Testicular prosthesis is fitted to patients who have lost their testicles for various reasons or who do not have congenital testicles. The procedure is done in the operating room. It is a simple operation with very successful results and a high level of patient satisfaction.

Prostheses can stay in the body for a long time without any problems. In this article, I will give general information about testicular prosthesis.

What is a testicular prosthesis?

The testicular prosthesis is an artificial prosthesis in the form of a testicle made of silicone and placed in the scrotum (the bag in which the testicles are located) instead of the testicular that is removed for any reason such as testicular cancer or trauma or that is not congenital. Testicular prosthesis is only for cosmetic and psychological relief of the patient, it does not have any function.

It has been used since 1940. Today, these prostheses are more advanced and are made of silicone. There are different sizes of prostheses in the form of testicles. During the operation, we attach the appropriate size prosthesis to the patient.

Who gets the testicular prosthesis?

Testicular prosthesis is attached to people who have lost or had to have their testicles removed due to various reasons. Conditions that can cause testicular loss include:

• Testicular removal due to testicular cancer (radical orchiectomy)
• Non-congenital testicles
• Causes taken for reasons such as trauma or torsion
• Testes that do not descend into the scrotum congenitally
• Testes removed due to infection
• Male-female sex reassignment surgeries

How should an ideal prosthesis be?

Prostheses placed in the human body are medical products made of special materials. Testicular prostheses are structures designed in accordance with the shape of the testis. These are usually made of silicone. These prostheses should have some features. We can list them as follows:

• No chemical reactivity
• Should not cause inflammation in the body
• Must be resistant to mechanical stresses
• Must be sterile
• Must be able to take the correct shape and maintain this shape
• The person wearing the prosthesis should be comfortable

How does the testicular prosthesis look?

Testicular prostheses are special prostheses made of silicone in the form of testicles. They resemble testicles in appearance. It has different sizes. It is surgically placed in the scrotum by choosing the appropriate size for the patient. If the patient is to be fitted with a single-sided prosthesis, there should be no size difference. In order to avoid size difference in unilateral patients, it is necessary to choose the prosthesis that is suitable for the size of the existing testis.

Can the T. prosthesis be placed on one or both sides?

One of the frequently asked questions by our patients is whether the prosthesis will be placed on one or both sides. Testicular prostheses are usually inserted unilaterally because testicular losses are unilateral. If patients have lost both testicles, prostheses can be placed on both sides. In double-sided prosthesis surgeries, the dimensions of both testicles should be the same. In this way, the difference in appearance in both scrotums is prevented.

Do T. prostheses do the normal testicular function?

No, testicular prostheses do not do the job of normal testicles. In other words, they do not produce sperm like normal testicles, they do not produce testosterone (male hormone), they do not contribute to the conceiving of children. They are prostheses worn for cosmetic purposes only. This situation must be explained to the patients.

If these patients are receiving treatment for testosterone deficiency (hypogonadism), they should continue this treatment.

If patients have erectile dysfunction due to testosterone deficiency (ED, impotence, erectile dysfunction), this surgery will not have any curative effect. Patients receiving treatment for ED should continue their treatment.

What are the benefits of testicular prosthesis?

Testicular prostheses do not have any function. They cannot perform the duties of normal testicles. Serious psychological problems occur in patients who lose their testicles. In these patients, because there is no testicle in the scrotum, the patients feel uncomfortable cosmetically. With the prosthesis, these situations are prevented. In short, testicular prostheses provide serious psychological improvement in patients by improving the cosmetic appearance of the scrotum.

Can children use prostheses?

Since children are in the developmental period, testicular prostheses are not attached to them. The scrotum is not fully developed in them. Since the development of the scrotum will increase with age, if a prosthesis is inserted during this period, asymmetry occurs in both scrotums. For these reasons, we do not consider it appropriate to wear prostheses for our pediatric patients. This surgery can be performed after children reach adulthood and complete their normal development.

How long do T. prostheses stay in the body?

Testicular prostheses, like other prostheses worn on the body, are prostheses that can stay for a long time. As long as there is no problem that requires removal of the prosthesis due to infection or trauma, testicular prostheses remain in the body for a long time. It is important for these patients to be careful against trauma in their daily lives. Otherwise, the prosthesis will be damaged and surgical removal may be required.

What is the price of the prosthesis?

