Testicular Prosthesis Implantation Research Articles

Short-term revision rate of Rigicon Testi10TM testicular prosthesis in adolescents and adults: a retrospective chart review.

Testicular prosthesis implantation is a valuable solution for the physical, cosmetic, and psychological challenges associated with testicular loss which may affect males of any age. We evaluated the safety and reliability of the new Rigicon Testi10TM testicular prosthesis in adults and adolescents by performing an IRB-approved retrospective study of data drawn from Patient Information Forms (PIFs). A total of 427 patients (382 adults and 45 adolescents) had at least one testicular prosthesis implanted. Only one adult patient required revision surgery due to rupture of the Rigicon Testi10 TM saline-filled prosthesis. A 40-year-old patient was found to have a leaking prosthesis approximately one week postoperatively, which was suspected to be due to inadvertently punctured by the surgeon during the sterile saline filling process. There were no post-implantation revisions required for adolescent patients. According to our results, Kaplan-Meier calculation of survival from removal or revision was 99.8% for all patients at 54 months (99.7% for adults and 100% for adolescents). The complication rates among patients in this study are lower than those reported in previous published studies. Our study underscores the generally safe nature of testicular prosthesis implantation, as well as the very rare incidence of revision surgery for this new device.

Trends in the use of testicular prostheses in Germany: a total population analysis from 2006-2021.

Testicular tumors are the most common malignancies in young adults and their incidence is growing. The implantation of a testicular prosthesis, for example, during orchiectomy is a standard procedure but its frequency in Germany is unknown. This study aims to analyze trends of testicular prosthesis implantation in recent years in Germany. The nationwide German hospital billing database and the German hospital quality reports from 2006 to 2021 were studied. A total of 12,753 surgical procedures with implantation of testicular prosthesis and 1,244 procedures with testicular prosthesis explantation were included. Testicular prosthesis implantation increased in total from 699 cases in 2006 to 870 cases in 2020 (+11.4 cases/year; p<0.001). The share of implantation of testicular prosthesis due to testicular tumor decreased from 72.6% in 2006 to 67.5% in 2020 (p<0.001). The share of implantation due to gender affirming surgery increased from 6.8% in 2006 to 23.3% in 2020 (p<0.001). The share of implantation due to testicular atrophy decreased from 11.4% in 2006 to 3.4% in 2020 (p<0.001). Simultaneous implantation of testicular prosthesis during orchiectomy for testicular cancer increased from 7.8% in 2006 to 11.4% in 2020 (p<0.001). In 2006, 146 hospitals (85%) performed<5 testicular prosthesis implantation, while 20 hospitals (12%) performed 5-15 implantation procedures and 6 hospitals (3%) performed>15 testicular implantation surgeries. In 2021, 115 hospitals (72%) performed<5 testicular prosthesis implantation, while 39 hospitals (25%) performed 5-15 implantation procedures and 5 hospitals (3%) performed>15 testicular implantation surgeries. This study shows that implantation of testicular prostheses is steadily increasing. Explantation rates are low. Besides testicular cancer transgender surgeries were the main driver for increasing case numbers in recent years.

Cost and utilization analysis of concurrent versus staged testicular prosthesis implantation for radical orchiectomy.

American Urological Association guidelines recommend testicular prosthesis discussion prior to orchiectomy. Utilization may be low. We compared outcomes and care utilization between concurrent implant (CI) and staged implant (SI) insertion after radical orchiectomy. The MarketScan Commercial claims database (2008-2017) was queried for men ages >18 years who underwent radical orchiectomy for testicular mass, stratified as orchiectomy with no implant, CI, or SI. 90-day outcomes included rate of reoperation, readmission, emergency department (ED) presentation, and outpatient visits. Regression models provided rate ratio comparison. 8803 patients (8564 no implant, 190 CI, 49 SI; 2.7% implant rate) were identified with no difference in age, Charlson Comorbidity Index, insurance plan, additional cancer treatment, or metastasis. Median perioperative cost at orchiectomy (+/- implant) for no implant, CI, and SI were $5682 (3648-8554), $7823 (5403-10973), and $5380 (4130-10521), respectively (p<0.001). Median perioperative cost for SI at implantation was $8180 (4920-14591) for a total cost (orchiectomy + implant) of $13650 (5380 + 8180). CI patients were more likely to have follow-up (p = 0.006) with more visits (p = 0.030) compared to the SI group post-implantation but had similar follow-up (p = 0.065) and less visits (p = 0.025) compared to the SI patients' post-orchiectomy period. Overall explant rates were 4.7% for CI and 14.3% for SI (p = 0.04) with a median time to explant of 166 (IQR: 135-210) and 40 days (IQR: 9.5-141.5; p = 0.06). Median cost of removal was $2060 (IQR: 967-2880). CI placement has less total perioperative cost, lower explant rate, and similar postoperative utilization to SI.

