Surgical techniques in the treatment of testicular carcinoma are involving to improve efficacy and decrease morbidity in order to limit the incidence of post-operative ejaculatory dysfunction in patients after retroperitoneal lymph node dissection. Techniques to spare the postganglionic lumbar sympathetic fibers have been developed and applied. Initially, these techniques were used in patients with low stage disease with excellent results. Since 1988, a highly selected subset of patients who initially received chemotherapy for metastatic disease have undergone post chemotherapy retroperitoneal lymph dissection using nerve sparring techniques in an attempt to preserve post-operative ejaculatory function. Between March of 1998 and January of 1995, 20% of patients undergoing post-chemo therapy RPLND at Indiana University underwent nerve sparing procedures. Of these 93 patients, 2 died within six months, and 10 were lost to follow-up. The remaining patients were followed for a mean period of thirty-six months with a minimum of 12 months. Sixty-two of these patients (76.5%) report normal ejaculatory function. There had been no retroperitoneal recurrences in these patients. The careful application of nerve sparing techniques to a well selected population of patients undergoing post-chemotherapy RPLND is effective in preserving emission and ejaculation without compromising efficacy of the treatment. In addition to selecting patients with relatively low volume, predominately unilateral retroperitoneal disease, other fertility concerns in the population must also be considered in selecting patients for this approach.
|Original language||English (US)|
|Number of pages||1|
|Journal||British Journal of Urology|
|Issue number||SUPPL. 2|
|State||Published - Dec 1 1997|
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