Loss Of Ejaculation Research Articles

Morphological variations of the human ejaculatory ducts in relation to the prostatic urethra.

Loss of ejaculation can follow transurethral resection of the prostate (TURP). Periverumontanal prostate tissue is preserved in ejaculation-preserving TURP (ep-TURP). Knowledge of ejaculatory duct anatomy in relation to the prostatic urethra can help in ep-TURP. This was evaluated in cross-sections of the prostate using a 3 D model to determine a safe zone for resecting the prostate in ep-TURP. A 3 D reconstruction of the ejaculatory ducts was developed on the basis of six prostate gland cross-sections. The measurements obtained from the 3 D model were standardized according to the maximum width of the prostate. Simple linear regressions were used to predict the relationships of the ejaculatory ducts. The maximum widths of the prostates ranged from 22.60 to 52.10 mm. The ejaculatory ducts entered the prostate with a concavity directed posterolaterally. They then proceeded toward the seminal colliculus in a fairly straight course, and from that point they angulated anteromedially. As they opened into the prostatic urethra they diverged. Significant regression models predicted the relationships of the ejaculatory ducts to the prostatic urethra based on the sizes of the prostates. The 3 D anatomy of ejaculatory ducts can be predicted on the basis of prostate width. The ejaculatory ducts can be preserved with 95% accuracy if a block of tissue 7.5 mm from the midline on either side of the seminal colliculus is preserved, up to 10 mm proximal to the level of the seminal colliculus, during TURP. Clin. Anat. 31:456-461, 2018. © 2017 Wiley Periodicals, Inc.

Impact of Thulium Laser Enucleation of the Prostate on Erectile, Ejaculatory and Urinary Functions

Objective: To test the impact of Thulium laser enucleation of the prostate (ThuLEP) on erectile and ejaculatory functions, on lower urinary tract symptoms and on quality of life (QoL). Methods: From July 2013 to May 2015, we prospectively evaluated 177 patients with LUTS related to benign prostatic hyperplasia. All patients were assessed with the International Index of Erectile Function (IIEF-5), Male Sexual Health Questionnaire-Ejaculatory Disease (MSHQ-EjD), International Prostate Symptom Score (IPSS), QoL, PSA and uroflowmetry before and at 4 and 8 months after surgery. Results: Erectile function did not show variation with IIEF-5 preoperative score 22.49 ± 1.8 and postoperative score 22.14 ± 3.1 (p = 0.195) and 22.18 ± 3.2 (p = 0.26) at 4 and 8 months after treatment. The ejaculatory function on the MSHQ-EjD test indicated the reduction of ejaculation, changing from 14.90 ± 6.88 to 5.51 ± 4.17 (p < 0.0001) and 5.38 ± 3.93 (p < 0.0001) at 4 and 8 months follow-up. IPSS score decreased from preoperative 21.12 ± 5.81 to 3.14 ± 3.16 (p < 0.0001) and 3.08 ± 3.12 (p < 0.0001) 4 and 8 months after surgery. PSA decreased from 4.50 ± 3.72 to 1.39 ± 1.04 (p < 0.0001) and 1.47 ± 1.14 ng/ml (p < 0.0001) at 4 and 8 months follow-up, while QoL score improved from 5.41 ± 0.69 to 0.57 ± 0.84 (p < 0.0001) and 0.51 ± 0.80 (p < 0.0001) at 4 and 8 months follow-up. Conclusions: ThuLEP does not affect erectile function and determines the resolution of LUTS with improvement of QoL. Loss of ejaculation did not impair the sexual intercourse activities of the patients.

Diagnostic and Outcome Differences Between Heterosexual and Nonheterosexual Men Treated for Prostate Cancer

To determine if heterosexual and nonheterosexual men treated for prostate cancer differ in diagnostic and treatment outcomes and in various measures of physical health, sexual function, and well being, before and after the treatment. Four hundred sixty self-identified heterosexual and 96 self-identified nonheterosexual men completed an anonymous online survey. The men in the 2 groups were then compared using logistic regressions that controlled for differences among countries. There were no significant differences in age at diagnosis for men in the 2 groups. However, Gleason scores at diagnosis were significantly lower for the nonheterosexual men (P = .02). There were no significant differences among men in the 2 groups in the proportion who receive different treatment modalities or in the incidence of urinary incontinence, who experience bone pain (as a marker of disease progression), who take antidepressants (as a proxy measure for mental health), or who experience erectile dysfunction after the treatment. However, nonheterosexual men rated the degree to which they were bothered by an inability to ejaculate significantly higher than did the heterosexual men (P = .04). This is the first set of findings from a survey that compares heterosexual and nonheterosexual men treated for prostate cancer. Although the groups were generally similar, nonheterosexual men might experience more intensive screening for disease, as indicated by lower Gleason scores at diagnosis. Nonheterosexual men appear more distressed by loss of ejaculation after prostatectomy.

