Cosmetic Orchiectomy Using Pedicled Fibro-Fatty Tissue Graft for Prostate Cancer:A New Approach

Kihara, Kazunori; Oshima, Hiroyuki

doi:10.1159/000019715

Cited by 7 publications

(3 citation statements)

References 20 publications

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“…Various surgical modifications like subcapsular orchiectomy, subcapsular orchiectomy with eversion of the tunica albuginea about the epididymis, implantation of testicular prostheses, subepididymal orchiectomy, and orchiectomy in combination with a fibrofatty graft to the tunica vaginalis have been designed to preserve the appearance of testes [7][8][9]. These modifications have not gained acceptance because of scepticism of leaving behind testosterone secreting tissue.…”

Section: Discussionmentioning

confidence: 99%

Prospective Randomised Controlled Trial Comparing Sub-Epididymal Orchiectomy Versus Conventional Orchiectomy in Metastatic Carcinoma of Prostate

Bapat¹,

Mahajan²,

Bhave³

et al. 2011

Indian J Surg

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Androgen blockade (surgical or medical castration) is a standard procedure for patients with metastatic carcinoma prostate. Sub-epididymal orchiectomy involves removal of testis leaving behind epididymis. This epididymal stump over a period gives a pseudo testicular feel within the scrotum. We present a prospective randomized study to assess the functional utility of this procedure and compare it with total orchiectomy in terms of achieving castrate levels. From July 2005-Jan 2008, 60 patients with metastatic carcinoma prostate were alternately randomised and allotted to two groups, 30 underwent sub-epididymal orchiectomy (group A) and remaining 30 (group B) underwent total orchiectomy. Age: 56-80 years. Serum PSA: 55-268 ng/ml. Preoperative serum testosterone: Group A-300-650 ng/ml and group B-320-640 ng/ml. Postoperative serum testosterone: group A-2-18 ng\ml and group B-7-15 ng\ml on day 7 after surgery. Operating time-26-40 mins for group A and 20-34 mins for group B. Follow up-6 weeks and 3 months. At 3 months patients were asked to grade appearance of scrotum for asthetic value on a scale of 1-100 using visual analogue score. Postoperative serum testosterone reached castrate levels in seven days (both groups). Duration of surgery in both groups was comparable. Complications-wound infection in 1 patient (group A) & 1 scrotal hematoma (group B). Satisfaction score for group A (83.5 ± 9.7) was significantly (p < 0.05) better (95%CI-18.58-28.42), compared to that of group B (60 ± 9.4) by using't' test. Sub epididymal orchiectomy is comparable to total orchiectomy in terms of achieving castrate levels with similar operating time. It has significant advantage in terms of mental satisfaction to patients. It is a simple and safe procedure that can be conveniently performed in an outpatient clinic setting using pure local anaesthesia.

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Section: Discussionmentioning

confidence: 99%

Prospective Randomised Controlled Trial Comparing Sub-Epididymal Orchiectomy Versus Conventional Orchiectomy in Metastatic Carcinoma of Prostate

Bapat¹,

Mahajan²,

Bhave³

et al. 2011

Indian J Surg

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“…Among the other modifications used are intracapsular fibrofatty tissue grafts, polytetrafluoroethylene paste or testicular prosthesis to simulate the appearance of normal testis [15][16][17]. For the most part, these modifications are cumbersome and have not gained sufficient popularity and acceptance in the urological community.…”

Section: Discussionmentioning

confidence: 99%

Can Subepididymal Orchiectomy Re-emerge as the Treatment of Choice in Patients with Advanced Prostatic Carcinoma?

Agarwal

Agrawal

2012

Indian J Surg

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To study the effectiveness of bilateral subepididymal orchiectomy compared to bilateral simple and subcapsular orchiectomy in terms of androgen ablation, control of disease progression and esthetic superiority. 114 patients of advanced prostatic carcinoma (T3, T4, M1) were randomized to 3 groups-Group A: bilateral simple orchiectomy (38 patients), Group B: bilateral subcapsular orchiectomy (38 patients), & Group C: bilateral subepididymal orchiectomy (38 patients). Serum PSA and serum testosterone values were checked pre-operatively and at 3 months follow-up. Patients' esthetic satisfaction was scored on a quality of life scale of 1-5. In Groups A, B and C, at 3 months the post-operative mean serum testosterone values were 34.7, 38.1 and 36.7 ng/ dl (p00.0524); and mean serum PSA values were 4.2, 3.9 and 3.4 ng/ml (p00.09) respectively, the differences not being statistically significant. On esthetic satisfaction scale the average scores were 1.8, 2.7 and 4.0 respectively, the difference being highly significant (p<0.0001). Subepididymal orchiectomy maintains esthetic appearance of scrotum and provides superior patient satisfaction as compared to standard total and subcapsular orchiectomy, while achieving equal efficacy. Bilateral sub-epididymal orchiectomy may thus be considered procedure of choice to achieve androgen ablation in advanced prostatic carcinoma.

