title: Outcomes with the "V" implantation technique vs. standard technique for testosterone pellet therapy.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  We sought to examine the impact of this technical modification on therapeutic efficacy and surgical complication rates.
  
  
  METHODS
  Retrospective chart review of all patients treated with testosterone pellets at our institution.
  
  
  METHODS
  Complication rates for infection, extrusion, hematoma, and pain.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  VT allows successful placement of larger number of pellets, with low rates of complications, especially extrusion, even in men on anticoagulants.
authors: Men's Health Boston, Beth Israel Deaconess Medical Center--Harvard University Medical School, Division of Urology, Boston, MA 02445, USA. wconners@bidmc.harvard.edu
authors: William
authors: W
authors: Conners
authors: Kevin
authors: K
authors: Flinn
authors: Abraham
authors: A
authors: Morgentaler
mesh_terms: D000728:Androgens / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D004343:Drug Implants / Q000008:administration & dosage; D006801:Humans; D007006:Hypogonadism / Q000188:drug therapy*; D055104:Infusions, Subcutaneous; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013223:Statistics as Topic; D013739:Testosterone / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000728:Androgens; D004343:Drug Implants; D013739:Testosterone