Your surgeon will always discuss with you and recommend the treatment that is appropriate for you. During the consultation, the surgeon will also explain the treatment, its results and benefits, the duration of the result and the frequency of repeating the treatment.
TESTICULAR IMPLANTS
Testicular implants are important not only for cosmetic reasons but can also improve a man’s quality of life. Men who have torsion or twisting of a testis, testis cancer or a traumatic injury, may all require removal of the affected testicle. A testicular prosthesis can restore the look and well being of men affected by these conditions. Testicular implants may also be an appropriate choice for children born with undescended testicles or torsion. For most undescended testicles, attempts are made find and lower it into the scrotum, but occasionally this is not possible and the undescended testicle is removed to prevent the later development of testis cancer. Finally, men who have small, non-functioning testes may also be candidates for an implant. Importantly, an implant should not be placed in the setting of infection or untreated cancer. The alternative treatment to the placement of a testicular implant is not placed it and receive no treatment. Please remember that a testicular implant does not function like a natural testicle and therefore can not make sperms or male hormone.
WHERE THE SURGERY WILL BE PERFORMED
The testicular implant procedure is performed in our Dubai Healthcare City clinic.
TYPE OF ANAESTHESIA
The testicular implant procedure is carried out under intravenous sedation so there will be no pain and you will sleep through the operation.
THE SURGERY
Testicular Implant procedure usually takes one to one and a half hour.
THE TESTICULAR PROTHESIS PROCEDURE
Testicular prostheses are placed in a small surgical procedure that takes 30-60 minutes under sedation and is performed as day case procedure. Patients receive intravenous antibiotics and a thorough skin preparation before the procedure. A small incision can be made either in the scrotum or in the groin to place the device. Dr Viel prefers a muscle-sparing upper scrotal incision that allows for an entry site that is distant from the final resting position of the prosthesis. After the incision, a scrotal pouch is created and a suture can be used to fix the prosthesis (Through the suture tab) in a dependent position in the scrotum. The prosthetic is bather in an antibiotic solution, placed in the scrotum and examined for overall suitability and for a good position. The incision is closed in multiple, non-overlapping layers after antibiotic irrigation. Patients are then discharged with several days of oral antibiotics and followed up carefully over the next 3 months.
Like any other medical implant, testicular implants should not be considered lifetime devices. There is a small risk that the body may try to reject or extrude the device or that the device could leak or rupture, all of which will require that the implant be removed. In addition, the long-term rate of deflation within the device is still unclear. Furthermore, about 1 in 40 patients will need another surgical procedure within the first year to either remove or adjust the implant. In children, a smaller implant will likely need to be replaced by a larger implant as the child grows. Finally, the body’s natural reaction to any device within it is to form scar tissue around it.
This is called a capsule and, although rare, it can occur with testis implants too. In some men, this may cause a hardening of the implant, leading to discomfort, pain or decreased satisfaction.
TESTICULAR PROSTHESIS PATIENT INSTRUCTIONS
The following is an outline of what to expect and do before and after the procedure:
THE CONSULTATION VISIT
This visit is important for you to meet and feel comfortable with Dr Viel, to figure out whether you are a good candidate for testis prosthesis, and to discuss the benefits and risks of having such a procedure. At this visit:
Dr Viel will ask you questions about the kinds of symptoms you are having and also ask questions about your medical history.
Dr Viel will perform a limited and very brief physical examination on you to assess your anatomy and to determine your candidacy for the procedure. Issues he will consider are the scrotal anatomy, the size of the opposite testis and optimal placement of an incision.
Dr Viel will then discuss the options for testis prosthesis placement, including benefits and risks so that you have a good idea of what the procedure involves, the recovery afterwards when you can resume your normal activities.
PREPARING FOR YOUR SURGERY
You will be given specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking and taking or avoiding certain vitamins and medicines.
If you smoke, plan to quit at least two weeks prior to the surgery and not resume smoking for at least two weeks after your surgery. Avoid overexposure to the sun before the surgery, especially on the abdomen, and do not go on the astringent diet, as both can inhibit your ability to heal. If you develop a cold or infection of any kind, it is important to inform the surgeon, as your surgery may need to be postponed.
You will need to arrange for someone to collect you after your surgery, as you will be unable to drive. It is also advisable to have someone to stay with you for a few days to help you out if needed.
PRE-PROCEDURE CHECKLIST
Eat normally the night before surgery, but follow the directions that anesthesia recommends for the morning of surgery. If no specific directions are given, withhold
all food and drink after midnight and on the morning of surgery.
Do not take any aspirin, or any ibuprofen containing medications (Advil, Motrin, Aleve) at least 10 days prior to the procedure, as these medications have a side effect that can reduce platelet function and therefore lower blood clotting ability.
Someone will need to drive you home or to your hotel after the procedure, following your recovery from the procedure. Buy some frozen peas or mixed vegetable bags from the grocery to use as cold “sandbag” to the area after the procedure.
DIET
Regarding diet, start with clear liquids or something light and then progress to your normal diet.
ACTIVITY
You should rest for the first 24 hours following the procedure to lessen the chance of swelling. Avoid strenuous exercise (including sex) or heavy lifting for 7 days. After that, you can do all of your normal activities, but at the start, let discomfort be your guide: if it feels uncomfortable, slow down.
Apply ice packs (frozen peas or mixed vegetables work well) to the groin area over the covered area for 24 hours to help with swelling. If your job involves desk work or very light activity, you may return to work 2 or 3 days after surgery. Remember that it is likely that you will have some discomfort for the first few days after surgery when deciding when to go back to work.
WOUND CARE
Shower daily, but do not soak in a bath for at least 5 days. The sutures are buried under the skin and are self-absorbing and do not need to be removed.
MEDICATIONS
Take your prescribed pain medicine, usually Vicodin, for moderate discomfort. Always take the Vicodin with food in your stomach, so that you do not get nauseated. You can take Tylenol or Ibuprofen for mild discomfort. When taking pain medication, be careful as you walk or climb stairs, as your judgement can be impaired. Dizziness is also not unusual.
AFTER ANAESTHESIA
Do not make important decisions until the next day as some anaesthetics have a delayed metabolism and can interfere with the ability to perform these tasks.
Avoid alcoholic beverages for 24 hours. Do not drive or operate heavy machinery for 48 hours. Do not eat heavy or large meals until the next day, as a heavy meal may be difficult to digest. Spicy and greasy foods should be avoided.
PROBLEMS TO REPORT
Problems you should report to the doctor if they occur :
Fever > 101° F, shaking and chills.
Nausea and vomiting.
Expect a small amount of bloody discharge from the incision, however, call us if it continues and the incision site becomes red, painful or separates.
Drug reactions such as hives, rash, nausea or vomiting.
You may get black and blue around the incision site and also in scrotum and on the penis. If the amount of swelling concerns you, please call the office.