiectomy were counseled by their surgeon about TPP, and 22.2% (14/63) received a prosthesis. The most common reasons for declining TPP included lack of concern for cosmetic appearance and lack of counseling. Leading reasons for pursuing TPP included improving self-confidence and cosmetic appearance. Although 71% (10/14) of patients were satisfied with TPP, they did highlight areas for improvement. Twenty percent (2/10) felt their implant was too high, 60% (6/10) felt their implant was too firm, 10% (1/10) endorsed discomfort during sex, and 30% (3/10) felt that TPP did not match their size expectations. Despite these findings, 71% (10/14) reported that they would have TPP again and 79% (11/14) would recommend TPP to others. TPP improves body image and quality of life following orchiectomy. Provider counseling plays an important role in influencing a patient’s decision to undergo TPP. Areas of improvement include implant positioning and more effective replication of testicular consistency.
... 4,5 Saline-filled prostheses were first used in the USA in 1995. 6 In China, a hollow Silastic testicular ORIGINAL ARTICLE Novel double-layer Silastic testicular prosthesis with controlled release of testosterone in vitro, and its effects on castrated rats ...
Article
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Testicular prostheses have been used to deal with anorchia for nearly 80 years. Here, we evaluated a novel testicular prosthesis that can controllably release hormones to maintain physiological levels of testosterone in vivo for a long time. Silastic testicular prostheses with controlled release of testosterone (STPT) with different dosages of testosterone undecanoate (TU) were prepared and implanted into castrated Sprague-Dawley rats. TU oil was applied by oral administration to a separate group of castrated rats. Castrated untreated and sham-operated groups were used as controls. Serum samples from every group were collected to measure the levels of testosterone (T), follicle-stimulating hormone and luteinizing hormone (LH). Maximum intracavernous penile pressure (ICPmax) was recorded. The prostates and seminal vesicles were weighed and subjected to histology, and a terminal dexynucleotidyl transferase-mediated UTP nick end labeling (TUNEL) assay was used to evaluate apoptosis. Our results revealed that the weights of these tissues and the levels of T and LH showed significant statistical differences in the oral administration and TU replacement groups compared with the castrated group (P < 0.05). Compared with the sham-operated group, the ICPmax, histology and TUNEL staining for apoptosis, showed no significant differences in the hormone replacement groups implanted with medium and high doses of STPT. Our results suggested that this new STPT could release TU stably through its double semi-permeable membranes with excellent biocompatibility. The study provides a new approach for testosterone replacement therapy.
... Since the 1990s and the well-documented complications with silicone gel-filled breast implants and their theoretical health risks, such as connective tissue and autoimmune disorders or the possibility of tumor development [7], silicone elastomer or saline-filled prostheses have been now used [8,9]. ...
Article
Full-text available
. We report a case of spontaneous rupture of a single testicular prosthesis in a patient who had undergone bilateral orchiectomy and silicone gel-filled prosthesis insertion. The consequences of this rare event are discussed. There is no management algorithm. Case Presentation . A 55-year-old man presented to our outpatient department with altered consistency in his right testicular prosthesis and a painful right hemiscrotum with no systemic symptoms thirty-three years after the implantation of the prosthesis. We removed this implant without replacement, in accordance with the patient’s wishes. Conclusion . The long time between the implantation and the spontaneous rupture is remarkable and was never before described. The removal of the prosthesis was straightforward and it would have been possible to implant a new prosthesis after taking into account the condition of the skin.
... Testicular prosthesis or implants were introduced to give a sense of fullness in the scrotum and avoid psychological trauma. Modern day testicular prostheses are available in different sizes and made of silicone filled with gel or saline [7,8]. High satisfaction rates of patients after TPI are well documented and counselling patients for about TPI is an essential part in consenting patients undergoing orchidectomy [9][10][11]. ...
Article
Full-text available
Objectives: To assess the practice of testicular prosthesis insertion (TPI) related to orchidectomy in one geographical region and to identify the difference in the rates of insertion among different age groups. Patients and methods: Males who underwent orchidectomy between 1989 and 2009 were identified from data collected from Scottish Morbidity Records. Patients were classified into six age groups. The TPI rate and relation to original orchidectomy were analysed according to different age groups. Results: In all, 3364 patients underwent orchidectomy in the 20-year period of the study. The most common indications for orchidectomy were atrophy, undescended testes, torsion, and tumour. In the same period, 530 patients had a TPI, with 59.4% of them (316 patients) having TPI at initial surgery, 17.3% (92) as a second surgical procedure, and 22.8% (122) having the TPI without prior history of orchidectomy. Among patients who underwent TPI, postpubertal males were more likely to have simultaneous insertion at the time of orchidectomy than prepubertal males (83% vs 32%; odds ratio 10.44, 95% confidence interval 5.23-20.82; P < 0.01). Conclusion: Younger males are more likely to have TPI at a later date. Paediatric urologists should be mindful of the possibility of concurrent TPI at the time of initial scrotal/groin exploration.
... Furthermore the few studies (11,12) who analyse this aspect use simple and generic questions without using validated questionnaires. The only paper in literature analysing sexual activity after testicular prosthesis implantation with validated questionnaires is the study by Turek et al. (13). These authors used the same psychological validated questionnaires (BESAQ, Body-Esteem Scale and Rosenberg Self-Esteem) that we used in our study but they didn't use IEEF-5 and PEDT for the analysis of erectile dysfunction and premature ejaculation before and after testicular prosthesis implantation as we did. ...
Article
Full-text available
Purpose: We studied patient satisfaction about sexual activity after prosthesis implantation using validated questionnaires with the aim to discover if testicular prosthesis could be responsible of sexual dysfunctions (erectile dysfunction or premature ejaculation). Materials and methods: We evaluated a total of 67 men who underwent radical orchiectomy for testicular cancer and a silicon testicular prosthesis implantation from January 2008 to June 2014 at our Hospital. These patients completed 5 validated questionnaires the day before orchiectomy and 6 months after surgery: the International Index of Erectile Function 5 (IIEF5), the Premature Ejaculation Diagnostic Tool (PEDT), the Body Exposure during Sexual Activities Questionnaire (BESAQ), the Body-Esteem Scale and the Rosenberg Self- Esteem Scale. We also evaluated 6 months after surgery any defects of the prosthesis complained by the patients. Results: The questionnaires completed by patients didn't show statistically significant changes for erectile dysfunction (p > 0.05) and premature ejaculation (p > 0.05). On the contrary the psychological questionnaires showed statistically significant change for the BESAQ (p < 0.001) and the Body Esteem Scale (p < 0.001), but not for the Rosenberg Self-Esteem Scale (p > 0,05). A total of 15 patients (22.37%) were dissatisfied about the prosthesis: the most frequent complaint (8 patients; 11.94%) was that the prosthesis was firmer than the normal testis. Conclusions: Testicular prosthesis implantation is a safe surgical procedure that should be always proposed before orchiectomy for cancer of the testis. The defects complained by patients with testicular prosthesis are few, they don't influence sexual activity and they aren't able to cause erectile dysfunction or premature ejaculation.
