Survivorship: Health Concerns After Retroperitoneal Lymph Node Dissection (RPLND)
Retroperitoneal lymph node dissection (RPLND) may be done as part of treatment for testicular cancer for two reasons – removal of lymph nodes in the pelvis that may be involved with cancer, and to provide staging information. The procedure can be done before or after chemotherapy. The risk of complications is higher for men having the procedure after chemotherapy, perhaps because their surgery may be more extensive.
RPLND does not often cause long-term issues, but you should be aware of potential problems. Due to the number and complexity of nerves (including the spinal cord) in the area of the surgery, injury to these structures is possible. This can result in pain, weakness or paralysis. In a very small number of patients, the main return blood vessel for the lower extremities (inferior vena cava) is involved with the tumor and is removed. This is very rare and can result in chronic swelling of the lower extremities. In most cases, this swelling is in the feet and goes away within a few months, but it can become a chronic issue.
Sympathetic nerves in the retroperitoneum (lower abdomen) are responsible for sperm release and normal ejaculation. Some men may have retrograde ejaculation (RE), which means the ejaculate enters the bladder instead of exiting through the penis. Some men report a less satisfying orgasm without ejaculation. Men with RE wishing to father a child should see a reproductive specialist. Sperm can often be retrieved from urine after ejaculation. If you have a nerve-sparing RPLND, your chance of retrograde ejaculation is low.
In addition, abdominal surgeries can put survivors at risk for bowel obstructions (due to scarring), hernia (due to cutting the abdominal muscle) and changes in bowel patterns. Radiation therapy to the abdomen and pelvis can increase the risk of these complications.
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Crestani, A., Esperto, F., Rossanese, M., Giannarini, G., Nicolai, N., & Ficarra, V. (2017). Andrological complications following retroperitoneal lymph node dissection for testicular cancer. Minerva urologica e nefrologica= The Italian journal of urology and nephrology, 69(3), 209-219.
Dimitropoulos, K., Karatzas, A., Papandreou, C., Daliani, D., Zachos, I., Pisters, L. L., & Tzortzis, V. (2016). Sexual dysfunction in testicular cancer patients subjected to post‐chemotherapy retroperitoneal lymph node dissection: a focus beyond ejaculation disorders. Andrologia, 48(4), 425-430.Rague, J. T., Varda, B. K., Wagner, A. A., & Lee, R. S. (2019). Delayed Return of Ejaculatory Function in Adolescent Males Treated With Retroperitoneal Lymph Node Dissection and Adjuvant Therapy for Paratesticular Rhabdomyosarcoma. Urology, 124, 254-256.