October 4, 2000

An Implant Story

This is the story of my experience having a testicular prosthesis implanted. The decision to have the surgery is personal. My only intention here is to provide people with a first-person account of what it?s like to have the procedure. This information cannot be found in a medical textbook, and your urologist will probably be unable to relate the specific day-to-day details of how testicular implant surgery heals. I wanted to provide a detailed and graphically explicit description of the procedure so that: 1) Those who were still deciding whether or not an implant is right for them could make an informed decision; and 2) Those who have already decided to go ahead with an implant could find out what the operation and recovery entails.

Introduction

Although I was not initially interested in an implant, over the course of the last few months I had slowly begun to change my mind. I began to research the subject of testicular implants at the university medical library. Around this time I discovered TCRC on the Internet, and I found the information here very useful. The feedback about implants however, tended to lean towards the negative side-- most men seemed disinterested in the procedure. This may be attributable to the fact that most of the men who spoke out on the subject of testicular implants, were either married or in long-term relationships, and perceived the surgery as unnecessary.

In contrast, as a sexually active gay male in my 20s, I often felt uncomfortable having only one testicle. The notion that one?s sexual partners "cannot tell if you only have one testicle" or "wouldn?t realize the difference" did not hold true in my case. As I learned more about implants, I became increasingly satisfied with the safety of the technology, and concluded that it was the right choice for me. Since I live in Canada, there was no problem finding a doctor who could perform the operation.

Initial Consultation

I booked an appointment with a urologist for an initial consultation. The doctor explained to me that he only performed the procedure every few years, because few men were interested in an implant. With the FDA ban in the United States, I suspect that less and less American urologists will have performed testicular implant surgery in the last few years.

Right away, I liked my urologist. He was very supportive of the fact that I had done my own research, and that I knew all about the operation. He was not the kind of doctor who is apprehensive about patients who know ?too much?. This would later prove important when it came to selecting the prosthesis.

Pre-operative Testing

I was given a surgery date a few weeks later, and I was sent to the hospital for my pre-operative testing. A nurse took routine blood and urine samples for blood sugar, red blood cell counts etc. I was given standard consent forms to sign, and the nurse went over the day surgery procedure. (At this particular hospital, testicular implants are done on a day surgery basis. Some hospitals might let you stay overnight, but I was frankly happy to go home the same day.)

I was sent down to the urology department where one of the urology residents examined me and took notes for the operation. I was unimpressed by the resident. He did not have my file in the examination room, and knew very little about the procedure. My real irritation with the resident came when I asked him about the implant product itself-- he was completely unfamiliar with what kind of implant was available in the hospital. At my insistence he checked with the senior urology resident and told me that the hospital used silicone implants.

Following the great suggestion of one contributor to the TCRC web site, and much to the annoyance of the resident, I asked to see the implant. One of the operating room nurses brought down the implant, which turned out to be Mentor Corporation?s silicone elastomer model. The product came sealed in a sterile clear plastic packaging which allowed me to see and feel the product through the plastic. Although I was sternly told that "this was the product used in this hospital," I was curious about the new saline implant from Mentor, and I insisted on finding out if it could be ordered.

I returned to my urologist?s office and asked him about saline implants, which he was not familiar with. He emphasized the safety of the solid-silicone elastomer product (which replaced the older silicone-gel filled implants), but was willing to use a saline filled product if it was available. As far as I understand it, the saline implant relies on an exterior shell made of silicone, so the two products are not that different. The only benefit behind the saline prosthesis, is that it feels more realistic when squeezed. (Although unless you?re into sado-masochism, I can?t imagine why you would have another person squeeze your testes!)

My urologist was willing to use the saline implant, but was concerned that it might not be covered by my insurance plan. In the end the saline model ended up costing $450, while the silicone elastomer model was $350 (Canadian dollars, purchased in Canada in 1999-- The price might vary depending on where and when you buy it). I was forced to pay the difference out of my pocket, but I didn?t mind.

The Surgery

Since the surgery was performed under a general anaesthetic, I did not eat or drink since the night before my surgery. I arrived at the hospital at 7:00 am and was taken to a change room where I put my clothes in a locker and changed into a hospital gown. From there I spoke briefly with a nurse who introduced me to one of the orderlies who found a bed for me. I hopped on the bed and was wheeled to the operating room. My bed was ?parked? in the hallway outside the operating room, where I was introduced to the anaesthesiologist who asked me if I wanted a general anaesthetic or a spinal that would freeze the lower half of my body. I made an on-the-spot decision and opted for the latter, because it would allow me to remain fully conscious throughout the operation. At this point the nurse who had shown me the implants a few days earlier, arrived and tossed a white shrink-wrapped box onto my bed, announcing, "This is it!" Unlike the silicone elastomer model, which comes in a clear plastic see-through packaging, the saline model comes ?deflated? in a cardboard box along with a special kit to fill the implant with a Sodium Chloride solution. I wasn?t actually able to see the saline prosthesis before it was implanted, but the nurse explained that it was more oval shaped than the silicone elastomer model which seemed more rounded.

I was wheeled in the operating room where the nurses started an IV on my left hand. The anaesthetist injected a series of needles into my lower back, and I started losing feeling in my legs. The nurses put up a screen to prevent me from seeing the operation, however, I was able to hear the entire operating room conversation.

