Preservation of Antegrade
Ejaculation in Retroperitoneal
Lymphadenectomy due to
Residual Masses after
Primary Chemotherapy for
Testicular Carcinoma

Solsona, E.; Iborra, I.; Ricós, J.V.; Monrós, J.L.; Dumont, R.; Casanova, J.; Guillem, V.

doi:10.1159/000475283

Cited by 12 publications

(11 citation statements)

References 15 publications

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“…64 Some reports showed that 80% of cases with unilateral or bilateral NS-RPLND maintained normal ejacu- lation with a relapse rate of 10%. 65,66 Our experience also clarified the safety and good outcome of NS-PC-RPLND; with a relapse rate of 1.9% (2/78) at a median follow-up of 42 months, and preservation of antegrade ejaculation in 83.1% of cases. 67 Post-chemotherapy retroperitoneal lymph node dissection for the residual tumor of advanced testicular cancer is still challenging.…”

Section: Extent Of Rplnd and Nerve Sparing Methodssupporting

confidence: 54%

Recent strategy for the management of advanced testicular cancer

Nakamura

Miki

2010

Int J of Urology

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Testicular cancer is the most common cancer in young men and the cure rate has been approximately 80% since the introduction of cisplatin in the 1970s. BEP therapy (including bleomycin, etoposide and cisplatin) has become a standard induction therapy instead of PVB therapy (cisplatin, vinblastin and bleomycin). However, the patients with incomplete responses to cisplatin-based first-line therapy or with relapsed disease have an extremely poor prognosis. For such difficult-to-treat patients, there are some proposed treatment options such as ifosfamide-containing salvage chemotherapy or high-dose chemotherapy (HDCT). HDCT with bone marrow rescue has been carried out as salvage or induction chemotherapy. However, a randomized control trial did not show the superiority to conventional first line therapy or salvage therapy. Therefore, a new anticancer agent was tested for cisplatin-refractory or resistant testicular cancer. The development of combination therapy with new anticancer agents such as paclitaxel and irinotecan seems to be effective for these patients. TIP therapy including paclitaxel, ifosfamide and cisplatin would be a standard second line therapy for the patients with BEP failure. Residual tumor resection including retroperitoneal lymph node dissection integrated with induction and salvage chemotherapy still remains to play an important role to achieving a cure for advanced testicular cancer because there is no modality to predict residual viable cancer cells or teratoma element in the residual tumors. In the present review, we discuss and focus on the recent treatment strategy of advanced testicular cancer.

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Section: Extent Of Rplnd and Nerve Sparing Methodssupporting

confidence: 54%

Recent strategy for the management of advanced testicular cancer

Nakamura

Miki

2010

Int J of Urology

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“…), anterior lumbar interbody fusion (Johnson & McGuire, ), retroperitoneal lymphadenectomy for testicular cancer (Solsona et al. ) and colorectal cancer surgery (Hojo et al. ).…”

Section: Introductionmentioning

confidence: 99%

Identification of the origin of adrenergic and cholinergic nerve fibers within the superior hypogastric plexus of the human fetus

et al. 2013

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Nerve fibers contributing to the superior hypogastric plexus (SHP) and the hypogastric nerves (HN) are currently considered to comprise an adrenergic part of the autonomic nervous system located between vertebrae (T1 and L2), with cholinergic aspects originating from the second to fourth sacral spinal segments (S2, S3 and S4). The aim of this study was to identify the origin and the nature of the nerve fibers within the SHP and the HN, especially the cholinergic fibers, using computer-assisted anatomic dissection (CAAD). Serial histological sections were performed at the level of the lumbar spine and pelvis in five human fetuses between 14 and 30 weeks of gestation. Sections were treated with histological staining [hematoxylin-eosin (HE) and Masson's trichrome (TriM)] and with immunohistochemical methods to detect nerve fibers (anti-S100), adrenergic fibers (anti-TH), cholinergic fibers (anti-VAChT) and nitrergic fibers (anti-nNOS). The sections were then digitalized using a highresolution scanner and the 3D images were reconstructed using WINSURF software. These experiments revealed the coexistence of adrenergic and cholinergic fibers within the SHP and the HNs. One-third of these cholinergic fibers were nitrergic fibers [anti-VACHT (+)/anti-NOS (+)] and potentially pro-erectile, while the others were non-nitrergic [anti-VACHT (+)/anti-NOS (À)]. We found these cholinergic fibers arose from the lumbar nerve roots. This study described the nature of the SHP nerve fibers which gives a better understanding of the urinary and sexual dysfunctions after surgical injuries.

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Section: Discussionmentioning

confidence: 99%

“…Recent advances in anatomical insights and surgical techniques have led to the ability to identify and surgically preserve the retroperitoneal neurovascular structures responsible for emission and antegrade ejaculation.6-s Highly efficient chemotherapy provides, in most cases, a smaller and well-encapsulated residual mass, which allows RPLND to be performed preserving the sympathetic structures. 12 Wahle et al first reported nerve-sparing techniques in selected patients with relatively small volumes of residual retroperitoneal disease after receiving p i -mary chemotherapy for metastatic testicular cancer.I0 However, only 1 case of nerve-sparing RPLND has been reported in the Japanese literature. 16 Recently, nerve-sparing techniques have been further extended to patients witha bulkyretroperitoneal r e s i d~a l r n a s s .~~~'~ Coogan et al reported that 62 of their 81 (76.5%) patients recovered emission and ejaculation after postchemotherapy FWLND.…”

Section: Discussionmentioning

confidence: 99%

Nerve‐Sparing Retroperitoneal Lymph Node Dissection for Metastatic Testicular Cancer

et al. 1997

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Background: Nerve-sparing techniques are used during retroperitoneal lymph node dissection (RPLND) in patients with early stage testicular cancer to preserve postoperative ejaculatory function. Indications for the procedures have been extended to patients with a postchemotherapy retroperitoneal residual mass without compromising the efficacy of surgery. We report 6 cases diagnosed with metastatic testicular cancer who underwent nerve-sparing RPLND. Methods: Between January 1994 and March 1996, 6 patients with metastatic testicular cancer underwent nerve-sparing RPLND. Five of these patients received primary chemotherapy and had a retroperitoneal residual mass. Four patients underwent complete bilateral RPLND and 2 underwent unilateral template surgery. Results: After a mean follow-up of 18.7 months (range, 8 to 34), there have been no local recurrences and 5 (83%) patients report antegrade ejaculation. Conclusion: Nerve-sparing RPLND is applicable for selected patients with metastatic testicular cancer without increasing the risk of local recurrence. Ejaculatory function is preserved in the majority of patients, contributing to the improvement of the quality of life in men who require such surgery.Int

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Preservation of Antegrade Ejaculation in Retroperitoneal Lymphadenectomy due to Residual Masses after Primary Chemotherapy for Testicular Carcinoma

Cited by 12 publications

References 15 publications

Recent strategy for the management of advanced testicular cancer

Recent strategy for the management of advanced testicular cancer

Identification of the origin of adrenergic and cholinergic nerve fibers within the superior hypogastric plexus of the human fetus

Nerve‐Sparing Retroperitoneal Lymph Node Dissection for Metastatic Testicular Cancer

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