Testicular Biopsy and Testicular Mass Removal
Testicular Removal (Orchiectomy, uni or bilateral) with or without Insertion of Testicular Prosthesis. Orchiectomy, or the process of testicle removal, may be necessary for several medical conditions. Testicular cancer is the most common reason for testicle removal. Other condition such as severe trauma to the testicles, testicular atrophy (shrinkage), or testosterone cessation treatment for prostate cancer may be other reasons for testicle removal.
After diagnosis and determination of indication, Dr. Elist performs testicular removal surgeries on an outpatient basis (short hospital stay may be arranged if desired by the patient). Regular activities can usually be resumed in 1 to 2 weeks after testicular removal, and full recovery is expected within 2 to 4 weeks. Testicle removal is a major part of testicular cancer treatment. Testicular cancer is the most common cancer in men aged 20-39 years. It can present itself with or without pain.
The mass usually feels firm and arises from the testicle. Testicular cancer has one of the highest rates of cure, over 90%, and even 100% if it has not spread. Occasionally, testicular cancer may appear with symptoms of metastasis, which could include cough, shortness of breath, or weight loss. Even in case of metastasis, modern chemotherapy can achieve a cure rate of over 80%. Monthly testicular self-exams are recommended for every man between the ages of 18-40 years old.
Signs and symptoms:
- a lump in one testis which may or may not be painful
- sharp pain or a dull ache in the lower abdomen or scrotum
- a feeling often described as “heaviness” in the scrotum
- breast enlargement (gynecomastia) from hormonal effects of β-hCG
- low back pain (lumbago) tumor spread to the lymph nodes along the back
If testicular cancer spreads, the following symptoms may be present:
- shortness of breath (dyspnea), cough or coughing up blood (hemoptysis) from metastatic spread to the lungs
- a lump in the neck due to metastases to the lymph nodes
Diagnosis: Self examination, physical and history, imaging studies, biopsy, or a removal of affected testicle (orchiectomy, testicle removal) for diagnosis and treatment purposes.
Treatment: Treatment of testicular cancer is depending on the pathology and may include surgery, radiation therapy, and chemotherapy.
Dr. Elist Orchiectomy (Testicle Removal Surgery)
Orchiectomy (testicle removal) is the removal of one or both testicles due to underlying pathology. Testicular cancer, undescended testicles, or other pathologies are some of the causes that may warrant a removal of the testicle.
During the testicle removal procedure one or both testis are removed without any damage to the penis or the scrotum. Dr. Elist performs orchiectomies (testicle removal) by given pathology, and offers a replacement of the diseased testicle(s) with a testicular prosthesis.
Dr. Elist performs simple testicle removal through a scrotal inguinal approach and radical Orchiectomy through an inguinal approach with abdominal exploration (during the testicle removal, Dr. Elist looks inside the abdomen to rule out possible affected lymph nodes or other metastasis foci).
An incision is made in one side of the scrotum and the tissues are separated to expose the spermatic cord. The spermatic cord is opened and the individual bundles making up the cord are cross-clamped, cut, and secured with nonabsorbable suture material. The testis is removed through the scrotal incision (testicle removal phase). If the patient chooses and if no contraindications are present, a prosthetic testis is inserted into the scrotum before the wound is closed in layers by suturing. An alternative method uses an incision in the groin. The testis is pulled up through the incision after cutting and trying the cord in a fashion similar to the scrotal approach.
Dr. Elist performs a radical testicle removal by removing en bloc the contents of half of the scrotum. An incision is made in the inguinal area from the pubic bone up towards the lateral pelvic bone. The incision made deep into the tissues and the spermatic cord is dissected free and cross-clamped. The testis and all its associated structures are pushed up from the scrotum into the incision and removed. Packing is then placed in the empty scrotum. When the spermatic cord is opened and the individual bundles making up the cord are cross-clamped, cut, and secured with nonabsorbable suture material, care is taken to avoid important nerves and vessels in the area. The packing is removed and bleeding controlled. A prosthetic testis may be placed in the scrotum before the incision is closed in layers by suturing. This procedure results in complete removal of the testis. If abdominal exploration is warranted, a midline incision is made from the upper to the lower abdomen and the abdominal cavity is entered. The back wall of the abdomen is exposed and the lymph nodes are checked for spread of tumor. Some may be removed and/or biopsied and the abdominal wound is closed in multiple layers by suturing.
Testicle removal can be a dramatic life event for men. The resulting scrotal deformity and the uneven look of the scrotum can pose a serious psychological stress to many men resulting in decrease of self-esteem and even sexual dysfunction. Testicle removal can be accompanied by the insertion of uni or bilateral testicular prosthesis to achieve a natural look of the scrotum.
Dr. Elist Insertion of Testicular Prosthesis or Implant
After a unilateral or bilateral testicle removal and for cosmetic reasons, Dr. Elist places an artificial testis in the scrotum of a patient. The aesthetic results can positively affect the psychological well-being and self-confidence of men who have had a testicle removal for different reasons (e.g., undescended testis, testicular cancer, etc.)
Furthermore, Dr. Elist offers a unilateral or bilateral testicular implant placement for testicular and scrotal enhancement. The Silicone Testicular Implants consist of a medical degree soft silicone material, and are designed to enhance the size of an existing testicle.
The Silicone Testicular Implants serve to enhance the testicular size or to adjust the size of one testicle to the opposite site. Typical patients for the Silicone Testicular Implant are men who desire an overall aesthetic enhancement of their scrotum, who suffer from asymmetrical testicular size, or have undergone an orchiectomy with prosthesis placement and asymmetrical results.(Testicular Enhancement Surgery)
After adequate local anesthesia, an incision is made in the inguinal area and the empty scrotal sac is carefully dilated by passing a dissecting figure or a moist gauze sponge through the inguinal canal into the scrotal sac and the neck of the scrotum is closed by suturing. The inguinal incision is closed inlayers by suturing.
Insertion of uni or bilateral testicular prosthesis after testicle removal may sometimes result in an asymmetric scrotal appearance. In case of an asymmetric end result after testicle removal and prosthesis insertion, Dr. Elist will improve the scrotal appearance and symmetry using his patented Silicone Testicular Implants which if desired can simultaneously increase the testicular/scrotal size.