Preservation of Ejaculation in Patients Undergoing Nerve-Sparing Postchemotherapy Retroperitoneal Lymph Node Dissection for Metastatic Testicular Cancer

Joseph A. Pettus, Brett S. Carver, Timothy Masterson, Jason Stasi, Joel Sheinfeld

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Abstract

Objectives: To evaluate the clinical parameters associated with the recovery of ejaculation after nerve-sparing postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) for nonseminomatous germ cell tumor. Methods: We queried our institutional database for all patients who had undergone nerve-sparing PC-RPLND from 1995 to 2005 using a bilateral template. Nerve sparing was performed whenever technically feasible and oncologically prudent. Antegrade ejaculation was defined as any seminal fluid expulsion and was determined by patient report. We evaluated the recovery of antegrade ejaculation using clinical and pathologic parameters and fit a logistic regression model to determine which preoperative variables were associated with antegrade ejaculation. Results: A total of 341 patients had undergone PC-RPLND during the study period, 136 (40%) with nerve-sparing techniques. Postoperative antegrade ejaculation was reported by 107 of 136 patients (79%) with information available. On multivariate analysis, a right-sided primary testicular tumor (odds ratio 0.4, 95% confidence interval 0.1-1.0, P = .044) and residual masses ≥5 cm (odds ratio 0.1, 95% confidence interval 0.0-0.7, P = .020) were associated with retrograde ejaculation. However, 40 of 54 patients (74%) with right-sided primary tumors and 4 of 9 patients (44%) with a mass ≥5 cm reported antegrade ejaculation. The 5-year relapse-free survival rate was 98%, with a median follow-up of 39 months (interquartile range 19-66). Conclusions: Nerve-sparing PC-RPLND is associated with excellent functional return of antegrade ejaculation, is feasible in select patients with bulky disease, and results in excellent oncologic outcomes.

Original languageEnglish (US)
Pages (from-to)328-331
Number of pages4
JournalUrology
Volume73
Issue number2
DOIs
StatePublished - Feb 2009
Externally publishedYes

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Ejaculation
Testicular Neoplasms
Lymph Node Excision
Logistic Models
Odds Ratio
Confidence Intervals
Multivariate Analysis
Survival Rate
Databases
Recurrence

ASJC Scopus subject areas

  • Urology

Cite this

Preservation of Ejaculation in Patients Undergoing Nerve-Sparing Postchemotherapy Retroperitoneal Lymph Node Dissection for Metastatic Testicular Cancer. / Pettus, Joseph A.; Carver, Brett S.; Masterson, Timothy; Stasi, Jason; Sheinfeld, Joel.

In: Urology, Vol. 73, No. 2, 02.2009, p. 328-331.

Research output: Contribution to journalArticle

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title = "Preservation of Ejaculation in Patients Undergoing Nerve-Sparing Postchemotherapy Retroperitoneal Lymph Node Dissection for Metastatic Testicular Cancer",
abstract = "Objectives: To evaluate the clinical parameters associated with the recovery of ejaculation after nerve-sparing postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) for nonseminomatous germ cell tumor. Methods: We queried our institutional database for all patients who had undergone nerve-sparing PC-RPLND from 1995 to 2005 using a bilateral template. Nerve sparing was performed whenever technically feasible and oncologically prudent. Antegrade ejaculation was defined as any seminal fluid expulsion and was determined by patient report. We evaluated the recovery of antegrade ejaculation using clinical and pathologic parameters and fit a logistic regression model to determine which preoperative variables were associated with antegrade ejaculation. Results: A total of 341 patients had undergone PC-RPLND during the study period, 136 (40{\%}) with nerve-sparing techniques. Postoperative antegrade ejaculation was reported by 107 of 136 patients (79{\%}) with information available. On multivariate analysis, a right-sided primary testicular tumor (odds ratio 0.4, 95{\%} confidence interval 0.1-1.0, P = .044) and residual masses ≥5 cm (odds ratio 0.1, 95{\%} confidence interval 0.0-0.7, P = .020) were associated with retrograde ejaculation. However, 40 of 54 patients (74{\%}) with right-sided primary tumors and 4 of 9 patients (44{\%}) with a mass ≥5 cm reported antegrade ejaculation. The 5-year relapse-free survival rate was 98{\%}, with a median follow-up of 39 months (interquartile range 19-66). Conclusions: Nerve-sparing PC-RPLND is associated with excellent functional return of antegrade ejaculation, is feasible in select patients with bulky disease, and results in excellent oncologic outcomes.",
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AU - Stasi, Jason

AU - Sheinfeld, Joel

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N2 - Objectives: To evaluate the clinical parameters associated with the recovery of ejaculation after nerve-sparing postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) for nonseminomatous germ cell tumor. Methods: We queried our institutional database for all patients who had undergone nerve-sparing PC-RPLND from 1995 to 2005 using a bilateral template. Nerve sparing was performed whenever technically feasible and oncologically prudent. Antegrade ejaculation was defined as any seminal fluid expulsion and was determined by patient report. We evaluated the recovery of antegrade ejaculation using clinical and pathologic parameters and fit a logistic regression model to determine which preoperative variables were associated with antegrade ejaculation. Results: A total of 341 patients had undergone PC-RPLND during the study period, 136 (40%) with nerve-sparing techniques. Postoperative antegrade ejaculation was reported by 107 of 136 patients (79%) with information available. On multivariate analysis, a right-sided primary testicular tumor (odds ratio 0.4, 95% confidence interval 0.1-1.0, P = .044) and residual masses ≥5 cm (odds ratio 0.1, 95% confidence interval 0.0-0.7, P = .020) were associated with retrograde ejaculation. However, 40 of 54 patients (74%) with right-sided primary tumors and 4 of 9 patients (44%) with a mass ≥5 cm reported antegrade ejaculation. The 5-year relapse-free survival rate was 98%, with a median follow-up of 39 months (interquartile range 19-66). Conclusions: Nerve-sparing PC-RPLND is associated with excellent functional return of antegrade ejaculation, is feasible in select patients with bulky disease, and results in excellent oncologic outcomes.

AB - Objectives: To evaluate the clinical parameters associated with the recovery of ejaculation after nerve-sparing postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) for nonseminomatous germ cell tumor. Methods: We queried our institutional database for all patients who had undergone nerve-sparing PC-RPLND from 1995 to 2005 using a bilateral template. Nerve sparing was performed whenever technically feasible and oncologically prudent. Antegrade ejaculation was defined as any seminal fluid expulsion and was determined by patient report. We evaluated the recovery of antegrade ejaculation using clinical and pathologic parameters and fit a logistic regression model to determine which preoperative variables were associated with antegrade ejaculation. Results: A total of 341 patients had undergone PC-RPLND during the study period, 136 (40%) with nerve-sparing techniques. Postoperative antegrade ejaculation was reported by 107 of 136 patients (79%) with information available. On multivariate analysis, a right-sided primary testicular tumor (odds ratio 0.4, 95% confidence interval 0.1-1.0, P = .044) and residual masses ≥5 cm (odds ratio 0.1, 95% confidence interval 0.0-0.7, P = .020) were associated with retrograde ejaculation. However, 40 of 54 patients (74%) with right-sided primary tumors and 4 of 9 patients (44%) with a mass ≥5 cm reported antegrade ejaculation. The 5-year relapse-free survival rate was 98%, with a median follow-up of 39 months (interquartile range 19-66). Conclusions: Nerve-sparing PC-RPLND is associated with excellent functional return of antegrade ejaculation, is feasible in select patients with bulky disease, and results in excellent oncologic outcomes.

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