V325 NEW ASPECTS OF EJACULATION AND ITS SIGNIFICANCE: EJACULATION PRESERVING TRANSURETHRAL RESECTION AND LASERVAPORESECTION OF THE PROSTATE

You have accessJournal of UrologyMale Voiding Dysfunction (BPH & Incontinence) & Infection1 Apr 2010V325 NEW ASPECTS OF EJACULATION AND ITS SIGNIFICANCE: EJACULATION PRESERVING TRANSURETHRAL RESECTION AND LASERVAPORESECTION OF THE PROSTATE Christoph Lang, Awad Al-Kaabneh, Robert Eichel, Saladin Helmut Alloussi, and Schahnaz Alloussi Christoph LangChristoph Lang More articles by this author , Awad Al-KaabnehAwad Al-Kaabneh More articles by this author , Robert EichelRobert Eichel More articles by this author , Saladin Helmut AlloussiSaladin Helmut Alloussi More articles by this author , and Schahnaz AlloussiSchahnaz Alloussi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.390AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Clinical, physiological and anatomical findings have resulted in challenging the current theory of the ejaculation mechanism. Videourodynamic observations in patients with opened internal bladder neck are able to ejaculate antegradely and patients with loss of ejaculation after retroperitoneal lymphadenectomy presented a closed internal bladder neck. Anatomic and histological examinations could confirm a musculus ejaculatorius to bring into line the colliculus seminalis. Due to the findings and understanding of ejaculation mechanism a new technique in TUR (epTUR) and Laservaporesection (epLaVaP) of the prostate is established. This video is performed to present the functional aspects of ejaculation and the resection techniques. METHODS Since 1996 in 197 patients, aged 27 to 78 years an ejaculation preserving technique of the prostate is performed, since 2001 87 patients in a prospectiv study with 5 year follow up control and since 2008 in 22 patients by laservaporesection. The functional outcome is controlled by uroflow, residual volume, International Prostate Symptom Score (IPSS) and Live Quality Index (LQI). The ejaculate is controlled in the first 50 patients by seminal fluid analysis and for all patients by questionnaire IIEF 5+. RESULTS In 92% of patients, treated by epTUR-P and epLaVaP for bladder outlet obstruction the orthograde ejaculation could be preserved. In seminal fluid analysis a reduction of volume of 30% is shown. Micturition symptoms show a substantial improvement as objective parameters like uroflow and residual volume presented in table 1. Table 1. Functional results of epTUR-P with 5 year follow up, n=87 Preop Postop Follow-up IPSS 23 7 4.7 LQI 4.7 2 1.5 Uroflow [ml/s] 7 24 24 Residual [ml] 52 13 12.5 CONCLUSIONS Ejaculation preserving treatment of the prostate by endoscopic resection is possible. The presented techniques are suitable for ejaculation preservation. The functional outcome is excellent and could be confirmed in long term follow up for epTUR-P. The internal bladder neck is irrelevant for orthogradic ejaculation. No incontinence could be observed. The old concept of ejaculation physiology must be reviewed. Neunkirchen, Germany© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e129 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christoph Lang More articles by this author Awad Al-Kaabneh More articles by this author Robert Eichel More articles by this author Saladin Helmut Alloussi More articles by this author Schahnaz Alloussi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prostate Operations: Long-Term Effects on Sexual and Urinary Function and Quality of Life. Comparison With an Age-Matched Control Population

