MONITORING OF EMISSION AS DIRECT INTRAOPERATIVE CONTROL FOR NERVE SPARING RETROPERITONEAL LYMPHADENECTOMY

An intraoperative test to identify emission relevant lumbar postgangli onic nerves during nerve sparing retroperitoneal lymph node dissection is presented. The neurophysiological course of the ejaculation into t he posterior urethra, the emission, is described. A retroperitoneal ne rve sparing procedure was done for nonseminomatous testicular tumors b ilaterally in 7 patients with pathological stage I disease and unilate rally in 4 with pathological stage IIa disease. While the isolated lum bar nerves were electrostimulated, the seminal vesicles and bladder ne ck were monitored by suprapubic transvesical sonography. Simultaneousl y, endoscopy of the posterior urethra was performed and time code was registered. Emission began with bladder neck closure, propulsive contr action of the seminal vesicles in the periphery and opening of the par acollicular region. Then, complete contraction of the seminal vesicles was associated with closure of the prostatic urethra and ended in the separate secretion from the ductuli prostatici and ejaculatorii. Desc ending from nerve L1 to L3, their importance for emission usually incr eased. For intraoperative monitoring of emission transvesical sonograp hy alone is sufficient. In 2 patients this method allowed us to identi fy the relevant nerves within the retroperitoneal residual mass (fibro sis) after chemotherapy.