Testicular prosthesis complications and satisfaction rates after gender affirming scrotoplasty

Liliana Guadagni¹, Marco Falcone^2,3,4, Lorenzo Cirigliano^2,5,*, Ilaria Ferro², Mirko Preto², Natalia Plamadeala², Martina Scavone², Emanuele Zupo², Paolo Gontero²
1 Urology Clinic, Santa Maria della Misericordia Hospital, University of Perugia, Department of Surgical and Biomedical Sciences, Perugia, Italy
2 Urology Clinic, A.O.U. “Città della Salute e della Scienza”, Molinette Hospital, University of Turin, Turin, Italy
3 Neurourology Clinic, A.O.U. “Città della Salute e della Scienza”, Unità Spinale Unipolare, Turin, Italy
4 Department of Urology, Biruni University School of Medicine, İstanbul, Turkey
5 Pediatric Urology Unit, A.O.U. “Città della Salute e della Scienza”, Regina Margherita Children’s Hospital, Turin, Italy
* Corresponding Author: Lorenzo Cirigliano. Email: email

Canadian Journal of Urology https://doi.org/10.32604/cju.2026.076284

Received 18 November 2025; Accepted 03 February 2026; Published online 06 March 2026

Abstract

Background: Testicular prosthesis implantation (TPI) is frequently performed as part of masculinizing genital gender-affirming surgery (GGAS), but complication and satisfaction data for assigned female at birth (AFAB) men remain limited. We report a single-centre experience assessing postoperative complications, explantation-free survival (EFS) and patient-reported satisfaction. Methods: We conducted a retrospective cohort study including all patients who underwent unilateral or bilateral transmasculine TPI (TM-TPI) from May 2007 to April 2025. Primary outcomes were postoperative complications (e.g., surgical-site infection, contamination, hematoma, migration, pain, extrusion) and EFS rate. Satisfaction was measured at 12 months using the 13-item Transmasculine Testicular Prosthesis Satisfaction Index (TM-TPSI), a questionnaire tool developed for this cohort. Results: Forty-four patients (mean age 40 ± 10 years) received solid silicone prostheses; median follow-up was 84.5 (IQR 65.3–95.0) months. Complications included superficial surgical-site infection in 8/44 (18%), one prosthesis contamination requiring removal, one extrusion requiring replacement, and one migration requiring repositioning (2%). Mean time to explant/reposition was 57.7 ± 61.5 months; the 5-year EFS rate was 97%. Of 41 respondents to the TM-TPSI, 84% were “mostly satisfied” or “more satisfied than unsatisfied”; the mean score was 46.0 ± 10.5. Conclusions: In this cohort, TM-TPI showed a low rate of surgical revisions and high patient-reported satisfaction over long-term follow-up. Multicentre studies and formal validation of the TM-TPSI are warranted to refine benchmarks and enable cross-cohort comparisons. TM-TPI is a procedure that needs to be further investigated with clear specificity for AFAB men.