The application of polypropylene mesh for testicular prosthesis in surgical castration for patients with prostate cancer

The testicular prosthesis was made of a polypropylene mesh provided by China Holycon Medical Supplies Co. Ltd. (Nantong, Jiangsu; patent name: testicular prosthesis, patent no.: ZL 201320681687.0, patent owner: Yongqiang Xia). This prosthesis was used in clinical practice after the approval of the Ethics Committee of the Central Hospital of Zaozhuang Mining Group of Shandong Province. Families of the patients were informed that the polypropylene mesh testicular prosthesis is not a testicular prosthesis certified by the China Food and Drug Administration, but a scrotum filling material made of medical materials, and the purpose of the implantation is to maintain the male self-esteem. Written informed consent was obtained from all patients.

Patients were laid in the supine position. General disinfection was performed, and surgical drapes were placed on the lower abdomen and scrotum. After the success of systemic or local anesthesia, palpation was performed to determine the size, shape, and texture of the testis and epididymis. The testis was adjusted to facilitate its free exterior edge to be the operative field, and the epididymis was placed in the deep part of the testis. The epididymis and testis were fixed by the left hand of the surgeon, while the assistant helped tighten the skin of the scrotum, in order to expose the incision of each layer. The skin and dartos coat were cut by the surgeon with a knife using his right hand. Next, the fascia spermatica externa, cremaster muscles, fascia spermatica interna, and tunica vaginalis of parietal layer were cut off layer by layer using an electrotome. Thus, the vaginal cavity was exposed, hydrocele and accessory calcium salt were removed, and iodophor disinfection was performed when necessary. Finally, the tunica vaginalis of the visceral layer and tunica albuginea were cut off. The polypropylene mesh testicular prostheses were previously produced with appropriate shapes. The contents of the testis were removed with a scoring tooth or a surgical knife handle. When obvious active bleeding occurred on the inner surface of the tunica albuginea, only appropriate electrocautery was conducted, in order to protect the blood supply of the tunica albuginea. The pre-made polypropylene mesh testicular prosthesis was implanted, and the tunica albuginea was continuously sutured with absorbable 4–0 suture. The testicular prosthesis and epididymis were adjusted to a suitable position, and two to three radial incisions were made on the tunica vaginalis of the wall layer with an electric knife, where the testis was located in the center of the incisions. Next, adequate hemostasis was performed. Interrupted suture was performed on the fascia spermatica externa, cremasteric muscle, and fascia spermatica interna (with three stitches each). The skin of the scrotum and dartos coat was sutured for three stitches for each layer. No drainage was placed in the incisions, while incisions were not treated with pressurized bandage. The contralateral implantation was treated in the same way. The appearance of the testicular prosthesis is shown in Fig. 1a. The appearance after testicular evisceration is shown in Fig. 1b. The appearance of the testis after the tamponage of testicular prosthesis is shown in Fig. 2a. In addition, the appearance of the scrotum after testicular prosthesis implantation is shown in Fig. 2b.

The surgical procedures applied were the same as that in traditional orchiectomy.