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 where cancer may have spread, 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) near the surgery, injury to them is possible. This can result in pain, weakness, or paralysis. In a very small number of patients, the main blood vessel that takes blood from the lower extremities back to the heart (inferior vena cava) has tumor around it and needs to be removed. This is very rare but 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.
Sexuality & Fertility Issues
There are nerves in the lower abdomen that are responsible for sperm release and normal ejaculation. After RPLND, some men can have retrograde ejaculation (RE), which means the ejaculate goes into 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 fertility specialist. Sperm can often be retrieved from urine after ejaculation. If you have a nerve-sparing RPLND, your chance of having retrograde ejaculation is low.
Risks of Abdominal Surgery
In addition, abdominal surgeries can put survivors at risk for blood clots, 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.
Baniel, J., Foster, R. S., Rowland, R. G., Bihrle, R., & Donohue, J. P. (1994). Complications of primary retroperitoneal lymph node dissection. The Journal of urology, 152(2 Part 1), 424-427.
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.