Should You Fix Testicular Prosthesis? A Satisfaction Survey From a Monocentric Cohort

Objective:To evaluate whether testicular prosthesis should be fixed MethodsRetrospective monocentric study including 169 patients who had implantation of testicular prosthesis between January 2013 and December 2022. Patients answered a telephone questionnaire regarding prosthesis characteristics and satisfaction. ResultsProsthesis was sutured for 59 patients (34.9%) out of 169. 146 patients answered the questionnaire. Satisfaction was excellent regarding size, weight, consistency and shape. A position too high was a major complain in both groups. Pain and discomfort were significantly higher in the fixed group (30.8% vs 9.78%, p<0,001). Few patients reported discomfort with the anchor prosthesis (22,9%). ConclusionsOverall satisfaction of the prosthesis is high but discomfort and high positioning are the two items remaining to improve. Our study suggests that fixing prosthesis is a cause of discomfort and won’t allow a better positioning

(279) Total Phalloplasty with Latissimus Dorsi Myocutaneous Flap. Our Italian Experience

Abstract Introduction Total phalloplasty (TP) is used for the creation of a penis in female to male sex reassignment surgery (FTM SRS). Objective We focused our work on free flap transfer technique using latissimus dorsi myocutaneous flap (MLDF) in order to create a neophallus that allows safe performance of urethroplasty and two cylinders prosthesis implantation. Methods Five patient underwent surgery. A necessary precondition for this technique was the normal body mass index. The donor site was prepared preoperatively by skin massage at least one month before surgery to enable easier donor site closure. The first surgical step includes removal of female genitalia (transvaginal hysterectomy, adnexectomy, colpocleisis), proximal urethroplasty, perineoplasty, the formation of external male genitalia (scrotoplasty, free flap transfer phalloplasty), and 1st stage distal urethroplasty. The second stage includes distal tubularizing urethroplasty, glans plasty, and testicular prosthesis implantation. In the third stage implantation of a 2-cylinder penile prosthesis is performed through the infrapubic approach. The time between stages was 6-9 months. Results The five pts underwent just the first two stages. Penile length varies from 12-18cm and penile girth from 11-16cm. One partial flap loss occurred. Penile urethral stricture developed in 3 pts; 1 pt developed proximal urethral diverticulum. Donor site healed satisfactorily in three pts, two of them required additional scar correction. Conclusions This surgery is a high-risk, complex staged procedure, but with a satisfactory functional and esthetic outcome Disclosure No

Testicular torsion: a modified surgical technique for immediate intravaginal testicular prosthesis implant.

ABSTRACTPurpose:The aim of this paper is to propose a modified surgical technique for immediate intravaginal prosthesis implantation in patients undergoing orchiectomy due to testicular torsion, and to evaluate the wound healing process and patient’s satisfaction.Material and methods:We prospectively analyzed 137 patients with testicular torsion admitted to our facility between April 2018 and May 2020. Twenty-five patients who underwent orchiectomy were included in this study. Fifteen had a testicular prosthesis implanted at the same time as orchiectomy using a modified intravaginal technique (summary figure) and 10 received implants 6 to 12 months after orchiectomy. Wound healing was evaluated at a minimum of four checkpoints (on days 15, 45, 90 and 180 after surgery). At the end of the study, a questionnaire was administered to measure patients’ satisfaction rate. Student’s t test was used for comparison of quantitative data between negative vs. positive cultures (p <0.05). The chi-square test was used to verify associations between categorical variables and immediate vs. late prosthesis implantation (p <0.05).Results:Patient’s ages ranged from 13 to 23 years (mean 16.44 years). Overall time lapse from symptoms to orchiectomy ranged from 10 hours to 25 days (mean 7.92 days). Only one extrusion occurred and it happened in the late implant group. All wounds were healed in 72%, 88%, 95.8% and 100% of the cases on the 15th, 45th, 90th and 180th days after implant, respectively. At the end of the study, all patients stated they would recommend it to a friend or relative. The only patient that had prothesis extrusion asked to have it implanted again.Conclusion:There was no prosthesis extrusion using the modified intravaginal surgical technique for immediate testicular prosthesis implantation, which proved to be an easily performed and safe procedure that can avoid further reconstructive surgery in patients whose testicle was removed due to testicular torsion.

