Your surgeon will always discuss with you and recommend the treatment that is appropriate for you. During the consultation, the surgeon will also explain the treatment, its results and benefits, the duration of the result and the frequency of repeating the treatment.
3 to 10 Days
Testis implant are important not only for cosmetic reasons but can also improve a man’s quality of life. Men who have torsion or twisting of a testis, testis cancer or a traumatic injury, may all require removal of the affected testicle. A testis prosthesis can restore the look and well being of men affected by these conditions. Testicular implants may also be an appropriate choice for children born with undescended testicles or torsion. For most undescended testicles, attempts are made find and lower it into the scrotum, but occasionally this is not possible and the undescended testicle is removed to prevent the later development of testis cancer. Finally, men who have small, non-functioning testes may also be candidates for an implant. Importantly, an implant should not be placed in the setting of infection or untreated cancer. The alternative treatment to placement of a testis implant is not place it and receive no treatment. Please remember that a testis implant in no way functions like a natural testicle as it does not make sperm or male hormone.
The Testis Prothesis Procedure
Testis prostheses are placed in a small surgical procedure that takes 30-60 minutes under sedation and is performed as day case procedure. Patients receive intravenous antibiotics and a thorough skin preparation before the procedure. A small incision can be made either in the scrotum or in the groin to be place the device. Dr. Viel prefers a muscle sparing upper scrotal incision that allows for an entry site that is distant from the final resting position of the prosthesis. After the incision, a scrotal pouch is created and a suture can be used to fix the prosthesis (Through the suture tab) in a dependent position in the scrotum. The prosthetic is bather in a antibiotic solution, placed in the scrotum and examined for overall suitability and for good position. The incision is closed in multiple, non-overlapping layers after antibiotic irrigation. Patients are then discharged with several days of oral antibiotics and followed up carefully over the next 3 months.
Like any other medical implant, testis implants should not be considered lifetime devices. There is a small risk that the body may try to reject or extrude the device or that the device could leak or rupture, all of which will require that the implant be removed. In addition, the long-term rate of deflation within the device is still unclear. Furthermore, about 1 in 40 patients will need another surgical procedure within the first year to either remove or adjust the implant. In children, a smaller implant will likely need to be replaced by a larger implant as the child grows. Finally, the body’s natural reaction to any device within it is to form scar tissue around it.
This is called a capsule and, although rare, it can occur with testis implants too. In some men, this may cause a hardening of the implant, leading to discomfort, pain or decreased satisfaction.
Testis Prosthesis Patient Instructions
The following is an outline of the what to expect and do before and after the procedure:
The Consultation Visit
This visit is visit is important for your to meet and feel comfortable with Dr. Viel, to figure out whether you are a good candidate for testis prosthesis, and to discuss the benefits and risks of having such a procedure. At this visit:
Dr. Viel will ask you questions about the kinds of symptoms you are having and also ask questions about your medical history.
Dr. Viel will perform a limited and very brief physical examination on you to assess your anatomy and to determine your candidacy for the procedure. Issues he will consider are the scrotal anatomy, the size of the opposite testis and optimal placement of an incision.
Dr. Viel will then discuss the options for testis prosthesis placement, including benefits and risks, so that you have a good idea of what the procedure involves, the recovery afterward, when you can resume your normal activities.
Eat normally the night before surgery, but follow the directions that anesthesia recommends for the morning of surgery. If no specific directions are given, withhold all food and drink after midnight and on the morning of surgery.
Do not take any aspirin, or any ibuprofen containing medications (Advil, Motrin, Aleve) at least 10 days prior to the procedure, as these medications have a side effect that can reducing platelet function and therefore lower blood clotting ability.
Someone will need to drive you home or to your hotel after the procedure, following your recovery from the procedure. Buy some frozen peas or mixed vegetable bags from the grocery to use as cold “sandbag” to the area after the procedure.
Regarding diet, start with clear liquids or something light and then progress to your normal diet.
You should rest for the first 24 hours following the procedure to lessen the chance of swelling. Avoid strenuous exercise (including sex) or heavy lifting for 7 days. After that, you can do all of your normal activities, but at the start, let discomfort be your guide: if it feels uncomfortable, slow down.
Apply ice packs (frozen peas or mixed vegetables work well) to the groin area over the covered area for 24 hours to help with swelling. If your job involves deskwork or very light activity, you may return to work 2 or 3 days after surgery. Remember that it is likely that your will have some discomfort for the first few days after surgery when deciding when to go back to work.
Shower daily, but do not soak in a bath for at least 5 days. The sutures are buried under the skin and are self-absorbing and do not need to be removed.
Take your prescribed pain medicine, usually Vicodin, for moderate discomfort. Always take the Vicodin with food in your stomach, so that you do not get nauseated. You can take Tylenol or Ibuprofen for mild discomfort. When taking pain medication, be careful as you walk or climb stairs, as your judgement can be impaired. Dizziness is also not unusual.
Do not make important decisions until the next day as some anesthetics have a delayed metabolism and can interfere with the ability to perform these tasks.
- Avoid alcoholic beverages for 24 hours.
- Do not drive or operate heavy machinery for 48 hours.
- Do not eat heavy or large meals until the next day, as a heavy meal may be difficult to digest. Spicy and greasy foods should be avoided.
Problems to Report
Problems you should report to the doctor if they occur :
- Fever > 101° F, shaking and chills.
- Nausea and vomiting.
- Expect a small amount of bloody discharge from the incision, However, call us if it continues and the incision site becomes red, painful or separates.
- Drug reactions such as hives, rash, nausea or vomiting.
- You may get black and blue around the incision site and also in scrotum and on the penis. If the amount of swelling concerns you, please call the office.