title: Andrological complications following retroperitoneal lymph node dissection for testicular cancer.
abstract: Retroperitoneal lymph node dissection (RPLND) is a fundamental surgical step in the treatment of testicular cancer. Nowadays, primary RPLND has partially lost its role in favour of active surveillance (for low risk stage I disease) and short cycle chemotherapy in non-seminomatous germ cell tumor (NSGCT). Conversely, post-chemotherapy RPLND (PC-RPLND) remains the standard treatment for residual masses after chemotherapy. In consideration of curability rate of testicular cancer and the life expectancy of testicular cancer survivors the identification and the prevention of andrological complications became fundamental. Erectile dysfunction (ED) is generally transitory and interests about 25% of patients, conversely retrograde ejaculation (RE) is definitive. Antegrade ejaculation is guaranteed by the sparing of at least one paravertebral sympathetic trunks and the postganglionic sympathetic fibers, which travel dorsal to the inferior vena cava and cross ventrally to the aorta. The maintenance of antegrade ejaculation can be obtained by a bilateral sparing of these fibers or by the modification of templates. In primary RPLND setting RE ranged between 2-6.7% and 1.2-61% in the major open and laparoscopic series respectively. In PC-RPLND series it ranged between 21-36% and 4-7.1% for open and laparoscopic approach respectively with the limitation of the restrictive indications of laparoscopic approach. The setting of this surgery and the importance of the oncological and functional outcomes that are pursued reinforced following the evidence that RPLND is a highly technical demanding procedure, whose best performances are achieved only when delivered in referral, high-volume centers.
authors.affiliation: Urology Unit, Santa Maria della Misericordia University Hospital, Udine, Italy - alessandro.crest@gmail.com.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Crestani
authors.affiliation: Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Esperto
authors.affiliation: Urology Unit, Santa Maria della Misericordia University Hospital, Udine, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Rossanese
authors.affiliation: Urology Unit, Santa Maria della Misericordia University Hospital, Udine, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Giannarini
authors.affiliation: Department of Urology, Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Nicolai
authors.affiliation: Urology Unit, Santa Maria della Misericordia University Hospital, Udine, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ficarra
mesh_terms: D007172:Erectile Dysfunction / Q000209:etiology*; D006801:Humans; D007248:Infertility, Male / Q000209:etiology*; D008197:Lymph Node Excision / Q000009:adverse effects* / Q000379:methods; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000601:surgery*; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000601:surgery*