021 Characterization of Patient Attitudes Towards Testicular Prosthesis Placement after Orchiectomy

Abstract

Orchiectomy is standard of care for testicular cancer (TC) and emergent conditions including testicular torsion. Testicular prosthesis placement (TPP) is an option for patients following orchiectomy to mitigate psychosocial burden and return normal quality of life. Limited data exist regarding patient attitudes towards TPP. To our knowledge, only one prior study investigated patient satisfaction with TPP in the USA1. Existing literature focuses on implantation within a urologic oncology context with minimal data regarding patient attitudes towards TPP for benign indications2. To characterize patient experiences with TPP, rationale for pursuing/declining TPP and satisfaction levels. Patients were identified in the urology department at a large academic institution through an IRB approved protocol. All patients with a history of orchiectomy were included. Patients were sent an anonymous 23 question survey via Survey Monkey. Questions addressed demographics, counseling, attitudes towards TPP, satisfaction rates and post-operative complications. A total of 45 patients responded and were included. Of these, 73% (33/45) underwent orchiectomy for TC and 5 of the remaining 12 for emergent indications; 60% (27/45) were counseled by their surgeon about TPP, and 60% (27/45) declined TPP prior to orchiectomy. Reasons for declining TPP included cost (3/27, 11%), risk of complications (7/27, 26%) and limited concern for cosmetic changes for others (17/27, 63%) and self (15/27, 56%). 40% (2/5) undergoing emergent orchiectomy felt they were not adequately counseled about TPP and therefore chose to not receive an implant. A total of 13 / 45 patients received TPP (2 after orchiectomy for testicular pain or injury, and 8 after TC). 69% (9/13) indicated that their surgeon was their first line source of information regarding TPP. 30% (4/13) received information from auxiliary sources including the internet prior to discussing TPP with surgeons. 9/13 patients had TPP at orchiectomy. Leading reasons for TPP included adequate counseling by surgeons and cosmetic appearance. Patients receiving TPP did not experience complications following implantation. Although 77% (10/13) were satisfied with TPP, they did highlight areas for improvement. 15% (2/13) felt their implant was positioned too high, 46% (6/13) felt their implant was too firm, 7.6% (1/13) felt it was uncomfortable during sex and 23% (3/13) felt that TPP did not match their size expectations. Despite these findings, 69% (9/13) reported that they would have TPP again and 77% (10/13) would recommend TPP.