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Infant testicular prostheses
J S Elder1, M A Keating, J W Duckett
1Division of Urology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine.
Insights
Early testicular prosthesis insertion in young boys with an absent testis can improve cosmetic appearance and family satisfaction. This approach may prevent psychosocial distress associated with delayed decisions about prosthetic implants.
Area of Science:
- Pediatric Surgery
- Urology
- Developmental Pediatrics
Background:
- Traditionally, boys with an absent testis decide on testicular prosthesis after puberty.
- Delayed prosthesis insertion can lead to adolescent embarrassment and ridicule regarding genital appearance.
Purpose of the Study:
- To evaluate the safety and efficacy of simultaneous testicular prosthesis insertion in young boys with an absent testis.
- To assess cosmetic outcomes and parental satisfaction with early prosthesis placement.
Main Methods:
- 41 boys under 5 years old with an absent testis underwent simultaneous testicular prosthesis insertion during inguinal/abdominal exploration.
- Follow-up assessments included complication monitoring, cosmetic appearance rating, and parental satisfaction.
Main Results:
- The only complication was a superficial wound infection, not requiring prosthesis removal.
- 91% of families reported good cosmetic appearance, and 94% were content with the decision.
- Mild scrotal discomfort was reported by two boys.
Conclusions:
- Simultaneous testicular prosthesis insertion in young boys with an absent testis is a safe and effective procedure.
- Early placement leads to high cosmetic satisfaction and may positively impact psychosexual development.
- Consideration for early prosthesis insertion during exploration or orchiectomy is recommended.
Abstract:
Traditionally, the parents of young boys with an absent testis are advised to let the child decide whether he wants a testicular prosthesis after he enters puberty. Unfortunately, the decision by an adolescent to undergo prosthesis insertion often is made only after experiencing ridicule and embarrassment about the genital appearance. Accordingly, we have offered to implant an infant size prosthesis in patients with cryptorchidism when inguinal and abdominal exploration demonstrates that the testis is absent. A total of 41 boys less than 5 years old with an absent testis underwent simultaneous insertion of a testicular prosthesis. The only complication was a superficial wound infection that did not necessitate removal of the prosthesis. Two boys report mild scrotal discomfort. In long-term followup 91 per cent of the families rated the cosmetic appearance as "good" and 94 per cent were content with the decision regarding placement of a prosthesis. Although many assume that these boys will desire a larger prosthesis after puberty, this consideration seems to be irrelevant. Longer followup will be necessary to ascertain whether this approach alters the psychosexual development of these patients. We believe that young boys with an absent testis should be considered for simultaneous testicular prosthesis insertion at inguinal exploration or orchiectomy.