There are not many companies that produce these products. Since the existing companies are foreign companies, wages are usually given in foreign currency. Therefore, it would not be correct to say a fixed price in TL. In general, they are not very expensive products. The fact that the operation is bilateral and the hospital to be performed are the factors affecting the price.

How is the pre-operative preparation?

No serious preparation is required before the surgery, as in every surgery, the necessary routine tests (bleeding tests, etc.) are taken. If the patient uses blood thinners such as aspirin, they should be discontinued one week beforehand. Patients who will undergo surgery should not eat or drink anything by mouth 4-5 hours before. If patients are taking medications such as diabetes or blood pressure medication, they can be taken with a very small amount of water.

What kind of anesthesia is given, how many days is hospitalized?

Surgery is performed under general or spinal anesthesia and sometimes local anesthesia. Patients are discharged on the same day 5-6 hours after the operation. Patients do not need to stay in the hospital.

Is surgery performed in the same session in testicular cancer patients?

Patients who will undergo surgery for testicular cancer can also be fitted with a prosthesis in the same session. These patients should be informed in advance. If the patient accepts, the same seanta prosthesis surgery is also performed. In this way, the patient does not experience the stress of surgery for the second time. The prosthesis is placed in the scrotum in the same session from the incision where the testis is taken.

How is T. prosthesis surgery performed?

It is entered with a 2 cm incision from the scrotum (the bag in which the testicles are located) or the lower part of the abdomen, a pouch is formed in the scrotum where the prosthesis will be placed, and the prosthesis is placed in this pouch in a suitable position and fixed. If it is to be inserted unilaterally, it is important to wear a prosthesis that is suitable for the patient’s current testicle in terms of appearance.

Since we are suturing the surgical site aesthetically, there is no trace of surgery afterwards.

After the testicular prosthesis surgery, patients have a very comfortable time. There are no complaints other than simple pain and swelling at the wound site. Patients are discharged with postoperative pain relievers and antibiotics to prevent infection.

• There may be pain and tenderness in the early period (24-48 hours)
• A scrotal bandage is applied for a few days.
• Does not interfere with urination

What should be considered after the operation?

This surgery is a simple operation. No serious complications develop after the surgery. The following are the points that patients should pay attention to after surgery:

• Comfortable clothes that will not squeeze the testicles should be preferred for the first 2-3 weeks.
• It should not be touched with water for a week.
• Should not stand for long periods of 2-3 weeks
• Antibiotics and painkillers given should be used regularly.
• No heavy lifting, no heavy physical activity, no cycling for 3-4 weeks

When should a doctor be called after surgery?

If the patients follow the recommendations, there will be no serious problems after the surgery. In the following cases, the doctor who performed the surgery should be sought:

• If there is severe pain
• If there is discharge from the surgical site
• If there is high fever, nausea, vomiting

What are the risks of testicular prosthesis?

As with every surgical intervention and prosthesis, testicular prosthesis also has complications and risky patients for these complications. In general, complications are extremely rare. We have not encountered any problems in our patients so far. In some patients, the risk of infection is high as the body resistance will decrease. The patient groups at risk for infection for testicular prosthesis are:

• Diabetics
• Those who take immunosuppressive therapy 8 immunosuppressive drugs)
• If there is a previous operation on the scrotum

What are the complications of testicular prosthesis surgery?

Testicular prosthesis is not an operation with very serious complications. The most important complication is infections that occur especially in diabetics and patients with suppressed immune system, and accordingly the possibility of infection of the prosthesis and the possibility of removal of the prosthesis as a result. Other complications are simple and can occur in any surgery. Common complaints after surgery are:

• •Pain
• •Infection
• Hematoma (blood collection in the surgery area)
• Patient dissatisfaction after the surgery (because of the image)
• Scar tissue development
• Displacement of the prosthesis
• Rupture of the prosthesis (fragmentation)
• Prosthesis infection and removal

In summary: Testicular prosthesis surgery is a simple operation without serious complications. It is not worn in children, but this surgery is performed after completing the developmental period. Unilateral or bilateral testicular prosthesis can be inserted in those who do not have both testicles. Prostheses have no function. They do not produce testosterone, they do not produce sperm, it is a cosmetic procedure only.

Prof. Dr. Emin ÖZBEK

Urology Specialist

Istanbul- TURKEY