Testicular prostheses in patients with testicular cancer - acceptance rate and patient satisfaction.

BACKGROUND: The loss of a testicle to cancer involves much emotional impact to young males. Little is known about the number of patients with testicular germ cell tumour (GCT) who would accept a testicular prosthesis. Also, knowledge about the satisfaction of implant recipients with the device is limited. METHODS: A retrospective chart analysis was performed on 475 consecutive GCT patients. Prior to orchiectomy, all patients were offered prosthesis insertion. Acceptance of implant was noted along with age, clinical stage, histology and year of surgery. 171 implant recipients were interviewed using an 18 item questionnaire to analyze satisfaction with the prosthesis. Statistical analysis involved calculating proportions and 95% confidence intervals. Multivariate analysis was performed to look for interrelations between the various items of satisfaction with the implant. RESULTS: 26.9% of the patients accepted a prosthesis. The acceptance rate was significantly higher in younger men. Over-all satisfaction with the implant was "very high" and "high" in 31.1% and 52.4%, respectively. 86% would decide again to have a prosthesis. Particular items of dis-satisfaction were: implant too firm (52.4%), shape inconvenient (15.4%), implant too small (23.8%), position too high (30.3%). Living with a permanent partner had no influence on patient ratings. Multivariate analysis disclosed numerous inter-relations between the particular items of satisfaction. CONCLUSIONS: More than one quarter of GCT patients wish to have a testicular prosthesis. Over-all satisfaction with implants is high in more than 80% of patients. Thus, all patients undergoing surgery for GCT should be offered a testicular prosthesis. However, surgeons should be aware of specific items of dis-satisfaction, particularly shape, size and consistency of the implant and inconvenient high position of the implant within the scrotum. Appropriate preoperative counselling is paramount.

Non-risk-adapted surveillance for patients with stage I nonseminomatous testicular germ-cell tumors: diminishing treatment-related morbidity while maintaining efficacy.

BACKGROUND: With treatment leading to nearly uniform cure in clinical stage I nonseminomatous testicular cancer (CSI-NSGCT), diminishing treatment-related morbidity has become the primary concern. This study examined feasibility and outcome of active surveillance as treatment in an unselected CSI patient population. MATERIALS AND METHODS: All patients with CSI-NSGCT referred from 1998 to 2007 to the British Columbia Cancer Agency and the Oregon Testis Cancer Program were retrospectively reviewed. A total of 233 patients were identified, of which 223 chose active surveillance. RESULTS: Vascular invasion (VI) was absent, present and unknown in 66%, 27% and 7% of cases, respectively. Overall, 49% of patients had embryonal predominant disease. Fifty-nine patients (26%) relapsed, all but one with good prognosis disease. VI was present in 30 relapsed patients. Most patients relapsed within 2 years (88%). Only 7 of 223 patients (3%) relapsed beyond 2 years. All relapses were in long-term remission following chemotherapy with or without retroperitoneal lymph node dissection (RPLND). Only 17 of 223 patients (8%) required postorchiectomy surgery. Disease-specific survival is 100% after a median follow-up of 52 months (3-136). No patient has required second-line chemotherapy. CONCLUSIONS: Active surveillance for all CSI-NSGCT patients is associated with excellent outcomes comparable with the best results reported with primary RPLND or adjuvant chemotherapy. Nearly 75% of patients are spared any therapy after orchiectomy.

Benefit of sperm freezing before radical orchiectomy

A patient with a unilateral testis tumour who had been treated with radical orchiectomy was referred to our centre. He was oligospermic before orchiectomy and needed chemotherapy because of abnormal tumour markers after the aforementioned operation. He did not have any sperm suitable for freezing. Because of a lack of information about the spermatogenic abilities in the other testis, it is advisable to freeze sperm prior to orchiectomy at least in patients with semen analysis disorders (AU)

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Displasia quística de rete testis: revisión de la literatura / Cystic displasia of the testis. Review of literature

Objetivo: Revisión de la Displasia Quística de Rete Testis en el momento actual. Material y Métodos: Búsqueda bibliográfica en la base de datos Medline/PubMed del término “Cystic dysplasia of the testis”, con análisis de las revisiones bibliográficas encontradas. Resultados: La displasia quística de rete testis (DQRT) es una rara enfermedad benigna, asociada a malformaciones del tracto urinario superior. Su manifestación clínica más frecuente es el aumento de tamaño testicular, demostrándose la presencia de los quistes ecográficamente. No existe consenso en el tratamiento, optándose en la mayoría de los casos por la confirmación anatomopatológica con conservación del parénquima testicular. Conclusión: La DQRT es una enfermedad que debe ser tenida en cuenta en el diagnóstico diferencial de la masa escrotal infantil (AU)