The purpose of this study was to investigate the effects of radical prostatectomy (RP) for prostate cancer, transurethral resection of the prostate (TURP) for benign prostate hyperplasia (BPH), and the alterations induced by ageing on quality of life, urinary and sexual function, and bother. We evaluated 283 patients who filled in and returned the questionnaire used. A total of 105 were treated with RP and were selected prostate cancer patients with localised disease without recurrences. An additional 98 underwent TURP for BPH and a third group consisted of 80 apparently healthy men. The general quality of life was estimated by the Rand 36-Item Health Survey 1.0. Urinary function was estimated by the AUA Symptom Index and the UCLA Prostate Cancer Index (urinary function and bother scale). Sexual function and bother, were explored using the Brief Male Sexual Function Inventory for Urology. Patient outcome 2 years post treatment was compared to the pre-treatment status and to that of the matched control population. General quality of life was not affected by RP or TURP, with the exception of an increase in the emotional/well being domain in RP patients to control group levels. After RP there was more bother reported for the urinary function than urinary malfunction itself, while TURP, as expected, restored urinary function and bother to normal population norms. Elderly males had urinary function and bother similar to the operated patients. Estimating sexual function on RP patients, erectile dysfunction (ED) predominates, leading to decreased sexual life. TURP marginally affects sexual life, mainly due to the loss of ejaculation, while in men from the control group, sexual function, although affected, was still present.

Novel presentation of retroperitoneal germ cell tumor with loss of ejaculation but preservation of erection in two patients

To examine the effect of large-volume retroperitoneal germ cell tumor on nerve fibers required for erection and ejaculation. Retrospective case reports. Cancer treatment center. Two male patients presenting with loss of ejaculation but preservation of erection. Retroperitoneal lymph nodes lie very close to the sympathetic nerve fibers that control ejaculation. Large-volume tumors would encase the sympathetic plexuses at L1 to L3, making ejaculation impossible. Parasympathetic fibers arise from S2 to S4, so they would not be damaged, preserving erection. Thorough history taking is important in the investigation of infertility. Presentation with these symptoms requires further investigation at an early stage to exclude retroperitoneal tumor.

Sexuality in patients with ulcerative colitis before and after restorative proctocolectomy: a prospective study

Background: The purpose of this study was to assess sexuality in patients with ulcerative colitis (UC), before and one year after an ileal‐pouch anal anastomosis (IPAA). Methods: Group I comprised 14 medically treated patients (7 M) and Group II comprised 29 patients (18 M), operated with colectomy and ileostomy, with preservation of the rectum. Patients were interviewed about desire, excitement and general sexual satisfaction before and one year after the IPAA operation. Results: Most of the patients had restarted sexual activity ≤3 months after surgery. Sexual desire and desire for intercourse had not changed from before the IPAA operation. In Group I, one woman suffered from dyspareunia both before and after the IPAA. In Group II, three women had dyspareunia before the IPAA and four after surgery. Erection and ejaculation were normal in all men before the IPAA operation. After IPAA, one man in Group I and two men in Group II had loss of ejaculation. In Group I, 10 out of 14 patients were satisfied with their sexual life both before and after the IPAA. In Group II the corresponding figures were 15 out of 28 before and 22 after IPAA surgery. Conclusions: A third of the patients stated that they were dissatisfied with their sexual life before IPAA. Although a few patients experienced sexual imperfections such as loss of ejaculation and dyspareunia, the majority of patients in both groups considered that the overall general satisfaction with their sexual life had normalized considerably after surgery.

Bladder and male sexual functions after autonomic nerve-sparing TME with or without lateral node dissection for rectal cancer.

We evaluated to what extent lateral lymph node dissection (LND) interferes with bladder and male sexual functions after radical rectal excision with adoption of careful total autonomic nerve preservation. The study comprised 77 patients resected for mid-rectal or lower rectal cancer. Bladder and male sexual functions were studied by means of a questionnaire more than one year after surgery. Outcomes were compared between patients who received lateral LND (group 1, 65 patients) and those who did not (group 2, 12 patients). Only minor disturbances of bladder function were reported in 10 patients (15%) of group 1, and in 3 patients (25%) of group 2. Ten out of 37 preoperatively sexually active patients (27%) in group 1 males and one of 5 patients (20%) in group 2 males had partial or total impotency after surgery and retrograde ejaculation occurred in 3 of 27 patients (11%) and one of 4 patients (25%), respectively. Erectile impotency occurred less frequently when patients were operated during the period 1993-1996 than during 1988-1992 (11% vs. 42%, p<0.05). The age was significantly greater among patients who had loss of ejaculation. If lateral lymph node dissection should be used with the aim of improving radicality in rectal excision for cancer, it should be combined with careful nerve-preserving technique--which may reduce the risk of bladder and male sexual dysfunctions.

