Men's Health Boston, Beth Israel Deaconess Medical Center--Harvard University Medical School, Division of Urology, Boston, MA 02445, USA.
J Sex Med. 2011 Dec;8(12):3465-70. doi: 10.1111/j.1743-6109.2011.02441.x. Epub 2011 Aug 24.
Standard technique (ST) for implantation of testosterone pellets involves making a single linear track in the subcutaneous tissue of the buttock from the incision. After our initial experience with this modality, we modified this surgical technique to our current "V" technique (VT). This involves two tracks both caudally directed and emanating from the same skin incision but angulated approximately 10-15 degrees apart. While this allows additional pellets to be inserted more easily, and increased space to place those pellets further from the skin incision, it minimally increases the surgical procedure.
We sought to examine the impact of this technical modification on therapeutic efficacy and surgical complication rates.
Retrospective chart review of all patients treated with testosterone pellets at our institution.
Complication rates for infection, extrusion, hematoma, and pain.
One hundred sixty-eight patients underwent 281 implantation procedures (40 via ST and 241 via VT). The mode number of pellets used with ST was 8 (range 6-8) and with VT was 10 (range 10-13). Incidence of pellet extrusion was 7.5% with ST and 0.8% with VT. Infection complicated ST in 5% of cases but only 1.2% with VT. No cases of hematoma were seen with ST but 1.2% of VT cases. Pain prompting discontinuation of therapy was seen in 7.5% with ST and 1.7% with VT. Significant pain without discontinuation was seen in 5% with ST and 1.2% with VT. Only in 1 of the 3 cases of hematoma was the individual on blood thinners. Fifty-eight other insertions were performed on blood thinners without significant hematoma. None of the individuals who developed infection or bleeding required additional surgical therapy.
VT allows successful placement of larger number of pellets, with low rates of complications, especially extrusion, even in men on anticoagulants.
植入睾丸激素丸的标准技术（ST）涉及在臀部的皮下组织从切口处制造一条单一的线性轨道。在我们最初使用这种方式的经验之后，我们将这种手术技术修改为我们目前的“V”技术（VT）。这涉及两条轨道，都向尾部方向延伸，从同一皮肤切口发出，但角度相差约 10-15 度。虽然这允许更容易地插入更多的丸剂，并为那些丸剂提供更大的空间远离皮肤切口，但它最小化地增加了手术程序。
我们旨在研究这种技术修改对治疗效果和手术并发症发生率的影响。
回顾性分析我院所有接受睾丸激素丸治疗的患者的病历。
感染、排出、血肿和疼痛的并发症发生率。
168 例患者进行了 281 次植入手术（40 次采用 ST，241 次采用 VT）。ST 采用的丸剂数量模式为 8（范围 6-8），VT 为 10（范围 10-13）。ST 组的丸剂排出发生率为 7.5%，VT 组为 0.8%。ST 组感染并发症发生率为 5%，VT 组为 1.2%。ST 组无血肿病例，但 VT 组有 1.2%的病例出现血肿。因疼痛而停止治疗的病例在 ST 组为 7.5%，VT 组为 1.7%。ST 组有 5%的病例出现明显疼痛但未停止治疗，VT 组有 1.2%的病例出现疼痛。只有在 3 例血肿中，个体正在服用血液稀释剂。在没有明显血肿的情况下，对 58 名其他接受插入术的个体使用血液稀释剂。感染或出血的个体均无需进一步手术治疗。
VT 允许成功放置更多数量的丸剂，并发症发生率低，特别是排出率低，即使在服用抗凝剂的男性中也是如此。
