RU2231300C2 - Method for testicular prosthetics at monarchism and anarchism - Google Patents

Abstract

FIELD: medicine, endoprosthetics, urology.

SUBSTANCE: one should preapply a dissector onto corrected scrotal half from its lateral side. For the depth between scrotal skin and flashy membrane one should perform scrotal puncture to introduce sterile hydrogel PAAG of 6 density degree.

EFFECT: lower traumaticity.

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Description

The invention relates to medicine, namely to endoprosthetics in urology, and will find wide application for the correction of the symptom of “empty scrotum”.

The absence of a testicle in the scrotum occurs in 2% of full-term, 20% of premature infants and 1% of boys 1 year old. In more than 60% of cases, a testicle that does not descend into the scrotum can be palpated, since it is located on the superficial inguinal ring. The reasons for the absence of the testicle in the scrotum are ectopy of the testicle, monorchism (congenital or acquired), anorchism and cryptorchidism (true and false). Cryptorchidism is the undescended testicle in the scrotum, monorchism is the absence of one testicle, and anorchism is the absence of two testicles.

Normally, both testicles are equal in density and size. In a newborn, the testicle is approximately 15 mm long and 10 mm wide. The length of the testis of an adult male is on average 3.8 cm, width - 2.5 cm. Their weight reaches 25-50 g, depending on the height of the man (J. Merth, 1998). The testicles produce androgens, male sex hormones that virilize the boy, that is, make him a man, and also produce male sex cells - sperm cells, without which a man cannot become a father. Thus, the healthy state of the testicles is a matter of paramount importance - any dysfunction of the testicles can lead to malfunction in the entire reproductive system of the body, including the penis.

The absence of one testicle can be a congenital defect, it can be the result of trauma or surgery for some diseases. If necessary, after removal of the testicle, the empty space can be filled with a prosthesis - an artificial testicle made of inert material and adjusted in size, weight and consistency to the rest.

Usually the prosthesis is harmless and outwardly no different from the testicle. Although prosthetics does not eliminate many of the problems associated sometimes with the loss of the ability to bear children, nevertheless, restoration of a normal appearance helps to improve the psychological well-being of a teenager or man.

In urological practice, a wide arsenal of tools has been developed to eliminate the defect of the “empty scrotum” that has arisen as a result of the congenital absence of the testicle in the scrotum, subcapsular orchiectomy or sex change. This includes the implantation of various testicular prostheses made from paraffin (Volpyan I.G., 1947), a foam sponge (Sayfutdinov R.A., 1968), silicone (Zuev Yu.E. et al., 1982 ), AKR-10 plastics (Mukhtarov A.M., Murvanidze D.D., 1988), silastika (Karpatovsky I.D., 1989). This prosthesis is harmless and looks no different from the testicle. Although prosthetics does not eliminate many of the problems associated sometimes with the loss of the ability to bear children, nevertheless, restoration of a normal appearance helps to improve the psychological well-being and social adaptation of a man. The time of abstinence after implantation is usually determined depending on the size of the edema and the degree of pain. However, due to its imperfection, the prostheses caused inflammation of the tissues, sequestered and rejected, which served as an impetus for the development of two other areas: prosthesis of the testis with body tissues and transplantation of the donor testicle.

The question of testicular transplantation arises as a result of their congenital absence and is resolved during puberty, which takes 15-16 years. It is necessary to increase the hormonal level of a man, his ability to have offspring. Only a person can become a testicular donor. The possibility of donation is justified in the case of the voluntary consent of the person or in case of need for his sex change.

In 1987, a Chinese surgeon, Jean Bint Ban, announced a testicular transplant operation three years ago at the International Transplantology Forum. Operations were performed on thirteen patients; by the time the essay was announced, the wife of one of the patients was pregnant. However, 11 patients underwent symptoms of rejection (reaction of the body's immune system to foreign tissues). Despite the fact that these symptoms have been eliminated with the help of drugs, further studies are needed to reduce the risk of rejection.

The method of testicular transplantation according to A.S. No. 1353427, 1987, by taking the organ and fixing it on the arteriovenous legs of both testicles, at the same time, the testes are transplanted with appendages and spermatic cord in both vaginal membranes. The disadvantages of this method: complexity, the need for a transplant, which limits its widespread use.

A method for testicular prosthetics after subcapsular orchiectomy according to A.S. No. 1671273, 1991, including exposure of the testicle, dissection of its albuminous membrane and removal of the parenchyma, forming a flap on the feeding leg from scrotum tissue, immersing it inside the cavity of the albumen, fixing it and suturing the incision of the albumen to the flap leg. The disadvantage of this method: trauma, the possibility of inflammatory postoperative complications.

Closest to the claimed method is a method for prosthetics of the testis for mono- and anarchism (Journal of Surgery, No. 11, 1990, pp. 108-111) by implanting endoprostheses of the testicles into the cavity of the scrotum. The prosthesis is a gel-filled shell made of silicone polymer in the form of a natural testicle, which is sewn through incisions in the inguinal region for a retaining pad to its own fascia at the bottom of the scrotum, after which the wound is sutured in layers. The disadvantages of the method: 1) the need for surgical intervention, 2) according to the experimental study of aging of silicone polymers in a living organism, the period of stability of testicular endoprostheses in the operated patients was determined to be 20-25 years. Therefore, patients operated on at the age of 12-22 years will need repeated surgical treatment, more traumatic, as it will be associated with the preliminary removal of old endoprostheses.

