Arai Y, Kawakita M, Okada Y, Yoshida O
Department of Urology, Faculty of Medicine, Kyoto University, Japan.
J Clin Oncol. 1997 Apr;15(4):1444-8. doi: 10.1200/JCO.1997.15.4.1444.
We assessed the impact of different treatment modalities on sexuality and fertility in long-term survivors of testicular cancer.
The sample consisted of 85 testicular cancer patients, of whom 19 had undergone chemotherapy with retroperitoneal lymph node dissection (RPLND), 15 had received chemotherapy only, 42 had received infradiaphragmatic radiotherapy, and nine had received surveillance therapy. The questionnaire reported sexual function, marital status, and issues related to fertility and childbearing.
One fourth to one half reported some type of sexual impairment in each group. The only significant difference was that approximately 70% of men with RPLND reported inability of ejaculation and a greater decline in semen volume, which is expected. The most striking finding is that the rates and nature of sexual dysfunction of surveillance patients were similar to other treatment groups, except for ejaculatory function. The highest rates of infertility distress were observed in chemotherapy patients.
These data suggest that sexual dysfunction and infertility represent the major persisting side effects, even years after diagnosis. The hypothesis that surveillance patients have fewer sexual problems is not upheld in this study.
我们评估了不同治疗方式对睾丸癌长期幸存者性功能和生育能力的影响。
样本包括85例睾丸癌患者，其中19例接受了化疗联合腹膜后淋巴结清扫术（RPLND），15例仅接受了化疗，42例接受了膈下放疗，9例接受了观察等待治疗。问卷报告了性功能、婚姻状况以及与生育和生殖相关的问题。
每组中有四分之一到二分之一的患者报告存在某种类型的性功能障碍。唯一显著的差异是，接受RPLND的男性中约70%报告无法射精且精液量下降更明显，这是预期之中的。最引人注目的发现是，除射精功能外，观察等待治疗患者性功能障碍的发生率和性质与其他治疗组相似。化疗患者中不育困扰的发生率最高。
这些数据表明，性功能障碍和不育是主要的持续存在的副作用，即使在诊断多年后也是如此。本研究不支持观察等待治疗患者性功能问题较少的假设。