... The rate of extrusion of testicular prosthesis is quoted at 3-8% [4]; however, a review performed in the USA of 149 patients undergoing insertion of testicular prosthesis reported extrusion in 2.6% of cases [5]. ...
Article
Full-text available
Testicular prostheses are regularly used in urological surgery and are important for postoperative psychological well-being in many patients undergoing orchiectomy. One of the recognised complications of this procedure is graft extrusion, which can result in significant morbidity for patients and require operative reintervention. Whilst most cases of extrusion involve upward graft migration to the external inguinal ring or direct displacement through the scrotal skin, we present an unusual case of complete expulsion of testicular implant three weeks postoperatively through a previously healthy scrotum. During surgical insertion of testicular prostheses, the urological surgeon must carefully consider the different surgical strategies at each step of the operation to prevent future extrusion of the graft. A stepwise review of the preventive surgical strategies to reduce the risk of graft extrusion encompasses the choice of optimal surgical incision, the technique of dissection to create the receiving anatomical pouch, the method of fixation of the implant within the receiving hemiscrotum, and the adoption of good postoperative care measures in line with the principles of sound scrotal surgery.
... Although there are other testicular prostheses available in the European and Asian markets, these are not FDA-approved due to the silicone composition of these devices (66). A 5-year multicenter prospective trial across 18 centers in 1998-1999 assessing the efficacy and safety of the saline-filled testicular prosthesis solidified the FDA's approval as the current goldstandard testicular prosthesis (67). The Torosa comes in four sizes: extra small, small, medium, and large. ...
Article
Scrotal surgery encompasses a wide-variety of surgical techniques for an even wider variety of indications. In this manuscript, we review our indications, techniques, and pit-falls for various reconstructive scrotal surgeries as-well-as surgical tips for placement of testicular prostheses. Penoscrotal webbing (PSW) is an abnormal, often-problematic distal insertion of scrotal skin onto the ventral penile shaft. There are several effective and straightforward techniques used to revise this condition, which include simple scrotoplasty, single- or double-Z-plasty, or the VY-flap scrotoplasty. Reconstruction is also commonly indicated following scrotal skin loss caused by infection, trauma, lymphedema, hidradenitis, and cancer. Although initial management of these conditions often involves scrotal skin removal, repair of expansive scrotal skin loss can be technically difficult and can be accomplished by using one of several skin flaps or skin grafting. Splitthickness skin grafting of scrotal defects can be accomplished easily, and provides durable results.
... Although it seems intuitive that a testicular loss would result in decreased self-esteem and decreased emotional wellbeing, it has not been formally studied and reported in the literature. It is believed that the study by Turek et al. is the first to apply well-validated psychological instruments in a prospective manner to assess the impact of testicular gain on psychological wellbeing in a large cohort of patients [18]. Their results confirmed that significant increases of wellbeing and quality of life are possible with testis prosthesis placement. ...
Article
Introduction: The absence of a testis occurs for various reasons in children, but testicular prosthesis implantation in children is uncommon. The optimal time for prosthesis placement is still unclear, and its complication rate has been poorly studied in children. Objective: The aim of this study was to determine the risk factors of complications in cases of testicular prosthesis implantation in children. Study design: A monocentric, retrospective review was performed of children implanted with a testicular prosthesis between 2008 and 2014. All implantations were performed through an inguinal incision with a standardized procedure. Children were divided into two groups depending on the interval after orchiectomy: (A) early implantation (delay between surgeries <1 year); and (B) delayed surgeries (delay ≥1 year). Statistical analysis was performed with Student and Fisher tests. Results: Twenty-six patients (A, 15; B, 11) had a total of 38 testicular prostheses placements. Mean follow-up was 36.2 months. First surgery was performed at the mean age of 11.8 years (range 0-17.9) (A, 14.1; B, 8.1; P = 0.01) and testicular prosthesis implantation at the mean age of 14.7 years (range 9-18) (A, 14.3; B, 14.6) with a mean delay of 36.1 months (A, 1.3; B, 80.3). Indications were mainly spermatic cord torsion (27%), bilateral anorchia (27%), and testicular atrophy after cryptorchidism surgery (19.2%). Complications (10.5%) included two cases of extrusion, one infection and one migration. Patient 1 had a history of acute lymphoblastic leukemia with testicle relapse 2 years after induction therapy. High-dose chemotherapy, total body irradiation and bilateral orchiectomies were performed, and bilateral prostheses were implanted 12 years after the end of chemotherapy. Complications happened 85 days after surgery. Patient 2 was followed-up for a proximal hypospadias. The tunica vaginalis flap, which was used during a redo urethroplasty, lead to testicular atrophy. Thirteen years after the last penile surgery, a testicular prosthesis was placed through an inguinal incision, and extrusion occurred 203 days after surgery. Bacterial cultures of the prostheses were sterile and histological review showed no sign of granuloma or graft rejection. The complication rate was significantly higher if the delay between the two surgeries exceeded 1 year (P = 0.01). Indications of orchiectomy, prior scrotal incision, and prosthesis size were not risk factors. Conclusions: Testicular prosthesis implantation was relatively safe in a pediatric cohort. The complication rate was significantly higher if the delay between the orchiectomy and the prosthetic placement exceeded 1 year. These results suggest that reducing the delay between orchiectomy and prosthesis implantation may lead to fewer complications.
... Sin embargo, esta actitud no se ha estandarizado debido a que la prótesis deberá ser reemplazada por una de mayor tamaño después de la pubertad, y a que hay evidencias que sugieren efectos nocivos de las prótesis de silicona a largo plazo en los niños, que incluyen, no sólo reacciones locales, sino migración de partículas a distancia, rotura del gel de silicona o detección de anticuerpos anti-silicona (5,6) . Se han buscado alternativas a las prótesis de silicona, habiéndose implantado con éxito las prótesis rellenas de salino en la edad pediátrica (7) . ...
