Ejaculatory dysfunction after retroperitoneal lymphadenectomy.
The effects of retroperitoneal lymphadenectomy on ejaculation have been examined in 186 patients who had removal of residual masses after chemotherapy for metastatic non-seminomatous germ cell tumours. The results were analysed for significance using a chi 2 test of independence. Forty-one men (22%) permanently lost ejaculation postoperatively. The larger the size of the mass removed, the more likely the patient was to have ejaculatory failure (< 4 cm = 4%, 4-8 cm = 17%, > 8 cm = 58%; p < 0.005). Removal of bilateral masses was more likely to result in loss of ejaculation than unilateral masses (45 and 12%, respectively, p < 0.005). There has been significantly less postoperative ejaculatory dysfunction since 1984 when a nerve sparing dissection was introduced (before 1984 36%, since 1984 16%, p < 0.005). The incidence of ejaculatory dysfunction following retroperitoneal lymphadenectomy is therefore determined by the size and position of residual lymph node masses after chemotherapy and can be kept to a minimum by a careful nerve sparing operative technique.
Jones
D R
DR
Testicular Tumour Unit, Royal Marsden Hospital, London, UK.
Norman
A R
AR
Horwich
A
A
Hendry
W F
WF
D003627:Data Interpretation, Statistical; D004542:Ejaculation / Q000502:physiology*; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects*; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000503:physiopathology / Q000601:surgery*; D012187:Retroperitoneal Space; D013076:Sperm Count; D013736:Testicular Neoplasms / Q000503:physiopathology / Q000601:surgery*; D014556:Urine / Q000166:cytology