Department of Urology, Christian Medical College and Hospital, Vellore, Tamil Nadu, 632004, India.
Consultant Department of Urology and Renal Transplantation, Shrimann Superspeciality Hospital, Jalandhar, 144012, India.
Int Urol Nephrol. 2021 Aug;53(8):1583-1589. doi: 10.1007/s11255-021-02849-z. Epub 2021 Apr 13.
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.
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.
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.
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.
由于对空阴囊的感知，前列腺癌患者行双侧囊外或全睾丸切除术（BEO）后，推测会产生心理后果。双侧睾丸被膜下切除术（BSO）旨在保留对可触及睾丸的感知。我们比较了 BEO 和 BSO 后患者的满意度和生殖器感知。
选择适合雄激素剥夺治疗且选择睾丸切除术的前列腺癌患者参加前瞻性随机研究。排除有出血障碍或未纠正的凝血障碍、表现评分差和精神问题的患者。使用改良 Fugl-Meyer 问卷（FMQ）评估手术前 3 个月后的生活前景和一般健康状况、对手术过程的总体满意度和生殖器感知。患者在手术时使用区组随机化分为 BEO 和 BSO 组。主要结局是比较睾丸丧失的生殖器感知和患者对 BSO 和 BEO 的满意度。次要结局包括睾酮和 PSA 控制、手术时间和并发症。
每组各有 35 例患者入组，两组具有可比性。3 个月时 PSA 控制无差异。BEO 组的平均手术时间和失血量明显较少。3 个月时 FMQ 评分无显著差异。两组大多数患者对手术过程和手术后阴囊的美学价值感到满意。然而，与 BEO 组的 28%相比，BSO 组有 84%的患者在自我检查时感觉不到睾丸被切除。两组大多数患者均未报告因阴囊内容物改变而出现身体或心理不适。
结果表明，BSO 和 BEO 后患者的满意度和生殖器感知相似。BSO 后残留的鞘内内容物感觉并未在生殖器感知方面带来额外的心理优势。
