Background: Testicles are naturally paired structures residing in the scrotal sac. Loss of a testicle can occur for a variety of reasons which in an adult male is usually due to cancer or a traumatic injury. Scrotal sac asymmetry obviously occurs when only one testicle remains. Whether having only one testicle is a concern will vary for each man so affected.
For those men bothered by scrotal sac asymmetry, testicular replacement surgery can provide a straightforward and low risk solution. There are two implant options for testicular replacements, saline-filled and solid silicone. There is little question that the ultra soft, low durometer silicone testicular implant offers the most natural feel. In addition, they offer no risk of mechanical failure over a patient’s lifetime. This is unlike saline testicular implants which have an increasing risk of spontaneous deflation the longer they have been implanted.
Testicles obviously are different in size for each man. Presumably a pair of testicles has the same size although size discrepancies in the same man are known to exist. It would also be anticipated that the larger the man, the bigger the testicles are. Thus, a range of silicone testicular sizes are needed to properly service the broadest range of male patients. Size ranges exist from 2.5 x 2cms to 5 x 4 cms. Sizes can be determined by preoperative measurements or the use of intraoperative sizers.
Case Study: This 40 year-old man had his right testicle removed several years previously due to cancer. He was having other surgical procedures and desired to have it replaced at the same time. He had not had radiation after his testicular cancer surgery.
Under general anesthesia a 4.5 x 3.5cm silicone testicular implant was placed into a created scrotal pocket. This was done through a high scrotal incision placed near the groin crease. The size of the implant was based on measurements and feel of the opposite testicle with a range of implants available at the time of the procedure.
The proper size of a testicular replacement is just as important as the implant having a similar feel to the opposite normal testicle. Preoperative measurements can be done before surgery to have the proper implant size available for surgery. The alternative strategy is to have a variety of testicular replacement sizes available and made the size judgment during surgery.
Highlights:
- Lost of a testicle in an adult male creates scrotal asymmetry and potential self-esteem issues.
- Soft silicone implants offer the most natural form of testicular replacement.
3. The sizing of testicle implants can be done by preoperative measurements or intraoperative sizing.
Dr. Barry Eppley
Indianapolis, Indiana