Article
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There is a controversy concerning infant testicular prosthesis. The problem is that this may necessitate further surgery to insert a larger prosthesis when the child gets older. An alternative strategy is to delay the placement of the definitive prosthesis until the child reaches adolescence. However, the underdeveloped scrotum may fail to accommodate the desired sized testicular prosthesis. We present scrotoplasty using hyaluronic acid gel injection as a minimally-invasive alternative to enhance the volume of scrotum until puberty. A prospective report of 35 boys younger than seven years old with monorchia underwent injection of hyaluronic acid for scrotal filling. Mean follow-up of 24 months (range 12-48 months). The only complication was early resorption in 2 patients at 8 and 10 months after implantation, respectively. In long-term followup 100 per cent of the families rated the cosmetic appearance as good and 95 per cent were content with the decision regarding placement of a testicular implant irrespective of whether they had been retreated. It shows that hyaluronic acid gel scrotal injection can provide satisfactory improvement in enhance the volume of scrotum. It is associated with high family and patient satisfaction, and provides a long-lasting result. This technique makes placement of prosthetic testis a very simple procedure that can be performed at the time of diagnostic exploration or orchiectomy, increasing scrotal space until post pubertal definitive prosthesis.
... Een andere bevinding is dat prothesedragers ontevreden zijn over de textuur van de prothese. De textuur wordt vaak als te hard ervaren, wat suggereert dat van de beschikbare modellen steeds de zachtste prothese zou moeten worden gekozen [10,11]. Toekomstig onderzoek zou de focus moeten leggen op patiënttevredenheid in relatie tot de kenmerken van de prothese (grootte, gewicht, vorm en textuur) en het materiaal waarvan de prothese is gemaakt. ...
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Samenvatting Na orchidectomie in het kader van een testismaligniteit kan een testisprothese worden geplaatst. Deze mogelijkheid en de patiënttevredenheid ten aanzien van deze prothese wordt echter niet met elke patiënt besproken. In deze studie werd nagegaan in hoeverre artsen de mogelijkheid van zo’n prothese bespreken met de patiënt. Daarnaast werd de tevredenheid van bezitters onderzocht. Alle patiënten die in de periode 1995–2015 in het Leids Universitair Medisch Centrum waren behandeld, werden benaderd voor deelname aan vragenlijstonderzoek. Van de 573 patiënten namen 204 (35,6 %) deel aan het onderzoek. Met 152 patiënten (74,5 %) bleek een prothese besproken te zijn, in 113 (55,4 %) gevallen voorafgaand aan de orchidectomie. Bij 28 (13,7 %) patiënten werd daadwerkelijk een prothese gerealiseerd, van wie 75 % tevreden was. De bespreking van een testisprothese moet plaatsvinden voorafgaand aan de orchidectomie, ongeacht leeftijd van de patiënt. Artsen moeten zich ervan bewust zijn dat 25 % van mannen die een prothese heeft, daar niet geheel tevreden over is en ook dit dient besproken te worden tijdens het preoperatieve consult.
... Since 1941 implantation of testicular prosthesis has become an established therapeutic approach for patients with absent testes. 1,2 The two UK companies that manufacture the large majority of implants used in the UK (Nagor, Douglas, Isle of Man, and Mentor, Wantage, Oxfordshire) offer sizing that range from small (10-12cm 3 ) to large (17-19cm 3 ). 2 With the current pressures on the National Health Service (NHS), we present a novel, cost effective technique for intraoperative selection of an appropriately sized testicular prosthesis. ...
Article
Objective To compare the complication rate associated with synchronous prosthesis insertion at the time of radical orchidectomy with orchidectomy alone.Patient and Methods All men undergoing radical orchidectomy for testis cancer in the North West Region of England between April 1999 - July 2005 and November 2007 - November 2009 were included.Data on post-operative complications, length of stay (LOS), re-admission rate and return to theatre rate was collected.Results904 men (median age of 35 years, range 14 - 88), underwent a radical orchidectomy during the study period.413 (46.7%) were offered a prosthesis, of whom 55.2% chose to receive one.Those offered a prosthesis were significantly younger (p=0.0003), median age of 33 vs 37 years respectively.There was no significant difference between the 2 groups in LOS (p=0.387), hospital re-admission rates (p=0.539) or return to theatre rate (p=>0.999). 33/885 patients were readmitted within 30 days of orchidectomy, with 1/236 prosthesis patients requiring prosthesis removal (0.4%).Older age at orchidectomy was associated with an increased risk of 30-day hospital re-admission (OR 1.032, p=0.016).Conclusions Concurrent insertion of a testicular prosthesis does not increase the complication rate of radical orchidectomy as determined by LOS, re-admission or the need for further surgery.Prosthesis insertion at the time of orchidectomy for testis cancer is a safe and concerns about increased complications should not constrain the offer of testicular prosthesis insertion concurrently with primary surgery.
Article
IntroductionOrchiectomy followed by infradiaphragmatic radiotherapy is a common treatment for stage I-II testicular seminoma. Long-term effects of orchiectomy and radiotherapy for testicular seminomas on body image and sexual function have been reported; however, few data are available on short-term effects. Patients are usually of reproductive age and sexually active; therefore, short-term effects on body image and sexual function should also be studied. AimsTo prospectively evaluate short-term effects of orchiectomy and radiotherapy on body image and sexual function in testicular seminoma patients. Methods Questionnaires on body image and sexual function were prospectively distributed to all testicular seminoma patients treated between 1999 and 2013. The questionnaire distributed prior to radiotherapy was returned by 161 patients; 133 (82%) returned the second after 3 months, and 120 (75%) completed the questionnaire after 6 months. Main Outcome MeasuresBody image and sexual function as assessed by a Dutch questionnaire on body image and sexuality after radiotherapy and orchiectomy. ResultsMedian age was 36 years (range 18-70). After orchiectomy, 48% expressed fertility concerns, and 61% reported their body had changed. Six months after treatment, erectile rigidity was significantly decreased compared with prior to radiotherapy (P=0.016), and 23% reported decreased sexual interest, activity, and pleasure. Changes in body image were significantly associated with decreased sexual interest, pleasure, and erectile function. Even though 45% reported that treatment negatively affected their sexual life, the number of sexually active patients remained stable at 91%. [Correction added on 12 November 2014, after first online publication: prior radiotherapy' was corrected to prior to radiotherapy'.] Conclusions Short-term effects of treatment included fertility concerns and changes in body image. Reported erectile rigidity was significantly decreased after 6 months, as were sexual interest, activity, and pleasure. Disease and treatment had negative effects on sexual life, and changes in body image were associated with sexual dysfunction. Therefore, body image and sexual functioning should be addressed at an early stage in order to offer adequate treatment and counseling. Wortel RC, Ghidey Alemayehu W, and Incrocci L. Orchiectomy and radiotherapy for stage I-II testicular seminoma: A prospective evaluation of short-term effects on body image and sexual function. J Sex Med 2015;12:210-218.
