title: The Evolution and Technique of Nerve-Sparing Retroperitoneal Lymphadenectomy.
abstract: The evolution of retroperitoneal lymph node dissection technique and associated template modifications for nonseminomatous germ cell tumors have resulted in significant improvement in the long-term morbidity. Through the preservation of sympathetic nerves via exclusion from or prospective identification within the boundaries of resection, maintenance and recovery of antegrade ejaculation are achieved. Nerve-sparing strategies in early-stage disease are feasible in most patients. Postchemotherapy, select patients can be considered for nerve preservation. This article describes the anatomic and physiologic basis for, indications and technical aspects of, and functional and oncologic outcomes reported after nerve-sparing retroperitoneal lymphadenectomy in testicular cancer.
authors.affiliation: Department of Urology, Indiana University School of Medicine, 535 North Barnhill Drive, Suite 420, Indianapolis, IN 46202, USA. Electronic address: tamaster@iupui.edu.
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Masterson
authors.affiliation: Department of Urology, Indiana University School of Medicine, 535 North Barnhill Drive, Suite 420, Indianapolis, IN 46202, USA.
authors.forename: Clint
authors.initials: C
authors.lastname: Cary
authors.affiliation: Urologic Surgery, Walter Reed National Military Medical Center, 8901 Rockville Road, Bethesda, MD 20889, USA.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Rice
authors.affiliation: Department of Urology, Indiana University School of Medicine, 535 North Barnhill Drive, Suite 420, Indianapolis, IN 46202, USA.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Foster
mesh_terms: D004542:Ejaculation / Q000502:physiology; D059247:Fertility Preservation / Q000379:methods; D006801:Humans; D008160:Lumbosacral Plexus / Q000033:anatomy & histology / Q000502:physiology; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods; D008207:Lymphatic Metastasis; D008297:Male; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology / Q000601:surgery / Q000628:therapy; D058958:Organs at Risk; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000503:physiopathology / Q000517:prevention & control*; D012187:Retroperitoneal Space / Q000294:innervation / Q000473:pathology / Q000601:surgery; D013736:Testicular Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy
keywords: Antegrade ejaculation; Fertility; Nerve-sparing retroperitoneal lymph node dissection; Nonseminomatous germ cell tumor; Testicular cancer