Clinical Application Of Testicular Prosthesis Implantation In The Treatment Of Children With Testicular Deficiency

BackgroundTesticular prosthesis implantation(TPI)plays an increasingly important role in restoring the normal appearance of the male scrotum with testicular absence,improving self-esteem and quality of life.In recent years,with the improvement of people's living standard and medical and health conditions,more and more male patients with testicular absence require testicular prosthesis implantation.For children,with some congenital or acquired testicular diseases,such as congenital testicular dysplasia,monorchia,anorchia,congenital undesceended testicular leading to testicular atrophy or absence,testicular torsion and necrosis,testicular malignant tumors,and orchiectomy is the series of standard treatment of benign and malignant testicular diseases.The loss of testicles undoubtedly affects their physical and mental health,especially after puberty.Testicular prosthesis implantation undoubtedly brings hope to these children.More than 70 years have passed since the first testicular prosthesis was used in adults in 1941,and its safety and effectiveness have been widely recognized.Furthermore,there is a high degree of patient satisfaction and a low incidence of complications after testicular prosthesis implantation.However,the acceptance rate of testicular prosthesis implantation in male patients is generally low,only about one third of the rate of female breast prosthesis implantation,and even lower than this rate in China.Due to the large population base in China,children with testicular absence because of testicular diseases are not in the minority.How to apply testicular prosthesis implantation to more children with testicular absence is a big challenge for pediatric urologists.In general,testicular prosthesis implantation represents a simple,effective and safe surgical procedure that can improve the appearance of the scrotum,reduce the negative impact on body image in many children,and compensate for the psychological trauma of testicular loss,thus enabling them to integrate into the society as healthy as normal children.ObjectiveThis study of 11 cases of testicular prosthesis implantation treated at our hospital were retrospectively studied.Changes of its image and satisfaction of testis after implantation and effect and short-term complications after testicular prosthesis implantation surgery were analyzed in order to raise their awareness of prosthetic implants,summarizes clinical experience and provide reference for future clinical work.MethodsThis study collected 11 cases of children undergoing testicular prosthesis implantation in pediatric surgery department of the first affiliated hospital of Zhengzhou university from January 2017 to June 2019.Clinical data of the children were collected,including general information such as age of operation,etiology of testicular absence,time interval between testicular resection and prosthesis implantation,and surgical methods,as well as laboratory examinations such as urine routine,sex hormone level,rheumatology and complement indexes,as well as imaging examinations such as scrotal ultrasound.All the children underwent the implant implantation through the scrotal incision after the relevant examination.The patients were followed up for 6-12 months mainly by questionnaires.Serological immunoassay and scrotal ultrasonography were performed in each postoperative follow-up.The improvement of self-esteem and body image was observed by the scores of children before and after surgery on the Rosenberg self-esteem rating scale and self-esteem rating scale(physical attractiveness sub-scale).The effectiveness of prosthesis implantation was determined by the score of prosthesis satisfaction,and the short-term complications after implantation were observed.ResultsIn this study,all the 11 children received testicular prosthesis implantation according to the operation,and the serological immune indexes of the children were in the normal range during the postoperative follow-up,and no connective tissue diseases related to the prosthesis were found.Postoperative complications:1 case(9.09%)had delayed scrotal skin healing after surgery.There was no skin necrosis leading to the removal of the prosthesis,no prosthesis displacement and prolapse.The scores of the physical attractiveness sub-scale at 6 and 12 months after implant implantation were(25.30 ± 3.52)and(26.23± 3.60),respectively,and the scores before implantation were(20.15 ± 4.22).The differences before and after implantation were statistically significant(p<0.05).The scores of the Rosenberg self-esteem scale were(35.23 ± 2.51)and(36.24 ± 2.05)at 6 and 12 months after implant implantation,and the differences were statistically significant(p<0.05).The score before implantation was the overall image score of the affected side of the scrotum of the children,which was(15.53 ± 4.50)points before surgery,(32.45 ±3.52)points and(33.20 ± 4.11)points at 6 and 12 months after surgery,respectively.And the differences were statistically significant(p<0.05).There was no significant difference in satisfaction scores between 12 months after surgery and 6 months after surgery(p>0.05),the properties of the prosthesis were relatively stable.The postoperative follow-up was 6-12 months,and all the children were satisfied with the position,shape and consistence of the prosthesis.One case thought the prosthesis was too small,and the other one thought the prosthesis was too light.Nine(81.82%)cases were satisfied with the implant,with no other discomfort,and 10(90.91%)cases would recommend the implant to others.Conclusion1.The high scrotal transverse incision in the testicular prosthesis implantation has the advantages of simple operation,reliable efficacy,fewer complications and rapid postoperative recovery.2.Testicular prosthesis implantation has obvious advantages in improving children's self-esteem,enhancing self-confidence and improving life quality,which is worthy of further clinical research and promotion.