Initial results for combined orchiectomy and prosthesis exchange for unsalvageable testicular torsion in adolescents: Description of intravaginal prosthesis placement at orchiectomy

Purpose: Historically the placement of testicular prosthesis during orchiectomy for torsion is delayed despite reports of safe prosthesis placement during mastectomy and orchiectomy for cancer as well as the removal of infected penile prostheses. We describe our experience with intravaginal testicular prosthesis at orchiectomy in adolescents with torsion. Materials and Methods: Consecutive pubertal patients undergoing exploration for torsion from 2010 to 2011 were offered orchiectomy with staged prosthesis or combined orchiectomy and prosthesis exchange for nonsalvageable testis. Through a midline scrotal incision the ipsilateral tunica vaginalis was opened, testis detorsed and contralateral orchiopexy performed. When verified as unviable, the ipsilateral spermatic cord was suture ligated within the tunica vaginalis and preplaced sutures secured the saline filled prosthesis in the tunica vaginalis. Patients were discharged home on the day of surgery with 5 days of oral antibiotics and narcotics. Demographic, surgical and postoperative measures were prospectively recorded. Results: Of 19 patients 6 had testes deemed salvageable at surgery with a median time to presentation of 6 hours (range 4 to 48) vs 96 (range 14 to 168, p = 0.002) in the 13 patients with nonsalvageable torsion. Of these patients 12 (median age 15 years, range 12 to 16) elected combined orchiectomy and prosthesis exchange. With a median followup of 4.8 months (range 1.5 to 16) there were no infectious complications or extrusions. Eleven (91.7%) patients had a symmetric appearing scrotum with the prosthesis located in a mid to dependent scrotal position. Conclusions: We demonstrate the feasibility of intravaginal prosthesis placement for immediate scrotal reconstruction in adolescents with nonsalvageable testicular torsion. Advantages of combined orchiectomy and prosthesis exchange include orthotopic prosthetic position, extra tunica vaginalis barrier layer and avoidance of a second anesthetic.