Study Type – Outcomes (cohort)
Level of Evidence 2b
What's known on the subject? and What does the study add?
Modern surgical techniques have allowed preservation of fertility in most patients after post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND), but some patients still have infertility after surgery. We reviewed our experience treating infertility in 26 men after PC-RPLND. Using a structured clinical pathway we obtained sperm in 81% of men for use in assisted reproduction.
- • To evaluate the effectiveness of a clinical pathway on sperm retrieval outcomes in patients presenting with infertility after post-chemotherapy (PC) retroperitoneal lymph node dissection (RPLND).
PATIENTS AND METHODS
- • We carried out a retrospective review of patients with advanced testicular cancer, presenting with infertility after PC-RPLND in a large reproductive urology practice.
- • We implemented a clinical pathway where pseudoephedrine was first administered. If this medication failed, electroejaculation (EEJ) and/or testicular sperm extraction (TESE) was carried out.
- • The primary outcome was retrieval of sperm for use in assisted reproduction.
- • Four men had retrograde ejaculation, of whom two converted to antegrade ejaculation with medical therapy.
- • In all, 22 patients had failure of emission (FOE) and, of these, no patient converted to antegrade ejaculation with medication.
- • In patients with FOE, sperm was found in 15/20 of those experiencing a successful EEJ.
- • Seven patients underwent TESE for azoospermia on EEJ or no ejaculate on EEJ, three of whom had sperm found on TESE.
- • Sperm was found for assisted reproduction in 81% (21/26) patients.
- • There appears to be no role for the use of pseudoephedrine therapy in patients with FOE after PC-RPLND.
- • The use of a structured clinical pathway may optimize patient care.