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Araújo AS, Anacleto S, Rodrigues R, Tinoco C, Cardoso A, Oliveira C, Leão R. Testicular prostheses - impact on quality of life and sexual function. Asian J Androl 2024; 26:160-164. [PMID: 37459043 PMCID: PMC10919427 DOI: 10.4103/aja202325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 05/03/2023] [Indexed: 08/04/2023] Open
Abstract
Orchiectomy is the recommended treatment for many testicular conditions. However, testicular prosthesis placement is not always performed for different reasons. In this study, we aimed to evaluate patients' opinions and the impact on sexual function and quality of life. This retrospective observational single-center study included patients who underwent orchiectomy between January 2014 and December 2020 at the Department of Urology, Braga's Hospital (Braga, Portugal), where testicular implants were always available and the decision to undergo the procedure was made fully independent of cost. Patients completed four questionnaires that assessed demographic data, satisfaction, self-esteem, and sexual function. Of the 96 patients who underwent orchidectomy, 59 replied to the questionnaires, and of these patients, 86.4% decided to undergo silicone-based testicular prostheses implantation. The remaining 13.6% refused the implant based on concerns about complications (37.5%), because they felt that it was unnecessary (37.5%), or because it was not offered by the doctor (25.0%). Overall, 96.1% of these patients were satisfied with the implant; however, 25.5% classified it as "too firm". No statistically significant differences were found in sexual function (all P > 0.05). However, it can be observed that there are more patients with prostheses presenting normal sexual activity compared to patients without prostheses (74.0% vs 50.0%), and none of them reported severe erectile dysfunction (0 vs 16.7%). Regarding self-esteem, both patients with and without prostheses present very similar average scores with no statistically significant differences. The present study highlights the highest level of satisfaction among patients who received testicular prostheses. Testicular prostheses implantation is a safe procedure that does not hamper sexual function after orchiectomy.
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Affiliation(s)
| | - Sara Anacleto
- Department of Urology, Braga’s Hospital, Braga 4710, Portugal
| | | | - Catarina Tinoco
- Department of Urology, Braga’s Hospital, Braga 4710, Portugal
| | - Andreia Cardoso
- Department of Urology, Braga’s Hospital, Braga 4710, Portugal
| | - Carlos Oliveira
- Department of Urology, Braga’s Hospital, Braga 4710, Portugal
| | - Ricardo Leão
- Department of Urology, Braga’s Hospital, Braga 4710, Portugal
- Faculty of Medicine, Coimbra University, Coimbra 3000, Portugal
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Besombes T, Suartz CV, Poinard F, Plassais C, Dariane C, Hurel S, Timsit MO, Mejean A, Audenet F. Should You Fix Testicular Prosthesis? A Satisfaction Survey From a Monocentric Cohort. Urology 2024; 184:278-282. [PMID: 38056509 DOI: 10.1016/j.urology.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/16/2023] [Accepted: 11/22/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE To evaluate whether testicular prosthesis should be fixed. METHODS Retrospective monocentric study including 169 patients who had implantation of testicular prosthesis between January 2013 and December 2022. Patients answered a telephone questionnaire regarding prosthesis characteristics and satisfaction. RESULTS Prosthesis was sutured for 59 patients (34.9%) out of 169. 146 patients answered the questionnaire. Satisfaction was excellent regarding size, weight, consistency, and shape. A position too high was a major complain in both groups. Pain and discomfort were significantly higher in the fixed group (30.8% vs 9.78%, P < .001). Few patients reported discomfort with the anchor prosthesis (22.9%). CONCLUSION Overall satisfaction of the prosthesis is high but discomfort and high positioning are the two items remaining to improve. Our study suggests that fixing prosthesis is a cause of discomfort and won't allow a better positioning.
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Affiliation(s)
- Thomas Besombes
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP.Centre, Université Paris Cité, Paris, France.