Article
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An interdisciplinary team-work experience in the assistance of 85 patients with silicone testicular prosthesis (STP) as well as the families’ guidance from December 1985 until December 2005 is presented. Our purpose is to demonstrate the importance of prevention in the different aspects of this pathology. The age average was 6,3 years old, with a media of 5,8. The ages ranged between 1,7 to 14 years old. Frequent checkups were carried out since newborns until the age of 20, with an average age of 7,6 years and a media of 7. The team’s strategies used for an early assistance are described. They help prevent the difficulties these patients suffer specially related to their physical appearance, self-respect, sexual behaviour and social acceptance. As a result a good life quality of the whole family group was successfully promoted. The working experience was satisfactory and most of the patients showed a high approval degree in regards to the treatment. Therefore we strongly recommend the use of the STP.
Article
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The loss of a testicle to cancer involves much emotional impact to young males. Little is known about the number of patients with testicular germ cell tumour (GCT) who would accept a testicular prosthesis. Also, knowledge about the satisfaction of implant recipients with the device is limited. A retrospective chart analysis was performed on 475 consecutive GCT patients. Prior to orchiectomy, all patients were offered prosthesis insertion. Acceptance of implant was noted along with age, clinical stage, histology and year of surgery. 171 implant recipients were interviewed using an 18 item questionnaire to analyze satisfaction with the prosthesis. Statistical analysis involved calculating proportions and 95% confidence intervals. Multivariate analysis was performed to look for interrelations between the various items of satisfaction with the implant. 26.9% of the patients accepted a prosthesis. The acceptance rate was significantly higher in younger men. Over-all satisfaction with the implant was "very high" and "high" in 31.1% and 52.4%, respectively. 86% would decide again to have a prosthesis. Particular items of dis-satisfaction were: implant too firm (52.4%), shape inconvenient (15.4%), implant too small (23.8%), position too high (30.3%). Living with a permanent partner had no influence on patient ratings. Multivariate analysis disclosed numerous inter-relations between the particular items of satisfaction. More than one quarter of GCT patients wish to have a testicular prosthesis. Over-all satisfaction with implants is high in more than 80% of patients. Thus, all patients undergoing surgery for GCT should be offered a testicular prosthesis. However, surgeons should be aware of specific items of dis-satisfaction, particularly shape, size and consistency of the implant and inconvenient high position of the implant within the scrotum. Appropriate preoperative counselling is paramount.
Chapter
The undescended testis is a common problem in pediatric urological practice with 3–5% of newborns affected, although the majority descend in the first few months of life resulting in an incidence of 0.8–1.1% at 1 year of age. Treatment options are hormone manipulation and surgery. Surgical procedures for the palpable testis include the standard inguinal and more recently described scrotal orchidopexy. Impalpable testes may require a modified surgical approach and success rates are not as high as those for palpable undescended testes. The aim of this chapter is to look at the outcomes of these surgeries, to document the range of surgical complications that occur, and provide advice on how to prevent and manage these complications.
Article
Objective: Researchers have observed gender differences in the frequency of emotion language used in cancer forums, with men more likely to seek medical information and women more likely to seek social and emotional support (Blank, Schmidt, Vangsness, Monteiro, & Santagata, 2010; Seale, Ziebland, & Charteris-Black, 2006). The aim of this article was to investigate Internet support groups to examine the support mechanisms that men employed when deciding whether or not to have a testicular implant. Method: The four longest threads about prostheses were taken from four separate testicular cancer online support forums (totaling a number of 129 posts). A discursive approach (Edwards & Potter, 2001) was employed in order to consider what support mechanisms were employed by men. Results: Findings illustrate that men employed a number of discursive strategies in "doing" support, including assessments, attending to issues of accountability, humor, providing alternative information, constructing decisions as personal choices, reconstituting normality, and sanctioning "emotional" talk. Conclusions: The psychological benefits of online homosocial support are discussed, and it is suggested that clinicians recommend Internet support groups to men with testicular cancer in order to start the psychological healing process.
Chapter
Der testikuläre Keimzelltumor (KZT) repräsentiert den häufigsten bösartigen Tumor in der Altersgruppe der 20- bis 40-jährigen Männer. Die Altersverteilung des KZT unterscheidet sich von den übrigen soliden Neoplasien des Menschen dahingehend, dass ein erster Altersgipfel zwischen dem 25. und 35. Lebensjahr, ein zweiter geringerer Gipfel nach dem 80. Lebensjahr auftritt.
Article
Androgen replacement modalities have been associated with various complications, fluctuation of serum testosterone levels, and repeated treatments. Tissue engineering and regenerative medicine strategies, including androgen replacement therapy, provide alternative possibilities for the management of various pathologic tissue conditions. This article presents tissue engineering approaches, which involve the development of androgen supplementation systems for functional androgen replacement.
Article
Surgery on the external male genitalia has developed for the management of congenital (hypospadias, epispadias) and acquired (Peyronie’s disease, penile injuries and neoplasms) diseases of the penis; its main purpose is the achievement of functional and aesthetic results. In the past 10 years penile lengthening and augmentation have been proposed as a cosmetic procedure for the normal penis and great interest in these procedures has been generated in the media. Penile size varies with ethnicity and this has to be remembered when evaluating a man with concerns about penile adequacy. Most men have a misconception about normal penile size and many patients interested in surgical penile augmentation have a penis within the normal size range. Surgical procedures aimed at increasing penile size are not standardized. Various complications have been reported. The most common procedures to lengthen the penis improve only its visual aspect because the length of penile structures remains unchanged. Men seeking penile augmentation surgery should be offered full counselling on the reliability and outcome of these procedures to avoid unrealistic expectations and post surgical disappointment. Phalloplasty: Surgical reconstruction of the penis is a major challenge because of the functional and aesthetic targets that have to be addressed. Surgical procedures have to be tailored to the aetiology and entity of the mutilation. Flap transfer and subsequent penile prosthesis placement offer the best results in patients who have undergone partial or total penectomy for cancer. Testicular prosthesis: The placement of a testicular prosthesis is not considered a merely aesthetic issue. The absence or the loss of a testis is a traumatic experience at any age and the restoration of the normal scrotal silhouette may prevent the psychological consequences of having an empty scrotum. Testicular prostheses have an excellent record of safety and efficacy and a low rate of post operative adverse effects. Because testicular cancer has become one of the most curable solid neoplasms, the placement of a testicular prosthesis represents an important step in counselling men undergoing surgery for testicular cancer. Scrotal skin redundancy: The visual aspect of a normal penis may be affected by congenital or acquired abnormalities of the penile shaft and prepubic fat pad resulting in a hidden or concealed penis. This situation causes hygiene problems, predisposing to urinary infections and, in the adult, affecting vaginal penetration. Surgical correction of these situations has to be considered as a rehabilitative rather than a cosmetic procedure.
