The Evolution and Technique of Nerve-Sparing Retroperitoneal Lymphadenectomy

Timothy A Masterson; Clint Cary; Kevin R Rice; Richard S Foster

doi:10.1016/j.ucl.2015.04.005

The Evolution and Technique of Nerve-Sparing Retroperitoneal Lymphadenectomy

Urol Clin North Am. 2015 Aug;42(3):311-20. doi: 10.1016/j.ucl.2015.04.005. Epub 2015 Jun 6.

Authors

Timothy A Masterson¹, Clint Cary², Kevin R Rice³, Richard S Foster²

Affiliations

¹ Department of Urology, Indiana University School of Medicine, 535 North Barnhill Drive, Suite 420, Indianapolis, IN 46202, USA. Electronic address: tamaster@iupui.edu.
² Department of Urology, Indiana University School of Medicine, 535 North Barnhill Drive, Suite 420, Indianapolis, IN 46202, USA.
³ Urologic Surgery, Walter Reed National Military Medical Center, 8901 Rockville Road, Bethesda, MD 20889, USA.

PMID: 26216818
DOI: 10.1016/j.ucl.2015.04.005

Abstract

The evolution of retroperitoneal lymph node dissection technique and associated template modifications for nonseminomatous germ cell tumors have resulted in significant improvement in the long-term morbidity. Through the preservation of sympathetic nerves via exclusion from or prospective identification within the boundaries of resection, maintenance and recovery of antegrade ejaculation are achieved. Nerve-sparing strategies in early-stage disease are feasible in most patients. Postchemotherapy, select patients can be considered for nerve preservation. This article describes the anatomic and physiologic basis for, indications and technical aspects of, and functional and oncologic outcomes reported after nerve-sparing retroperitoneal lymphadenectomy in testicular cancer.

Keywords: Antegrade ejaculation; Fertility; Nerve-sparing retroperitoneal lymph node dissection; Nonseminomatous germ cell tumor; Testicular cancer.

Publication types

Review

MeSH terms

Ejaculation / physiology
Fertility Preservation / methods
Humans
Lumbosacral Plexus* / anatomy & histology
Lumbosacral Plexus* / physiology
Lymph Node Excision* / adverse effects
Lymph Node Excision* / methods
Lymphatic Metastasis
Male
Neoplasm Staging
Neoplasms, Germ Cell and Embryonal* / pathology
Neoplasms, Germ Cell and Embryonal* / surgery
Neoplasms, Germ Cell and Embryonal* / therapy
Organs at Risk
Outcome Assessment, Health Care
Postoperative Complications / physiopathology
Postoperative Complications / prevention & control*
Retroperitoneal Space* / innervation
Retroperitoneal Space* / pathology
Retroperitoneal Space* / surgery
Testicular Neoplasms* / pathology
Testicular Neoplasms* / surgery
Testicular Neoplasms* / therapy

Supplementary concepts

Nonseminomatous germ cell tumor