SEXUAL FUNCTIONING AFTER MULTIMODALITY TREATMENT FOR DISSEMINATED NONSEMINOMATOUS TESTICULAR GERM-CELL TUMOR

Purpose: We determined sexual functioning after chemotherapy for disse minated nonseminomatous testicular germ cell tumor, and evaluated the impact of resection of post-chemotherapy residual retroperitoneal tumo r. Materials and Methods: A total of 155 consecutive patients treated with chemotherapy for disseminated nonseminomatous testicular germ cel l tumor (between 1980 and 1994) was questioned about their sexual func tioning. The patients were divided in 2 subgroups: patients treated wi th or without resection of post-chemotherapy residual retroperitoneal tumor. Volume and location (divided into left para-aortal or right par acaval/interaortacaval) of the resected tumor were related to absence of ejaculation as well as decreased semen amount. In addition, libido, arousal, erection and orgasm were related to ejaculatory dysfunction. Results: A total of 43 patients (27.7%) was treated with chemotherapy only and 112 (72.3%) had additional resection of post-chemotherapy re sidual retroperitoneal tumor mass. Overall, 22.4% reported loss of lib ido, 14.1% decreased arousal, 16% erectile dysfunction, 23.1% decrease d orgasmic intensity, 17.4% decreased semen amount and 18.7% complete absence of antegrade ejaculation. With exception of absence of ejacula tion, sexual dysfunctions were reported in similar frequencies in both treatment subgroups. In the resection of post-chemotherapy residual r etroperitoneal tumor subgroup, 25.9% of the patients had complete abse nce of ejaculation. The other sexual dysfunctions were related neither to decreased semen amount nor to complete absence of ejaculation. The mean volume of resected tumor was higher (95 cm.(3)) in patients with absence of ejaculation than in those without (40 cm.(3)), and patient s with right paracaval/interaortacaval tumor (20 of 58, 34.5%) reporte d more often absence of ejaculation than those with left para-aortal t umor (9 of 54, 16.7%). Conclusions: In patients treated for disseminat ed nonseminomatous testicular germ cell tumor, post-chemotherapy sexua l morbidity cannot be neglected. Except for loss of antegrade ejaculat ion, sexual dysfunctions are not related to resection of post-chemothe rapy residual retroperitoneal mass. A high volume of tumor and a right paracaval/interaortacaval location predispose to loss of antegrade ej aculation.