The loss or absence of a testicle can be a psychologically traumatic experience for men of all ages. Cancer, torsion, or injury can require the surgical removal of a testicle. An undescended testis that cannot be lowered into the scrotum frequently has to be removed to prevent cancer. Some men have very small, non-functioning testes. Regardless of the reason, an empty scrotum can wreak havoc on a man’s self-esteem and confidence. Fortunately for many men, self-esteem, confidence, and the normal appearance of the scrotum can be restored by the surgical implantation of a testicular prosthesis.
Testicular implants have been in use since the 1940’s and have a safe track record. The first commercially available testicular prosthesis came on the market in 1973 and consisted of silicone gel-filled silicone rubber shell. Concern was raised back in the 1990’s over the potential health risk posed by leaking silicone gel from breast implants. It was suggested that leaking gel could act as an antigen (foreign invader in the body) and trigger autoimmune diseases. To err on the side of caution, manufacturers of silicone gel-filled testicular implants voluntarily discontinued production of these devices and explored new types of fillers. For the record, no published data has ever substantiated that silicone prosthetics cause disease in humans.
Currently there are two types of testicular prostheses available on the market for use in the United States. The first is the Coloplast (formerly Mentor) Saline Filled Testicular Prosthesis. It is made of a molded silicone elastomer shell that is filled with saline (salt water) at the time of implantation. It has a self-sealing injection site at one end to allow the surgeon to fill it, and a small silicone elastomer tab at the other end to enable the surgeon to suture it in place in the scrotum, if desired. The Coloplast Saline Filled implant is designed to “look and feel” just like a normal testis – same weight, shape, density, and consistency. It also comes in four different sizes. From an esthetic and tactile vantage point, the only person who should know it’s a prosthetic device is the patient. The Coloplast Saline Filled Testicular Prosthesis is also the only testicular implant on the market that has FDA approval.
The second testicular implant available for use in the United States is Sientra’s (formerly Silimed) Silicone Elastomer Implant, also known as the Oval Carving Block. It consists of a silicone elastomer envelope that is filled with reinforced dimethylsiloxanes. The thin, soft, smooth envelope, coupled with the density and consistency of the filling, give Sientra’s implant a very realistic “look and feel”, and it comes in five different sizes. Sientra’s implant is pending approval by the FDA.
The procedure to implant a testicular prosthesis takes between 30 to 60 minutes and is usually performed at an out-patient ambulatory operating facility. An incision is made in either the groin or scrotum. Using a finger, the surgeon creates a space for the prosthesis and then inserts and positions it in the scrotum. If desired, the prosthesis is sutured in place. After an hour or two in the recovery room, most patients are ready to go home. Patients typically experience minor discomfort for the first day or two following the procedure and might have scrotal swelling and tenderness for several days afterwards. However, most daily activities can be resumed within seven to ten days.
Most patients having a testicular implant will probably never need to have it replaced. However, a child with a testicular implant may eventually need to have it replaced by a larger implant as he matures. A small percentage of men need to have their implants readjusted or removed. Some men may develop scar tissue around their implant which can result in hardening of the implant. However, the overwhelming majority of men with testicular implants are quite satisfied, citing improved self-esteem, body image, and confidence.
If you are considering a testicular implant, make sure to research potential surgeons. It is not a common urologic surgical procedure and so not many urologists have experience performing it. Make sure you find a urologic surgeon who has an established track record of implanting testicular prostheses.
Bodiwala D, Summerton DJ, Terry TR. Testicular Prostheses: Development and Modern Usage. Ann R Coll Surg Engl. May 2007; 89(4): 349-353.0