[Antegrade ejaculation after modified lumboaortic laparoscopic lymphadenectomy]

Testicular cancer affects young and fertile patients. Half of them are non seminomatous tumors. The management of this cancer in stage I includes: watchful waiting, chemotherapy and retroperitoneal lymph node dissection (RPLND). In the past, classic RPLND produced a high rate of anejaculation with the subsequent compromise to fertility. Currently, antegrade ejaculation is achieved in almost 90% of the cases with the modified technique. The objective of this work is to show the conservation of antegrade ejaculation and some surgical anal cortical features of the modified laparoscopic RPLND.

From January 2003 to July 2006 24 patients with non-seminomatous testicular tumors underwent modified laparoscopic RPLND. Patients were asked about preservation of antegrade ejaculation six weeks after surgery. We also analyze surgical and oncological variables in the series.

All surgeries where successfully completed laparoscopically. Mean age 29.8 years (15-50). Antegrade ejaculation was preserved in 91.6% (22/24) of the patients. Mean surgical time was 122 minutes (90-215). Mean hospital stay was 1.7 days (1-4). Mean number of lymph nodes excised was 13 (5-22). Metastatic lymph node involvement was found in 29% of the patients 17/24). There were no surgical complications.

Laparoscopic approach is as effective as the classic open technique to maintain antegrade ejaculation and subsequent fertility Additionally, it has low morbidity the advantages of a minimally invasive approach and oncological outcomes are similar to the classic approach. For these reasons the laparoscopic approach should be the technique of choice for patients in who decision to undergo surgical staging is taken.