| | - Caio Vinícius Suartz
- Division of Urology, Instituto do Cancer do Estado de São Paulo, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Florence Poinard
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP.Centre, Université Paris Cité, Paris, France
| | - Caroline Plassais
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP.Centre, Université Paris Cité, Paris, France
| | - Charles Dariane
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP.Centre, Université Paris Cité, Paris, France
| | - Sophie Hurel
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP.Centre, Université Paris Cité, Paris, France
| | - Marc-Olivier Timsit
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP.Centre, Université Paris Cité, Paris, France
| | - Arnaud Mejean
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP.Centre, Université Paris Cité, Paris, France
| | - François Audenet
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP.Centre, Université Paris Cité, Paris, France
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Aksoy C, Reimold P, Karschuck P, Groeben C, Koch R, Eisenmenger N, Thoduka S, Zacharis A, Schmelz H, Huber J, Flegar L. Trends in the use of testicular prostheses in Germany: a total population analysis from 2006-2021. Andrology 2024. [PMID: 38228573 DOI: 10.1111/andr.13598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/25/2023] [Accepted: 12/28/2023] [Indexed: 01/18/2024]
Abstract
INTRODUCTION Testicular tumors are the most common malignancies in young adults and their incidence is growing. The implantation of a testicular prosthesis, for example, during orchiectomy is a standard procedure but its frequency in Germany is unknown. This study aims to analyze trends of testicular prosthesis implantation in recent years in Germany. MATERIAL AND METHODS The nationwide German hospital billing database and the German hospital quality reports from 2006 to 2021 were studied. RESULTS A total of 12,753 surgical procedures with implantation of testicular prosthesis and 1,244 procedures with testicular prosthesis explantation were included. Testicular prosthesis implantation increased in total from 699 cases in 2006 to 870 cases in 2020 (+11.4 cases/year; p < 0.001). The share of implantation of testicular prosthesis due to testicular tumor decreased from 72.6% in 2006 to 67.5% in 2020 (p < 0.001). The share of implantation due to gender affirming surgery increased from 6.8% in 2006 to 23.3% in 2020 (p < 0.001). The share of implantation due to testicular atrophy decreased from 11.4% in 2006 to 3.4% in 2020 (p < 0.001). Simultaneous implantation of testicular prosthesis during orchiectomy for testicular cancer increased from 7.8% in 2006 to 11.4% in 2020 (p < 0.001). In 2006, 146 hospitals (85%) performed < 5 testicular prosthesis implantation, while 20 hospitals (12%) performed 5-15 implantation procedures and 6 hospitals (3%) performed > 15 testicular implantation surgeries. In 2021, 115 hospitals (72%) performed < 5 testicular prosthesis implantation, while 39 hospitals (25%) performed 5-15 implantation procedures and 5 hospitals (3%) performed > 15 testicular implantation surgeries. CONCLUSION This study shows that implantation of testicular prostheses is steadily increasing. Explantation rates are low. Besides testicular cancer transgender surgeries were the main driver for increasing case numbers in recent years.
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Affiliation(s)
- Cem Aksoy
- Department of Urology, Philipps-University Marburg, Marburg, Germany
| | - Philipp Reimold
- Department of Urology, Philipps-University Marburg, Marburg, Germany
| | - Philipp Karschuck
- Department of Urology, Philipps-University Marburg, Marburg, Germany
| | - Christer Groeben
- Department of Urology, Philipps-University Marburg, Marburg, Germany
| | - Rainer Koch
- Department of Urology, Philipps-University Marburg, Marburg, Germany
| | | | - Smita Thoduka
- Department of Nuclear Medicine, Philipps-University Marburg, Marburg, Germany
| | | | - Hans Schmelz
- Department of Urology, German Federal Armed Forces Hospital Koblenz, Koblenz, Germany
| | - Johannes Huber
- Department of Urology, Philipps-University Marburg, Marburg, Germany
| | - Luka Flegar
- Department of Urology, Philipps-University Marburg, Marburg, Germany
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Nguyen V, Walia A, Horns JJ, Paudel N, Bagrodia A, Patel DP, Hsieh TC, Hotaling JM. Cost and utilization analysis of concurrent versus staged testicular prosthesis implantation for radical orchiectomy. PLoS One 2024; 19:e0296735. [PMID: 38190399 PMCID: PMC10773930 DOI: 10.1371/journal.pone.0296735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 12/18/2023] [Indexed: 01/10/2024] Open
Abstract
PURPOSE American Urological Association guidelines recommend testicular prosthesis discussion prior to orchiectomy. Utilization may be low. We compared outcomes and care utilization between concurrent implant (CI) and staged implant (SI) insertion after radical orchiectomy. MATERIALS & METHODS The MarketScan Commercial claims database (2008-2017) was queried for men ages >18 years who underwent radical orchiectomy for testicular mass, stratified as orchiectomy with no implant, CI, or SI. 90-day outcomes included rate of reoperation, readmission, emergency department (ED) presentation, and outpatient visits. Regression models provided rate ratio comparison. RESULTS 8803 patients (8564 no implant, 190 CI, 49 SI; 2.7% implant rate) were identified with no difference in age, Charlson Comorbidity Index, insurance plan, additional cancer treatment, or metastasis. Median perioperative cost at orchiectomy (+/- implant) for no implant, CI, and SI were $5682 (3648-8554), $7823 (5403-10973), and $5380 (4130-10521), respectively (p<0.001). Median perioperative cost for SI at implantation was $8180 (4920-14591) for a total cost (orchiectomy + implant) of $13650 (5380 + 8180). CI patients were more likely to have follow-up (p = 0.006) with more visits (p = 0.030) compared to the SI group post-implantation but had similar follow-up (p = 0.065) and less visits (p = 0.025) compared to the SI patients' post-orchiectomy period. Overall explant rates were 4.7% for CI and 14.3% for SI (p = 0.04) with a median time to explant of 166 (IQR: 135-210) and 40 days (IQR: 9.5-141.5; p = 0.06). Median cost of removal was $2060 (IQR: 967-2880). CONCLUSIONS CI placement has less total perioperative cost, lower explant rate, and similar postoperative utilization to SI.
