COSMETIC ORCHIECTOMY

Surgical Technique that Meets Medical and Psychologic Needs of Patients with Advanced Prostatic Carcinoma REI K. CHIOU, M.D., PH.D. From the Department of Urological Surgery, University of Minnesota Hospital and Clinic and the Veterans Administration Medical Center, Minneapolis, Minnesota

hieetomy is the most reliable way androgen ablation, many men g negative feeling about the re:estes. 1,~ Herein, we report our exg a surgical technique that presmetie testis while achieving the gen deprivation. ~atient under local anesthesia, a otal incision is made, the tuniea ?ened, and the testis is delivered vound. A longitudinal incision is side of the testis opposite to the

epididymis. The testis tissue is then dissected from its capsule and the capsular vessels are fulgurated and severed (Fig. 1A). Dissection is carried down to the mediastinum testis, which is transected and the testis tissue is removed (Fig. 1B). Hemostatic sutures are applied to the stump using 3-0 Vicryl, continuous sutures. The testis is then restored using Teflon paste (Mentor Inc., Hingham, MA). The testicular capsule is closed using 3-0 Vicryl sutures but an opening is left for injection of the paste. Teflon paste is placed in a 10 cc syringe for injection. A

tic orchiectomy. (A) sticular tissue. (B) testis to remove tesis at attachment of d. (C) Injection of

~O~'O~Y / ]ULY1990 / VOLUMEXXXVI,NUMBER1

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surgery, but feels similar to a normal testi~ when palpated. Comment

FIGURE 2. Testisbefore (A) and after (B) cosmetic orchiectomy.

purse-string suture is applied to the opening around the tip of syringe and is tied after the paste has been injected (Fig. 1C). The volume is adjusted according to the size of testis. An average of 4.0 + 0.6 mL of Teflon paste is used to restore each testis. The wound is irrigated with antibiotic solution throughout the procedure. The tunica vaginalis and the scrotal wound are closed in layers (Fig. 2). We have performed cosmetic orchiectomy in 11 patients, all patients reported that they were satisfied with the cosmetic result of the surgery. The serum testosterone level was demonstrated to be at a castration level (range of 11 to 39 ng/ dL) after surgery in all 11 patients. After the surgery the testis is slightly smaller than before

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Cosmetic orchiectomy can achieve preserve, tion of the cosmetic testis while achieving tli~ goal of androgen deprivation. Drugs used f~ androgen deprivation have side effects aa~ their efficacy depends to a great extent on t ~ compliance of patients. Furthermore, vario~ degree of testis shrinkage is often observed j~ patients treated with medical orchiectorn~ Thus, the advantages of drugs are debatablei~ Migration of the Teflon particles is a theore~ cal concern. In a report on animal experimen(~ Malizia et al.3 indicated the possibility of Sy~ temic migration of Teflon particles after pe~ urethral injection. However, in a similar stu~ of vocal cord injection, which is less vascul~ no systemic migration was observed. 4 Furtl7 more, even when Teflon is injected in hig vascular areas, there have been no clinically! nificant complications related to Teflon partk migration. 5 Although patients should be i formed about the possibility of Teflon partil migration, the risk of using Teflon in a confin avaseular cavity such as a testis after intrac~ sular orchiectomy should be minimal. Veterans Administration Medical Cen~ 50 Irving Street, NI~ Washington, D.C. 20~ References 1. Trachtenberg J: Hormonal management of stage D ~ cinoma of the prostate, Urol C1in North Am 14:685 (1987)i 2. Pavone-Macaluso M, et al: Comparison of diethylstflb~t~ cyproterone acetate and medroxyprogesterone acetate in:i~ treatment of advanced prostatic cancer: final analysis of a ~ domized phase III trial of the European Organization f 0 r ~ search on Treatment of Cancer urological group, J Urol 136i~ (1986). 3. Malizia AA Jr, et ah Migration and granulomatous r e a ~ after periurethral injection of polytef (teflon), JAMA 251' ~ (1984). 4. Ellis JC, MeCaffrey TV, DeSanto LW, and Reiman HVi~ gration of teflon after vocal cord injection, Otolaryngol tt~ Neck Surg 96" 63 (1987). 5. Kaufman M, Lockhart JL, Sflverstein MJ, and Politan0~ Transurethral polytetrafluoroethylene (teflon) injection for ~$~ prostatectomy urinary incontinence, J Urol 132:463 (1984),

UROLOGY / JULY 1990 / VOLUME XXXVI, N u M B ~

Cosmetic orchiectomy. Surgical technique that meets medical and psychologic needs of patients with advanced prostatic carcinoma.

COSMETIC ORCHIECTOMY Surgical Technique that Meets Medical and Psychologic Needs of Patients with Advanced Prostatic Carcinoma REI K. CHIOU, M.D., PH...
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