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Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 0,536
Online ISSN 1827-1758
Alessandro CRESTANI 1, Francesco ESPERTO 2, Marta ROSSANESE 1, Gianluca GIANNARINI 1, Nicola NICOLAI 3, Vincenzo FICARRA 1
1 Urology Unit, Academic Medical Centre Hospital Santa Maria della Misericordia, Udine, Italy; 2 Department of Urology, Sant’ Andrea Hospital, Sapienza University, Rome, Italy; 3 Department of Urology, IRCCS Istituto Nazionale dei Tumori, Milan, Italy
Retroperitoneal lymphnode dissection (RPLND) is a fundamental surgical step in the treatment of testicular cancer. Nowadays primary RPLND has partially lost its role in favour of active surveillance (for low risk stage I disease) and short cycle chemotherapy in non-seminomatous germ cell tumour (NSGCT). Conversely, postchemotherapy-RPLND (PC-RPLND) remains the standard treatment for residual masses after chemotherapy. In consideration of curability rate of testicular cancer and the life expectancy of testicular cancer survivors the identification and the prevention of andrological complications became fundamental. Erectile dysfunction (ED) is generally transitory and interests about 25% of patients, conversely retrograde ejaculation is definitive. Antegrade ejaculation is guaranteed by the sparing of at least one paravertebral sympathetic trunks and the postganglionic sympathetic fibres, which travel dorsal to the inferior vena cava and cross ventrally to the aorta. The maintenance of antegrade ejaculation can be obtained by a bilateral sparing of these fibres or by the modification of templates. In primary RPLND setting RE ranged between 2- 6.7% and 1.2-61% in the major open and laparoscopic series respectively. In PC-RPLND series it ranged between 21-36% and 4-7.1% for open and laparoscopic approach respectively with the limitation of the restrictive indications of laparoscopic approach. The setting of this surgery and the importance of the oncological and functional outcomes that are pursued reinforced following the evidence that RPLND is a highly technical demanding procedure, whose best performances are achieved only when delivered in referral, high-volume centres.