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Affiliation(s)
- Vi Nguyen
- Department of Urology, University of California, San Diego, San Diego, California, United States of America
| | - Arman Walia
- Department of Urology, University of California, San Diego, San Diego, California, United States of America
| | - Joshua J. Horns
- Department of Urology, University of Utah, Salt Lake City, Utah, United States of America
| | - Niraj Paudel
- Department of Urology, University of Utah, Salt Lake City, Utah, United States of America
| | - Aditya Bagrodia
- Department of Urology, University of California, San Diego, San Diego, California, United States of America
| | - Darshan P. Patel
- Department of Urology, University of California, San Diego, San Diego, California, United States of America
| | - Tung-Chin Hsieh
- Department of Urology, University of California, San Diego, San Diego, California, United States of America
| | - James M. Hotaling
- Department of Urology, University of Utah, Salt Lake City, Utah, United States of America
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Shrem NS, Wood L, Hamilton RJ, Kuhathaas K, Czaykowski P, Roberts M, Matthew A, Izard JP, Chung P, Nappi L, Jones J, Soulières D, Aprikian A, Power N, Canil C. Testicular cancer survivorship: Long-term toxicity and management. Can Urol Assoc J 2022; 16:257-272. [PMID: 35905486 PMCID: PMC9343164 DOI: 10.5489/cuaj.8009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Affiliation(s)
- Noa Shani Shrem
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Lori Wood
- Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Robert J. Hamilton
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Kopika Kuhathaas
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Piotr Czaykowski
- Department of Medical Oncology and Hematology, CancerCare Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Matthew Roberts
- Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Andrew Matthew
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jason P. Izard
- Departments of Urology and Oncology, Queen’s University, Kingston, ON, Canada
| | - Peter Chung
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Hospital, University of Health Network, University of Toronto, Toronto, ON, Canada
| | - Lucia Nappi
- Division of Medical Oncology, British Columbia Cancer - Vancouver Cancer Centre, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Jones
- Department of Supportive Care, Princess Margaret Cancer Centre, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Denis Soulières
- Division of Medical Oncology/Hematology, Le Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Armen Aprikian
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Nicholas Power
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Christina Canil
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
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Satisfaction with testicular prosthesis: a Portuguese questionnaire-based study in testicular cancer survivors. Rev Int Androl 2022; 20:110-115. [PMID: 35477530 DOI: 10.1016/j.androl.2020.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/18/2020] [Accepted: 10/21/2020] [Indexed: 11/22/2022]
Abstract
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.
