Medical and social rehabilitation following testicular prosthesis in post-orchiectomy patients

Aim. The aim of this study was to optimize indications and techniques and to develop the optimal timing for testicular prosthesis following inversion in adolescence considering the assessment of quality of life of patients at different times following the surgery.

Materials and methods. We observed 70 patients with gonadal loss following critical ischemia (torsion) at ages 11-18 years (average, 15.5 ± 2.3 years). In total, 49 patients underwent joint replacement after orchiectomy due to torsion. In 21 patients, prosthetics were preceded by orchiectomy for testicular atrophy as a result of twis ting. The interval from an acute episode to joint replacement ranged from 6 months to 15 years. Three techniques for testicular prosthesis implantation were applied: prosthetics with inguinal access without suturing the scrotal entrance (n = 14); prosthetics with inguinal access with suturing the scrotal entrance by the originally developed technique (n = 34); and a prosthetic scrotum (n = 22). Patient satisfaction was assessed based on the different outcomes of testicular inversion according to the originally developed questionnaire.

Results. Suturing the scrotal entrance reduces the risk of implant migration in the proximal direction due to anatomical prerequisites. Scrotal access does not have this drawback but increases the risk of inflammatory complications. The esthetic result of prosthetics depends on patient’s age during orchiectomy. Older patients tend to have better cosmetic results. The most favorable results of prosthetics are noted at the time that has passed since the turn – no more than 3 years; all unsatisfactory results are noted at the time of more than 5 years since the twist. Testicular prosthesis increases social adaptation of patients after gonadal loss and improves their quality of life.

Conclusions. 1. Testicular prosthesis is an essential stage of patient rehabilitation after an orchiectomy for inversion. 2. Prosthetic inguinal access by the originally developed technique is optimal from a technical perspective and provides the most physiological standing of the implant. 3. Prosthetics results directly depend on the period following the initial operation. 4. Testicular prosthesis complications can be minimized with the accumulation of knowledge and surgical experience and their rational prevention. 5. Assessment of patients’ quality of life illustrates the necessity of gonadal prosthetics for cosmetic compensation of organ loss and psycho-emotional and social rehabilitation