Testicular prosthesis: Patient satisfaction and sexual dysfunctions in testis cancer survivors

Abstract

Purpose: We studied patient satisfaction about sexual activity after prosthesis implantation using validated questionnaires with the aim to discover if testicular prosthesis could be responsible of sexual dysfunctions (erectile dysfunction or premature ejaculation). Materials and Methods: We evaluated a total of 67 men who underwent radical orchiectomy for testicular cancer and a silicon testicular prosthesis implantation from January 2008 to June 2014 at our Hospital. These patients completed 5 validated questionnaires the day before orchiectomy and 6 months after surgery: the International Index of Erectile Function 5 (IIEF5), the Premature Ejaculation Diagnostic Tool (PEDT), the Body Exposure during Sexual Activities Questionnaire (BESAQ), the Body-Esteem Scale and the Rosenberg SelfEsteem Scale. We also evaluated 6 months after surgery any defects of the prosthesis complained by the patients. Results: The questionnaires completed by patients didn't show statistically significant changes for erectile dysfunction (p > 0.05) and premature ejaculation (p > 0.05). On the contrary the psychological questionnaires showed statistically significant change for the BESAQ (p < 0.001) and the Body Esteem Scale (p < 0.001), but not for the Rosenberg Self-Esteem Scale (p > 0,05). A total of 15 patients (22.37%) were dissatisfied about the prosthesis: the most frequent complaint (8 patients; 11.94%) was that the prosthesis was firmer than the normal testis. Conclusions: Testicular prosthesis implantation is a safe surgical procedure that should be always proposed before orchiectomy for cancer of the testis. The defects complained by patients with testicular prosthesis are few, they don't influence sexual activity and they aren't able to cause erectile dysfunction or premature ejaculation. most important period of life for sexual activity. The find of being affected by cancer of the testis and the following loss of the testis from the scrotal sac after orchiectomy are both responsible of a great psychological trauma in these young men, as described in literature (3). The implantation of testicular prostheses could be the solution, but even if good aesthetic results can be obtained, the presence of an artificial testis can be cause of shame and loss of self confidence during sexual activity. Most of the papers in literature analyse patient satisfaction for testicular prosthesis just about aesthetic side (size, texture, weight, position), in our study, on the contrary, we studied patient satisfaction after prosthesis implantation about sexual activity using validated questionnaires with the aim to discover if testicular prosthesis could be responsible of any sexual dysfunction (erectile dysfunction or premature ejaculation). METHODSIn lieu of a formal ethics committee, the principles of the Helsinki Declaration were followed. A total of 95 men underwent radical orchiectomy for testicular cancer from

Erectile dysfunction in testicular cancer survivors: a meta-analysis of case-control studies

“…In TC patients, psychogenic ED was often underestimated by clinicians. Diagnosis of TC is 8 Arch Med Sci a threat for sexual activity and productivity in the period when sexuality is still very important, so depression is a normal reaction after diagnosis of TC. Alacacioglu et al examined the effects of depression in TC patients, and found that erectile function was significantly affected by depression [19].…”

“…The prevalence of erectile dysfunction (ED) varies from 10% to 40% in patients with TC, according to different investigations [4][5][6][7][8][9]. However, most of the previous studies were conducted without comparison of groups.…”

Scrotal reconstruction and testicular prosthetics

“…Although testicular prostheses have high patient satisfaction, they are not without issues. The most common somatic complications associated with testicular prosthetic surgery are infection (0.6–4%), chronic pain (1–3%), extrusion (3–8%), and hematoma (0.3–3%) ( 72 , 73 ). In terms of dissatisfaction, common complaints include abnormal perceived size of the prosthesis, firmness different than the normal testis, or implant migration to a higher location ( 73 ).…”

“…The most common somatic complications associated with testicular prosthetic surgery are infection (0.6–4%), chronic pain (1–3%), extrusion (3–8%), and hematoma (0.3–3%) ( 72 , 73 ). In terms of dissatisfaction, common complaints include abnormal perceived size of the prosthesis, firmness different than the normal testis, or implant migration to a higher location ( 73 ). Regardless, implantation of prostheses is associated with significant improvements in self-esteem using various validated questionnaires ( 73 , 74 ), and can be easily accomplished using a variety of techniques.…”

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

“…Most commonly, complications reported after a testicular prosthesis positioning are the following: extrusion (3%–8%); scrotal contraction (3%–5%); pain (1%–3%); hematoma (0.3%–3%); and infection (0.6%–2%) (Marshall, 1986). Patients main complaints regard prosthesis feel, size, weight and position (Catanzariti, Polito, & Polito, 2016; Clifford et al., 2018; Hayon et al., 2020). In patients who are potential candidates for ChT or RT after orchiectomy, the main concern is that prosthesis‐related complications may delay treatment.…”