Nerve-Sparing Surgery Preserves Reproductive Function In Testicular Cancer Patients, Analysis Shows

INDIANAPOLIS-- Does the end justify the means? That is the question researchers at the Indiana University School of Medicine weighed when they analyzed 12 years of records of testicular cancer patients who had nerve-sparing surgery. A report on their findings was presented Sunday, May 31, at the 93rd Annual Meeting of the American Urological Association at San Diego May 30- June 4.

Since the early 1980s, the standard therapy for treating advanced stage germ cell testicular cancer included chemotherapy and nerve-sparing surgery known as retroperitoneal lymph node dissection (RPLND).

The RPLND surgical procedure was refined at IU School of Medicine and it, in combination with the chemotherapy regimen developed at IU, has greatly increased testicular cancer patients’ survival rates. However, the surgical nerve-sparing procedure is more complicated than other surgical methods, said Richard S. Foster, M.D., associate professor of urology at the IU School of Medicine and the presenter of the report.

Historically, when testicular cancer surgery and lymph node dissection were performed there were tiny nerves removed, said Dr. Foster. Those nerves control a man’s ability to secrete semen and expel semen. Physicians adopted the nerve-sparing technique because they believed more men would be able to live a full life, including fatherhood.

Testicular cancer frequently strikes men in their teens and 20s, and before the nerve-sparing surgery technique was refined, all were left incapable of fathering children.

Dr. Foster and his fellow IU researchers reviewed the long-term fertility preserving potential of the procedure.

Between 1984 and 1996, nerve-sparing RPLND was performed at IU on 483 stage I testicular cancer patients. Of those, 401 were available for follow-up analysis.

All of the patients surveyed were able to achieve ejaculation.

The analysis also determined:

* 124 patients, who had cancer of the right testicle, had the nerve-sparing procedure performed on the right side. Of those, 50 patients had attempted to father children and 40 of those patients (80 percent) had been successful.

* 185 patients had the procedure performed on the left side. Of those, 48 patients had attempted to father children and 42 of those patients (88 percent) had been successful.

The long-term analysis shows that nerve-sparing RPLND effectively preserves emission, ejaculation and long-term fertility, Dr. Foster said. The procedure indeed preserves a necessary function and improves the quality of life for these men.

Contact: Mary Hardin
317-274-7722
mhardin@iupui.edu

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