Ragheb, A.M.

Testicular, atrophy, empty scrotum, prosthesis, implant

In this step-by-step instructive surgical video, I demonstrate the implantation of a testicular prosthesis in an adult male patient with a unilateral atrophic testis. Although testicular prosthesis implantation is a simple and easy surgery yet may carry a significant psychological and social impact on men who have an atrophic or absent testis due to a congenital or acquired cause during their lifetime, e.g. removal for a malignant tumor or torsion. Our patient had suffered right testicular atrophy after surgery for right undescended testis which eventually led to hemiscrotal size discrepancy. We succeeded in implanting a testicular prosthesis adjacent to his native atrophic testis within the same intravaginal compartment.

Although many surgeons would prefer a low inguinal approach to minimize the risk of potential infection, there is a group that adopts the direct scrotal approach as we did. In this particular case, we avoided the inguinal region to avoid the dense scarring and adhesions due to prior surgery in that area. Our median raphe scrotal incision may also offer a more cosmetic scar compared to an inguinal incision. We choose to make it high in the scrotum to allow rapid healing and avoid any direct pressure from the implant which resides below and remote from the incision. From our experience, all our patients healed with no pain and were infection-free.

We also preferred to spare the atrophic testis to preserve any hormonal contribution it may carry. During preoperative examination, palpation of the atrophic testis caused no pain on pressure. Hence, we decided to implant our prosthesis adjacent to it within the same vaginal covering to guarantee a more anatomical and natural position for the prosthesis. The short and long-term postoperative period was uneventful. Our patient was satisfied and happy.