You have accessJournal of UrologyPediatrics & Reconstruction1 Apr 2011V1711 COMBINED ORCHIECTOMY AND PROSTHETIC EXCHANGE: SURGICAL TECHNIQUE Aditya Bagrodia, Douglas Preuss, and Nicol Bush Aditya BagrodiaAditya Bagrodia Dallas, TX More articles by this author , Douglas PreussDouglas Preuss Dallas, TX More articles by this author , and Nicol BushNicol Bush Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2036AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Historically, placement of testicular implant during orchiectomy for torsion is not recommended despite success during orchiectomy for cancer. We present our surgical technique for combined orchiectomy and prosthetic exchange (COPE) in an adolescent with torsion. METHODS A 16-year old presented with a 4 day history of abdominal pain and diagnosis of gastroenteritis elsewhere. He subsequently developed scrotal erythema and edema and ultrasound confirmed testicular torsion with necrosis. He was offered orchiectomy, contralateral orchiopexy, and simultaneous prosthesis. The patient received peri-operative vancomycin and gentamicin. The torsed hemiscrotum was entered through a midline incision and the testicle was detorsed. After contralateral ochiopexy, orchiectomy of the torsed testicle was performed with preservation of the tunica vaginalis. The spermatic cord was identified intravaginally and ligated using 4-0 polyglactin. Two 3-0 polypropylene sutures were placed at the proximal spermatic cord stump and tagged. Three individual 4-0 PDS sutures were preplaced in the superior, middle and inferior portions of the tunica vaginalis for later reapproximation. A large (20 ml capacity) saline-filled, adjustable testicular prosthesis (Coloplast, Denmark) was then filled with 16 ml of saline and secured near the cord stump through the tab of the prosthetic. The preplaced tunica sutures wrapped the prosthesis within the tunica. Finally, a 4-0 polyethylene terephthalate suture secured the most dependent portion of the tunica to scrotal dartos. After hemostasis and repeat antibiotic irrigation, the dartos fascia was closed in two layers (polyglactin) prior to subepithelial skin closure. The patient was discharged the same day with opioid pain medication and 5 day course of ciprofloxacin. RESULTS Left orchiectomy, right orchiopexy, and simultaneous left prosthesis placement were successfully performed. Total operative time was 62 minutes. Estimated blood loss was 10 ml. No infectious complication occurred. At 6-week follow up, the incision was healed, bilateral cremasteric reflexes were elicited, and scrotal symmetry was evident. CONCLUSIONS Our initial experience with COPE for torsion demonstrates the procedure to be safe and effective. In addition to well-documented body self-esteem advantages of prosthetic placement, advantages of COPE potentially include obviating the need for two anesthetics, decreasing number of days missed from school/work, and cost advantages associated with a single procedure. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e687-e688 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aditya Bagrodia Dallas, TX More articles by this author Douglas Preuss Dallas, TX More articles by this author Nicol Bush Dallas, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...