Objetive: Review this pathology nowadays. Methods: We search in Medline/PubMed database for reviews about cystic dysplasia of the testis. We review and discuss the relevant literature about it. Results: Cystic dysplasia of the testis (CDT) is a rare benign disease, associated with upper urinary tract malformations. Its most frequent clinical manifestation is the increase of testicular size; the presence of cysts is demonstrated by ultrasound. No consensus exists in its treatment, it oftenly requires histological confirmation, performing testicle-sparing surgery. Conclusion: CDT needs to be taken into account in the differential diagnosis of childhood testicular tumors (AU)

Benefit of sperm freezing before radical orchiectomy.

A patient with a unilateral testis tumour who had been treated with radical orchiectomy was referred to our centre. He was oligospermic before orchiectomy and needed chemotherapy because of abnormal tumour markers after the aforementioned operation. He did not have any sperm suitable for freezing. Because of a lack of information about the spermatogenic abilities in the other testis, it is advisable to freeze sperm prior to orchiectomy at least in patients with semen analysis disorders.

Estrogen receptor-alpha signaling in growth of the ventral prostate: comparison of neonatal growth and postcastration regrowth.

A role for estrogen receptor (ER)-alpha in branching morphogenesis in the ventral prostate (VP) has previously been demonstrated; in the VP of ERalpha(-/-) mice, there are fewer side branches than in wild-type littermates. In the present study, we show that in the postnatal VP, fibroblast growth factor 10 (FGF10) is expressed in wild-type mice but not in ERalpha(-/-) mice, and because branching involves proliferation pathways also used in malignant growth, we investigated whether branching during regrowth of the VP after castration involves ERalpha and FGF10. ERalpha was not detectable in the prostates of sham-operated or castrated mice but was expressed in the prostatic epithelium between d 3 and 5 after testosterone replacement. Blocking either ERalpha or ERbeta with ICI 182,780 had no detectable effects on epithelial cell proliferation during regrowth by testosterone. The ERalpha agonist, propylpyrazoletriol, did not induce regrowth by itself, but exposure to propylpyrazoletriol on d 3-5 of testosterone replacement resulted in cyclin D1-positive cells in the ductal epithelium, invasion of FGF10-positive immune cells in the regrowing prostate, and budding 14 d later. Testosterone replacement alone did not induce cyclin D1, FGF10, or bud formation. These results indicate that stimulation of ERalpha is essential for ductal branching during postnatal prostate growth. During regrowth after castration, there is a window in time when selective stimulation of ERalpha can also induce ductal branching. The FGF10 for this growth comes from the immune system, not from the prostatic mesenchyme.

¿Cuál es su diagnóstico? / What is your diagnosis?

Varón de 25 años que consulta por presentar aumentodel tamaño del testículo izquierdo. En la palpación, senota una masa nodular, de bordes bien definidos, en lamitad inferior de la gónada. En el examen ecográfi cose confirma la presencia de esta masa. El paciente essometido a orquiectomía...

Prótesis testicular en pacientes orquiectomizados por cáncer testicular. ¿se justifica como insumo del plan nacional de salud Auge Ges? / Testicular prostheses in patient after orchidectomy for testicular cancer: justified as devices of the AUGE-GES’s health national law?

