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Background: An absent testicle in an adult can be the result of various causes. It can either have never formed, was undescended from the abdominal cavity during development or was lost after birth due to trauma or a tumor. All of these are well known to occur with the most reason common being it was surgically removed. In a medically advanced society almost all cases of undescended testicles have been surgically treated early in life.

In an adult testicular replacement is done with implants of which both saline filled and solid silicone options exist. While each has their merits solid silicone testicle implants have the advantage of feeling more natural and never have the risk of need for replacement due to device failure. (rupture) They are also available in a wide variety of sizes including being capable of being made custom for larger sizes.

The sizing of testicle implants is based on their length:width ratio. Given their oval shape they are sized based on a length:width ratio of approximately .75. For example a 5.0cm implant has a 4.0cm width. Sizing is done by a simple side to side comparison by both visual and palpable comparison. While no perfect implant size match can ever be completely done the decision for the patient is whether they would prefer a slightly smaller or slightly bigger implant size compared to their natural testicle. While it can seem like an ideal size match is obtained before surgery the thickness of the scrotal tissues containing the testicle can create a sense of false sizing in some patients.

Case Study: This young male had a history of losing his left testicle due to torsion as a teenager. Ten years later he decided to have an implant replacement. Preoperative sizing was for a standard 5.0cm silicone implant with the goal of ensuring that the implant did not end up bigger than the existing testicle.

Under general anesthesia and a high scrotal incision (below the scrotal-inguinal skin crease) an implant pocket was created. Having had a testicle at one time, the scrotal tissues easily stretched to accommodate the implant.

Most testicle implants will initially be a little high and feel tight. But the implant drops down and softens as the tissue relax and stretch. This is particularly relevant in scrotums which have been missing the testicle for years and the tissues have shrunk a bit. But between swelling and the natural elasticity of the tissues scrotal expansion is usually generous

Case Highlights:

1) Testicular replacement is most commonly done using a standard soft solid testicular implant.

2) Given that the testicles are normally slightly different in size men can choose their implants as either slightly bigger or smaller than their existing testicle.

3) Testicular implants can be placed through either a high scrotal or midline raphe skin incision.

Dr. Barry Eppley

Indianapolis, Indiana

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