Surgical Approach to Testicular Implant Surgery: Our Technique

by Alex Shteynshlyuger MD

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Dr. Alex Shteynshlyuger is one of the most experienced surgeons performing testicular implant insertion and revision in New York City.

Testicular Prosthesis Insertion: Surgical Considerations

The surgery for placement of a testicular prosthesis (implant) is fairly simple in experienced hands. There are two common ways to place a testicular implant in the scrotum. The first method is through an incision in the scrotum. The other method is through an incision in the inguinal/subinguinal or high scrotal region.

Groin versus Scrotal Incision for Testicular Prosthesis Placement

At New York Urology Specialists, we prefer to use a subinguinal incision for testicular implant placement in most cases. For patients who are undergoing inguinal orchiectomy (removal of the testicle), simultaneous insertion of the prosthesis is possible through the same incision. For most other patients, a subinguinal incision provides an opportunity for a smaller incision, faster recovery, and a smaller risk of complications compared to a scrotal incision.

Because the scrotal incision sits adjacent to the implant itself, wound infection is more likely to spread to the newly-inserted prosthesis, which could lead to wound opening and extrusion of the implant.  In addition, the risk of extrusion is higher when the incision is adjacent to the prosthesis rather than when the incision is made away from the location of the prosthesis.  A subinguinal incision also allows the surgeon more opportunity to expand the scrotal sac.

Suture Anchored versus Free Floating Implant

There are two surgical approaches to placing a testicular implant in the scrotum. Traditionally, the implant is sutured (anchored with a stitch) to the scrotal wall so that it does not move. Studies show that while that provides an adequate surgical outcome, the aesthetic outcome tends to be better when the prosthesis is left unanchored or free floating in the scrotal sac.

If the patient can be relied on to comply with postoperative instructions for a few months, which include daily pulling of the implant down into the scrotum so that it heals in a good low position, then a more pleasing aesthetic outcome is typically achieved with a non-anchored prosthesis.

For most adult patients, we prefer placing an unanchored or free-floating testicular implant as it usually leads to better anesthetics and less scar tissue in the scrotum. To prevent the implant from riding up into the groin, we place a few stitches to close off the space leading to the skin opening in the subinguinal or inguinal region.

Disadvantages of Scrotal Sac Incision for Placement of Testicular Implants

The surgical placement of a testicular implant through the scrotal skin is simple, fast, and causes minimal pain to the patient. Unfortunately, in my opinion, it does not lead to optimal outcomes and increases risks of prosthesis erosion and infection.

Underdeveloped Scrotum and Size Discrepancy

Testicular implant surgery is sometimes more complicated in patients who have an underdeveloped scrotum on the side where the testicle is missing. This most commonly occurs when the testicular loss occurred in childhood or early adolescence. As a result of the missing testicle on one side, the testicle on the contralateral side may become larger than normal to compensate for the lost testicle.

The scrotum on the side where the testicle is missing is small and underdeveloped.  There is limited space in which to insert the prosthesis and because the size of the scrotum is not the same on the side of the missing testicle, the prosthesis would sit higher than the ‘normal testicle’ on the other side.  To address this problem, the scrotum needs to be expanded prior to testicular implantation.

Fortunately, the scrotum is often fairly ‘pliable’ and stretchable and the scrotum can be expanded to some extent during surgery with mechanical stretching. In more severe cases, tissue expanders may be used in an effort to stretch the tissue for a few months prior to testicular implant insertion.  Tissue expansion can take a few weeks to a few months to occur but may be beneficial in some men with disproportionately small scrotal volume compared to the ‘normal’ side.  New York Urology Specialists is one of the few practices in the US to offer scrotal tissue expansion.

Ideally, during the surgical procedure, the surgeon selects a prosthesis that is similar in size to the normal testicle on the other side. When a patient is missing both testes, the decision making is a little bit more complicated because oftentimes both sides of the scrotum are underdeveloped.

Age at Implantation

The second variable in testicular implant insertion involves the child’s age. Early prosthesis placement has the advantage of possibly preventing shrinkage of the scrotum over time, which can be a cosmetic concern, especially in adolescent boys.

However, when a prosthesis is placed in children or pre-adolescents, oftentimes it necessitates placing a smaller implant because a large implant would be disproportionate to the scrotal size and the child’s anatomy. The problem arises when the child grows up and the prosthesis becomes small relative to body size. Oftentimes, the patient desires testicular implant replacement to a larger-sized prosthesis that is commensurate with the size of adult anatomy.  Upsizing of the testicular implant is a fairly simple procedure for most patients and performed at New York Urology Specialists.

Testicular Implant Surgery at New York Urology Specialists – What to Expect

The testicular prosthesis does not affect the ability to obtain erections, does not affect the ability to ejaculate.  

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Testicular Prosthesis – Excellence in Care

Excellence-Urology_Care-banner2At New York Urology Specialists, our urologists are specially trained in the evaluation and treatment of erectile dysfunction.  We understand the challenges that ED creates for our patients, their relationships and their self-esteem.  We help you find a treatment for erectile dysfunction that fits your needs, your lifestyle and your preferences.

Urologists are doctors specializing in the treatment of men with erectile dysfunction. By the virtue of our experience and skill, we are able to offer an effective treatment option for nearly every man who desires an effective treatment for ED.  We offer medical and surgical treatment for erectile dysfunction.

We Treat Some of the Most Complex Health Problems in Men Including:

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Dr. Alex Shteynshlyuger is a fellowship trained board-certified urologist with expertise in evaluation and treatment of urological problems in men using modern effective and proven treatment methods.  He is highly recommended by top primary care physicians in the New York area. If you or someone you know has been experiencing urological symptoms, make an appointment to take advantage of Dr. Shteynshlyuger’s expert advice. Please feel free to contact us with any questions.