新型中空硅橡胶睾丸假体移植术治疗睾丸缺失的临床体会(附13例报告)

目的 评价新型中空硅橡胶睾丸假体阴囊移植术治疗男性睾丸缺失临床应用的安全性和有效性.方法 2009年1月至2011年3月,临床选择13例睾丸缺失者行睾丸假体植入术,包括:前列腺癌睾丸去势术2例、睾丸癌根治术5例、1侧无睾症2例、双侧无睾症1例、睾丸扭转坏死1例、睾丸萎缩1例、女性假两性畸形1例.睾丸假体为国产中空硅橡胶假体,13例中有4例在睾丸切除同时进行假体植入,另9例植入时间在睾丸切除6个月后;假体均为硅橡胶材料,睾丸假体的大小根据患者阴囊可容纳的空间及对侧睾丸大小来选择.结果 13例术后无感染、出血等并发症发生.手术6个月后进行随访;所有病例对植入睾丸假体后的阴囊外观及大小感到非常满意;对植入假体的重量:7例感到非常满意,5例感到较满意.全组无假体破裂及排异反应病例.结论 新型中空硅橡胶睾丸假体阴囊移植术治疗男性睾丸缺失能满足患者外观及心理的需要,临床表明安全有效.但长期生活质量及并发症还需进一步观察,设计更舒适及有功能的缓释型睾丸假体还需进一步研究.     

睾丸聚丙烯网假体植入57例报告

目的:探讨睾丸缺失患者假体植入的最佳手术方案。方法:回顾性分析晚期前列腺癌患者53例,单侧睾丸扭转4例采取聚丙烯网假体植入的手术方法及结果。结果:57例患者均行聚丙烯网植入术,随诊患者对植入睾丸假体后的阴囊外观及大小感到满意,无阴囊血肿形成,无假体穿出皮肤发生,无假体感染取出发生,未发现移植后自身免疫性疾病发生。结论:睾丸缺失患者临床并不少见,该术式采取阴囊内填塞聚丙烯网假体植入,不仅取得良好的组织相容性,还保留阴囊外观,是一种易被患者接受的治疗方法。     

睾丸假体的研制与临床应用

对于先天或后天性的单侧或双侧睾丸缺失患者,往往需要睾丸假体植入而重塑男性性征.现临床上已研制出多种新型材料的睾丸假体和假体释放睾酮的新方式,同时临床植入术不断改进,大大降低了手术并发症,改善了男性性外观.本文就睾丸假体研制进展与临床应用等方面进行综述.     

硅酮睾丸假体(STP)植入术后的长期随访

1978～ 1998年行STP植入术 5 1次 ,其中经腹股沟切口 37次 ,经阴囊径路 14次。手术年龄 14 .3～ 5 5 .4岁 ,平均 2 2 .3岁。术后 3～ 11周内因局部并发症取出假体 3例 ,此 3例术前均有未缓解的睾丸扭转。通过问卷随访回复39例 (76 .5 % )。死亡 2例均与假体植入无关。随访时间 4周～ 2 0 .4年 ,平均10 .1年。结果 :除早期取出假体 3例外 ,局部组织硬化和假体移动各 1例 ,无严重并发症 ,移植体无任何副作用。97%的患者表示乐意接受此手术 ,38例表示如需行睾丸切除术愿再选择STP ,92 .5 %的患者评估美容效果良好。值得注意的是仅 6 4 %的患…     

睾丸扭转(附18例报告)

目的　总结睾丸扭转的诊治经验。　方法　回顾性分析 18例睾丸扭转患者的临床资料。 18例平均年龄 2 3岁 ,<2 5岁者占 83% ,左侧占 83%。发病至确诊时间 5h～ 4 0d ,10h以上者占 89%。　结果　早期误诊 15例。 4例隐睾扭转者行睾丸切除术 ;14例阴囊内睾丸扭转者中 ,11例 (79% )因睾丸坏死予以切除 ,3例手术复位者随访 6个月～ 3年 ,睾丸萎缩 1例。　结论　隐睾扭转应与腹股沟嵌顿疝和急腹症鉴别 ,阴囊内睾丸扭转应与睾丸炎及附睾炎鉴别。早期手术探查对提高睾丸存活率有重要意义     

