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Abstract

Volume 24, Issue 6 (November 2022) 24, 579–583; 10.4103/aja2021132

A comprehensive evaluation of sexual and reproductive outcomes following robot-assisted retroperitoneal lymph node dissection for nonseminomatous germ cell tumor

Francesco A Mistretta1,2, Ottavio de Cobelli1,2, Paolo Verze3, Francesco Botticelli1, Letizia Jannello1, Stefano Luzzago1, Gabriele Cozzi1, Roberto Bianchi1, Ettore Di Trapani1, Matteo Ferro1, Giovanni Cordima1, Danilo Bottero1, Deliu Victor Matei1, Vincenzo Mirone3, Gennaro Musi1,2

1 Department of Urology, European Institute of Oncology, IRCCS, Milan 20141, Italy
2 Department of Oncology and Hemato-Oncology, University of Milan, Milan 20122, Italy
3 Department of Urology, University of Naples, Federico II, Naples 80138, Italy

Correspondence: Dr. FA Mistretta (mistretta.francesco.a@gmail.com)

Date of Submission 01-Oct-2021 Date of Acceptance 14-Jan-2022 Date of Web Publication 05-Apr-2022

Abstract

Sexual disorders following retroperitoneal pelvic lymph node dissection (RPLND) for testis tumor can affect the quality of life of patients. The aim of the current study was to investigate several different andrological outcomes, which may be influenced by robot-assisted (RA) RPLND. From January 2012 to March 2020, 32 patients underwent RA-RPLND for stage I nonseminomatous testis cancer or postchemotherapy (PC) residual mass. Modified unilateral RPLND nerve-sparing template was always used. Major variables of interest were erectile dysfunction (ED), premature ejaculation (PE), dry ejaculation (DE), or orgasm alteration. Finally, fertility as well as the fecundation process (sexual intercourse or medically assisted procreation [MAP]) was investigated. Ten patients (31.3%) presented an andrological disorder of any type after RA-RPLND. Hypospermia was present in 4 (12.5%) patients, DE (International Index of Erectile Function-5 [IIEF-5] <25) in 3 (9.4%) patients, and ED in 3 (9.4%) patients. No PE or orgasmic alterations were described. Similar median age at surgery, body mass index (BMI), number of nodes removed, scholar status, and preoperative risk factor rates were identified between groups. Of all these 10 patients, 6 (60.0%) were treated at the beginning of our robotic experience (2012–2016). Of all 32 patients, 5 (15.6%) attempted to have a child after RA-RPLND. All of these 5 patients have successfully fathered children, but 2 (40.0%) required a MAP. In conclusion, a nonnegligible number of andrological complications occurred after RA-RPLND, mainly represented by ejaculation disorders, but ED occurrence and overall sexual satisfaction deficit should be definitely considered. No negative impact on fertility was described after RA-RPLND.

Keywords: andrology; lymph node excision; nonseminomatous germ cell tumor; robotics; testicular cancer

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