Article
We assessed the perspectives of patients with testicular cancer on the placement of a prosthesis at orchiectomy and identified predictors of long-term satisfaction. Consecutive patients who underwent radical orchiectomy for testicular cancer in 1995 to 2009 were asked to complete a telephone questionnaire covering background demographics, subjective assessment of implant characteristics, impact of the prosthesis on daily and sexual activities, and overall satisfaction with outcome. A total of 98 patients completed the interview, of whom 86 (87%) received a prosthesis. Median interval from surgery to interview was 6 years and most men were married or engaged in a steady relationship. The majority found the prosthesis to be of appropriate weight and size. The main complaints were firm consistency (70%) and high scrotal position (39%), both of which were significantly associated with lesser patient satisfaction (p = 0.03) and regret of the decision to accept an implant (p = 0.02). Approximately 15% of patients indicated the prosthesis interfered with physical exercise or sexual activity. Younger age at surgery was associated with a greater likelihood of accepting a prosthesis but not with long-term satisfaction. Overall the outcome was rated good to excellent in 77% of cases. Patients with testicular cancer scheduled to undergo orchiectomy should be offered a testicular prosthesis, and reassured that complications are few and that expected long-term satisfaction is fair. Optimizing the texture of the implant and its position in the scrotum may improve outcome. However, patients should be counseled about possible adverse implications in terms of physical exercise or sexual activity.
Article
Testicular prosthesis placement is a useful important adjunctive reconstructive therapy for managing children with testicular loss or absence. Though these prostheses are functionless, experience has shown that they are extremely helpful in creating a more normal male body image and in preventing/ relieving psychological stress in males with a missing testicle. With attention to details of implant technique, excellent cosmetic results can be anticipated in simulating a normal appearing scrotum.
Article
Radical orchiectomy in testicular cancer patients can have a negative impact on body image and self-esteem. Reconstructive surgery with testicular prosthesis might mitigate this burden. We conducted a questionnaire-based study aiming to evaluate our patients’ satisfaction with testicular prosthesis. Overall satisfaction was rated as excellent or good in 97.7%. The main complaints were related to the prosthesis’ inappropriate texture (45.5%), size (18.1%) or position (15.9%). Among men interviewed, 59% considered that having a normal looking scrotum was either extremely important or important for their self-esteem. The majority (88.2%) stated they would make the same decision again, and nearly all patients would recommend it to other men with testicular cancer. We believe testicular implants should always be offered, leaving the final decision to the patient.
Chapter
There are numerous scrotal pathologies that require surgical management by urologists. In this chapter, we will discuss many of the more common scrotal procedures encountered by urologists, ranging from simple scrotoplasties to complex scrotoplasty with skin grafting/flaps and testicular implants. We hope that the descriptions provided herein will give additional confidence to general and reconstructive urologists alike.
Chapter
Phalloplasty may be performed either for the genetic (cis) male or in the context of gender reaffirmation surgery. Significant developments over the past decades have facilitated progress such that the phallus is more than simply an aesthetic organ. Function in terms of urethral incorporation and sexual function, by way of penile implants, have been major developments. Whilst there are specific differences when placing an implant in these two separate contexts, surgeons are being encouraged by well-documented satisfaction and complication rates. With appropriate patient counselling and the surgical ability to deal with specific complications, patients who have undergone phalloplasty are now able to achieve a quality of life which was previously not attainable.
Chapter
Erectile ability is a common goal for transgender men seeking phalloplasty, which necessitates prosthesis placement in most phalloplasty techniques. In the absence of preexisting corpora, implant placement is associated with increased risk of poor proximal fixation, device migration, distal erosion, and neurovascular compromise, infection, and malfunction. Modifications to conventional surgical technique, such as avoidance of critical structures, proximal prosthesis anchoring, and distal cushioning with vascular or synthetic grafts, are common techniques to address anatomic challenges.
Chapter
Vaginoplasty is the most common genital surgery performed for gender affirmation. Annually, there are more than 3000 performed each year. Vaginoplasty is a safe, reliable technique for performing genital transition in transgender female patients. Penile inversion vaginoplasty is the most common technique used today, although there are several other methods of vaginoplasty: penile inversion, visceral interposition, and pelvic peritoneal vaginoplasty. Overall, outcomes are excellent. It is recommended surgeons follow the World Professional Association for Transgender Health (WPATH) guidelines for determining who is a candidate for surgery. There are no absolute contraindications to vaginoplasty, only relative contraindications that include active smoking and morbid obesity. Important but rare complications include flap necrosis, rectal and urethral injuries, rectal fistula, vaginal stenosis, and urethral fistula. When performed correctly in appropriately selected patients by expert surgeons, this is a rewarding operation for both patient and surgeon.
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Parents of children with monorchidism are invited by clinicians to let their child decide if they want testicular prostheses after reaching puberty. Unfortunately, however, teenagers make this decision after experiencing shame, frustration, and embarrassment due to the appearance of the genitals. Understanding these emotional aspects can be a way to increase surgical compliance, the aesthetic effect of the implant, and the emotional, sexual, and bodily satisfaction of the child.
Article
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The testicular prosthesis can be an afterthought for providers when performing an orchiectomy for testicular cancer, torsion, atrophic testis, or trauma. However, data suggest that patients find the offer of a testicular prosthesis and counseling regarding placement to be extremely important from both a pragmatic and a psychosocial perspective. Only two-thirds of men undergoing orchiectomy are offered an implant at the time of orchiectomy and of those offered about one-third move forward with prosthesis placement. The relatively low acceptance rate is in stark contrast with high patient satisfaction and low complication rates for those who undergo the procedure. The most common postoperative patient concerns are minor and involve implant positioning, size, and weight. Herein, we provide an up-to-date review of modern preoperative evaluation, patient selection, expectation management, surgical technique, and expected outcomes for testicular prostheses.
Article
Significant developments have enabled the transformation of phalloplasty to a functional organ. Differences exist in the surgical placement of a prosthesis when within a phallus, such as the lack of corpora, pubic fixation requirement, distal sock placement, and the consideration of a vascular pedicle. Increased complications compared with nonphalloplasty cohorts remain one of the biggest challenges, including rates of infection, erosion, mechanical malfunction, and malposition. Nonetheless, the placement of penile prosthesis within a phalloplasty enables trans men to achieve a once near-impossible goal of penetrative sexual intercourse without an external device.
