Testicular prostheses: a new technique for insertion

Abstract

catheter balloon volume of 18 mL, medium to 24 mL and large to 30 mL.An Allis tissue holding forceps is placed on the scrotal skin at its most dependant position, shown by the catheter tip. The catheter balloon is deflated and removed from the scrotum. The Allis tissue forceps is then pushed in a cranial direction into the inguinal wound to invert the scrotal skin. The prosthesis is secured via its tab to the base of the scrotum using a 3/0 polypropylene suture at the site marked by the Allis. The Allis is removed from the scrotal skin and the prosthesis placed in the scrotum. COMPARISON WITH OTHER METHODSThe use of both a vaginal speculum [2] and a Hegar dilator [3] have been described to ensure a good cosmetic result from inserting a testicular prosthesis. Our technique has advantages over these; the use of a catheter balloon in the scrotal space prevents overstretching of the scrotal neck, hence reducing the risk of the prosthesis moving upwards during changes in temperature. The prosthesis is placed in the most dependant part of the scrotum and measuring the volume of fluid in the balloon allows an objective estimate of testicular volume to ensure correct sizing of the prosthesis. As a catheter balloon is closer in shape to a prosthesis this gives a better result than that achieved by the use of either a Hegar dilator or a vaginal speculum. ADVANTAGES AND DISADVANTAGESThis technique may be particularly useful in patients who have an empty scrotum before surgery, e.g. those with an undescended testis or who have had a previous orchidectomy, in whom the catheter balloon acts as a type of tissue expander. The cost of a Foley catheter in this technique is minimal. By ensuring that the prosthesis is correctly sized and placed, a greater proportion of men should be satisfied with the final result. We have used this technique in seven patients, and have found it to be reliable and reproducible, with good cosmetic results. , 27% of responders who had a prosthesis inserted were unhappy with its position and 37% were unhappy with its size. Also of interest in that study was that a third of men had not been offered a prosthesis. We describe a technique which prevents the 'high-riding' testicular prosthesis and ensures that it complements its neighbour in size. REFERENCES

Balloon distension of scrotum: a step to facilitate creation of dartos pouch during orchiopexy

“…Foley catheter balloon has been used earlier to break adhesions inside the scrotum before placement of testicular prosthesis following orchidectomy but dartos pouch is not created during this procedure [5]. Our modification can help in the creation of a large dartos pouch that would facilitate the placement of a testicular prosthesis with ease in such patients.…”

Simple placement of prosthetic testes in children

“…Various complications associated with insertion of testicular prostheses include infection, haematoma, failure of adequate scrotal distension with secondary displacement of the prostheses in a higher position, wound dehiscence with spontaneous extrusion of the prosthesis, transient or persistent scrotal contraction, rupture of the silicon envelope and persistent pain [5,6]. In an attempt to achieve good cosmetic results various techniques like use of a vaginal speculum [7], an invagination technique using two Hegar's dilators [8] and the use of a Foley catheter [9] have been described. All these techniques involves fixation of the prostheses to the base of the scrotum.…”

Balloon inflation-created subdartos pouch during orchiopexy: a new simplified technique

“…Most surgeons use blunt-tipped hemostatic forceps for the creation of this pouch but difficulty may be encountered due to unsteady scrotal layers [1]. In 2004, Simms et al [6] have inserted the deflated balloon of Foley catheter inside the scrotum through the inguinal incision then inflated balloon to break adhesions inside the scrotum before placement of testicular prosthesis following orchidectomy but dartos pouch was not created during this procedure.…”