[Erection and ejaculation disorders following retroperitoneal lymphadenectomy in non-seminomatous testicular tumors]

From 38 patients, who had undergone retroperitoneal lymphadenectomy in the period between April 1980 and October 1983, reliable statements were obtained referring to pre- and postoperative erectile and ejaculatory abilities. The thoracolumbar outflow (Th12-L3) of the centers for emission and psychogenic erection is usually damaged in this procedure. About 12% of the radically lymph node dissected patients complained of permanent erectile disturbances; 85% of the radically lymph node dissected patients revealed ejaculatory disorders, 58% of them with a total loss of ejaculation. About 50% of them showed a considerable psychic involvement. In 12 patients a modified lymph node dissection procedure was performed with the intention to preserve ejaculatory capability. Nevertheless 6 (50%) of them revealed postoperative ejaculatory failure, 3 of them with a total loss of ejaculation. Thus our own experiences and a review of the literature indicate that this modified lymph node dissection often fails in its purpose and can not always be considered a valuable procedure for preservation of ejaculation. The administration of sympathomimetic drugs and/or imipramine is a promising approach in the treatment of ejaculatory failure.