Testicular Reconstructive Surgeries

Diseases and disorders of testicles are ideally managed with conservative therapies; mainly because surgical intervention may aggravate the risk of serious complications; both in terms of function and cosmetic appearance. But unfortunately, some testicular conditions can be only managed with surgical procedures. For example, advanced malignancy or tumor of testes is ideally managed with surgical removal of the diseased testicle. Testicular surgery is also indicated for a number of other reasons. Needless to say that some cases may lead to cosmetic disfigurement.

Research and clinical data indicates that disfiguring diseases or cosmetic abnormalities of genitals are associated with a higher risk of negative psychological consequences. In all such cases, testicular reconstructive surgeries can significantly improve the quality of life in the affected individuals.

What Are Testicular Reconstructive Surgeries?

Testicular reconstructive or cosmetic surgeries are primarily aimed at restoring the confidence and self-esteem of affected males for a functional sex life. Indications of testicular reconstructive procedure are:

• Missing testicles: This could be unilateral or bilateral. Patients with missing testicles presents with empty scrotum, which is often secondary to testicular removal due to malignancy or other reasons (such as undescended testes, spermatic cord torsion, atrophic testicles, loss of testicles due to trauma). Missing testes can also be due to congenital anomalies such as monorchia (babies born with one testicle only) or anorchia (congenital absence of both testicles).
• Very small sized testicles: This is mainly due to congenital defects or as a complication of chronic steroid abuse.
• Personal preferences: Men who desire larger testicles are also good candidates for reconstructive/ cosmetic procedures)
• Unequal or disproportional testicles: This may be congenital or acquired.
• Individuals who are opting for transsexual surgeries (i.e. from female to male).

Testicular Enhancement Via Implants

Small sized or unequal testicles can be managed with testicular enhancement procedures. In addition, males with missing or absent testicles can also opt for testicular implant.

As part of the procedure, right-sized testicular implant/ prosthesis is introduced in the scrotal pouch. There are different types of implants, but silicone gel are most frequently used. Study reported in the Translational Andrology and Urology (2) suggested that these prosthesis or implants are functionless, but can help a great deal in improving the body image and self-esteem in males (especially young boys who underwent testicular excision procedures at a young age).

Are There Any Risks Associated With Testicular Implant/ Reconstruction Procedures?

Clinical data indicates that testicular reconstruction is associated with improved self-esteem and confidence in men. But like any prosthetic procedure, there are some immediate and delayed risks associated with the procedure; such as:

• Risk of bleeding
• Infection

The risk of serious complications is rare. Generally testicular prosthetic implants lasts for decades. According to a case study reported in the peer reviewed journal Case Reports in Urology (3), investigators reported a case of spontaneous rupture in a 55-year old man who presented with altered consistency in the implant/ prosthesis with swelling and pain in the hemiscrotum of the involved side, after 33 years of implant. Such cases are managed with surgical removal of broken implant with or without replacement.

FDA approved this procedure in 1993 but unfortunately not many surgeons are specialized to perform this procedure. DR. James Elist is one of the renowned specialists who is an expert in such procedures. If your loose, aesthetically unpleasing ball sac is interfering with the quality of your sex life, you should schedule an appointment with Dr. Elsit at earliest convenience for thorough consultation.

References

1. Seymour-Smith, S. (2013). A reconsideration of the gendered mechanisms of support in online interactions about testicular implants: a discursive approach. Health Psychology, 32(1), 91.

2. Kogan, S. (2014). The clinical utility of testicular prosthesis placement in children with genital and testicular disorders. Translational Andrology and Urology, 3(4), 391-397.

3. Phan, Q. B., Koutlidis, N., Duperron, C., Mourey, E., Michel, F., & Cormier, L. (2016). Management of Testicular Silicone Gel-Filled Prosthesis Rupture: Case Report of a Rare Event and a Review of the Literature. Case reports in urology, 2016.

4. Selvaggi, G. (2015). Surgical therapy: scrotal reconstruction in female-to-male transsexuals. In Management of Gender Dysphoria (pp. 295-301). Springer Milan.