睾丸扭转治疗方法的选择(附12例分析)

目的:探讨睾丸扭转发病时对治疗方法选择的意义。方法:对12例睾丸扭转的病人治疗方法及效果进行分析。结果与结论:睾丸扭转一旦确诊,其治疗目的是挽救睾丸。发病初期可试行手法复位;10h内扭转均应行睾丸扭转复位固定术,10～24h扭转复位的可行性尚存,大于24h者应行手术切除,不宜保留。     

睾丸良性占位性病变(附10例报告)

目的提高对睾丸良性占位病变的认识和诊疗水平。方法回顾分析10例睾丸良性占位临床资料。结果10例良性占位,其中6例肿块切除,4例睾丸切除,术后8例随访1年以上无复发。结论睾丸良性占位病变有一定的发病率,病史,体检及B超对本病的诊断十分重要,以避免不必要的睾丸切除。     

阴茎假体再次植入术原因分析与治疗体会(附8例报告)

目的 探讨因阴茎勃起功能障碍(ED)行可膨胀性阴茎假体植入术后,出现并发症而需再次手术的原因及治疗体会.方法 选择在本院行阴茎假体再次植入术的病人8例,病人均表现为阴茎假体功能失效,圆柱体无法充盈使阴茎达到半勃起状态,不能进行性交.本组8例患者,其中假体穿破阴茎头1例,假体大小不合适2例,机械故障5例.结果 8例患者再次手术后随访均取得良好的效果,术后阴茎勃起可以完成性交.结论 术前判断假体手术失败的原因,制定方案顺利取出假体,术中避免对假体的医源性损伤及严格无菌操作是再次手术成功的关键.     

睾丸扭转的诊断与治疗(附34例报告)

睾丸扭转临床并不少见，初诊时极易误诊为急性睾丸附睾炎或其他疾病，诊断不及时，常导致睾丸坏死或不可逆睾丸萎缩而被切除，进而给患者生理及心理造成较大影响，因此早期诊断和及时手术是关键，我院自1997年9月至2007年2月共收治睾丸扭转患者34例，总结报告如下。     

小儿睾丸肿瘤临床分析(附55例报告)

目的　总结小儿睾丸肿瘤的诊治经验。　方法　回顾分析 5 5例睾丸肿瘤的临床资料。患儿年龄 2个月～ 12岁。多以无痛性阴囊肿块就诊。其中卵黄囊瘤 2 5例 ,畸胎瘤 2 4例 ,淋巴瘤 2例 ,精原细胞瘤 1例 ,皮样囊肿 2例 ,淋巴管瘤 1例。　结果　 5 5例中获随访 31例 ,平均随访 3年。包括卵黄囊瘤 17例 ,其中Ⅰ期 9例 ,仅做高位精索切断睾丸切除术 ;Ⅳ期 1例及复发瘤 7例中的 3例经化疗及手术健康存活。畸胎瘤 14例 ,其中行保留睾丸的畸胎瘤摘除术 5例 ,恶性畸胎瘤 1例 ,均无瘤存活。　结论　卵黄囊瘤Ⅰ期宜行单纯睾丸切除术 ,Ⅱ～Ⅳ期应联合应用PVB(顺铂加长春新碱加博来霉素或足叶乙甙 )化疗方案。小部分畸胎瘤病例可行肿瘤摘除术而保留睾丸组织。     

Development and clinical application of a new testicular prosthesis

A new type of testicular prosthesis made of silastic with an elliptical shape to mimic a normal testis was developed by our team and submitted for patenting in China. The prosthesis was produced in different sizes to imitate the normal testis of the patient. To investigate the effects and safety of the testicular prosthesis, 20 patients receiving testicular prosthesis implantation were recruited for this study. Follow-up after 6 months revealed no complications in the patients. All the patients answered that they were satisfied with their body image and the position of the implants, 19 patients were satisfied with the size and 16 patients were satisfied with the weight. These results show that the testicular prosthesis used in this study can meet patient's expectations. Patients undergoing orchiectomy should be offered the option to receive a testicular prosthesis implantation. The dimensions and weight of the available prosthetic implants should be further addressed to improve patient satisfaction.     