Article
INTRODUCTION: Orchiectomy are performed by varied and justified reasons. Failure of the testicles can cause not only a psychological problem, but also physical or aesthetic, so the search for alternative solutions to the problem is necessary. The objective of this study was to report results obtained with the making of a handmade testicular prosthesis. SUBJECTS AND METHODS: observational, analytical, cross-sectional, non-probability sampling of consecutive cases of patients undergoing orchiectomy, between January 2010 and August 2014. A Foley 18 was used as a silicone prosthesis. Data are expressed as proportions. For comparison of the groups was considered p RESULTS: We included 61 patients aged 14 to 89 years (45.5 ± 26.2), 34 (55.7%) from the interior. The indication was prostate cancer in 23 (37.7%) cases of testicular cancer in 30 (49.2%), twist cord in 7 (11.5%) and cryptorchidism 1 (1.6% ). 22 (36.1%) were on the right side, 16 (26.2%) left and 23 (37.7%) bilateral. 8 (13.1%) were outpatients under local anesthesia. In 33 (54.1%) accessed via the inguinal approach. Saline solution 0.9% in 52 (85.2%) patients and in 9 (14.8%) 2% lidocaine gel was instilled. The ball was blowing between 10 cc and 25 cc (15 ± 4.3). 8 (13%) had complications. In terms of partnerships: diagnosis and side (p = 0.000), age and diagnosis (p = 0.000), surgical approach and complications (p = 0.018), diagnosis and complications (p = 0.085), type of complications and surgical access (p = 0.001). The cost of the prosthesis was around $ 10. DISCUSSION: Testicular prosthesis craft an effective alternative, low-cost and low morbidity. Key Words: Testis. Handmade Prosthetics. Orchiectomy. Morbidity
Chapter
Dans cette section sont décrites des techniques opératoires souvent utilisées sur les organes génitaux masculins. Ces interventions sont souvent déléguées à des médecins inexpérimentés, ce qui peut provoquer des invalidités à vie ; ainsi la circoncision de l’adulte doit être effectuée avec soin afin de ne pas enlever trop de peau du fourreau pénien. Les auteurs ont une grande expérience personnelle des techniques décrites et les ont enseignées. Il existe de nombreuses alternatives aux techniques décrites dans cette section mais les techniques décrites ici fonctionnent bien et sans risques. Les interventions suivantes sont décrites: circoncision, prothèse pénienne, redressement du pénis, orchidopexie, ablation de kyste épididymaire, hydrocèle, vasectomie et réparation de la vasectomie. Dans le Chap. II.4.17 le lecteur trouvera la description de la récupération de spermatozoïdes. La liste des interventions est limitée aux opérations les plus souvent effectuées et le lecteur pourra se reporter à un manuel de chirurgie spécialisée tel que le Campbell d’urologie pour les autres procédures chirurgicales.
Chapter
Der testikuläre Keimzelltumor (KZT) repräsentiert den häufigsten bösartigen Tumor in der Altersgruppe der 20bis 40-jährigen Männer. Die Altersverteilung des KZT unterscheidet sich von den übrigen soliden Neoplasien des Menschen dahingehend, dass ein erster Altersgipfel zwischen dem 25. und 35. Lebensjahr, ein zweiter geringerer Gipfel nach dem 80. Lebensjahr auftritt.
Chapter
In questa sezione sono descritte alcune tecniche chirurgiche spesso utilizzate sugli organi genitali maschili. Questi interventi sono spesso delegati a dei medici inesperti, cosa che può provocare delle invalidità a vita; così, la circoncisione dell’adulto deve essere eseguita con attenzione, al fine di non rimuovere troppa cute della guaina peniena. Gli autori hanno una considerevole esperienza personale delle tecniche descritte e le hanno insegnate. Esistono numerose alternative alle tecniche descritte in questa sezione. Sono descritti i seguenti interventi: circoncisione, protesi peniena, reversione della curvatura peniena, orchidopessi, asportazione di cisti dell’epididimo, idrocele, vasectomia e inversione della vasectomia. Nel Cap. II.4.17 il lettore troverà la descrizione del recupero degli spermatozoi. La lista degli interventi è limitata alle operazioni più spesso effettuate e il lettore potrà riferirsi a un manuale di chirurgia specialistica come il Campbell di urologia per le altre procedure chirurgiche.
Chapter
Testicular and paratesticular tumors of children and adolescents are rare entities with similar surgical management. Testicular tumors represent 1–2 % of all pediatric tumors, with annual incidence of 0.5–2.0 per 100,000 children [1–3]. A bimodal age distribution is observed with first peak in the first 3 years of life, and then again after puberty [4]. Primary testicular tumors are divided into germ cell tumors (seminoma, yolk sac, embryonal carcinoma, choriocarcinoma, and teratoma) and stromal tumors (leydig cell, sertoli cell, and granulosa cell). Germ cell tumors usually present with painless testicular mass and have malignant behavior. Stromal tumors typically have a benign course, although some can become metastatic, and can be associated with hormonal production leading to precocious puberty. Treatment of testicular tumors is directed by the histologic type and age at presentation. The bimodal age distribution, histologic subtype, and stage encountered at different ages exemplifies the different molecular and behavior of these tumors. Of prepubertal tumors, 68–74 % carry a benign pathology, with mature teratoma making up the largest proportion (48 %) [5–7]. Furthermore, over 85 % of prepubertal patients present with stage I (localized) disease [8]. Regardless of the age at presentations, patients require a formal evaluation with scrotal ultrasound, tumor markers (AFP, βHCG, and LDH), and if indicated hormonal studies to evaluate for a stromal tumor. Scrotal ultrasound helps localize the tumor, determine if it has characteristics that will permit testicular sparing surgery, and it assess the status of the contralateral testicle. If metastatic disease is highly suspected based on tumor markers, physical exam, or symptoms, preoperative staging imaging of the chest, abdomen, and pelvis can be considered. Pre-operative staging imaging can also enable simultaneous central venous access placement at that time of radical inguinal orchiectomy if subsequent chemotherapy is warranted. The initial treatment of a testicular tumor is to establish a diagnosis. Prepubertal tumors are generally less aggressive, as is their treatment. For prepubertal stage I tumors, surveillance is recommended and for metastatic disease chemotherapy is the first line. Postpubertal tumors tend to have similar tumor characteristics and behaviors as adult tumors, as such they are treated more aggressively following established adult protocols.
Chapter
There have been attempts to recreate the appearance and function of the genito-urinary tract with exogenous materials for millennia; but it is only within the last half century that real success has been achieved. This has been a result, to a large extent, of advancements in material science to provide inert yet pliable products. However, materials which are both resistant to infection and offer sustained functionality are still sought. In this chapter we explore how urologists worked in conjunction with industry to develop effective prosthetic solutions to: testicular absence or loss, erectile dysfunction, urinary incontinence, and strictures within the urinary tract.
Chapter
Testicular prostheses or implants have been in use for more than 70 years to guarantee an acceptable scrotal cosmesis in patients who have an empty scrotal sac or an atrophic testis and also when scrotal reconstruction is contemplated. Although various materials have been used in the production of testicular implants, silicone still remains the most popular option. The overall patient satisfaction can be as high as 91 %, with an overall improvement of self-esteem and body image.
