Rupture of silicone gel filled testicular prosthesis: Causes, diagnostic modalities and treatment of a rare event

Purpose: Rupture of the envelope of silicone gel filled testicular prosthes es is rare and alleged to be unlikely without intraoperative needle punctur e. We observed that it may be caused by chronic intermittent trauma or a si ngle acute increase of pressure, and report diagnostic and therapeutic moda lities. Materials and Methods: Four cases treated by us during the last 10 years ar e presented. One patient had testicular implants for Klinefelter's syndrome , whereas the other 3 had been treated for female-to-male transsexualism. D iagnosis was confirmed by ultrasonography and magnetic resonance imaging. T he fibrous capsule surrounding the ruptured prosthesis was left intact to a llow en bloc surgical extirpation. Histological evaluation of the resected specimen was performed. Results: Rupture of silicone gel filled testicular implants may be caused b y acute or chronic pressure without intraoperative needle puncture. Conclusions: Magnetic resonance imaging offers superior diagnostic accuracy and should be regarded the gold standard in the evaluation of implant rupt ure. Ultrasonography is an acceptable alternative. In cases when gross symp toms of scrotal inflammation are lacking replacement of implants is facilit ated by the fibrous capsule that forms around any prosthesis. Transcapsular migration of silicone particles was observed even when the fibrous capsule was intact.