An intra-operative seminal and prostate emission test as a control for nerve-sparing procedures in primary and secondary retroperitoneal lymphadenectomy.

OBJECTIVE

To determine the value of an intra-operative electrostimulatory test of post-ganglionic nerves for the preservation of ejaculation in primary and secondary retroperitoneal lymph-node dissection (RLND).

PATIENTS AND METHODS

Between 1991 and 1994, 21 patients with non-seminomatous testicular cancer of clinical stage A and 15 patients with bulky or clinical stage C disease underwent primary or secondary RLND, respectively. During surgery, post-ganglionic nerves were electrostimulated at 30 Hz and up to 20 V, for 3-10 s. Emissions were recorded simultaneously by suprapubic ultrasonography of the seminal vesicals and bladder neck (in 36 patients) and by endoscopy of the posterior urethra (in 11 patients).

RESULTS

A positive intra-operative emission test in 15 pathological stage A (with bilateral nerve-sparing) and six pathological stage B (with contralateral nerve-sparing) patients predicted the post-operative preservation of antegrade ejaculation. In the group undergoing secondary RLND, the test allowed the identification and sparing of the emission-related nerves in four of 15 patients with a residual mass consisting of necrosis/fibrosis, and preserved antegrade ejaculation after surgery.

CONCLUSIONS

A positive result in the seminal emission test predicted the preservation of antegrade ejaculation after surgery. The test is not necessary in patients with clinical stage A disease, but improves the chances of reducing morbidity. If the residual mass consists of necrosis or fibrosis, then electrostimulation during secondary RLND can help to identify important nerve structures when their origin is unknown initially. However, attempts to retain nerve function must not jeopardize the patient's survival. The test can be an option for clinical stage B disease with initial bilateral RLND, to identify and preserve emission-relevant nerves while the retroperitoneal space is removed radically. The test may also give additional information about the physiology of emission.