Decision Regret About Testicular Prosthesis After Radical Orchiectomy: Real-life Data to Improve Preoperative Patient Counseling

Background and objective: Patients undergoing orchiectomy for testicular cancer (TC) may have body image concerns, with a testicular prosthesis (TP) as a potential solution. Data on regret regarding synchronous TP placement are limited. We investigated postoperative patient-reported satisfaction and decision regret after unilateral orchiectomy for TC with or without synchronous TP placement. Methods: A retrospective analysis was conducted on 142 cN0M0 TC patients who underwent orchiectomy at two tertiary-referral academic centers between 2014 and 2023. A synchronous TP was proposed in all cases. In October 2024, patients completed a decision regret scale and questions on TP placement and satisfaction. Descriptive statistics and logistic regression were used for the analysis. Key findings and limitations: Sixty-one (43%) patients had synchronous TP placement. Patients with a TP more frequently reported that their decision was correct (p < 0.01), they had less regret (p = 0.01), and they would have repeated the same choice (p = 0.02). Patients without a TP more frequently reported that they were still missing the removed testicle and they felt ashamed about their body image (all p < 0.01). Partner's complaints about patient's body image were more common in men without a TP (p = 0.01). A multivariable analysis showed that TP placement (odds ratio 0.4, p = 0.03) was associated with less regret. This study may have selection biases, and larger, multicentric studies are needed. Conclusions and clinical implications: Patients with synchronous TP placement reported higher satisfaction, less negative body image, lower partner disappointment, and less regret than those without a TP. Preoperative counseling should emphasize long-term satisfaction with a TP.