3D Printing Improved Testicular Prostheses: Using Lattice Infill Structure to Modify Mechanical Properties

Patients often opt for implantation of testicular prostheses following orchidectomy for cancer or torsion. Recipients of testicular prostheses report issues regarding firmness, shape, size, and position, aspects of which relate to current limitations of silicone materials used and manufacturing methods for soft prostheses. We aim to create a 3D printable testicular prosthesis which mimics the natural shape and stiffness of a human testicle using a lattice infill structure. Porous testicular prostheses were engineered with relative densities from 0.1 to 0.9 using a repeating cubic unit cell lattice inside an anatomically accurate testicle 3D model. These models were printed using a multi-jetting process with an elastomeric material and compared with current market prostheses using shore hardness tests. Additionally, standard sized porous specimens were printed for compression testing to verify and match the stiffness to human testicle elastic modulus (E-modulus) values from literature. The resulting 3D printed testicular prosthesis of relative density between 0.3 and 0.4 successfully achieved a reduction of its bulk compressive E-modulus from 360 KPa to a human testicle at 28 Kpa. Additionally, this is the first study to quantitatively show that current commercial testicular prostheses are too firm compared to native tissue. 3D printing allows us to create metamaterials that match the properties of human tissue to create customisable patient specific prostheses. This method expands the use cases for existing biomaterials by tuning their properties and could be applied to other implants mimicking native tissues.

Surgical outcomes of testicular prostheses implantation in transgender men with a history of prosthesis extrusion or infection

Background: Testicular prostheses implantation may be used for neoscrotal augmentation in transgender men. In current literature, explantation rates range from 0.6% to 30% and most are a result of infection or extrusion. Information on the surgical path of individuals after prosthesis explantation is scarce. Aim: To assess the frequency and success rate of testicular prosthesis implantation after previous explantation due to infection or extrusion. Methods: All transgender men who underwent testicular prosthesis explantation between January 1991 and December 2018 were retrospectively identified from a departmental database. A retrospective chart study was conducted, recording demographics, surgical and prosthesis characteristics, reoperations, and outcomes. Results: A total of 41 transgender men were included who underwent testicular prosthesis explantation in the study time period. Of these, 28 (68%) opted for new prosthesis implantation. Most explanted prosthesis had a volume ≥30cc and were replaced with an equally sized one. The postoperative course was uneventful in 19 out of 28 (68%) individuals. Explantation of one or both prostheses occurred in 7 out of 28 (25%) individuals, because of infection (n = 3, 11%) or extrusion (n = 4, 14%). Patients that experienced complications had more often a history of smoking (p = 0.049). The explantation rate was lower if a smaller or lighter prosthesis was reimplanted (p = 0.020). Discussion: Most patients opt for testicular prosthesis implantation after previous explantation due to extrusion or infection. Explantation rates are higher than after the primary implantation procedure. Results of current study can be used to inform individuals on postoperative outcomes.

