An inadequately small testicular implant and a contralateral hyper-reflexic (yo-yo) testicle

Dr. Reed,  Have 2 testicle problems.  In 2009 had torsion on right and required an orchiectomy, lost my testicle.  A year later this was followed up insertion of an implant which appears too small vs. my left. My left testicle tends to withdraw into my body at times. Should these problems be handled with one operation or separately?  Phil

Dear Phil,

The choice is yours.  Certainly the best way to suggest proper symmetrical implant size is by an office visit.  If you disagree with my recommendations, I will listen to your ideas and if still cosmetically sensible will honor your request, but you take the responsibility for the outcome.

Many patients think big is better but if the upper pole of your implant is above the emergence of the base of your penis, this will interfere with penetration.  Overly large implants in general tend to dwarf the appearance of penile size.

I will sketch the outline of a recommend oval on cardboard and you can apply this over your scrotum, stand on front of a full length mirror, to see if this makes sense.

Our implant company takes 1 week to manufacture and send us a sterile
implant ready for surgery.  This means we need to receive a 50% deposit
to cover your surgery.  

The current standard of care when surgically treating testicular torsion is to pex or fix the uninvolved side with sutures at the lower pole and side.  If your left spermatic cord is long enough to permit the left testicle to lie at the bottom.  To prevent intermittent retraction I will expose and divide and remove a portion of the cremasteric muscle.  The is usually done with loupes (magnifying glasses) to prevent injury to the testicular artery, vein, nerves or vas deferens.  Do obtain a seminal analysis now for volume and count to obtain a pre-operative baseline.

Please advise,
Harold M. Reed, M.D.
The Reed Centre for Ambulatory Surgery | Miami

Testicles (Testes). Illustration of a cross section of the testImage result for spermatic cord 

Measurement (from wikipedia).

The volume of the testicle can be estimated by palpating it and comparing it to ellipsoids of known sizes. Another method is to use calipers (an orchidometer) or a ruler either on the person or on an ultrasound image to obtain the three measurements of the x, y, and z axes (length, depth and width). These measurements can then be used to calculate the volume, using the formula for the volume of an ellipsoid: 4/3 � (length/2) � (width/2) � (depth/2).

The dimensions of the average adult testicle are up to 2 inches long, 0.8 inches in breadth, and 1.2 inches in height (5 � 2 � 3 cm).


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