Torção testicular: Técnica cirúrgica modificada para o implante intravaginal imediato de prótese testicular

Abstract

Torsion of the spermatic cord or testicular torsion is a urological emergency that annually affects approximately 4.5 per 100,000 men up to 25 years of age. The incidence of the disease is bimodal, usually occurring in the neonatal period and, more commonly, in the pubertal period. Treatment is surgical and should be performed as soon as possible, because when performed in a timely manner, there is distortion and rescue of the sprained organ and, when postponed, orchiectomy (surgical removal of the testicle) is the common outcome. Many doubts and uncertainties are related to the ideal treatment of testicular torsion and one of them is the definition of the best time for the implantation of testicular prosthesis. The aim of the study is to propose a new technique for the immediate intravaginal implant (at the same surgical time as the orchiectomy), to analyze and compare its results with those of the late implant. In addition, analyze the degree of patient satisfaction with the testicular implant. For this purpose, 25 patients were included and divided into 2 groups; fifteen patients underwent immediate implantation of the testicular prosthesis with the new technique proposed and 10 had the prosthesis implanted inguinally between 6 and 12 months after the orchiectomy. The implants used were donated by Silimed® and are characterized by silicone elastomers with smooth surface filled with silicone gel. In outpatient follow-up, which took place with a minimum of 4 consultations on the 15th, 45th, 90th and 180th postoperative days, the healing process was clinically classified according to the Southampton Wound Score System. At the end of the outpatient follow-up, patients answered a questionnaire to estimate the degree of satisfaction with the implants. For statistical analysis, the IBM SPSS program in version 2.0 was used. The T-student test was used for quantitative data analysis (p <0.05) and the chi-square test to analyze the associations between categorical variables between the groups of late and immediate implantation. The average age of the sample was 16.44 years and the average time between the onset of symptoms and orchiectomy was 7.92 days. On the 15th postoperative day, 72% of all patients had normal healing. On day 45, 88% of patients had normal healing. In the late implant group, there was 1 prosthesis extrusion 60 days after its placement and the patient was excluded from future statistical analyzes. With 90 days postoperatively, 95.8% of the patients had normal healing. At 180 days after implantation, all patients had normal healing. The study then demonstrated that the new surgical technique proposed for the implant was safe, that the degree of patient satisfaction is similar in both groups and that, even when the prosthesis is extruded, there is no condition that threatens the patient's life or that compromise the desire to have the prosthesis implanted again