Orchiectomy after torsion testis: Simultaneous prosthesis placement versus staged procedures

Abstract

Testicular torsion(TT) with unsalvageable testis has a significant psychosocial impact. Orchiectomy can be performed with optional testicular prosthesis(TP) placement, commonly deferred(dTP). Orchiectomy and simultaneous testicular prosthesis placement(sTP) may be a feasible and safe option and has been implemented in our department since 2018. The authors aim to perform a reflective analysis of the patient's experience and assess the feasibility, safety, and satisfaction of the sTP, by comparing it with the dTP. All patients with TT and unsalvageable testis submitted to orchiectomy were included in the study. An anonymous questionnaire assessed the patients' experience. Those submitted to orchiectomy and TP placement were divided in sTP and dTP groups and their clinical details, satisfaction and quality-of-life were analyzed and compared. Scrotal exploration due to TT was performed in 185 patients, 54 were submitted to orchiectomy and 37 placed a TP(17 sTP, 20 dTP). All dTP patients and 66.7% of those without TP, would prefer having a prosthesis placed at the time of the orchiectomy. No significant differences in clinical details and outcomes were found, except prosthesis position (higher in dTP, p=0.011) and operative time (13min longer in sTP, p=0.015). Both groups reported being satisfied with the prosthesis. Only one patient regretted placing a prosthesis(in dTP). The sTP approach is as safe and effective as dTP. The patients preferred the sTP, as it avoids a second operation and possibly by having a lower psychological impact. Level III.