TESTICULAR IMPLANT: FILLING THE EMPTY SCROTUM

 We had a patient who came to us with right testicular pain persistent despite of medications and left testicular atrophy.He could not attribute the process of atrophy to any antecedent trauma / twisting or infection( swelling).

On USG scrotum , left testis was a nubbin and right testicle was normal in size( around 22 cc).There was a grade 2 varicocele.

His semen analysis showed low motility.We  did left orchidectomy and AMS testicular implant ( large size 22 cc) and right sided Microsurgical varicocelectomy and spermatic cord denervation. 

This implant gave the patient self image and immense psychological satisfaction.

Empty hemiscrotum can be psychologically traumatising for the patient.The empty scrotum can be due to congenital absence of the testis( crypto-orchidism),removal of the testicle following accidental injury, infection,torsion or testicular malignancy.

History of the testicular implant:

It is a great task infront of a surgeon to restore the   normal anatomy of an individual and giving him confidence.

The first  attempt to put an artificial testis was done in 1939( metallic vitallium implant); thereafter several modifications in the materials were done( glass , methacrylate, polyurethane foam).But the implant got momentum in 1973 after the breast implant started becoming vogue.Silicon filled implants were being used.But in 1995 these implants were withdrawn from the market for the fears of the connection between the connective tissue disorders and the silicon material.

But later studies didn't come to conclusion regarding any definitive proof  between silicon implant and the connective tissue disorders.

To minimise the side effects silicon shell (with water filled )  were used.The implants come in different sizes for different age groups and to match with the size of the contralateral testis.

APPEARANCE OF THE BOTH HEMISCROTUMS AFTER THE IMPLANT

AMS 22 CC SIZE PROSTHESIS

Procedure:

We prefer to do the implant through a subinguinal approach.We make a space in the scrotum by blunt dissection.We then decide the size as per the size of the contralateral testis.

We prefer AMS implant.It is kept in antibiotic soaked saline kidney dish and inserted in the hemiscrotum.To prevent migration and extrusion we close the hemiscrotal neck by a purse string sutures.

Post operatively we discharge the patient very next day with oral antibiotics/ anti-inflammatory medications and enzyme preparations.We advise the patient not to engage in strenuous activity for a period of 2 weeks.

We advise them to come for regular dressings and report if any pain/ swelling/fever/redness over the inguinal or scrotal region develops.

Complications like infection, extrusion, hematoma,( less than 2%), allergic phenomenon( 5-8%),hemiscrotal discomfort( 5-10%) can develop.
In children the implants can be exchanged for bigger ones as the child grows and the contralateral testis also develops.