Retroperitoneal lymphadenectomy and sexual disfunction in patients with testis and funicle tumours: our experience.

Objectives : The aim of this study was to evaluate retrospectively the pres ervation of fertility in a number of patients with testis or funicle tumour treated with retroperitoneal lymph node dissection (RPLND). Material and Methods : Between 1983 and 1998, 41 patients with testis or fu nicle cancer (mean age 29 years, range 18-58) underwent RPLND at our instit ution. Clinical staging included abdominal CT scan, chest X-rays and serum tumour markers (alpha FP, beta HCG, LDH). RPLND was performed bilaterally i n 14 patients and unilaterally in 13 patients (6 right and 7 left). The ner ve sparing technique was used in 14 cases. Ejaculation was evaluated in 39 patients (2 patients died of metastases before the study). Mean follow up w as 64 months (range 5-182). Semen was available for 21 patients before RPLN D and for 19 patients after RPLND. The much less thant Student much greater than test was used to compare the semen parameters before and after surger y. Results : Bilateral RPLND caused loss of ejaculation in 67% of the patients (8/12). Unilateral right and left RPLND allowed to maintain ejaculation in 100% (6/6) and 57% (4/7) of cases respectively Nerve sparing procedure pre served ejaculation in 100% of the patients (14/14). After RPLND, both mean total sperm count and mean motility rate were not significantly changed (14 3 +/- 124 x 106 vs 128.2 +/- 72 x 106 p > 0.05; 40.7 +/- 17.6 vs 48 +/- 15. 5%, p > 0.05). The survival rate of the patients treated with RPLND was 95% . None of the patients treated with unilateral (en bloc or nerve sparing) R PLND had relapse. Conclusion : The evolution of surgical technique has notably reduced the an drological complications of the RPLND without affecting the oncological res ults.