Abstract
Objectives
Bilateral extracapsular or total orchiectomy (BEO) for prostate cancer is presumed to have psychological consequences after the surgery due to perception of an empty scrotum. Bilateral subcapsular orchiectomy (BSO) was designed to preserve perception of palpable testes. We compared the patients' satisfaction and genital perception following BEO and BSO.
Materials and methods
Prostate cancer patients eligible for androgen deprivation therapy who opted for orchiectomy were enrolled in prospective randomized study. Patients with bleeding disorder or uncorrected coagulopathy, poor performance score, and psychiatric problems were excluded. Outlook to life and own health in-general, overall satisfaction to the procedure and genital perception was evaluated using modified Fugl-Meyer questionnaire (FMQ) which was administered before and after 3 months of the surgery. Patients were randomized to BEO and BSO groups at the time of surgery using block randomization. Primary outcome was to compare the genital perception of testicular loss and patients’ satisfaction to BSO and BEO. Secondary outcomes included testosterone and PSA control, operative time, and complications.
Results
Total 35 patients were enrolled in each group which was comparable. There was no difference in PSA control at 3 months. Mean operative time and blood loss were significantly lesser in BEO group. FMQ score at 3 months did not show significant difference. Majority of the patients in both groups were satisfied with procedure and the aesthetic value of scrotum after surgery. However, 84% in BSO group did not feel that testes were removed on self-examination, as compared to 28% in BEO group. Majority patients in both groups did not report physical or psychological discomfort from change in scrotal content.
Conclusions
Results showed that patients’ satisfaction and genital perception following BSO and BEO were similar. Feeling of remaining intrascrotal contents after BSO did not had added psychological advantage in terms of perception of genitalia.
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Appendix 1: Modified Fugl-Meyer questionnaire
Appendix 1: Modified Fugl-Meyer questionnaire
Fugl-Meyer questionnaire: Part 1
Following questions are to be answered by the patients BEFORE AND AFTER the surgery (as instructed).
This is a two-part questionnaire. We want you to mark “X” on the number that best describes how you felt about yourself BEFORE surgery on each of the questions. Then once you are done, go over all the questions again and mark “O” on the number that best describes how you feel TODAY i.e. after the surgery. We understand that in some circumstances you might mark the same number in the response to how you feel before and after the surgery. The answers might look as below:
1 = Very dissatisfying |
2 = Dissatisfying |
3 = Rather dissatisfying |
4 = Rather satisfying |
5 = Satisfying |
6 = Very satisfying |
1. | My Life as a whole | 1 | 2 | 3 | 4 | 5 | 6 |
2. | My Sexual life | 1 | 2 | 3 | 4 | 5 | 6 |
3. | My partner relationship | 1 | 2 | 3 | 4 | 5 | 6 |
4. | My Family life | 1 | 2 | 3 | 4 | 5 | 6 |
5. | My Contacts with friends | 1 | 2 | 3 | 4 | 5 | 6 |
6. | My Leisure situation | 1 | 2 | 3 | 4 | 5 | 6 |
7. | My Vocational situation | 1 | 2 | 3 | 4 | 5 | 6 |
8. | My Financial situation | 1 | 2 | 3 | 4 | 5 | 6 |
Fugl-Meyer questionnaire: Part 2
Following questions to be answered by the patients AFTER the surgery:
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1.
How would you grade the appearance of scrotum for its aesthetic value (appearance to yourself)? Satisfied/Neutral/Dissatisfied
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2.
After the surgery, on self examination, do you feel that your testes have been removed? Yes/Maybe/No
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3.
After the surgery, has the change in scrotal content caused any physical discomfort? Yes/Maybe/No
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4.
After the surgery, has the change in scrotal content caused any psychological discomfort? Yes/Maybe/No
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5.
After the surgery, has there been any change in your masculinity? Yes/Maybe/No
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6.
Has the surgery affected your sexual performance? Yes/Maybe/No
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7.
How satisfied are you with this procedure? Satisfied/Neutral/Dissatisfied
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8.
If you were given a choice, would you select the same procedure again? Yes/Maybe/No
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9.
Would you recommend this procedure to other patients/family members/friends with same illness? Yes/Maybe/No
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Singh, O., Mukherjee, P., Sakthivel, M.S. et al. Satisfaction and genital perception after orchiectomy for prostate cancer: does the technique matter? A randomized trial. Int Urol Nephrol 53, 1583–1589 (2021). https://doi.org/10.1007/s11255-021-02849-z
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DOI: https://doi.org/10.1007/s11255-021-02849-z