Testicular Prosthesis, First Systematic Review In Paediatric Population

Abstract

PURPOSE To systematically review the insertion of paediatric testicular prosthesis at our institute over last 14 years and to define a safe protocol for insertion. MATERIAL AND METHODS A retrospective medical record review was performed of all patients who had received testicular prosthesis between 1994 and 2007. Comparative analysis was performed using Chi-squared test and Fischer's exact test. RESULTS 72 patient's notes were reviewed. Reason for testicular absence was testicular atrophy in 30 (42%), orchidectomy in 27 (37%) and congenital absence in 15 (20%). Increase in the trend of prosthesis insertion was noted (one prosthesis in 1994 to 13 in 2007). 39 (54 %) patients received large size prosthesis (mean age at insertion 14.4 years) 19 (26 %) medium (14.2 years) and 10 (13 %) small (11.5 years). 2 patients with small prosthesis had it replaced with larger one. Surgically scrotal route was used in 38 (53%) and groin route in 34 (47%). 10 patients (13.8 %) had complications. Complications were infection 5 (7%) extrusion 4 (5.6%), discomfort 4 (5.6%), and malposition 2 (2.8%). Complication rate was higher in scrotal group compared to groin: 8 (21%) patients versus 2 (5.8%) though only the results regarding deep infection were statistically significant (P = 0.0707). CONCLUSIONS Commonest reason of testicular absence was testicular atrophy. The use of testicular prosthesis is increasing. A large adult sized prosthesis can be placed safely at adolescence (11-17 years) without the need of it later being replaced with a larger size. Groin route should be preferred as it is associated with fewer complications.