The actual procedure involves shaving and sterilizing the skin on the scrotum; making an incision on the face of the scrotum; filling the ?deflated? implant with a saline solution; inserting it into the scrotum; securing the implant with an anchor; and finally closing up the opening with stitches. The whole procedure took about 20 minutes. Some of the urology textbooks I had read suggested making a diagonal incision across one side of the scrotum. My doctor went for a horizontal cut adjacent to the natural crease that runs square down the middle of the scrotum, because the scar disappears faster, and it naturally blends in better.

From the operating room I was wheeled to the recovery room, where I was fully awake and alert. At this point I was really glad I had chosen not to go under general anaesthetic, because I don?t like the loss of control and feeling of disorientation that accompanies general anaesthetics. (Something about waking up to find a surly nurse barking, "DO YOU KNOW WHERE YOU ARE?" and "YOU?RE IN THE RECOVERY ROOM!" to your face). It took about three hours for my legs and hips to unfreeze. I was then moved to a chair where I was given painkillers and some toast to eat. The nurses gave me an ice-pack to apply to the bandages. The urologist had covered the stitched up incision with ?steri-strips? and a thick clear plastic tape that resembled warehouse packaging-tape. The nurses in the recovery room were surprised to say the least, that my doctor had covered my scrotum with this thick tape. Ultimately, I thought it was a good choice because it kept the bleeding to a minimum. I was given a pair of disposal underwear for support, and by 2:00 pm I was ready to go home.

My only complaint about the hospital was their policy of not filling prescriptions for outpatients at the hospital pharmacy. I was forced to go from the hospital to a pharmacy near my house to fill the prescription for painkillers (ASA w/Codeine) and antibiotics to guard against infection. I would highly recommend getting the prescription from your doctor beforehand, and filling it before your surgery. The nurses explained that the hospital prefers to give patients prescriptions after surgery, because people sometimes fill them and start taking the medicine before their operation. I found this explanation ridiculous.

Recovery

At first I didn?t feel anything. I spent the afternoon of my surgery day talking on the phone to friends. By nightfall however, my scrotum had grown to the size of a large grapefruit and was covered with black, blue, and purple bruise marks. On a good note, because the surgery does not involve the penis, urination and ejaculation are unaffected by the surgery. (Although during the recovery you probably won?t feel too sexy, what with a grapefruit-sized purple scrotum and all!) I stuck to ?sponge baths? for the first two days, mostly cleaning up the sickly yellowish stain from the anti-infection agent from the operating room, that covered my genital area and my thighs. I followed the regimen of three antibiotic pills a day, plus painkillers, generally taking it easy. By day three I took my first regular shower, keeping my back to the spray, to avoid direct contact with my scrotum. I had taken the ?steri-strips? and tape off, so I was able to lightly wash the surgery area with water. That night, things got rough! The pubic hair that had been shaved for the surgery starting growing back on my scrotum which was already sensitive from the swelling. The resulting itchiness was sheer agony. I tried everything from Tylenol to Benedryl, skin moisturizers, talc powder, antibiotic ointment, even hydrocortisone cream! Nothing seemed to work. The only thing that brought relief was an abrasive skin scrub that I used to remove all the lotions and creams that I had used. From that point on, I sparingly used the abrasive skin scrub to control the itch.

By day four I was well enough to leave the house to see a movie, although I was still limping and walking strangely. Around day five, the itchiness subsided, but was quickly replaced by pain. The pain was more intense when I stood up or walked around. I quickly ran out of painkillers, so I was stuck taking Extra-Strength Tylenols. One a good note, I noticed that the swelling of my scrotum was slowly going down, and the skin was gradually returning to a healthy pinkish colour. I was also pleased that the skin on my scrotum was beginning to wrinkle again.

I was walking normally again around day eight. By day ten the swelling had gone down and things were going very well-- until the bleeding started! I soon discovered why my scrotum had swollen so much. It was full of blood from the operation! The blood started draining on day ten, and I was met with a steady flow of blood from the incision. My urologist assured me that this was ?old blood? and it was quite healthy that it was draining from my scrotum. I picked up a package of underwear liner pads from the adult incontinence section of the pharmacy to soak up the blood. It took care of the problem and by day fourteen the bleeding stopped. At this point, most of the bruising was gone and the skin on my scrotum was regaining its limber character. The distinct outline of each testicle was becoming more apparent as the fluid and swelling went away.

Follow-up

I resumed participation in sports (swimming, jogging, and weightlifting) three weeks after the operation without any problems. It?s been almost two months now since the surgery. Most of my pubic hair has grown back and the incision scar continues to fade. It?s not really noticeable unless you?re up close, so I am quite comfortable showering in public at the gym. The two testes are beginning to align nicely in my scrotum. (Most people aren?t perfectly ?balanced? in terms of symmetry anyway). I?m glad that my urologist made the incision down the middle crease of my scrotum, because the scar has blended in very well on account of the natural fold.

The only disappointment I have is the ?feel? of the saline implant. It is unquestionable harder than my real testicle. A good analogy would be the difference between a real plum or grape and ?plastic fruit?. Real produce is soft to the touch, while the fake stuff looks convincing, but is surprisingly stiff. This doesn?t really bother me too much, but some patients might find the artificial feeling unsettling, particularly since it might trigger associations with the toughness of tumour tissue. I?m not sure if filling the implant with less water would make the implant feel more realistic.

Overall though, I?m quite pleased with the results. I feel more sexually confident than I did before. Just last week I went to a sporting goods store and bought a Speedo swimsuit-- something I wouldn?t have felt comfortable wearing before. True, most people probably wouldn?t have noticed anything different, but I was always apprehensive. I?m glad I went through with the operation. If I had to do it over again, I would definitely go for an implant.


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