An artificial saline solution-filled testicle implanted into the scrotum after a cancerous testicle is removed. A testicular pros-theses can create or restore the more normal cosmetic appearance of a testicle-containing scrotum. Several studies have described the negative psychological effects that can result from the loss or absence of a testicle and have indicated that the cosmetic aspect of saline solution-filled testicular implants can provide emotional benefits. However, a testicular implant is used strictly for cosmetic appearances only and in no way functions as a natural testicle does. Before choosing to receive a testicular implant, patients should discuss their long-term expectations and the potential risks and complications of the procedure.

Types of Prostheses

There are two types of testicular prosthesis. A saline solution-filled type produced by the Mentor Corporation is the only prosthesis commercially available. The saline solution implant is about the same weight, shape, and texture of a normal testicle and is manufactured in four sizes: extra-small, small, medium, and large. The implant is made of a molded silicone elastomer shell about 0.035 inch thick that is not visible on X-ray.

A solid silicone elastomer produced by the Silimed Corporation is experimental and has not yet been approved by the U.S. Food and Drug Administration (FDA) for commercial use in patients.

The Process

The implant includes a self-sealing injection site at one end that allows the doctor to fill the device with a sterile saline solution immediately before surgery. On the opposite end of the implant is a silicone tab that the doctor can use to suture the implant into a secure position.

A testicular prosthesis is usually implanted under local anesthesia in an outpatient setting, the patient can return to work shortly afterward. With local anesthesia, patients are awake, but the lower part of the body is numb throughout the procedure.

Typically, testicular implant procedures are relatively simple and take 20 to 40 minutes. There are several different accepted surgical approaches that can be used to insert an implant. Once the implant has been filled and sutured into place, the doctor can add more saline solution for better cosmetic appearance.

Patients should be aware that implantation of a testicular prosthesis may not be a one-time procedure: Any surgical complications may require further procedures.

Contraindications

Implantation of the device should be carefully considered if the patient has a current infection, the scrotum is too small or damaged from prior surgery or radiation, the patient has uncontrolled diabetes or poor circulation, or the patient wants to avoid future surgery to remove it.

Risks

The known or potential risks of saline solution-filled testicular implants or the implant surgery include rupture or leakage of the implant, calcium deposits, pain, shifting, extrusion, fluid collection, infection, hardening, and hematoma.

Rupture and leakage

Testicular implants, as for other medical implant devices, do not last a lifetime. There is a slight chance of the body’s having an adverse reaction to the implant, and the implant may rupture or leak or both, necessitating removal. The long-term rates of deflation and resurgery are currently not known; however, a five-year study is currently being done to assess these possible problems. In terms of information from the clinical studies of the saline solution-filled testicular implant, about one in 30 patients needs surgery again within the first year either to remove or to adjust the implant. Infection or extrusion (the implant shifts and presses out through the skin) may also require additional surgery.

Discomfort or pain

An uncomfortable feeling around the surgical site is usually temporary. The duration of this discomfort or pain should be discussed with the doctor or surgeon.

Migration or shifting

In studies of the implant, the device moved from its original position about 2 percent of the time.

Extrusion

In about 2 percent of cases, the implant shifts and presses out through the skin (extrusion). In addition, skin damage, shedding of dead skin, or wound separation may be caused by tight pull of skin over the implant, trauma to the skin during the surgery, or insufficient tissue to cover the implant.

Fluid collection

In a natural process, occasionally excess fluid accumulates around the implant after surgery.

Hardening

As a result of the body’s natural reaction to an implanted device, scar tissue forms around the implant and contracts, causing discomfort. The implant may be difficult to remove if the degree of scar tissue is significant.

Hematoma

A collection of blood (usually a clot) may be found in tissue after a blood vessel breaks. Large hematomas cause enlarged, tender, and discolored tissue that may, if untreated, lead to extrusion of the implant.

Infection

Swelling, tenderness, pain, and fever may occur immediately after surgery or at any time after the implant is inserted. If an infection does not clear up promptly with proper treatment, the surgeon may have to remove the implant.

After the Procedure

Patients may experience some discomfort during the first one or two days after surgery; a small amount of bright red blood is to be expected. Most patients are instructed to keep surgical bandages on the scrotum for at least a few days. Most patients feel tired, and the scrotum is swollen, tender, and sensitive for some time. Swelling and black-and-blue bruises are normal. However, the ability to urinate should not be affected.

Although recovery times differ, patients should be able to resume most daily activities within a week to 10 days. Patients can usually begin to shower two days after the surgery. The dressing should be kept dry until then. However, patients should wait at least a month before resuming strenuous activities. The doctor can provide more specific details about recovery, including the amount of time to wait before resuming sex.

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