Outcomes of the management of post-chemotherapy retroperitoneal lymph node dissection-associated anejaculation

Authors


John P. Mulhall, Division of Urology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA. e-mail: mulhalj1@mskcc.org

Abstract

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.

OBJECTIVE

  • • 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.

RESULTS

  • • 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.

CONCLUSIONS

  • • 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.

Ancillary