Nerve preserving retroperitoneal lymph node excision in non-seminomatous testicular cancer

Thirty-nine patients with a non-seminomatous testicular tumor underwent retroperitoneal lymphadenectomy (RPLND) between 12/90 and 7/93. Twenty-four patients with stage I disease were operated on with a modified nerve-sparing RPLND, while 7 patients with stage IIA and 8 patients with stage IIB had bilateral RPLND. Twelve of fifteen patients with stage IIA and IIB had preservation of their sympathetic postsynaptic fibers. Intraoperative electric stimulation of the fibers resulted in ejaculation in 25/26 patients. Semen analysis revealed 21 patients with necrospermia and maturation arrest, while 3 had aspermia. Antegrade ejaculation was restored after 1.1 months following nerve-sparing RPLND and 7 months following radical RPLND. Ejaculation did not return in one patient. No patient showed relapse. Our results show that the sympathetic postsynaptic fibers can be preserved during RPLND. Nerve-sparing RPLND is superior to radical and modified RPLND with regard to preservation of ejaculation without compromising the radicalness of the tumor surgery.