La pérdida de un testículo es un trauma físico y psicológico, en particular si la causa es por cáncer. En Chile desde julio de 2005 rige la Ley Nº 19.966, AUGE GES en Salud, y el cáncer testicular del adulto está incluido, pero no contempla la prótesis testicular. Fue esta la motivación para realizar este trabajo y objetivar si es un punto importante del tratamiento del cáncer de testículo. Material y Métodos: Se realizó una entrevista personal a 60 pacientes orquiectomizados por cáncer testicular, entregándoles un cuestionario dividido en preguntas antes y después de la orquiectomía ampliada, y si aceptan o rechazan la prótesis testicular y sus razones. Las respuestas se tabularon en una base de datos Microsoft Access. Se aplicó análisis estadístico con método de Fisher' Irving. Resultados: La mediana de edad fue 31 años (17-57). El 66,7 por ciento refirió no tener problemas de ser monórquicos; el 28,3 por ciento relató complejo de mostrarse desnudo y el 5 por ciento indicó incomodidad física. El 58,3 por ciento se operaría nuevamente para instalar la prótesis testicular y de éstos el 88,5 por ciento lo haría por estética. El 93,3 por ciento hubiese aceptado la instalación de prótesis al momento de la orquiectomía. No existió diferencia al comparar grupo de solteros y casados, ni grupo etario. Discusión: La repercusión psicológica es algo muy difícil de objetivar, sobre todo en una sociedad machista. Al momento de preguntar si se operarían varios de los pacientes cambian su respuesta y muestran su malestar de ser monórquicos. Es muy importante el hecho de contar con la prótesis al momento de la orquiectomía para optimizar los tiempos y disminuir los costos físicos y psicológicos de una nueva cirugía. Conclusiones: Dado que la Ley 19.966 de Salud, establece las prestaciones de carácter promocional, preventivo, curativo, de rehabilitación y paliativo, y que en el caso del cáncer testicular no cuenta con la prótesis dentro del Listado de Prestaciones Específicas, no se estaría cumpliendo con el carácter de rehabilitación garantizado por la Ley mencionada. Es por esta razón, y en base a los resultados obtenidos en este estudio, que se justifica plenamente que la prótesis testicular fuese parte del Plan AUGE GES.

Orquiectomía subalbugínea y reconstitución del volumen testicular con gelatina absorbible / Subalbuginea orchiectomy and reconstitution of testicular volume with absorbable gel

Se presentan los resultados obtenidos en una serie de 15 pacientes portadores de un cáncer prostático avanzado, tratados con orquiectomía subalbugínea y reemplazo del parénquima con gelita absorbible (Gelfoam). En un caso fue necesaria la extracción unilateral por infección. En los 14 pacientes restantes el resultado cosmético fue a su entera satisfacción.

Cosmetic orchiectomy using pedicled fibro-fatty tissue graft for prostate cancer: a new approach.

OBJECTIVE: To preserve the appearance of a normal scrotum at orchiectomy, a pedicled fibro-fatty tissue graft was inserted in the lumen of the tunica vaginalis. METHODS: 42 testes of 21 patients with metastatic prostate cancer were treated. A pedicled fibro-fatty tissue graft prepared from the region between the spermatic cord and the scrotal septum was inserted in the lumen of the tunica vaginalis following epididymis-sparing orchiectomy under local or spinal anesthesia. RESULTS: A pedicled fibro-fatty tissue graft which reached the epididymal tail was prepared in all instances. The average postoperative volume of the scrotal content was 18 ml (range 5-30 ml). Postoperative complications were scrotal edema, sensation of traction at the inguinal region and epididymitis. All but 1 patient were satisfied with the appearance of the scrotum and achieved sufficient androgen ablation. Mean follow-up was 8 (3-11) months. CONCLUSION: This cosmetic orchiectomy is a safe, simple and economical procedure to preserve the appearance of a normal scrotum; it also achieves the reliable result of androgen deprivation.

Evaluación del potencial fértil en pacientes operados de cáncer testicular unilateral / Fertility assessment in unilateral testis cancer operated patients

Debido a la importancia del tema de la fertilidad en hombres portadores de cáncer testicular gracias a las elevadas tasas de curación de esta patología y a la conservación de la eyaculación anterógradas, decidimos reevaluar el potencial de fertilidad de estos pacientes en nuestra población. El 90 por ciento muestra hallazgos compatibles con potencial fértil conservada en las muestras de testículo contralateral. Se discute la trascendencia y posibles explicaciones a esta situación

Torsión de testículo: presentación de seis casos / Testicular torsion: a six case report

Revisión de los expedientes clínicos de seis pacientes con diagnóstico de torsión testicular atendidos en el servicio de urología y nefrología del Hospital General de México, SS. La manifestación clínica más frecuente fue dolor (100 por ciento) y náusea (66 por ciento). El tratamiento utilizado fue la orquiectomía y la pexia contralateral

Prótesis testiculares de metilmetacrilato y silicón elaboradas en el Hospital General de México, SS: modelo experimental en animales / Metthyl meta-acrilate and silicone testicular prothesis manufactured in the Hospital General de Mexico, SS: experimental model in animals

