AN INTRAOPERATIVE SEMINAL AND PROSTATE EMISSION TEST AS A CONTROL FORNERVE-SPARING PROCEDURES IN PRIMARY AND SECONDARY RETROPERITONEAL LYMPHADENECTOMY

Objective To determine the value of an intra-operative electrostimulat ory test of post-ganglionic nerves for the preservation of ejaculation in primary and secondary retroperitoneal lymph-node dissection (RLND) . Patients and methods Between 1991 and 1994, 21 patients with non-sem inomatous testicular cancer of clinical stage A and 15 patients with b ulky or clinical stage C disease underwent primary or secondary RLND, respectively, During surgery, post-ganglionic nerves were electrostimu lated at 30 Hz and up to 20 V, for 3-10 s, Emissions were recorded sim ultaneously by suprapubic ultrasonography of the seminal vesicals and bladder neck (in 36 patients) and by endoscopy of the posterior urethr a (in 11 patients). Results A positive intra-operative emission test i n 15 pathological stage A (with bilateral nerve-sparing) and six patho logical stage B (with contralateral nerve-sparing) patients predicted the post-operative preservation of antegrade ejaculation, In the group undergoing secondary RLND, the test allowed the identification and sp aring of the emission-related nerves in four of 15 patients with a res idual mass consisting of necrosis/fibrosis, and preserved antegrade ej aculation after surgery. Conclusions A positive result in the seminal emission test predicted the preservation of antegrade ejaculation afte r surgery, The test is not necessary in patients with clinical stage A disease, but improves the chances of reducing morbidity. If the resid ual mass consists of necrosis or fibrosis, then electrostimulation dur ing secondary RLND can help to identify important nerve structures whe n their origin is unknown initially, However, attempts to retain nerve function must not jeopardize the patient's survival. The test can be an option for clinical stage B disease with initial bilateral RLND, to identify and preserve emission-relevant nerves while the retroperiton eal space is removed radically, The test may also give additional info rmation about the physiology of emission.