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7
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Ali Benali N, Pradère B, Lannes F, Thi Dang V, Mauger de Varennes A, Gaillard C, Berchiche W, Margue G, Bardet F, Manuguerra A, Pinar U, Duquesne I, Plassais C, Wandoren W, Hulin M, Khene ZE, Vallée M, Michiels C, Chabenes M, Gaillard V, Felber M, Kaulanjan K, Dominique I, Sbizerra M, Seizilles de Mazancourt E, Freton L, Gondran-Tellier B, Matillon X. TORSAFUF - Surgical exploration for torsion of spermatic cord suspicion and risk factors for unnecessary surgery: Results of a French nationwide retrospective study on 2940 patients. Prog Urol 2021; 32:92-100. [PMID: 34920923 DOI: 10.1016/j.purol.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/10/2021] [Accepted: 10/31/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUNDS Spermatic cord torsion is a frequent urological emergency that mostly concerns teenagers and young adults. This study aimed to determine the clinical and surgical characteristics of young adults who had scrotal exploration for suspected spermatic cord torsion and to identify clinical risk factors associated with needless scrotal exploration. METHODS We retrospectively collected national data from patients aged 12years and older who underwent a surgical exploration for suspicion of torsion of the spermatic cord between 2005 and 2019 in 17 hospitals. We analyzed demographics, surgical and postoperative characteristics in our population. We compared the cohort according to the intraoperative diagnosis of torsion or not. RESULTS In total, 2940 had surgical exploration: 1802 (61.3%) patients had torsion of the spermatic cord and 1138 (38.7%) had another diagnosis. In multivariate analysis, age (OR: 1.04; 95% CI: 1.01-1.06; P=0.005), medical history of cryptorchism (OR: 4.14; 95% CI: 1.05-16.31; P=0.042) and VAS pain score (OR: 0.91; 95% CI: 0.83-0.98; P=0.018) were risk factors significantly associated with unnecessary surgical exploration. The rate of complications in the 90days after surgery was 11% in the "torsion" group, and 9.7% in the "non-torsion" group (P=0.28). CONCLUSION Scrotal exploration without intraoperative diagnosis of torsion was performed in 40% of our cohort. VAS pain score and cryptorchism history can help for the diagnosis but scrotal exploration remains the way to diagnose spermatic cord torsion and should be performed on the slightest suspicion, even after 24hours of symptoms, as the chances for testicular salvage remains around 50%.
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Affiliation(s)
- N Ali Benali
- Department of Urology, Poitiers University Hospital, Poitiers, France.
| | - B Pradère
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - F Lannes
- Department of Urology, Nord University Hospital, Marseille, France
| | - V Thi Dang
- Department of Urology, Toulouse University Hospital, Toulouse, France
| | | | - C Gaillard
- Department of Urology, Tours University Hospital, Tours, France
| | - W Berchiche
- Department of Urology, Nord University Hospital, Marseille, France
| | - G Margue
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - F Bardet
- Department of Urology, Dijon University Hospital, Dijon, France
| | - A Manuguerra
- Department of Urology, Nancy University Hospital, Nancy, France
| | - U Pinar
- Department of Urology, Hôpitaux Universitaire Pitié-Salpêtrière, AP-HP, Paris, France
| | - I Duquesne
- Department of Urology, Hôpitaux Universitaire Pitié-Salpêtrière, AP-HP, Paris, France
| | - C Plassais
- Department of Urology, Hôpitaux Universitaire Pitié-Salpêtrière, AP-HP, Paris, France
| | - W Wandoren
- Department of Urology, Pointe-à-Pitre University Hospital, Pointe-à-Pitre, Guadeloupe
| | - M Hulin
- Department of Urology, Reims University Hospital, Reims, France
| | - Z-E Khene
- Department of Urology, Rennes University Hospital, Rennes, France
| | - M Vallée
- Department of Urology, Poitiers University Hospital, Poitiers, France; Poitiers University, INSERM U1070, "Pharmacologie des Anti-Infectieux", UFR Médecine-Pharmacie, Pôle Biologie Santé, Poitiers, France
| | | | - C Michiels
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - M Chabenes
- Department of Urology, Grenoble University Hospital, Grenoble, France
| | - V Gaillard
- Department of Urology, Strasbourg University Hospital, Strasbourg, France
| | - M Felber
- Department of Urology, Nancy University Hospital, Nancy, France
| | - K Kaulanjan
- Department of Urology, Pointe-à-Pitre University Hospital, Pointe-à-Pitre, Guadeloupe
| | - I Dominique
- Department of Urology, Lyon Sud University Hospital, Lyon, France
| | - M Sbizerra
- Department of Urology, Lyon Sud University Hospital, Lyon, France
| | | | - L Freton
- Department of Urology, Rennes University Hospital, Rennes, France
| | | | - X Matillon
- Department of Urology, Lyon Sud University Hospital, Lyon, France
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Bhanvadia RR, Baky FJ, Lafin JT, Bagrodia A. How can we mitigate treatment-associated morbidity in patients with germ cell tumors? Expert Rev Anticancer Ther 2021; 21:805-807. [PMID: 34006160 DOI: 10.1080/14737140.2021.1932473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Raj R Bhanvadia
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - Fady J Baky
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - John T Lafin
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - Aditya Bagrodia
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
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9
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Koschel SG, Wong LM. Radical inguinal orchidectomy: the gold standard for initial management of testicular cancer. Transl Androl Urol 2020; 9:3094-3102. [PMID: 33457282 PMCID: PMC7807348 DOI: 10.21037/tau.2019.12.20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Radical inguinal orchidectomy with division of the spermatic cord at the internal inguinal ring is the gold standard for diagnosis and local treatment of testicular malignancies. The technique is well established and described in detail in this paper, collating methods from various surgical textbooks and articles. We also discuss pre-operative considerations including fertility counselling and potential testicular prosthesis at time of orchidectomy, and the importance of contemplating differential diagnoses such as para-testicular sarcoma and primary testicular lymphoma (PTL) prior to performing radical orchidectomy (RO). The evidence and indications for new surgical techniques to treat local testicular malignancies are also described, including testis sparing surgery (TSS) and spermatic cord sparing orchidectomy.