Clinical and Histopathological Evaluations of Testicular Regression Syn-drome: A Case Report

BackgroundTesticular regression syndrome (TRS) is defined as the partial or total absence of testicular tissue in 46XY patients with normal external genitalia. The incidence of TRS has been reported to be less than 5% in patients with cryptorchidism. Herein, we report a case of a one-year old boy who underwent surgical exploration with an initial diagnosis of cryptorchidism.Case descriptiona one-year old male came to the outpatient clinic at Al Emadi Hospital, Doha, Qatar. Physical examination revealed normal external genitalia with palpable right testis and non-palpable left testis. The initial diagnosis was cryptorchidism. Testicular structure was not identified and a presumed testicular remnant in the left superficial inguinal ring was sent for histological examination. The histological examination revealed a fibrovascular nodule, spermatic cord structures, calcification and hemosiderin deposits supporting the diagnosis of TRS.ConclusionWhen patient fulfills clinical and pathological criteria for TRS, we should consider the possibility of orchiopexy and testicular prosthesis implantation to decrease the risk of testicular torsion and negative psychological effects.

The application of polypropylene mesh for testicular prosthesis in surgical castration for patients with prostate cancer

BackgroundTo explore whether a polypropylene mesh is suitable for application as a new material for testicular prostheses.MethodsThe data of 65 patients with advanced prostate cancer who underwent surgical castration in hospital were collected and analyzed. Patients who preferred to undergo traditional orchidectomy (n = 16) were assigned to the control group, and patients who underwent subcapsular orchiectomy plus implantation of a polypropylene mesh testicular prosthesis (n = 49) were assigned to the experimental group. The presence of hematoma, infection, and other complications in patients in these two groups were investigated at 3 and 12 months following the surgery. The patients were also followed up using a self-designed testicular castration satisfaction questionnaire.ResultsA higher score indicated greater satisfaction. The mean score was 15.33 ± 2.85 in the experimental group and 4.63 ± 1.45 in the control group at 3 months after the surgery. The mean score was 14.92 ± 1.74 in the experimental group and 4.25 ± 1.61 in the control group at 12 months after the surgery. The difference between the two groups was statistically significant at the two time points (P < 0.01).ConclusionsCompared with orchidectomy alone, patients were more satisfied with subcapsular orchiectomy plus the implantation of a polypropylene mesh testicular prosthesis for the treatment of advanced prostate cancer. Furthermore, the polypropylene mesh testicular prosthesis maintained its original character over the duration of the study, with a good long-term effect. Thus, implantation of a polypropylene mesh testicular prosthesis is indicated to be safe and effective, and polypropylene mesh is potentially useful as a new material for testicular prostheses.

Techniques and considerations of prosthetic surgery after phalloplasty in the transgender male.

For many transgender males, "lower" or "bottom" surgery (the construction of a phallus and scrotum) is the definitive step in their surgical journey for gender affirmation. The implantation of penile and testicular prostheses is often the final anatomic addition and serves to add both functionality and aesthetics to the reconstruction. However, with markedly distinctive anatomy from cis-gender men, the implantation of prostheses designed for cis-male genitalia poses a significant surgical challenge for the reconstructive urologist. The surgical techniques for these procedures remain in their infancy. Implantation of devices originally engineered for cis-men is an imperfect solution but not insurmountable if approached with ingenuity, patience, and persistence. Urologists and patients undergoing implantation should be aware of the high complication rates associated with these procedures as well as the current uncertainty of long-term outcomes. This review provides a comprehensive overview of the perioperative considerations, adaptive surgical techniques, and unique complications of penile and testicular prosthetic implantation in transgender men.

Medical and social rehabilitation following testicular prosthesis in post-orchiectomy patients