The objective of the invention is to simplify the method, reducing the morbidity.

The problem is solved in that a dissector is imposed on the corrected half of the scrotum on the lateral side, a puncture is made to the depth of the zone between the scrotum skin and the meaty membrane, through which sterile hydrophobic PAAG of the 6th degree is introduced.

A positive result achieved by using this method is to reduce trauma, the absence of side and systemic complications, a significant simplification, which allows prosthetics to be freely performed on an outpatient basis and to adjust the size of the prosthesis in accordance with age. The use of this method of treatment of mono- and anorchism allows achieving stable results and significantly improving the quality of life of the patient.

The biocompatible PAAG hydrogel (RF patent 2067873, 1996) is a bioinert material and is intended to correct cosmetic or functional defects by endoprosthetics. Over the past decade, it has been actively used in plastic surgery to correct the face, mammary glands and other parts of the body. In the available medical, scientific and patent literature, we have not come across a description of the use of PAAG for the treatment of mono- and anarchism. The use of a hydrogel of the 6th degree of density allows one to achieve the physiological shape of the testicle and the stable state of the scrotum after arthroplasty, and preliminary application to the scrotum from the lateral side of the dissector limits the zone of distribution of the hydrogel. The volume of gel administered depends on the age of the patient with anorchism and the volume of the opposite testicle with monorchism (usually 2.0-40 ml).

Indications for surgery is a symptom of an “empty scrotum”, resulting from:

- congenital absence of the testicle in the scrotum;

- castration after injury;

- sex change;

- castration in prostate cancer.

In order to establish a diagnosis of monorchism, in addition to palpation examination, the following are mandatory: abdominal echoscopy, contrasting of the testicular vein; according to indications - revision of the abdominal cavity.

There are no contraindications to hydrogel endoprosthetics in practically healthy people (Methodology for performing manipulations on the contour plasty of soft tissues with PAAG biogel, Moscow, 1996). Contraindications and examination are general surgical in nature of planned surgical interventions. In the process of recovery for two weeks, it is necessary to avoid physical exertion, for three weeks to refrain from sexual activity and masturbation. Follow the doctor’s instructions unconditionally. The efficiency of the method is confirmed by the following clinical examples.

Example 1

Patient Iv, 13 years old, medical history No. 8743/769, was admitted to the urology department with a diagnosis of congenital monorchism on the left.

Conducted laboratory and general clinical examination.

The prosthesis of the left testicle was performed with a PAAG hydrogel. The operation was performed in a small operating room in compliance with all the rules of asepsis and antiseptics. The patient's position is horizontal. After processing the scrotum with a solution of chlorhexidine, anesthesia was performed - blockage of the spermatic cord according to the method of A.V. 0.25% solution of novocaine. A dissector is placed on the left side of the scrotum from the lateral side until the scrotum tissue is squeezed slightly. An injection needle from an injection gun (STORZ firm) is inserted from below into the scrotum area bounded by the dissector to the depth of the zone between the scrotum skin and the meaty membrane (about 8 mm). An injection gun is attached to the needle with a syringe (STORZ company) filled with sterile PAAG hydrogel of the 6th degree of density in a volume equal to the volume of the right testicle - about 10 ml. After the complete introduction of the hydrogel, the needle is removed, the injection site is sealed with a bactericidal patch, the dissector is removed. The patient was discharged on the second day, it is recommended to wear a bandage during the week. No complications were observed. Control examination after 6 and 12 months did not reveal changes in the size and consistency of the prosthetic testicle, there were no complaints, sexual development was age-appropriate.

Example 2

Patient Kev, 24 years old, medical history No. 9500/833. Received an outpatient examination and treatment for castration of the right testicle due to trauma resulting from a wound. The prosthesis of the right testicle was made according to the claimed method. 30 ml of PAAG hydrogel of the 6th degree of density was introduced, the injection site was sealed with a bactericidal patch and it was recommended that the patient wear a fixative bandage and abstain from sexual activity for 2-3 weeks. On examination after a week, there are no complaints and complications. Control examination after 6 and 12 months did not reveal changes in the size and consistency of the prosthetic testicle. No complications were found, the patient was pleased with the result, performed full-fledged sexual acts, without experiencing difficulties. The emotional state is good.

Our proposed testicular prosthesis for monorchism and anorchism was used in 11 patients aged 12 to 28 years. Observation of patients for 2.5 years did not reveal complications. Patient complaints were not presented, the result of prosthetics was satisfied. There was a restoration of the psychoemotional sphere of patients, an increase in working capacity, contributing to social adaptation. Observation of patients allowed us to conclude on the reliability and feasibility of widespread use of the proposed method.

Thus, the claimed method is the most effective in comparison with the known and gives good immediate and long-term results. The advantages of the testicular prosthesis with PAAG hydrogel according to the claimed method are as follows:

- the technique is distinguished by comparative ease of implementation, non-invasiveness, lack of need for hospitalization of the patient;

- A good and stable cosmetic effect is achieved;

- the psychosocial adaptation and quality of life of patients improves, regardless of their age.

This method can be widely implemented in clinical practice.

Claims (1)

A method of testicular prosthetics for monorchism and anorchism by implanting an endoprosthesis into the scrotum cavity, characterized in that a dissector is applied to the corrected half of the scrotum from the lateral side, and the scrotum is punctured to the depth of the zone between the scrotum skin and the meaty membrane, through which sterile hydrophobic PAAG 6- is introduced. th degree of density.