Indications for Implantation
Testicular removal is most commonly performed in men with testicular cancer however men may have absence of one or both testicles for other reasons such as undesceneded testes, previous testicular torsion (extreme twisting of the testicle), trauma or as part of the treatment for advanced prostate cancer.
At the time of surgery to remove the testicle (called orchiectomy) a silicone testicular prosthesis of similar size to the remaining testicle can be implanted. If not performed at the time of testicular removal then a prosthetic testicular implant may subsequently be performed months or years later. The purpose of implantation is to maintain the cosmetic appearance of the scrotum; many patients elect to have this done at the time of orchiectomy, however the decision is individual and some men are not concerned by having only one testicle in the scrotum.
The Controversy Behind Silicone Prostheses
Older silicone prostheses contained liquid silicone. The concern is whether the silicone gel leaked from the implant and caused autoimmune diseases where the body’s own immune system acts against itself causing inflammation and scarring in otherwise healthy tissue. Newer devices do not contain liquid silicone and there has never been an association of these diseases with testicular prostheses.
Aspirin and any other blood thinning medications need to be stopped one week prior to surgery.
The implantation adds approximately 10 minutes of operative time to the procedure of orchiectomy. If performed several months or years following an orchiectomy then the original groin incision is re-opened and the prosthesis is pushed down into the scrotum from above.
Post-operatively there will be some groin pain at the site of incision and in the scrotum which is usually adequately treated with oral painkillers. The scrotum will be tender and swollen for some time. Testicular implant surgery is usually performed on an outpatient basis (no overnight stay). Each person’s recovery time is different, however you should be able to resume most of your daily activities within a week to ten days.
Implantation of any prosthesis carries with it the risk of infection. For this reason antibiotics are given both prior to and after the procedure and antibiotic solution is used during the case to irrigate the wound. The overall risk of an infection is less than 5%. If an infection does occur then it is usually easily treated with a course of antibiotics however if the prosthesis became infected then it would need to be removed. Other possible complications include displacement or extrusion of the device, haematoma formation (a collection of blood inside the body in and around where the incision is made), bleeding and possible anaesthetic reactions. Approximately 1 in 30 patients require re-surgery within the first year to either remove or adjust the implant.