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“…Various surgical procedures have been designed to preserve palpable testes. These have included subcapsular orchiectomy, subcapsular orchiectomy with eversion of the tunica albuginea about the epididymis, implantation of testicular prostheses, subepididymal orchiectomy, and orchiectomy in combination with a fibrofatty graft to the tunica vaginalis (Glenn, 1990; Kihara and Oshima, 1998). These options have not gained general acceptance because of skepticism that they achieve castrate levels of testosterone and/or preserve significant testicular size.…”

mentioning

confidence: 99%

Autologous Tunica Vaginalis and Subcapsular Orchiectomy: A Hormonal Therapy for Prostate Cancer

Vickers¹,

Lamontagne

Guru

et al. 2004

Journal of Andrology

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Two novel surgical procedures that combine an autologous tunica vaginalis pedicle graft (TVG) with a subcapsular orchiectomy (SCOT) were evaluated in asymptomatic patients with rising prostate-specific antigen (PSA) values following radiation therapy, a radical retropubic prostatectomy, or a newly diagnosed prostatic cancer with bony metastasis. In the SCOT I procedure, the TVG was secured to the inner wall of the tunica albuginea. In the SCOT II procedure, the TVG was folded and secured to the external wall of the tunica albuginea. Between December 1, 1999, and July 1, 2000, 26 patients were offered hormonal therapy. Twelve patients selected the SCOT I procedure, 12 selected a luteinizing hormone-releasing hormone (LHRH) agonist, and 2 selected a bilateral total orchiectomy (BTO). Because the cosmetic outcome of the SCOT I procedure was less than ideal, this procedure was modified in December 2001. Between December 1, 2001, and July 1, 2002, 28 hormonal candidates were evaluated. Twelve patients selected the SCOT II procedure, 11 selected an LHRH agonist, and 5 selected a BTO. Preoperative measurements of the testicular area and PSA were obtained. During postoperative visits, the total testosterone, PSA, and testicular area were determined, and the Fugl-Meyer questionnaire (FMQ) and SCOT-specific questionnaire (SSQ) were completed. Between March 1, 2000, and December 1, 2002, 10 patients underwent a BTO. This group was the control for the postoperative SCOT total testosterone values. Sixty-three percent of the mean preoperative testicular area was preserved in the SCOT II group vs 43% in the SCOT I group at the 9- to 12-month visit (P <.01). The mean postoperative total testosterone values for the SCOT I, SCOT II, and BTO groups were in the castrate range. No statistically significant difference was noted between the preoperative and postoperative FMQ scores among the SCOT I and SCOT II groups. Eighty-three percent of the SCOT II patients experienced no change in masculine identity, and 58% noted no change in testicular size. One hundred percent of the SCOT I patients experienced no change in masculine identity and noted no change in testicular size. The SCOT II procedure preserved a greater testicular area than the SCOT I. Both SCOT procedures achieved castrate levels of total testosterone and maintained masculine identity in 83%-100% of patients.

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Cosmetic Orchiectomy Using Pedicled Fibro-Fatty Tissue Graft for Prostate Cancer:A New Approach

Cited by 7 publications

References 20 publications

Prospective Randomised Controlled Trial Comparing Sub-Epididymal Orchiectomy Versus Conventional Orchiectomy in Metastatic Carcinoma of Prostate

Prospective Randomised Controlled Trial Comparing Sub-Epididymal Orchiectomy Versus Conventional Orchiectomy in Metastatic Carcinoma of Prostate

Can Subepididymal Orchiectomy Re-emerge as the Treatment of Choice in Patients with Advanced Prostatic Carcinoma?

Autologous Tunica Vaginalis and Subcapsular Orchiectomy: A Hormonal Therapy for Prostate Cancer

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