Growing up as a kid, you expect to find two jewels right where they belong down there. And about the size of small grapes. But did you know that 2% of boys at birth are missing a testicle? It’s just not there in the sac. Yup, undescended testicles are the most common genital birth defect. That means that quite a chunk of boys grow up dealing with this issue.
Urologists are very good at finding undescended testicles wherever they reside north of the scrotum, and bringing them down to where they belong. A couple of hours of surgery on the little guy and its all fixed. But, sometimes there is no testicle found (the so called ‘vanishing testis’) or it is too small or unable to be brought down, and so it is removed (as they are prone to cancer if left up high). And then there is one, or even none, in some cases.
I recently talked with the parents of a school-aged boy and they raised a great question: Do you, and when do you, restore the “normal” look of the scrotum in boys and teenagers who are missing testicles? Examine the FDA approved testis implants that we designed, and you will see that implant sizes fit boys of all ages, before puberty, during puberty or teenagers after puberty. So, it’s possible to place implants at any time in their lives.
A Pair of Pears
Whether implants should be placed is really up to the parents and the child. After all, it is a surgical procedure that has minor risks attached to it. But when to place these little puppies is an equally important consideration.
We know that adult men who received testis implants feel better about themselves. In fact, using validated self-esteem measures, they experience real and significant quality of life improvement after implants are placed.
However, we know very little about whether the lives of prepubertal boys are measurably enriched with implants. And the same is true for teenagers. One has to assume that there would be some quality of life benefit in teens, as self-awareness levels go through the roof during puberty. But mix this into the cauldron of everything else that goes on as teens learn to manage their bigger bodies, and the effect is unclear at best.
Another consideration when discussing testis implants in boys and teens is the fact that during those seemingly-endless-couple-of-years called puberty, testicles grow rapidly from the size of small grapes to that of eggs. In fact, the rapid increase in testicle size is a known early sign of puberty. So, given that matching implant size to that of the native testicle is an important principle of prosthesis surgery, do you place, and then replace, implants at ever increasing sizes before, during and after puberty? Or, do you wait until puberty is finished and, in a single surgical procedure, place a full-on, egg-sized implant that is good to go for life?
I didn’t have hard answers for the parents of this boy. I did suggest, however, that they listen to their boy’s concerns and include them in any decision about whether and when to add a matching jewel to the corner pocket.