Las prótesis testiculares utilizadas en México son importadas y de costo elevado y, por este motivo, la mayoría de los pacientes que se someten por diversos motivos a orquiectomia no reciben un implante protésico, lo que origina mal aspecto estético y repercusiones psicológicas, sobre todo en sujetos jóvenes. A causa de la imposibilidad del paciente y del hospital para adquirir prótesis importadas, se elaboró en esta institución un protocolo experimental de prótesis de testículo en animales de tres especies diferentes (perros, conejos y ratas), y se compararon cuatro tipos de materiales distintos, silicón de grado médico, silicón de grado industrial, metilmetacrilato autopolimerizable y metimetacrilato termocurable; la prótesis de estos materiales se implantaron individualmente en la bolsa escrotal después de la orquiectomía inguinal, salvo en las ratas, en las que se implantaron en la región de la cruz; se efectuó seguimiento hasta por un año para investigar tolerancia, biocompatibilidad, o toxicidad de estos materiales, y se observaron la reacción tisular local y la sistématica, tanto en forma clínica como por medio del estudio histológico de escroto, pulmón, hígado y riñón. Los resultados presentados en este documento son totales; se encontró que el metimetacrilato en sus dos variedades, autopolimerizable y termocurable, y el silicón de grados tanto médico como industrial fue bien tolerado por los perros (grupo I). Los conejos (grupo II) aceptación bien los implantes de metilmetacrilato y silicón en sus dos variedades. En las ratas (grupo III) se presentaron infecciones locales y sistématicas en 91.6 por ciento de los animales, lo que no sucedió en los grupos I y II; se decidió en consecuencia cambiar la técnica colocando la prótesis en la región de la cruz de la rata, y se observó que estos animales aceptaron bien los implantes protésicos en sus cuatro variedades.

[The sexual future of patients cured of testicular cancer]. / L'avenir sexuel du malade guéri d'un cancer du testicule.

The sexual future of patients cured of testicular cancer is a legitimate preoccupation due to the high rate of successful treatment for this disease. The psychological and functional aspects and the fertility before and after treatment of operated patients are reviewed and the least harmful solution is proposed for each handicap. The question of induction of new cancers by chemotherapy remains unanswered; a number of years of follow-up will be required before an answer can be proposed.

Adenocarcinoma prostático en hombre menor de 50 años / Prostatic adenocarcinoma in man less that 50 years old

Se presenta un paciente portador de adenocarcinoma prostático en etapa D2, menor de 50 años y con 18 meses de buena evolución posterior a orquidectomía

[Clinical studies of subcapsular orchiectomy with an intracapsular testicular prosthesis--improving the quality of life in patients with prostatic cancer].

Twenty-five patients termed the method group, having a carcinoma of the prostate, underwent a subcapsular orchiectomy, followed by the placement of an intracapsular prosthesis for anti-androgen treatment. In tandem, a control group of 16 patients, having a carcinoma of the prostate underwent, a total orchiectomy. Further, a histological study of a testicular capsula was performed on an autopsy specimen, but almost no seminiferous residue was detected. Postoperatively, serum testosterone levels decreased to less than 10% of their Preoperative levels, and remained at this level for 30 months. Similar results were obtained in both the method group and the control group postoperative questionnaires showed that the method group experienced less mental and physical stress than did the control group. In a society composed largely of elderly people, this type of operation can be very beneficial to those suffering from prostate carcinoma in maintaining the quality of their lives.

Infant testicular prostheses.

Traditionally, the parents of young boys with an absent testis are advised to let the child decide whether he wants a testicular prosthesis after he enters puberty. Unfortunately, the decision by an adolescent to undergo prosthesis insertion often is made only after experiencing ridicule and embarrassment about the genital appearance. Accordingly, we have offered to implant an infant size prosthesis in patients with cryptorchidism when inguinal and abdominal exploration demonstrates that the testis is absent. A total of 41 boys less than 5 years old with an absent testis underwent simultaneous insertion of a testicular prosthesis. The only complication was a superficial wound infection that did not necessitate removal of the prosthesis. Two boys report mild scrotal discomfort. In long-term followup 91 per cent of the families rated the cosmetic appearance as "good" and 94 per cent were content with the decision regarding placement of a prosthesis. Although many assume that these boys will desire a larger prosthesis after puberty, this consideration seems to be irrelevant. Longer followup will be necessary to ascertain whether this approach alters the psychosexual development of these patients. We believe that young boys with an absent testis should be considered for simultaneous testicular prosthesis insertion at inguinal exploration or orchiectomy.