Phantom testis syndrome: prevalence, phenomenology and putative mechanisms

Abstract

Chronic phantom pain has been found in up to 78% of limb amputees and is a major complication of limb amputation. Less is known about phantom phenomena after the amputation of other, i.e. visceral, parts of the body. In a retrospective design, we identified 539 patients in whom one testis was removed between 1995 and 2005. The operative technique was a unilateral standard radical inguinal orchiectomy. The underlying pathology in all cases was a testicular germ cell tumour. All patients received a detailed questionnaire asking about the occurrence of phantom testis pain (pain felt in the removed testis), phantom testis sensations (non-painful sensations as if the removed testis was still intact) and hallucinations (illusionary perceptions on the removed testis). Furthermore, we asked about the occurrence and clinical presentation of pain before and after surgery and about pre-operative testicular pain. Out of 238 respondents, 125 patients (53%) reported any kind of phantom experience. The prevalence of phantom testis pain was 25% (60/238), non-painful phantom sensations 16% (37/238) and male gonad hallucinations 12% (28/238). Patients with phantom symptoms reported pre-operative pain in the removed testis more often than patients without phantom symptoms. This study presents first data on the clinical characteristics and possible mechanisms of the phantom testis syndrome after surgical removal of one testis.

Chronic Pain Has a Negative Impact on Sexuality in Testis Cancer Survivors

“…The questionnaire method itself may favor symptomatic patients, who are more likely to respond than asymptomatic patients, resulting in an overestimation of chronic pain and sexual dysfunction after testicular cancer treatment. With a view to similar results in a previous study (Sörös et al, 2003; Pühse et al, 2010) we are confident that the reported prevalence is not influenced by major selection bias. The best way to assess whether presurgical and postsurgical pain is confounding the patients' reporting is to carry out the survey at several time points before and after surgery and regularly during follow‐up.…”

“…The testis has rich visceral and somatosensory innervations, predisposing it for the development of pain and phantom sensations. Although the exact mechanisms of pain and phantom sensations after testicular amputation are unknown, we assume that plastic changes in the cortex with the loss of physiologic inhibition and hyperexcitability of the stump of the nerves are involved in the development of painful sensations after removal of the testis (Pühse et al, 2010). From neurophysiologic sight, an implanted testicular prothesis may interfere in this regard.…”

“…Chronic testicular pain disorders (ie, phantom testis syndrome are a frequent long‐term complication of testicular cancer treatment (Pühse et al, 2010). Chronic pain is suspected to impair sexual function and health.…”

Functional Expansion of Sensorimotor Representation and Structural Reorganization of Callosal Connections in Lower Limb Amputees

“…However, phantom sensations have also been reported after mastectomy (Staps et al, 1985;Björkman et al, 2008), testis resection (Pühse et al, 2010), teeth extraction (Marbach, 1978), eye enucleation (Sörös et al, 2003), and even surgical removal of internal organs (Dorpat, 1971;Arcadi, 1977;Ovesen et al, 1991).…”

Urogenital/pelvic pain in men

“…Puhse et al [14] published on 539 postorchidectomy patients operated on between 1995 and 2005. Out of 238 respondents, 53% reported a phantom experience, with a prevalence of phantom testis pain of 25%, nonpainful phantom sensations 16% and male gonad hallucinations 12%.…”