Testicular prostheses in patients with testicular cancer - acceptance rate and patient satisfaction

Abstract

BackgroundThe loss of a testicle to cancer involves much emotional impact to young males. Little is known about the number of patients with testicular germ cell tumour (GCT) who would accept a testicular prosthesis. Also, knowledge about the satisfaction of implant recipients with the device is limited.MethodsA retrospective chart analysis was performed on 475 consecutive GCT patients. Prior to orchiectomy, all patients were offered prosthesis insertion. Acceptance of implant was noted along with age, clinical stage, histology and year of surgery. 171 implant recipients were interviewed using an 18 item questionnaire to analyze satisfaction with the prosthesis. Statistical analysis involved calculating proportions and 95% confidence intervals. Multivariate analysis was performed to look for interrelations between the various items of satisfaction with the implant.Results26.9% of the patients accepted a prosthesis. The acceptance rate was significantly higher in younger men. Over-all satisfaction with the implant was “very high” and “high” in 31.1% and 52.4%, respectively. 86% would decide again to have a prosthesis. Particular items of dis-satisfaction were: implant too firm (52.4%), shape inconvenient (15.4%), implant too small (23.8%), position too high (30.3%). Living with a permanent partner had no influence on patient ratings. Multivariate analysis disclosed numerous inter-relations between the particular items of satisfaction.ConclusionsMore than one quarter of GCT patients wish to have a testicular prosthesis. Over-all satisfaction with implants is high in more than 80% of patients. Thus, all patients undergoing surgery for GCT should be offered a testicular prosthesis. However, surgeons should be aware of specific items of dis-satisfaction, particularly shape, size and consistency of the implant and inconvenient high position of the implant within the scrotum. Appropriate preoperative counselling is paramount.Electronic supplementary materialThe online version of this article (doi:10.1186/s12894-015-0010-0) contains supplementary material, which is available to authorized users.

Testicular Cancer, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology

“…23 Concurrent insertion of testicular prosthesis may be considered during radical inguinal orchiectomy if desired by the patient. [24][25][26] In cases in which ultrasound shows an ambiguous abnormality that might be malignant, an open inguinal biopsy (testissparing surgery or partial orchiectomy) with intraoperative frozen section analysis can be performed, but such cases are extremely rare. Reflex orchiectomy is recommended in most circumstances should malignancy be detected.…”

Insertion of a testicular prosthesis at the time of radical orchiectomy for testicular cancer is safe in patients who will subsequently undergo chemotherapy or radiotherapy

“…Several authors reported high satisfaction rates in patients who had a testicular prosthesis. Patients usually perceive an implant at the time of surgery as extremely important (Adshead, Khoubehi, Wood, & Rustin, 2001; Dieckmann et al., 2015).…”

“…Size and positioning of the prosthesis deserve particular attention, in order not to generate complaints about a “too small” or “too high” prosthesis (Dieckmann et al., 2015): in fact, these conditions have been reported to be significantly associated with lesser patient satisfaction and regret about the decision to accept an implant (Yossepowitch, Aviv, Wainchwaig, & Baniel, 2011). Demonstrating the size pre‐operatively to the patient leads to a better satisfaction (Hayon et al., 2020).…”

“…Furthermore, the acceptance rates for testicular prostheses are quite low in the available series, ranging from 26% to 55% (Dieckmann et al., 2015; Robinson et al., 2016). This could be explained by selection in favour of young patients or small sample sizes (Dieckmann et al., 2015).…”

“…Despite of this, surprisingly, current TC international guidelines still do not clearly address the issue of prosthesis positioning at the time of orchiectomy (Dieckmann et al., 2015; EAU Guidelines. Edn.…”