ORTHOSTATIC ABNORMAL PENILE ERECTIONS - A CONSEQUENCE OF RETROPERITONEAL LYMPHADENECTOMY WITH VENA-CAVAL RESECTION

Involvement of the inferior vena cava is reported in 7 to 12% of patie nts with bulky metastatic germ cell tumor. Resection of the vena cava is not uncommonly required during post-chemotherapy retroperitoneal ly mph node dissection to ensure complete tumor clearance or resect a non functional vena cava occluded by scar or tumor thrombus.(1,2) Despite the less favorable prognosis in such cases of advanced bulky germ cell tumors, satisfactory results are reported with the combination of int ensive chemotherapy and radical resection of residual masses.(1) After interruption of the vena cava preexisting collateral venous channels consisting mainly of the ascending lumbar, gonadal and ureteral veins, and the vertebral venous system establish an effective alternate syst em that circumvents the interrupted segment and enables ample venous r eturn to the heart.(3,4) Specific complications of vena caval resectio n include leg edema, ascites, chylothorax, deep venous thrombosis and renal insufficiency.(1,2) Despite the enormity of procedures that invo lve post-chemotherapy retroperitoneal lymph node dissection with en bl oc vena caval resection, associated specific morbidity is slight and u sually transitory due to the immediate opening of effective venous col laterals.(1,2) We report an additional unique consequence of vena cava l resection during post-chemotherapy retroperitoneal lymph node dissec tion for retroperitoneal bulky metastatic germ cell tumor with inferio r vena caval encroachment.