PROSTHESIS OF THE TESTICLE IN PERSONS WHO HAVE UNDERGONE HIS TWITCH AT ADOLESCENCE

Relevance. Prosthesis of the testicle is a matter that is sharply discussed in the literature, accompanied by significant polarity of opinions regarding indications, techniques, choice of implant and evaluation of results. Publications relating to prosthetics about the bloat in childhood, are single and do not give an unambiguous answer to emerging questions.

Goal. Optimize the indications, techniques and develop optimal terms for prosthetic testis after its turn in adolescence.

Materials and methods.70 patients who lost gonad after torsion with critical ischemia at the age of 11-18 years, an average of 15.5 ± 2.3 years. In 49 patients, endoprosthetics were performed after orchiectomy for torsion. In 21 patients, orthhectomy was preceded by prosthetics due to the atrophy of the testicle preserved after the twist. The interval from an acute episode to endoprosthetics was from 6 months to 15 years.

Three techniques of implantation of the prosthetic testis were used: prosthetics with inguinal access without suturing the entrance to the scrotum (n = 14); prosthetics by inguinal access with suturing the entrance to the scrotum according to the original developed technique. (n = 34); prosthetics with scrotal access (n = 22).

Results. Sewing the entrance to the scrotum reduces the risk of implant migration in the proximal direction, due to anatomical prerequisites. Access through the scrotum is free from this deficiency, but increases the risk of inflammatory complications.

The aesthetic result of the prosthesis directly depends on the age at which the orchiectomy is performed - the older the patient who underwent the operation, the better the cosmetic effect.

Inguinal access with suturing the entrance to the scrotum with a comparable number of good results makes it possible to obtain a greater number of satisfactory and does not lead to complications.

The most favorable results of prosthetics are noted at the time that has elapsed since the moment of turning - not more than three years; all unsatisfactory results were noted at a term of more than five years from the moment of torsion.

Conclusions. 1. Prosthesis of the testis is an integral stage in the rehabilitation of the patient after an orchectomy for a bloat. 2. Prosthetic groin access according to the proposed original technique is optimal from a technical point of view and provides the most physiological standing of the implant. 3. The results of prosthetics directly depend on the period after the primary operation. 4. Complications of prosthetic testis can be minimized with the accumulation of experience and their rational prevention.

1. Shill V-B, Komkhair F, Khargriv E. Klinicheskaya andrologiya. Moscow: GEOTAR-Media; 2011. (In Russ)

2. Venable C, Stuck W. Testicular implants. Ann. Surg. 1937;105:917. doi: 10.1097/00000658-193706000-00006

3. Marshal S. Potential problems with testicular prostheses. Urology. 1986;28(5):388–390. doi: 10.1016/0090-4295(86)90068-3

4. Adshead J, Khoubehi B, Wood J, Rustin G. Testicular implants and patient satisfaction: a guestionnare-based study of men atier orchidectomy for testicular cancer. BJU International. 2001;88:559–562. doi: 10.1046/j.1464-4096.2001.02392.x

5. Okulov AB. Khirurgicheskaya taktika pri zabolevaniyakh organov reproduktivnoi sistemy u detei. [dissertation] Moscow; 2001. (In Russ)

6. Knight PJ, Vassy LE. The diagnosis and treatment of the acute scrotum in children and abolescents. Ann. Surg. 1984;200:664-673. doi: 10.1097/00000658-198411000-00019

7. Hajji F, Janane A. Images in clinical medicine. Torsion of undescended testis. N Engl J Med. 2012;366(17):1625. doi: 10.1056/NEJMicm1111776

8. Rivers KK, Rivers E., Stricker HJ. The clinical utility of serologic markers in the evaluation of the acute scrotum. Acad Emerg Med. 2000;7:1069 – 1072. doi: 10.1111/ j.1553-2712.2000.tb02103.x

9. Komarova SYu, Tsap NA, Chukreev VI. Features of conservative and operative tactics in torsion of the testis. Detskaya khirurgiya. 2016;20(4)185–188. (In Russ)

10. Patent №:2231300/07.08.02 Makarov GA, Chepurnoj GI. Sposob protezirovanija jaichek pri monorhizme i anorhizme. (In Russ). http://www.bankpatentov.ru/node/9311

11. Turek PJ. Master and The Testicular Prosthesis Group. Safety and eff ectiveness of a new saline fi lled testicular prosthesis. J.Urol. 2004;172:1427–1430. doi: 10.1097/01.ju.0000139718.09510.a4

12. Adshead J, Khoubehi B, Wood J, Rustin G. Testicular implants and patient satisfaction: a guestionnare-based study of men atier orchidectomy for testicular cancer. BJU International. 2001;88:559–562. doi: 10.1046/j.1464-4096.2001.02392.x

13. Lawrentschuk N, Webb DRD. Inserting testicular prostheses: a ew surgical technigue for diffi cult cases. BJU International. 2005;95(7):1111-114. doi: 10.1111/j.1464-410x.2005.05476.x

14. Madykin JuJu, Zolotuhin OV, Firsov OV. O nekotoryh osobennostjah protezirovanija jaichek. 8 kongress «Muzhskoe zdorov’e». Erevan. 2012:73-74. (In Russ)

15. Doherty AP, Mannion BM, Moss JJ, Ockrim JL, Christmas TJ. Spread of silicone to inguinal lymph nodes from a leaking testicular prosthesis: a cause for chronic fatigue? BJU International. 2000;86:1090. doi: 10.1046/j.1464-410x.2000.00961.x