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Affiliation(s)
- Samantha G Koschel
- Department of Urology, St. Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Lih-Ming Wong
- Department of Urology, St. Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Surgery, University of Melbourne, Melbourne, Australia
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10
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Hayon S, Michael J, Coward RM. The modern testicular prosthesis: patient selection and counseling, surgical technique, and outcomes. Asian J Androl 2020; 22:64-69. [PMID: 31744995 PMCID: PMC6958971 DOI: 10.4103/aja.aja_93_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
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.
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Affiliation(s)
- Solomon Hayon
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC 27500-7235, USA
| | - Jamie Michael
- University of North Carolina School of Medicine, Chapel Hill, NC 27500-7235, USA
| | - R Matthew Coward
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC 27500-7235, USA
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11
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Abstract
Since their popularization, genitourinary prosthetics have remained a gold-standard therapy for the treatment of erectile dysfunction and stress urinary incontinence and in cases of testicular loss or dysfunction. They have also represented an area of significant innovation, which has contributed to excellent long-term outcomes. Given this history, the objective of the current review was to provide a 5–10-year outlook on anticipated trends and developments in the field of genitourinary prosthetics. To accomplish this objective, a PubMed and patent search was performed of topics relating to penile and testicular prostheses and urinary sphincters. In regard to penile prostheses, findings demonstrated several new concepts including temperature-sensitive alloys, automated pumps, devices designed specifically for neophalluses, and improved malleable designs. With artificial urinary sphincters, new concepts include the ability to add or remove fluid from an existing system, two-piece systems, and new mechanisms to occlude the urethra. For testicular prosthetics, future implementations may not only better replicate the feel of a biological testicle but also add endocrinological functions. Beyond device innovation, the future of prosthetics is also one of expanding geographic boundaries, which necessitates variable cost modeling and regulatory considerations. Surgical trends are also changing, with a greater emphasis on nonnarcotic, postoperative pain control, outpatient surgeries, and adjunctive techniques to lengthen the penis and address concomitant stress incontinence, among others. Concomitant with device and surgical changes, future considerations also include a greater need for education and training, particularly given the rapid expansion of sexual medicine into developing nations.
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Affiliation(s)
- Landon Trost
- Mayo Clinic, Department of Urology, 200 First St SW Rochester, MN 55905, USA
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12
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Lu C, McKibben M. Testicular Implant Surgery: Indications and Technique. CURRENT SEXUAL HEALTH REPORTS 2020. [DOI: 10.1007/s11930-020-00255-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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13
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Musi G, Cozzi G, Mistretta FA, Tringali VML, Serino A, Jereczek-Fossa BA, Verri E, Ferro M, Catellani M, de Cobelli O. Insertion of a testicular prosthesis at the time of radical orchiectomy for testicular cancer is safe in patients who will subsequently undergo chemotherapy or radiotherapy. Andrologia 2020; 52:e13613. [PMID: 32352182 DOI: 10.1111/and.13613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 11/29/2022] Open
Abstract
We aimed to assess the incidence of prosthesis-related complications in patients who received a testicular prosthesis at the time of radical orchiectomy for testicular cancer and were then treated with chemotherapy (ChT) or radiotherapy (RT). We reviewed the records of the patients who underwent radical orchiectomy at our Institute since 1999; we also retrieved data from patients who underwent surgery elsewhere and then received ChT or RT at our Institution since 1999. We used the chi-square test to evaluate differences in the incidence of prosthesis-related complications between the groups. We retrieved the records of 587 patients; 393 had a testicular prosthesis implanted. Median follow-up was 57.7 months. One hundred thirty-eight patients (35.11%) received ChT, 129 RT (38.82%) and 10 (2.55%) both ChT and RT; of them, 6 (4.34%), 8 (6.20%) and 0 reported problems respectively. Seven (6.03%) of the 116 patients (29.52%) who had no further treatment had complications. The incidence of complications was not significantly different between patients who had no further treatment versus patients who underwent ChT (p = .75) or RT (p = .83). Testicular prosthesis insertion at the time of radical orchiectomy is safe even in patients subsequently undergoing ChT or RT.