Article
Full-text available
Purpose: The aim of this paper is to propose a modified surgical technique for immediate intravaginal prosthesis implantation in patients undergoing orchiectomy due to testicular torsion, and to evaluate the wound healing process and patient's satisfaction. Material and methods: We prospectively analyzed 137 patients with testicular torsion admitted to our facility between April 2018 and May 2020. Twenty-five patients who underwent orchiectomy were included in this study. Fifteen had a testicular prosthesis implanted at the same time as orchiectomy using a modified intravaginal technique (summary figure) and 10 received implants 6 to 12 months after orchiectomy. Wound healing was evaluated at a minimum of four checkpoints (on days 15, 45, 90 and 180 after surgery). At the end of the study, a questionnaire was administered to measure patients' satisfaction rate. Student's t test was used for comparison of quantitative data between negative vs. positive cultures (p<0.05). The chi-square test was used to verify associations between categorical variables and immediate vs. late prosthesis implantation (p <0.05). Results: Patient's ages ranged from 13 to 23 years (mean 16.44 years). Overall time lapse from symptoms to orchiectomy ranged from 10 hours to 25 days (mean 7.92 days). Only one extrusion occurred and it happened in the late implant group. All wounds were healed in 72%, 88%, 95.8% and 100% of the cases on the 15th, 45th, 90th and 180th days after implant, respectively. At the end of the study, all patients stated they would recommend it to a friend or relative. The only patient that had prothesis extrusion asked to have it implanted again. Conclusion: There was no prosthesis extrusion using the modified intravaginal surgical technique for immediate testicular prosthesis implantation, which proved to be an easily performed and safe procedure that can avoid further reconstructive surgery in patients whose testicle was removed due to testicular torsion.
Article
A new type of testicular prosthesis made of silastic with an elliptical shape to mimic a normal testis was developed by our team and submitted for patenting in China. The prosthesis was produced in different sizes to imitate the normal testis of the patient. To investigate the effects and safety of the testicular prosthesis, 20 patients receiving testicular prosthesis implantation were recruited for this study. Follow-up after 6 months revealed no complications in the patients. All the patients answered that they were satisfied with their body image and the position of the implants, 19 patients were satisfied with the size and 16 patients were satisfied with the weight. These results show that the testicular prosthesis used in this study can meet patient's expectations. Patients undergoing orchiectomy should be offered the option to receive a testicular prosthesis implantation. The dimensions and weight of the available prosthetic implants should be further addressed to improve patient satisfaction.
Article
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To assess the satisfaction of men with their testicular implants after undergoing orchidectomy for testicular cancer, and to determine their reasons for accepting or declining a prosthesis. In all, 424 men who had undergone radical orchidectomy and were part of the testicular cancer follow-up programme were sent an anonymous questionnaire comprising 10 questions covering two main areas. First, the reasons for accepting or declining an implant and second (if they received an implant) their satisfaction with the size, position, feel, shape and overall comfort; 234 men (55%) responded. About a third (71 men) accepted an implant, a third declined and a third were not offered the choice. Of the men who replied 91% felt that it was extremely important to be offered an implant at the time of surgery. Of the 71 who received an implant, 19 (27%) were dissatisfied and felt that they had an average or poor cosmetic result. The reasons for this dissatisfaction are presented and discussed. All men undergoing orchidectomy should be offered a testicular implant, irrespective of age. Sample implants in all sizes should be available in the outpatient department. This will give men realistic expectations and allow them to choose a suitable size of implant. The dimensions of the available implants should be improved to create a more elliptical prosthesis, to avoid dissatisfaction with the shape. Adequate fixation to the base of the scrotum is important to avoid the 'high riding' implant.
A 9-year-old Puerto Rican boy with agenesis of the testicles provided an unusual opportunity to explore the role of the testicles in psychosexual development. The recent literature on the psychological role of the testicles is reviewed. This case report demonstrates that the patient experienced the absence of testicles as a phallic defect. He did not appear to have a mental image of the testicles separate from that of the penis. Surgical implant of prosthetic testicles in latency was of great benefit.
A 9-year-old Puerto Rican boy with agenesis of the testicles provided an unusual opportunity to explore the role of the testicles in psychosexual development. The recent literature on the psychological role of the testicles is reviewed. This case report demonstrates that the patient experienced the absence of testicles as a phallic defect. He did not appear to have a mental image of the testicles separate from that of the penis. Surgical implant of prosthetic testicles in latency was of great benefit.
Article
A patient with Kallmann's syndrome received prosthetic testicular implants. In interviews and letters, he demonstrates that delay in electing surgery, and its eventual success, were both related to incorporation of the foreign bodies into the body image.
Article
There is a paucity of data to determine if the insertion of a testicular prosthesis is effective in overcoming the psychological effects of an absent testis. A review of 25 patients who had had testicular prostheses showed a high overall level of satisfaction in the 19 patients who were traced. This satisfaction was subject to some qualification.
Article
Testicular prosthesis implantation is a generally simple and low-morbidity method of softening the psychological trauma suffered by patients faced with the loss of a testis.
Article
In a survey of members of the Western Section of the American Urological Association who had testicular prostheses inserted within the preceding ten years, the responses indicated that the overall complication rate for this procedure is low. Generally, the scrotal cavity distends easily to a size adequate to accommodate the prosthesis. However, in cases of delayed secondary scrotal surgery, or when a previous inflammatory process has existed in the scrotum, the limited scrotal distensibility may lead to further complications.
Article
Three patients are described in whom autoimmune connective tissue disease developed within 21/2 years after cosmetic mammary augmentation with silicone gel–filled, elastomer envelope-type prostheses. Comparison is made with previously reported cases concerning the complications after paraffin and processed petroleum were injected into the breast. Although evidence for a causal relationship between the implantation and the development of connective tissue disease is circumstantial, it is possible that these 3 patients represent examples of human adjuvant disease.
Article
Recipients of silicone gel filled testicular prostheses were evaluated for the possible immunological abnormalities of human adjuvant disease. Medical record audits were performed for 48 recipients of a silicone gel filled testicular prosthesis. Seven patients consented to a detailed health profile questionnaire, physical examination and serological testing. Retrospective chart analyses and physical examinations were unremarkable. Serological results and questionnaire responses varied. One patient with signs and symptoms suggestive of human adjuvant disease underwent prosthesis removal but adjacent tissues had no evidence of silicosis. Long-term followup was poor. Immunological alterations were present in 71.4% of examined recipients but they may have been coincidental. Careful followup of recipients of a silicone gel filled testicular prosthesis is needed.
Article
Concerns exist regarding a possible link between the presence of silicone implants and the development of systemic disease. A retrospective review was carried out to determine whether or not a pattern of diseases could be found after the implantation of a testicular prosthesis. A specific pattern of diseases did not emerge in a group of 34 men harboring a scrotal silicone gel implant for a mean period of over five years. The findings, with a limited population and period of follow-up, are not conclusive but provide basis for reassurance to men about the health implications of their implants.
