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Hasirci E, Ceyhan E, Gultekin MH, Kayra MV, Kizilkan Y, Yildirim O, Altan M, Ure I, Cicek T, Sah C, Incekas C, Gul U, Turunc T. Parameters affecting the success rate of microscopic testicular sperm extraction in male patients with a solitary testis and non-obstructive azoospermia. Int Urol Nephrol 2024:10.1007/s11255-024-04074-w. [PMID: 38733502 DOI: 10.1007/s11255-024-04074-w] [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: 02/09/2024] [Accepted: 05/02/2024] [Indexed: 05/13/2024]
Abstract
PURPOSE We aimed to compare the success rate of spermatozoa retrieval through microscopic testicular sperm extraction (mTESE) in non-obstructive azoospermic (NOA) men with a solitary testis with that of mTESE in NOA men with bilateral testes and the parameters affecting these rates. METHODS A retrospective cross-sectional study of factors contributing to infertility in NOA patients with a solitary testis and men with bilateral testes was carried out. In this multicenter study, 74 patients with NOA with a solitary testis were matched with 74 patients with bilateral testes in terms of age, duration of infertility, and volume of the solitary testis from 2770 patients with NOA with bilateral testes. Hormonal parameters, presence of varicocele, history of varicocelectomy, history of undescended testis and karyotype analysis results were compared. RESULTS Spermatozoa were obtained from 40 (54.1%) patients with a solitary testis and 42 (56.76%) patients with bilateral testes. No differences were found regarding age, duration of infertility, or mean testicular volume between patients with a solitary testis and patients with bilateral testes. When serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels were compared regardless of sperm retrieval status, it was observed that both levels were greater in the group of patients with a solitary testis (p < 0.01). Patients with solitary and bilateral testes from whom spermatozoa were obtained had larger testes than those from whom spermatozoa could not be obtained (p < 0.05). Similarly, the serum levels of FSH and LH were significantly greater in patients with a solitary testis than in those with bilateral testes (p < 0.05). CONCLUSIONS To the best of our knowledge, this is the first study in the literature to evaluate the parameters that influence mTESE outcome in NOA patients with a solitary testis and NOA patients with bilateral testes. Greater testicular volume was found to positively affect spermatozoa retrieval for patients with a solitary testis. The higher levels of FSH and LH in patients with a solitary testis than in patients with bilateral testes of similar testicular volume may be due to a compensatory mechanism developed by the hypothalamic-pituitary-gonadal axis. The fact that these hormones are higher in patients with a solitary testis does not mean that the number of spermatozoa obtained through mTESE will be decreased.
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Affiliation(s)
- Eray Hasirci
- Faculty of Medicine, Department of Urology, Baskent University, Ankara, Turkey.
| | - Erman Ceyhan
- Faculty of Medicine, Department of Urology, Baskent University, Ankara, Turkey
| | - Mehmet Hamza Gultekin
- Cerrahpasa Faculty of Medicine, Department of Urology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mehmet Vehbi Kayra
- Faculty of Medicine, Department of Urology, Baskent University, Adana, Turkey
| | - Yalcin Kizilkan
- Department of Urology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Omer Yildirim
- Gelibolu Sehit Koray Onay State Hospital, Urology Clinic, Canakkale, Turkey
| | - Mesut Altan
- Faculty of Medicine, Department of Urology, Hacettepe University, Ankara, Turkey
| | - Iyimser Ure
- Faculty of Medicine, Department of Urology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Tufan Cicek
- Etlik Zubeyde Hanim Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Cem Sah
- Medline Hospital, Adana, Turkey
| | - Caner Incekas
- Faculty of Medicine, Department of Biostatistics, Baskent University, Ankara, Turkey
| | - Umit Gul
- Department of Urology, Private EPC Hospital, Adana, Turkey
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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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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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Santhanakrishnan R, Konamme VK, Saroja MG. Concurrent Placement of the Testicular Prosthesis in Children Following Orchiectomy/Testicular Loss. J Indian Assoc Pediatr Surg 2023; 28:111-115. [PMID: 37197240 PMCID: PMC10185028 DOI: 10.4103/jiaps.jiaps_100_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/02/2022] [Accepted: 10/07/2022] [Indexed: 05/19/2023] Open
Abstract
Introduction Testis is essential for male sexual hormone production, fertility, and psychological well-being of a male. In the unfortunate event of testicular loss, placement of a testicular prosthesis perhaps will offer a sense of well-being, improved body image, and overall confidence in the growing child. Aims The aim is to evaluate the feasibility and assessment of outcomes following concurrent placement of testicular prosthesis in children following orchiectomy. Materials and Methods This is a cross-sectional study conducted by reviewing the reports of patients who underwent simultaneous insertion testicular prosthesis following orchiectomy for various indications between January 2014 and December 2020 at tertiary hospitals in Bengaluru. Children <18 years were included in this study. A transscrotal approach was preferred in cases where a transscrotal orchiectomy was done. Transinguinal approach was preferred in children undergoing prosthesis insertion as an isolated procedure. The size of the prosthesis was chosen based on the age of the child and the size of the scrotum. Outcomes were assessed on follow-up. Results A total of 29 children underwent prosthesis insertion (25 unilateral and four bilateral). The mean standard deviation age was 5.58 (3.92) years. The indications for prosthesis insertion were cryptorchidism with atrophic testis (22), torsion (3), Leydig cell tumor (2), and severely virilized Congenital adrenal hyperplasia (CAH) (2). Of these, three children (9%) had complications (wound gaping in two and wound infection in one) that needed removal of the implant. The mean duration of follow-up was 49.23 months. All the parents reported a good outcome, and none of the children who underwent prosthesis placement needed a change during this follow-up. Conclusion Concurrent placement of a testicular prosthesis is technically easy and a safe procedure, achieves satisfactory cosmetic appearance with minimal morbidity.
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Affiliation(s)
- Ramesh Santhanakrishnan
- Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Vinay Kumar Konamme
- Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Murali Govindappa Saroja
- Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
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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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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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