Fertility Issues in the Therapy of Nonseminomatous Testicular Tumors

Lange, Paul H.; Chang, Wei lee; Fraley, Elwin E.

doi:10.1016/s0094-0143(21)01555-x

Cited by 67 publications

(1 citation statement)

References 45 publications

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“…Nerve sparing techniques have been refined to reduce the incidence of retrograde ejaculation in conjunction with modified templates. These techniques aim to avoid damage and dissection of the lumbar sympathetic chain, hypogastric plexus and postganglionic fibers which are all responsible for ejaculation [50,51].…”

Section: Surgical Nerve Spare Techniquesmentioning

confidence: 99%

Nerve-sparing technique in RPLND for testicular cancer

Nalavenkata

Patel

2023

Current Opinion in Urology

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Purpose of reviewThe management of testicular cancer has evolved over time with multimodal therapy. Retroperitoneal lymph node dissection (RPLND), which is a complex and potentially morbid treatment option, remains the mainstay in surgical treatment. This article reviews the surgical template, approach and anatomical considerations with regards to nerve spare in RPLND. Recent findingsThe standard full bilateral RPLND template has evolved over time to include the area between the renal hilum, bifurcation of the common iliac vessels, and the ureters. Morbidity with regards to ejaculatory dysfunction has led to further refinements in this procedure. Advancements in anatomical understanding of the retroperitoneal structures and their relationship to the sympathetic chain and hypogastric plexus has allowed for modification of surgical templates. Further refinements in surgical nerve sparing techniques have improved functional outcomes without sacrificing oncological outcomes. Finally, extraperitoneal access to the retroperitoneum and minimally invasive platforms have been implemented to further reduce morbidity. SummaryRPLND requires strict adherence to oncological surgical principles regardless of template, approach and technique. Contemporary evidence shows that outcomes are best for advanced testis cancer patients when managed at high volume tertiary care facilities with surgical expertise and access to multidisciplinary care.

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Section: Surgical Nerve Spare Techniquesmentioning

confidence: 99%