Insertion of a testicular prosthesis at the time of radical orchiectomy for testicular cancer is safe in patients who will subsequently undergo chemotherapy or radiotherapy

Musi, Gennaro; Cozzi, Guido; Mistretta, Francesco A.; Tringali, V.; Serino, Alessandro; Jereczek‐Fossa, Barbara Alicja; Verri, Elena; Ferro, Matteo; Catellani, Michele; Cobelli, Ottavio De

doi:10.1111/and.13613

Cited by 4 publications

(2 citation statements)

References 22 publications

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“…It has been previously demonstrated that concurrent insertion of testicular prosthesis during radical orchiectomy is safe, and this extra procedure does not increase the complication rate as determined by length of stay (p = 0.387), hospital readmission rates (p = 0.539), or reoperation (p = 0.999) compared to radical orchiectomy alone [ 15 ]. Another study demonstrated that concurrent implantation is safe even in the setting of adjuvant therapy, with no difference in complication rates between patients who did not undergo adjuvant treatment versus those who underwent chemotherapy (p = 0.75) or radiation (p = 0.83) [ 16 ]. Ours is the first study to directly compare the cost and clinical outcomes between a concurrent versus staged approach.…”

Section: Discussionmentioning

confidence: 99%

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

Nguyen,

Walia,

Horns

et al. 2024

PLoS ONE

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Purpose 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. Materials & methods 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. Results 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). Conclusions CI placement has less total perioperative cost, lower explant rate, and similar postoperative utilization to SI.

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Section: Discussionmentioning

confidence: 99%

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

Nguyen,

Walia,

Horns

et al. 2024

PLoS ONE

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“…В исследованиях последних лет продемонстрировано, что частота осложнений у данной категории пациентов не превышает таковую в иных группах пациентов [10]. G. Musi (2020) По данным S. Marshall, наиболее частым осложнением является экструзия импланта -3-8 %; среди других осложнений отмечены высокое стояние импланта -3-5 %, болевой синдром -1-3 %, гематомы -0,3-3 %, инфекционные осложнения -0,6-2 % [12]. Сходные данные о частоте экструзии сообщают и другие авторыдо 5,2 % [13].…”

Section: Introductionunclassified

Complications of testicular prosthetics: analysis of causes, surgical tactics, ways of prevention

Shormanov,

Shchedrov,

Spasskaya

et al. 2023

Androl. genit. hir.

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Background. Testicular prosthetics, despite the apparent simplicity of the technique of performing the operation, often leads to complications. At the same time, the spread of data from different authors on the frequency and structure of complications is extremely large. At the same time, the factors indicated by the authors as the causes of complications often contradict each other, and, as a rule, are not analyzed, therefore, methods of prevention and therapeutic tactics are not clearly defined today.Aim. To analyze the frequency and structure of complications during testicular prosthetics in patients over 18 years of age and adolescent children, as well as to suggest optimal ways to prevent the identified complications.Materials and methods. The results of testicular prosthetics were analyzed in 292 patients aged 12–59 years in the period 2007–2022. Various complications were found in 27 patients (9.24 %), including in the adolescent group (12–17 years) – in 13 (8.33 %) patients out of 156, in adults – in 14 (10.29 %) out of 136. MIT implants were used in 116 cases (adults – 54, adolescents – 62) and Promedon implants – in 176 cases (adults – 80, adolescents – 96). Data processing was carried out in the Statistica 20.0 program. The p <0.05 level was considered statistically significant.Results. The most common complications include implant extrusion (22.2 %) and surgical hemostasis disorders (29.6 %), they are also the most difficult to correct and often lead to the need to remove the implant. The use of antibacterial therapy by the course does not reduce the risk of complications, the absence of antibiotic prophylaxis increases the incidence of complications by 3.9 % in the adult group and by 2.28 % in the adolescent group. The most rational single perioperative antibiotic prophylaxis. The frequency of complications when using MIT implants is higher (n = 17) than Promedon (n = 10). The incidence of complications is significantly higher in the group of patients who underwent prosthetics for more than three years after primary orchectomy or in an initially hypoplasized scrotum.Conclusion. Complications of testicular prosthetics are 8.33–10.29 %. The structure is dominated by complications of hemostasis and implant extrusion, they are also the cause of the greatest number of repeated interventions and the reason for the removal of the implant. A number of factors influence the formation of complications – access, the scheme of antibacterial therapy/prevention, the implantable material, the period after the initial operation. The most rational is the use of a modern silicone implant for prosthetics 6–12 months after orchectomy with suprascrotal access with a single perioperative antibiotic prophylaxis. The risk of the most dangerous and frequent complications can be leveled by using preventive measures.

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Current attitudes to testicular prosthesis insertion during radical orchidectomy—An international perspective

Emmanuel,

Kanthabalan,

Alexander

et al. 2024

BJUI Compass

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ObjectivesThis study aimed to assess current international clinician practices, attitudes and barriers related to testicular prosthesis implantation in patients with testicular cancer at the time of radical inguinal orchidectomy.MethodsAn international online survey of urologists who perform radical orchidectomy for testicular cancer was developed. The recruitment process used social media and the emailing lists of national urological societies. Responses were collected between 10 February 2021 and 31 May 2021. The primary outcome was the proportion of urologists who always offered testicular prosthesis implantation to patients undergoing radical orchidectomy. Secondary outcomes included the reasons for not offering testicular prosthesis implantation.ResultsA total of 393 respondents took part in the online survey; of these, the majority were from the UK (66%), with the remaining international respondents (34%) from six different continents. Urologists (53%) reported they always offer testicular prosthesis implantation. Of those that offered testicular prosthesis implantation, 28% did so as a secondary procedure after radical orchidectomy, rather than the time of radical orchidectomy (72%). The most frequently selected reasons for not offering testicular prosthesis implantation included concerns about delaying chemotherapy (41%), infection (33%), impaired cosmesis (17%) and lack of availability (17%).ConclusionDespite evidence confirming the safety and the psychological benefit of testicular prosthesis implantation during radical orchidectomy, current international practice suggests just over half of urologists always offer this to their patients. Increased clinician awareness of the low risk of complications and high patient satisfaction may act to reduce the perceived barriers in offering testicular prosthesis implantation.

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Insertion of a testicular prosthesis at the time of radical orchiectomy for testicular cancer is safe in patients who will subsequently undergo chemotherapy or radiotherapy

Cited by 4 publications

References 22 publications

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

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

Complications of testicular prosthetics: analysis of causes, surgical tactics, ways of prevention

Current attitudes to testicular prosthesis insertion during radical orchidectomy—An international perspective

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