The use of a suprascrotal or 'wink' incision for placing a testicular prosthesis

OBJECTIVE: To describe a suprascrotal technique of testicular prosthesis insertion that obviates the difficulties and complications associated with either the inguinal or scrotal approach, as although the insertion of a testicular prosthesis is common there are few reports of the various techniques of insertion, associated complication rates, and patient satisfaction. PATIENTS AND METHODS: Eight males (aged 14-26 years) who had had a previous orchidectomy, had a testicular prosthesis inserted using a suprascrotal incision. A 2-cm semilunar incision is made just above the scrotum, 2-3 cm lateral to the penis ('wink' incision). The prosthesis is inserted after developing the intrascrotal space with blunt dissection. All patients tolerated the procedure well and all were outpatient procedures. RESULTS: After a median follow-up of 12 months, all patients were satisfied with the aesthetics of the prosthesis. Incisions were hidden by pubic hair. There were no wound infections at the incision site, and no reports of any pain or discomfort associated with the prosthesis. CONCLUSION: The 'wink' incision is an attractive alternative for inserting a testicular prosthesis; the advantages of the suprascrotal approach include: (i) the incision is hidden by pubic hair; (ii) no difficult dissection through fibrotic tissue in patients who have had previous inguinal surgery; and (iii) avoidance of direct contact between the prosthesis and suture line, minimizing the risk of infection, erosion and postoperative pain, while maintaining a pouch of adequate size.     

Insertion of a testicular prosthesis at the time of radical orchiectomy for testicular cancer is safe in patients who will subsequently undergo chemotherapy or radiotherapy

We aimed to assess the incidence of prosthesis-related complications in patients who received a testicular prosthesis at the time of radical orchiectomy for testicular cancer and were then treated with chemotherapy (ChT) or radiotherapy (RT). We reviewed the records of the patients who underwent radical orchiectomy at our Institute since 1999; we also retrieved data from patients who underwent surgery elsewhere and then received ChT or RT at our Institution since 1999. We used the chi-square test to evaluate differences in the incidence of prosthesis-related complications between the groups. We retrieved the records of 587 patients; 393 had a testicular prosthesis implanted. Median follow-up was 57.7 months. One hundred thirty-eight patients (35.11%) received ChT, 129 RT (38.82%) and 10 (2.55%) both ChT and RT; of them, 6 (4.34%), 8 (6.20%) and 0 reported problems respectively. Seven (6.03%) of the 116 patients (29.52%) who had no further treatment had complications. The incidence of complications was not significantly different between patients who had no further treatment versus patients who underwent ChT (p = .75) or RT (p = .83). Testicular prosthesis insertion at the time of radical orchiectomy is safe even in patients subsequently undergoing ChT or RT.     

阴茎假体植入术的临床应用与手术技巧(附光盘)

阴茎勃起功能障碍患者在接受药物及其他保守治疗后仍不能获得满意勃起时,阴茎假体植入术是理想的选择。阴茎假体植入后,无论患者本人还是其性伴侣都有很高的性生活满意度。近年来,国内接受阴茎假体植入术的患者越来越多。本文主要介绍阴茎假体植入术的临床应用与手术技巧。     

新生儿睾丸扭转8例诊治分析

目的 探讨新生儿睾丸扭转临床特点及诊治方法.方法 回顾性分析我院近5年收治的8例睾丸扭转新生儿的临床资料并复习相关文献.结果 新生儿睾丸扭转共8例;年龄7h~8d;左侧3例,右侧5例;入院查体均发现阴囊肿大呈暗红色或黑紫色,内可及质硬包块,触痛阳性;超声检查示患睾增大、密度不均、血流信号减少或消失;均行阴囊探查术,术中均发现精索睾丸扭转并已坏死,7例行患睾切除;病理结果示睾丸大片出血坏死,5例择期行对侧睾丸固定术.所有患儿随诊3~12月,1例家长拒绝切除患睾的患儿3月时B超复查已经萎缩,超声检查均未发现对侧睾丸异常.结论 新生儿睾丸扭转的睾丸坏死率极高;当发现新生儿阴囊色泽改变、肿大触痛等改变,在不能除外睾丸扭转时应尽早行阴囊探查术.     