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Affiliation(s)
- Gennaro Musi
- Division of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Gabriele Cozzi
- Division of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | | | | | - Alessandro Serino
- Division of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy.,Division of Radiotherapy, European Institute of Oncology, IRCCS, Milan, Italy
| | - Elena Verri
- Division of Urogenital Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Michele Catellani
- Division of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Ottavio de Cobelli
- Division of Urology, European Institute of Oncology, IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
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14
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Surgical Outcomes of Neoscrotal Augmentation with Testicular Prostheses in Transgender Men. J Sex Med 2019; 16:1664-1671. [PMID: 31501057 DOI: 10.1016/j.jsxm.2019.07.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/16/2019] [Accepted: 07/24/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Testicular prosthesis implantation may be used for neoscrotal augmentation in transgender men. AIM Assess the clinical outcomes and risk factors for postoperative complications of this procedure in transgender men. METHODS All transgender men who underwent neoscrotal augmentation with testicular implants between January 1992 and December 2018 were retrospectively identified. A retrospective chart study was performed that recorded surgical characteristics and postoperative complications. Risk factors on complications were identified using uni- and multivariate analyses. MAIN OUTCOME MEASURE Surgical outcomes included explantation due to infection, extrusion, discomfort, or leakage. RESULTS We identified 206 patients, and the following prostheses were placed: Dow Corning (n = 22), Eurosilicone (n = 2), Nagor (n = 205), Polytech (n = 10), Promedon (n = 105) , Prometel (n = 22), Sebbin (n = 44), and unknown (n = 2). The mean clinical follow-up time was 11.5 ± 8.3 years. In 43 patients (20.8%), one or both prostheses were explanted due to infection, extrusion, discomfort, prosthesis leakage, or urethral problems. Currently, scrotoplasty according to Hoebeke is the most frequently performed technique. Our review found that for this technique explantation occurred in 6 of 52 patients (11.5%). A history of smoking was a risk factor for postoperative infections and prosthesis explantation. In earlier years, larger prostheses were immediately placed at scrotal reconstruction; however, a trend can be seen toward smaller and lighter testicular prostheses and delayed implantation. CLINICAL IMPLICATIONS Patients wanting to undergo this procedure can be adequately informed on postoperative outcomes. STRENGTHS & LIMITATIONS Strengths of this study include the number of patients, long clinical follow-up time, and completeness of data. Weaknesses of this study include its retrospective nature and the high variability of prostheses and surgical techniques used. CONCLUSION Over the years, scrotoplasty techniques and testicular prostheses preferences have changed. Explantation rates have dropped over the last decade. Pigot GLS, Al-Tamimi M, Ronkes B, et al. Surgical Outcomes of Neoscrotal Augmentation with Testicular Prostheses in Transgender Men. J Sex Med 2019;16:1664-1671.
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15
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Srivatsav A, Balasubramanian A, Butaney M, Thirumavalavan N, McBride JA, Gondokusumo J, Pastuszak AW, Lipshultz L. Patient Attitudes Toward Testicular Prosthesis Placement After Orchiectomy. Am J Mens Health 2019; 13:1557988319861019. [PMID: 31359823 PMCID: PMC6685124 DOI: 10.1177/1557988319861019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
| | | | - Mohit Butaney
- 2 Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Nannan Thirumavalavan
- 3 Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.,4 Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
| | - J Abram McBride
- 3 Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.,4 Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Alexander W Pastuszak
- 5 Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Larry Lipshultz
- 3 Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.,4 Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
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16
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Abstract
In any man with a solid testicular mass, cancer should be considered until proven otherwise. Radical inguinal orchiectomy is the treatment of choice in patients with testis mass. Placement of a testicular prosthesis is safe with a very low complication rate and should be offered to all patients undergoing radical orchiectomy. In patients with widespread or life-threatening advanced disease, delayed orchiectomy following chemotherapy is recommended. Testis-sparing surgery can be performed in highly selected patients with solitary testicle mass, bilateral testicular tumors, or strong suspicion of a benign lesion.
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