Aim. The aim of this study was to optimize indications and techniques and to develop the optimal timing for testicular prosthesis following inversion in adolescence considering the assessment of quality of life of patients at different times following the surgery. Materials and methods. We observed 70 patients with gonadal loss following critical ischemia (torsion) at ages 11-18 years (average, 15.5 ± 2.3 years). In total, 49 patients underwent joint replacement after orchiectomy due to torsion. In 21 patients, prosthetics were preceded by orchiectomy for testicular atrophy as a result of twisting. The interval from an acute episode to joint replacement ranged from 6 months to 15 years. Three techniques for testicular prosthesis implantation were applied: prosthetics with inguinal access without suturing the scrotal entrance (n = 14); prosthetics with inguinal access with suturing the scrotal entrance by the originally developed technique (n = 34); and a prosthetic scrotum (n = 22). Patient satisfaction was assessed based on the different outcomes of testicular inversion according to the originally developed questionnaire. Results. Suturing the scrotal entrance reduces the risk of implant migration in the proximal direction due to anatomical prerequisites. Scrotal access does not have this drawback but increases the risk of inflammatory complications. The esthetic result of prosthetics depends on patient’s age during orchiectomy. Older patients tend to have better cosmetic results. The most favorable results of prosthetics are noted at the time that has passed since the turn - no more than 3 years; all unsatisfactory results are noted at the time of more than 5 years since the twist. Testicular prosthesis increases social adaptation of patients after gonadal loss and improves their quality of life. Conclusions. 1. Testicular prosthesis is an essential stage of patient rehabilitation after an orchiectomy for inversion. 2. Prosthetic inguinal access by the originally developed technique is optimal from a technical perspective and provides the most physiological standing of the implant. 3. Prosthetics results directly depend on the period following the initial operation. 4. Testicular prosthesis complications can be minimized with the accumulation of knowledge and surgical experience and their rational prevention. 5. Assessment of patients’ quality of life illustrates the necessity of gonadal prosthetics for cosmetic compensation of organ loss and psycho-emotional and social rehabilitation. (For citation: Shormanov IS, Shchedrov DN. Medical and social rehabilitation following testicular prosthesis in post-orchiectomy patients. Urologicheskie vedomosti. 2018;8(2):43-52. doi: 10.17816/uroved8243-52).

The use of testicular prostheses in boys.

Lack of the testis is an important factor in psycho-sexual development of the boys, and implantation of the prosthesis plays a very essential role in the treatment of that group of patients. Currently there are no standards regarding when prosthesis should be implanted, and which access is connected with minimal rates of complications. We present our experience of primary prosthesis implantations in boys treated in our department.From 2000 to 2014, primary implantation of the testicular prosthesis was performed in 290 boys. The early and late post-operative complications and long-term therapeutic results were analyzed, considering age at the time of implantation, the time between the initial operation and implantation of the prosthesis, and the surgical approach.Best results were observed in 267 patients and bad outcome in 23 patients. Prosthesis implantation in young boys operated within the first three years of life or during the first year after primary surgery was connected with statistically fewer complications (P = .002 and P < .05, respectively). Supra-scrotal access was connected with the lowest rate of complications (P = .01).Long-term therapeutic results in boys with testicular prostheses were good in the majority of cases. Implantation of the first prosthesis should be performed early between 1 and 3 years of life in boys with lack of the testis. Implantation of a prosthesis should also be performed within 1 year after removing of testis or during orchiectomy. Supra-scrotal access should be chosen for testicular prosthesis implantation due to the best long-term results.

Patient Decision-making and Predictors of Genital Satisfaction Associated With Testicular Prostheses After Radical Orchiectomy: A Questionnaire-based Study of Men With Germ Cell Tumors of the Testicle

To better understand patient decision-making and genital satisfaction associated with postorchiectomy testicular prosthesis (TP) implantation in patients with germ cell tumors of the testicle. An electronic survey to assess TP decision-making and genital satisfaction was distributed to patients via an institutional database (n = 70) and social media outlets (n = 167). Statistical analyses were performed using chi-square tests for categorical variables, Wilcoxon-Mann-Whitney tests for continuous variables, and multivariate regression analyses to identify independent predictors of receiving a prosthesis, genital satisfaction, and prosthesis satisfaction. 24.9% of respondents elected to receive a TP, but 42% of men without a prosthesis reported never being offered one. Identifying as a heterosexual man (2.86) and receiving a TP (odds ratio = 3.29) were both positive predictors of overall genital satisfaction. Having the orchiectomy performed at an academic institution (odds ratio = 2.87) was a positive predictor of testicular prosthesis TP placement. 89.8% of TP recipients were satisfied with the look of their prosthetic, but only 59.3% of respondents were satisfied with prosthetic feel. There are high levels of genital satisfaction in those who elect to receive a TP postorchiectomy. Associations between TP placement, genital satisfaction, and sexuality merit further investigation. Our results also indicate that patients who pursue an orchiectomy at an academic institution are more likely to receive a TP. The use of social media to recruit study participants in urology should be explored further.

