Pseudoephedrine for ejaculatory dysfunction after retroperitoneal lymph node dissection in testicular cancer

Area of Science:

• Oncology
• Urology
• Reproductive Medicine

Background:

• Retroperitoneal lymph node dissection (RPLND) for testicular cancer can lead to ejaculatory dysfunction (EjD).
• EjD may impact health-related quality of life (HRQoL) and sexual function post-surgery.
• Assessing the efficacy of treatments for post-RPLND EjD is crucial for patient well-being.

Purpose of the Study:

• To evaluate the impact of EjD on HRQoL after RPLND in testicular cancer patients.
• To determine the effectiveness of pseudoephedrine hydrochloride in treating post-RPLND EjD.
• To assess changes in sperm count and semen volume following pseudoephedrine treatment.

Main Methods:

• A single-arm, phase II trial involving patients at least 6 months post-RPLND.
• Patient-reported outcome measures (EORTC QLQ-C30, EORTC QLQ-TC26, BMPSI) assessed HRQoL and sexual function.
• Pseudoephedrine hydrochloride was administered to eligible patients with EjD, with primary endpoint being sperm count >39 million/ejaculate.

Main Results:

• 57% of patients reported EjD post-RPLND.
• EjD was associated with poorer role functioning, sexual problems, and sexual enjoyment, but not global HRQoL.
• Pseudoephedrine treatment resulted in a mean increase in sperm count and semen volume, but only 18% achieved the primary endpoint for sperm count.

Conclusions:

• EjD is a frequent complication of RPLND but does not significantly affect global HRQoL.
• Pseudoephedrine demonstrated limited efficacy in improving EjD parameters, with suboptimal achievement of treatment goals.
• Pseudoephedrine may be considered for individual patients with EjD after RPLND, with careful consideration of its modest effectiveness.