Ejaculation in testicular cancer patients after post-chemotherapy retroperitoneal lymph node dissection

The purpose of this study was to evaluate fertility after different types o f post-chemotherapy retroperitoneal lymph node dissection (RPLND). During 1 980-1994, 192 patients with metastatic testicular cancer underwent post-che motherapy RPLND with a gradual shift from modified bilateral template RPLND to nerve-sparing RPLND. Modified bilateral template RPLND was done in 92% of the patients operated during 1980-1984 as compared to 16% during 1989-19 94. Pre- and post-treatment fertility was assessed by microscopic sperm ana lysis, determination of serum FSH and information on ejaculation and patern ity. There was no significant difference of the survival rates between the three treatment periods. Antegrade ejaculation was preserved in 11% of the patients after modified bilateral template RPLND as compared to 89% after t he nerve-sparing operation technique. The median ejaculatory Volume decreas ed post-operatively, serum FSH increased and sperm density remained unchang ed. Fifty-six patients attempted fatherhood after their treatment, and 27 f athered at least one child after an observation-time of 55 months. nine of them by assisted fertilization. Patients with initially advanced testicular cancer but limited residual retroperitoneal masses after induction chemoth erapy can safely undergo limited post-chemotherapy RPLND as a part of multi modality treatment. After nerve-sparing RPLND antegrade ejaculation is pres erved in 89% of the patients though the ejaculatory volume decreases after RPLND. Post-treatment fatherhood can be achieved in at least 50% of the pat ients attempting paternity.