Navid Roessler, Malte W Vetterlein, Tim A Ludwig, Roland Dahlem, Margit Fisch, Florian Janisch
Of 5579 records screened, 22 studies including 2320 patients were eligible. Overall satisfaction was reported in 11 studies (n = 817), with a pooled proportion of 84% (95% confidence interval [CI], 77%-88%). Decision regret was reported in 8 studies (n = 584), with a pooled proportion of 10% (95% CI, 7%-13%). Most patients perceived prosthesis characteristics as appropriate, including shape (83%, 95% CI, 73%-89%, n = 531), weight (86%, 95% CI, 75%-92%, n = 652), size (76%, 95% CI, 70%-82%, n = 777), and position (75%, 95% CI, 66%-83%, n = 788). However, only 58% reported appropriate prosthesis consistency (95% CI, 40%-74%, n = 626), with firmness frequently perceived as suboptimal. Reintervention rates and major complications appeared uncommon but were inconsistently reported. Evidence was limited by heterogeneous outcome definitions, incomplete follow-up, and lack of standardized patient reported outcomes.
INTRODUCTION: Testicular prosthesis (TP) implantation is widely used to restore scrotal appearance or as a part of gender-affirming surgery. This systematic review and meta-analysis aimed to synthesize contemporary evidence on outcomes following TP implantation and identify gaps in outcome reporting.
METHODS: In this prospectively registered review (CRD420261332293), MEDLINE, Web of Science, and Google Scholar were searched in March 2026 for studies reporting outcomes following TP implantation in cisgender and transgender populations. Primary outcomes were overall patient satisfaction and decision regret. Secondary outcomes included patient-reported prosthesis characteristics and reintervention rates. Pooled proportions were calculated using random-effects models, and risk of bias was assessed using the Risk of Bias in Non-randomized Studies-of Interventions tool.
RESULTS: Of 5579 records screened, 22 studies including 2320 patients were eligible. Overall satisfaction was reported in 11 studies (n = 817), with a pooled proportion of 84% (95% confidence interval [CI], 77%-88%). Decision regret was reported in 8 studies (n = 584), with a pooled proportion of 10% (95% CI, 7%-13%). Most patients perceived prosthesis characteristics as appropriate, including shape (83%, 95% CI, 73%-89%, n = 531), weight (86%, 95% CI, 75%-92%, n = 652), size (76%, 95% CI, 70%-82%, n = 777), and position (75%, 95% CI, 66%-83%, n = 788). However, only 58% reported appropriate prosthesis consistency (95% CI, 40%-74%, n = 626), with firmness frequently perceived as suboptimal. Reintervention rates and major complications appeared uncommon but were inconsistently reported. Evidence was limited by heterogeneous outcome definitions, incomplete follow-up, and lack of standardized patient reported outcomes.
DISCUSSION: Testicular prosthesis implantation results in high patient satisfaction and low decision regret. However, inconsistent reporting and lack of validated outcome measures highlight the need for standardized patient reported outcome measures and harmonized surgical outcome reporting to support evidence-based counseling and clinical decision-making.