Nine cases of nonpalpable testicular mass: an incidental finding in a large scale ultrasonography survey

Objectives: Nonpalpable testicular masses are usually diagnosed during routine ultrasonography (US) examinations for other conditions. There are conflicting results on the final diagnosis and management of these lesions. In the present study we report the results of a large US series of 5104 patients on nonpalpable testicular masses and discuss the management of these patients. Methods: This retrospective observational study was performed in a secondary care military hospital. A total of 5104 patients underwent a US and 11 of them were diagnosed as having a nonpalpable testicular mass. These 11 patients also underwent magnetic resonance imaging (MRI). Two of them refused surgery and were excluded from the study. The remaining nine patients underwent intraoperative US‐guided localization and excisional biopsy of the non‐palpable testicular parenchymal mass. A radical orchiectomy was required in all of them. US and MRI findings, frozen and final pathology results were recorded. Results: The median age of study subjects was 24 years. The final pathology revealed a malign tumor in eight patients and an inflammatory mass in one patient. There were inconsistent results in four patients between frozen section analysis and final pathology. MRI improved the definition of the solid masses in all patients. Conclusions: MRI enhances the certainty of the diagnosis of malignity in nonpalpable testicular masses, particularly in conditions that generally can not be diagnosed with ultrasonography alone. Frozen section analysis is not an accredited method in diagnosing malign lesions in non‐palpable testicular masses.     

The clinical utility of testicular prosthesis placement in children with genital and testicular disorders

Testicular prosthesis placement is a useful important adjunctive reconstructive therapy for managing children with testicular loss or absence. Though these prostheses are functionless, experience has shown that they are extremely helpful in creating a more normal male body image and in preventing/relieving psychological stress in males with a missing testicle. With attention to details of implant technique, excellent cosmetic results can be anticipated in simulating a normal appearing scrotum.     

Radical inguinal orchidectomy: the gold standard for initial management of testicular cancer

Radical inguinal orchidectomy with division of the spermatic cord at the internal inguinal ring is the gold standard for diagnosis and local treatment of testicular malignancies. The technique is well established and described in detail in this paper, collating methods from various surgical textbooks and articles. We also discuss pre-operative considerations including fertility counselling and potential testicular prosthesis at time of orchidectomy, and the importance of contemplating differential diagnoses such as para-testicular sarcoma and primary testicular lymphoma (PTL) prior to performing radical orchidectomy (RO). The evidence and indications for new surgical techniques to treat local testicular malignancies are also described, including testis sparing surgery (TSS) and spermatic cord sparing orchidectomy.     

A case of complete testicular feminization: Laparoscopic orchiectomy and analysis of androgen receptor gene mutation

BACKGROUND: Analysis of an androgen receptor gene mutation and a bilateral laparoscopic orchiectomy were performed on a 19-year-old patient diagnosed as a case of complete testicular feminization. METHODS: DNA sequencing of an androgen receptor gene mutation and laparoscopic orchiectomy were performed. RESULTS: A novel point mutation substituting a proline residue (CCG) for a leucine residue (CTG) was observed in codon 892 of exon 8 in the hormone-binding domain of the androgen receptor gene. Bilateral intra-abdominal testes were resected uneventfully by means of laparoscopic orchiectomy. CONCLUSION: We conclude that genetic analysis of androgen receptor gene mutation is essential for diagnosis of teon and laparoscopic orchiectomy is a useful therapeutic alteration as a minimally invasive treatment.