Gender Identity and Sexual Function in 46,XX Patients with Congenital Adrenal Hyperplasia Raised as Males.

In individuals with congenital adrenal hyperplasia (CAH) and 46,XX karyotype, androgens produced by the adrenal glands during the intrauterine development promote virilization of the genitals, which may even result in the development of a well-formed penis. Some of these children with late diagnosis are registered as males after birth. After obtaining approval from the internal review board, we evaluated gender identity and sexual function in four 46,XX severely virilized patients with CAH, who were originally registered and raised as males, assisted in our Disorders of Sexual Development Clinic. The evaluation consisted of questionnaires to assess gender identity and sexual activity and interview with the multidisciplinary team that provides care for these patients. The patients underwent surgery to remove uterus, ovaries, and remaining vaginal structures, in addition to implantation of testicular prosthesis and correction of hypospadias, when necessary. All four patients have developed a clear male gender identity, and when evaluated for sexual activity, they have reported having erections, libido, orgasms, and sexual attraction to women only. Two of these 4 patients had satisfactory sexual intercourses when assessed using the International Index of Erectile Function questionnaire. The other two patients who never had sexual intercourse reported not having a partner for sexual activity; one is 18years old, and the other is 14years old. This study showed that this group of 46,XX severely virilized patients with CAH, registered and raised as males, adapted well to the assigned male gender, with satisfactory sexual function in patients who had sexual intercourse.

One-Stage Gender-Confirmation Surgery as a Viable Surgical Procedure for Female-to-Male Transsexuals

BackgroundFemale-to-male gender-confirmation surgery (GCS) includes removal of breasts and female genitalia and complete genital and urethral reconstruction. With a multidisciplinary approach, these procedures can be performed in one stage, avoiding multistage operations. AimTo present our results of one-stage sex-reassignment surgery in female-to-male transsexuals and to emphasize the advantages of single-stage over multistage surgery. MethodsDuring a period of 9 years (2007–2016), 473 patients (mean age = 31.5 years) underwent metoidioplasty. Of these, 137 (29%) underwent simultaneous hysterectomy, and 79 (16.7%) underwent one-stage GCS consisting of chest masculinization, total transvaginal hysterectomy with bilateral adnexectomy, vaginectomy, metoidioplasty, urethral lengthening, scrotoplasty, and implantation of bilateral testicular prostheses. All surgeries were performed simultaneously by teams of experienced gynecologic and gender surgeons. OutcomesPrimary outcome measurements were surgical time, length of hospital stay, and complication and reoperation rates compared with other published data and in relation to the number of stages needed to complete GCS. ResultsMean follow-up was 44 months (range = 10–92). Mean surgery time was 270 minutes (range = 215–325). Postoperative hospital stay was 3 to 6 days (mean = 4). Complications occurred in 20 patients (25.3%). Six patients (7.6%) had complications related to mastectomy, and one patient underwent revision surgery because of a breast hematoma. Two patients underwent conversion of transvaginal hysterectomy to an abdominal approach, and subcutaneous perineal cyst, as a consequence of colpocleisis, occurred in nine patients. There were eight complications (10%) from urethroplasty, including four fistulas, three strictures, and one diverticulum. Testicular implant rejection occurred in two patients and testicular implant displacement occurred in one patient. Clinical ImplicationsFemale-to-male transsexuals can undergo complete GCS, including mastectomy, hysterectomy, oophorectomy, vaginectomy, and metoidioplasty with urethral reconstruction as a one-stage procedure without increased surgical risks and complication rates. Strengths and LimitationsTo our knowledge, this is the largest cohort on this topic so far, with good surgical outcomes. Limitations include lack of selection or exclusion criteria and lack of other studies with a simple approach. For this reason, the technique should be studied further and compared with other techniques for female-to-male surgery before it can be recommended as an alternative procedure. ConclusionsThrough a multidisciplinary approach of experienced teams, one-stage GCS presents a safe, viable, and time- and cost-saving procedure. Complication rates do not differ from reported rates in multistage surgeries.Stojanovic B, Bizic M, Bencic M, et al. One-Stage Gender-Confirmation Surgery as a Viable Surgical Procedure for Female-to-Male Transsexuals. J Sex Med 2017;14:741–746.

