Sperm parameters and ejaculation before and after operative treatment of patients with germ-cell testicular cancer.

In testicular tumor patients, the stage of disease is most accurately determined by retroperitoneal lymph node dissection (RLND) and histologic examination of the operative specimen. The resection of possibly metastatic nodes is essential for securing a good prognosis. However, the most frequently encountered loss of ejaculatory function is a major disadvantage of radical RLND. In patients who intraoperatively proved to be free of metastases, we successfully employed a modified technique aiming at the preservation of sympathetic nerve fibers which mediate ejaculation. In 29 of 37 patients (78%), postoperative ejaculation was antegrade. It was retrograde in 5 of 37 patients (13.5%); 3 patients had no emission. These results are retrospectively compared with results of radical RLND in 87 patients of whom 64% suffered a total loss of ejaculation and only 23% had antegrade ejaculation. RLND did not affect sperm count, motility, and cell morphology. Potentia coeundi was preserved in all cases, although 27% of patients experienced diminished erectility or libido.