Retroperitoneal lymph node dissection

Retroperitoneal lymph node dissection (RPLND) is surgery often used to treat testicular cancer. It is done to remove lymph nodes that may be cancerous from the lower back and pelvis.

During the early phases of stage I nonseminoma testicular cancer, it can be very difficult to tell whether these lymph nodes are cancerous without surgically removing them first. For this reason, RPLND may be performed even though there is no sign that the cancer has spread (metastasized) beyond the testes.

For many men, the greatest risk associated with RPLND may be sexual side effects. Besides the risks related to any major surgery, RPLND also may lead to a condition known as retrograde ejaculation as a result of nerve damage caused by the surgery. In retrograde ejaculation, the semen flows from the prostate gland into the bladder rather than through the penis and outside the body, resulting in infertility. Men who suffer from retrograde ejaculation typically do not have erection problems or difficulty enjoying sex.

An increasing number of RPLNDs are done using laparoscopic surgery. Laparoscopy is a surgical technique in which a lighted viewing instrument (laparoscope) and other surgical instruments are inserted into the lower abdomen through small incisions, usually made below the navel. Though not yet commonly available, laparoscopic RPLND is much less invasive and carries less risk than standard RPLND surgery.

Laparoscopic and other "nerve-sparing" techniques now used in many RPLND surgeries have greatly lowered the risk of retrograde ejaculation. Studies show that 95% of men who have nerve-sparing RPLND have normal ejaculation after surgery.¹

Nerve-sparing surgery is not possible for all men who have RPLND surgery.

Try to find an experienced surgeon and a medical center where many surgeries are done for your kind of cancer. Experience can make a big difference. You will likely have fewer side effects, and you’ll recover more quickly.

Author:	Bets Davis, MFA	Last Updated: January 26, 2009
Medical Review:	Anne C. Poinier, MD - Internal Medicine Christopher G. Wood, MD, FACS - Urology/Oncology
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