PD63-10 ONE-STAGE GENDER CONFIRMATION SURGERY (METOIDIOPLASTY) FOR FEMALE-TO-MALE TRANSSEXUALS

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) II1 Apr 2017PD63-10 ONE-STAGE GENDER CONFIRMATION SURGERY (METOIDIOPLASTY) FOR FEMALE-TO-MALE TRANSSEXUALS Marta Bizic, Borko Stojanovic, Vladimir Kojovic, and Miroslav Djordjevic Marta BizicMarta Bizic More articles by this author , Borko StojanovicBorko Stojanovic More articles by this author , Vladimir KojovicVladimir Kojovic More articles by this author , and Miroslav DjordjevicMiroslav Djordjevic More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2934AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Female-to-male gender confirmation surgery (GCS) includes removal of breasts and female genitalia, as well as complete genital and urethral reconstruction. With multidisciplinary approach, all these procedures can be performed in one stage, enabling avoidance of multi-staged surgeries. Our aim was to present our experience in one-stage sex reassignment surgery in female-to-male transsexuals. METHODS During the period of 8 years (2008-2016), totally 485 patients (mean age 29.5 years) underwent metoidioplasty. Out of them, 140 (29%) had also a hysterectomy performed, and 79 (16.3%) underwent one-stage GCS comprising of bilateral mastectomy, total transvaginal hysterectomy with bilateral adnexectomy, vaginectomy, metoidioplasty, urethral lengthening, scrotoplasty and implantation of bilateral testicular prostheses. All surgeries were performed by gynecology and gender surgeons team, simultaneously. RESULTS The mean follow-up was 44 months (ranged from 14 to 92). Mean surgery time was 260 minutes (range 215-325). Postoperative hospital stay was 3-6 days (mean 4 days). Complications occurred in 22 patients (27.8%) in total. There were 8 cases (10%) with complications related to mastectomy: one patient had revision surgery because of the breast hematoma, 3 patients experienced partial nipple graft necrosis and 4 patients developed hypertrophied scars. Two patients underwent conversion of transvaginal hysterectomy to abdominal approach. One patient received blood transfusion due to excessive bleeding caused by the newly discovered Von Willebrand disease. There were 8 complications (10%) related to urethroplasty, including 4 fistulas, 3 strictures and 1 diverticulum. Two patients had testicular implant rejection, while one patient had testicular implant displacement. In the group of patients who experienced urethral complications, 5 patients required minor revision surgery along with the ones having complications with testicular implants. CONCLUSIONS Through multidisciplinary approach of experienced teams, one-stage gender confirmation surgery presents a viable, time and cost saving procedure. Complication rates do not differ from reported rates in multi-staged surgeries. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1258 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Marta Bizic More articles by this author Borko Stojanovic More articles by this author Vladimir Kojovic More articles by this author Miroslav Djordjevic More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Testicular prosthesis: Patient satisfaction and sexual dysfunctions in testis cancer survivors

We studied patient satisfaction about sexual activity after prosthesis implantation using validated questionnaires with the aim to discover if testicular prosthesis could be responsible of sexual dysfunctions (erectile dysfunction or premature ejaculation). We evaluated a total of 67 men who underwent radical orchiectomy for testicular cancer and a silicon testicular prosthesis implantation from January 2008 to June 2014 at our Hospital. These patients completed 5 validated questionnaires the day before orchiectomy and 6 months after surgery: the International Index of Erectile Function 5 (IIEF5), the Premature Ejaculation Diagnostic Tool (PEDT), the Body Exposure during Sexual Activities Questionnaire (BESAQ), the Body-Esteem Scale and the Rosenberg Self- Esteem Scale. We also evaluated 6 months after surgery any defects of the prosthesis complained by the patients. The questionnaires completed by patients didn't show statistically significant changes for erectile dysfunction (p &gt; 0.05) and premature ejaculation (p &gt; 0.05). On the contrary the psychological questionnaires showed statistically significant change for the BESAQ (p &lt; 0.001) and the Body Esteem Scale (p &lt; 0.001), but not for the Rosenberg Self-Esteem Scale (p &gt; 0,05). A total of 15 patients (22.37%) were dissatisfied about the prosthesis: the most frequent complaint (8 patients; 11.94%) was that the prosthesis was firmer than the normal testis. Testicular prosthesis implantation is a safe surgical procedure that should be always proposed before orchiectomy for cancer of the testis. The defects complained by patients with testicular prosthesis are few, they don't influence sexual activity and they aren't able to cause erectile dysfunction or premature ejaculation.

