Complications of testicular prosthetics: analysis of causes, surgical tactics, ways of prevention

Abstract

Background. Testicular prosthetics, despite the apparent simplicity of the technique of performing the operation, often leads to complications. At the same time, the spread of data from different authors on the frequency and structure of complications is extremely large. At the same time, the factors indicated by the authors as the causes of complications often contradict each other, and, as a rule, are not analyzed, therefore, methods of prevention and therapeutic tactics are not clearly defined today.Aim. To analyze the frequency and structure of complications during testicular prosthetics in patients over 18 years of age and adolescent children, as well as to suggest optimal ways to prevent the identified complications.Materials and methods. The results of testicular prosthetics were analyzed in 292 patients aged 12–59 years in the period 2007–2022. Various complications were found in 27 patients (9.24 %), including in the adolescent group (12–17 years) – in 13 (8.33 %) patients out of 156, in adults – in 14 (10.29 %) out of 136. MIT implants were used in 116 cases (adults – 54, adolescents – 62) and Promedon implants – in 176 cases (adults – 80, adolescents – 96). Data processing was carried out in the Statistica 20.0 program. The p <0.05 level was considered statistically significant.Results. The most common complications include implant extrusion (22.2 %) and surgical hemostasis disorders (29.6 %), they are also the most difficult to correct and often lead to the need to remove the implant. The use of antibacterial therapy by the course does not reduce the risk of complications, the absence of antibiotic prophylaxis increases the incidence of complications by 3.9 % in the adult group and by 2.28 % in the adolescent group. The most rational single perioperative antibiotic prophylaxis. The frequency of complications when using MIT implants is higher (n = 17) than Promedon (n = 10). The incidence of complications is significantly higher in the group of patients who underwent prosthetics for more than three years after primary orchectomy or in an initially hypoplasized scrotum.Conclusion. Complications of testicular prosthetics are 8.33–10.29 %. The structure is dominated by complications of hemostasis and implant extrusion, they are also the cause of the greatest number of repeated interventions and the reason for the removal of the implant. A number of factors influence the formation of complications – access, the scheme of antibacterial therapy/prevention, the implantable material, the period after the initial operation. The most rational is the use of a modern silicone implant for prosthetics 6–12 months after orchectomy with suprascrotal access with a single perioperative antibiotic prophylaxis. The risk of the most dangerous and frequent complications can be leveled by using preventive measures.