DECISION REGRET ABOUT TESTICULAR PROSTHESIS AFTER RADICAL ORCHIECTOMY: REAL-LIFE DATA TO IMPROVE PREOPERATIVE COUNSELLING

Patients treated with orchiectomy for testicular cancer (TC) might experience change in body image and reduced masculinity. For this reason, a testicular prosthesis (TP) can be placed at the same time of orchiectomy. Data is limited concerning regret about having or not placed the TP at the time of orchiectomy. We investigated postoperative patient-reported satisfaction and decision regret after orchiectomy with or without TP.

A retrospective analysis on 142 cN0M0 TC patients who underwent orchiectomy at two tertiary-referral academic centers between 01/2014 and 05/2024 was performed. Sociodemographic data and TC characteristics were collected. A TP was proposed in each case. Office-based visits or phone interviews were performed, and a decision regret scale was administered to each participant. Moreover, ad-hoc questions regarding the decision to place or not a TP and satisfaction with the implant and its characteristics were recorded. Descriptive statistics and logistic regression models described the whole cohort to identify predictors of decision regret.

Median (IQR) age at surgery was years 36 (28-43). Of 142, seminomas were found in 87 (61.3%) cases. Of all, 61 (43%) patients decided to have TP at the same time of orchiectomy. Median follow-up time was 60 months (40-80). Patients who had a TP more frequently reported that their decision was correct (p < 0.001), they had less regret (p = 0.01) and they will repeat the same choice (p = 0.02) as compared with those without TP. Patients without a TP more frequently reported that they miss the removed testicle and they feel ashamed about their body image (all p < 0.001) compared to men with a TP. Partner’s complaints about patient’s body image was more frequently reported in men without TP (p = 0.01). Multivariable logistic regression analysis showed that having a TP (OR 2.5, p < 0.01) was associated with less regret, after accounting for age and tumor stage. Only 8 (13.1%) men reported discomfort with TP.

Patients with a TP after orchiectomy experience high satisfaction, lower impact on body image, lower partner disappointment and less regret compared to those without TP. Preoperative counseling should be focused on long-term satisfaction with TP.

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