Nerve-sparing retroperitoneal lymphadenectomy for low stage testicular cancer

In order to maintain antegrade ejaculation after retroperitoneal lymphadenectomy (RLND) for low stage non-seminomatous germ cell cancer, we implemented a nerve-sparing technique in which the sympathetic nerves were preserved. Thirty-eight patients were clinically staged: 27 were stage I and 11 were either IIa or IIb. Laparotomy revealed that in 2 patients the nerve-sparing technique was not feasible. Fifteen patients had lymph node metastases at frozen section examination and underwent a bilateral nerve-sparing RLND. In the remaining 21 patients the procedure was unilateral. Clinical understaging occurred in 26% of patients (10/38) and overstaging in 8% (3/38). Patients with lymph node metastases received 2 cycles of adjuvant chemotherapy. Mean follow-up was 17 months. Antegrade ejaculation was preserved after bilateral and unilateral nerve-sparing RLND in 86% (12/14) and 95% (19/20) respectively. No recurrences were seen and so far the good prognosis of these patients has not been affected by this new technique.