Article
To evaluate retrospectively the body image and sexual functioning in patients who have a testicular prosthesis (TP). The medical charts were evaluated for 30 adult patients who received 32 TPs between 1985 and 1997. A questionnaire was mailed to each patient, asking about body image, satisfaction with the implant and with sexual functioning. Of the 30 patients, 22 (73%) replied; their mean (range) age was 30 (18-47) years. Most of the patients had a silicone gel-filled TP. No complications were reported in 25 (83%) patients and 80% reported no sexual problems; 20% felt uncomfortable in intimate contacts, 68% found their body image improved after having a TP, 58% were satisfied with their current sexual life, 90% had no erectile dysfunction and 45% reported premature ejaculation. Patients who have lost a testis for any reason should be informed about the availability of a TP. Prostheses were well accepted and no systemic disease was reported. Almost all patients reported an improvement in their body image. Sexual life and performance were apparently not compromised by having a TP. New surgical procedures are recommended to improve the cosmetic appearance of a TP in the scrotum.
Article
In the past decade, changing attitudes toward breast reconstruction among both patients and providers have led a growing number of women to seek breast reconstruction after mastectomy. Although investigators have documented the psychological, social, emotional, and functional benefits of breast reconstruction, little research has evaluated the effects of procedure choice on these outcomes. The current study prospectively evaluated and compared psychosocial outcomes for three common options for mastectomy reconstruction: tissue expander/implant, pedicle TRAM, and free TRAM techniques. In a prospective cohort design, patients undergoing postmastectomy reconstruction for the first time with expander/implant, pedicle TRAM, or free TRAM procedures were recruited from 12 centers and 23 plastic surgeons in the United States and Canada. Before reconstruction and at 1 year after reconstruction, patients were evaluated by a battery of questionnaires consisting of both generic and condition-specific surveys. Outcomes assessed included emotional well-being, vitality, general mental health, social functioning, functional well-being, social well-being, and body image. Baseline (preoperative) scores and the change in scores (the difference between postoperative and preoperative scores) were compared across procedure types using t tests and analysis of covariance. Preoperative and 1-year postoperative surveys were obtained from 273 patients. Procedure type was reported in 250 patients, of whom 56 received implant reconstructions, 128 pedicle TRAM flaps, and 66 free TRAM flaps. A total of 161 immediate and 89 delayed reconstructions were performed. Among women receiving immediate reconstruction, significant improvements were observed in all psychosocial variables except body image. However, no significant effects of procedure type on these changes over time existed. Similarly, delayed reconstruction patients had significant increases in emotional well-being, vitality, general mental health, functional well-being, and body image. Although the choice of reconstructive technique did not significantly impact most of these outcomes, significant differences existed among procedure types for three psychosocial subscales. Patients undergoing delayed expander/implant reconstructions reported greater improvements in vitality and social well-being relative to women receiving delayed TRAM procedures. By contrast, delayed TRAM patients noted significantly greater gains in body image compared with women choosing delayed expander-implant reconstruction. The authors conclude that both immediate and delayed breast reconstructions provide substantial psychosocial benefits for mastectomy patients. Although the choice of reconstructive procedure does not seem to significantly affect improvements in psychosocial status with immediate reconstruction, our data suggest that procedure type does have a significant effect on gains in vitality and body image for women undergoing delayed reconstruction.
Article
This paper critically examines the research literature relating to the psychological aspects of breast reconstruction. Particular attention is given to the role of specialist breast care nurses in supporting women faced with the decision of whether or not to opt for reconstructive surgery. Breast reconstruction is intended to offer psychological benefits (e.g. improvements to quality of life, body image, anxiety and depression) to women treated by mastectomy following diagnosis of breast cancer. A literature search was carried out on the PSYCHINFO, MEDLINE and CINAHL databases using the terms "breast reconstruction", "mastectomy", "reconstructive surgery", "breast surgery", "breast implants", "transverse rectus adominis myocutaneous (TRAM) flap" and "Lat-dorsi". Further relevant articles were identified from the reference lists of papers detected by this literature search. Finally, proceedings of recent psychological and surgical meetings were scrutinized to identify any conference papers on this topic. A thorough search of the existing literature revealed a lack of theoretically based studies examining breast reconstruction in terms of relevant psychological constructs, especially in relation to coping and decision-making. This review highlights the methodological flaws with much of the existing research in this area, in particular the reliance upon retrospective designs and the inappropriate use of randomised controlled trials. Suggestions are given for further research in this topical area. Existing research into the psychological aspects of breast reconstruction is limited and not sufficiently conclusive to inform changes to policy and the provision of care. More methodologically rigorous research is needed.
Brigham and Women's Hos-pital and Alan Retik, Children's Hospital Massachu-setts; Joseph Ortenberg, Children's Hospital
  • David G Mcleod
  • Walter Reed Center
  • D C Wash-Ington
  • Michael
  • Leary
David G. McLeod, Walter Reed Army Medical Center, Wash-ington, D.C.; Michael O'Leary, Brigham and Women's Hos-pital and Alan Retik, Children's Hospital, Boston, Massachu-setts; Joseph Ortenberg, Children's Hospital, New Orleans, Louisiana; Juan Palomar, Wright State University School of Medicine, Dayton, Ohio; Mark Sigman, Brown University School of Medicine, Providence, Rhode Island; and George Steinhardt, St. Louis University, St. Louis, Missouri. REFERENCES
Eastern Virginia Medical School, Nor-folk, Virginia Chil-dren's Hospital
  • David A Hatch
  • Joel Kaufman
  • Martin Aurora
  • Koyle
David A. Hatch, Loyola University Medical Center, Chicago, Illinois; Gerald Jorda, Eastern Virginia Medical School, Nor-folk, Virginia; Joel Kaufman, Aurora and Martin Koyle, Chil-dren's Hospital, Denver, Colorado; Stanley Kogan, New York Medical College, White Plains and Steven Tennenbaum, Columbia-Presbyterian Medical Center, New York, New York; Stephen Kramer, Mayo Clinic, Rochester, Minnesota;
provided testis prostheses, assisted with the study and reviewed the manuscript
  • Mentor
  • Corp
Mentor Corp. provided testis prostheses, assisted with the study and reviewed the manuscript. APPENDIX: TESTICULAR PROSTHESIS STUDY GROUP Martin K. Dineen, Dayton Beach, Florida;
Use of a vitallum testicular implant
  • J Girdansky
  • H F Newman
Girdansky, J. and Newman, H. F.: Use of a vitallum testicular implant. Am J Surg, 53: 514, 1941
  • Henderson