Long-Term Follow-Up after Treatment of Cryptorchidism.

When considering long-term prognosis and results in adult age following treatment of cryptorchidism in childhood there are three main issues to be discussed: cosmetics, fertility, and malignancy. In the present review, the most recent research on the topics related to summaries of well-known knowledge on the field is presented.To some extent a smaller testis in a higher scrotal position than normal must be accepted as a fair cosmetic result after orchidopexy in childhood. The smaller testis size is related to the impaired fertility potential of the testis. In cases with atrophy, testicular prosthesis implantation is an option with good operative results. The risk of impaired fertility potential in adults treated in childhood for cryptorchidism is still significant and worst in bilateral disease. We need repetitive solid long-term follow-up data to show that orchidopexy performed within first year of life has markedly improved the fertility potential. Men previously having orchidopexy for cryptorchidism related to intra-abdominal testes, abnormal external genitalia and/or abnormal karyotype, and/or hypospadias are of special increased risk of developing testicular cancer. In these cases intratubular germ cell neoplasia may be diagnosed in prepubertal age. Early orchidopexy may lower the risk of developing testicular cancer.

Testicular prostheses in children: Is earlier better?

The absence of a testis occurs for various reasons in children, but testicular prosthesis implantation in children is uncommon. The optimal time for prosthesis placement is still unclear, and its complication rate has been poorly studied in children. The aim of this study was to determine the risk factors of complications in cases of testicular prosthesis implantation in children. A monocentric, retrospective review was performed of children implanted with a testicular prosthesis between 2008 and 2014. All implantations were performed through an inguinal incision with a standardized procedure. Children were divided into two groups depending on the interval after orchiectomy: (A) early implantation (delay between surgeries <1 year); and (B) delayed surgeries (delay ≥1 year). Statistical analysis was performed with Student and Fisher tests. Twenty-six patients (A, 15; B, 11) had a total of 38 testicular prostheses placements. Mean follow-up was 36.2 months. First surgery was performed at the mean age of 11.8 years (range 0-17.9) (A, 14.1; B, 8.1; P=0.01) and testicular prosthesis implantation at the mean age of 14.7 years (range 9-18) (A, 14.3; B, 14.6) with a mean delay of 36.1 months (A, 1.3; B, 80.3). Indications were mainly spermatic cord torsion (27%), bilateral anorchia (27%), and testicular atrophy after cryptorchidism surgery (19.2%). Complications (10.5%) included two cases of extrusion, one infection and one migration. Patient 1 had a history of acute lymphoblastic leukemia with testicle relapse 2 years after induction therapy. High-dose chemotherapy, total body irradiation and bilateral orchiectomies were performed, and bilateral prostheses were implanted 12 years after the end of chemotherapy. Complications happened 85 days after surgery. Patient 2 was followed-up for a proximal hypospadias. The tunica vaginalis flap, which was used during a redo urethroplasty, lead to testicular atrophy. Thirteen years after the last penile surgery, a testicular prosthesis was placed through an inguinal incision, and extrusion occurred 203 days after surgery. Bacterial cultures of the prostheses were sterile and histological review showed no sign of granuloma or graft rejection. The complication rate was significantly higher if the delay between the two surgeries exceeded 1 year (P=0.01). Indications of orchiectomy, prior scrotal incision, and prosthesis size were not risk factors. Testicular prosthesis implantation was relatively safe in a pediatric cohort. The complication rate was significantly higher if the delay between the orchiectomy and the prosthetic placement exceeded 1 year. These results suggest that reducing the delay between orchiectomy and prosthesis implantation may lead to fewer complications.