Urologic injuries associated with repair of anorectal malformations in male patients

Background/Purpose: Serious injuries to the urinary tract may occur during the repair of an anorectal malformation, especially in boys. This review of a large series of patients characterizes factors that may either lead to, or prevent, those injuries. Methods: A retrospective review of 1,003 boys with anorectal malformations was performed. Results: A total of 129 injuries in 1,003 patients were identified. Five hundred seventy-two of the 1,003 patients (group A) underwent definitive repair at the authors' institution. In this group, there were 19 urologic injuries; 1 bladder perforation, 1 divided ureter, 2 divided vas defera, 1 prostatic injury, 7 seminal vesicles were opened and closed, and in 7 cases, the urethra was opened and closed during the repair. Follow-up ranges from 15 years to 1 month and no late sequelae have been observed. The second group (B) consisted of 431 patients who underwent various operations at other institutions. In this group, 110 urologic injuries in 97 patients were noted. These included neurogenic bladder (n = 27), persistent, recurrent or acquired recto-urethral fistulae (n = 30), posterior urethral diverticulae that required reoperation (n = 23), urethral injuries leading to stenosis or aquired atresia (n = 19), pull-through of major urinary structures (n = 2), injured ureter (n = 1), opened seminal vesicle (n = 1), divided vas defera (n = 4), impotence (n = 1), and loss of ejaculation (n = 2). Several significant associations were noted. The most significant was that all 27 patients with neurogenic bladder and all 19 of those in group B with urethral injuries did not undergo a distal colostogram to define the level of the fistula before repair. Posterior urethral diverticulae were seen only in cases of recto-bulbar urethral fistulae repaired via an abdominal-perineal approach. Conclusions: Significant urologic injuries are associated with the repair of anorectal malformations. The risk of injury is increased in those patients who undergo repair without a distal colostogram.

IMPACT OF INTERVENTIONAL THERAPY FOR BENIGN PROSTATIC HYPERPLASIA ON QUALITY OF LIFE AND SEXUAL FUNCTION: A PROSPECTIVE STUDY

Treatment for benign prostatic hyperplasia (BPH), including minimally invasive therapy, can impair the quality of life. We prospectively determined the impact of 4 different interventional therapies on quality of life and sexual function. A total of 173 patients were prospectively evaluated between February 1995 and August 1997. Treatment modalities consisted of standard transurethral resection of the prostate in 55 cases, transurethral microwave thermotherapy in 34, interstitial laser coagulation of the prostate in 42 and transurethral needle ablation in 42. Disease specific quality of life was assessed using the International Prostate Symptom Score quality of life assessment index and BPH impact index. In addition, a self-reporting questionnaire was completed before and 3 months after treatment to determine the impact on sexual function. All 4 treatment groups showed significant improvement in the symptom score, International Prostate Symptom Score quality of life assessment score and BPH impact index score. Satisfaction with treatment was highest in patients treated with transurethral resection or laser coagulation. A mild to moderate decrease in erectile function was noted in 26.5%, 18.2%, 18.4% and 20.0% of the transurethral resection, microwave thermotherapy, laser coagulation and needle ablation groups, respectively, but there was no significant difference of mean pretreatment and posttreatment erectile function or libido scores in any group. Ejaculation loss or severe decrease in ejaculate volume was reported by 48.6%, 28.1%, 21.6% and 24.3% of the patients, respectively. Interestingly, 20 of the 44 patients (45. 5%) with loss of ejaculation or severe decrease in ejaculate reported deterioration of the sex life, while only 2 (3.6%) of the 56 without any change in ejaculate volume reported such deterioration. The association of ejaculatory dysfunction with an adverse impact on sexual activity was highly significant (p <0.0001). Significant improvement in quality of life could be achieved with the present assessed interventional therapies. There was no significant change in sexual desire or erectile function with these therapies. Posttreatment sexual dysfunction appears to be mainly related to impaired ejaculatory function. Urologists should provide proper counseling regarding the possibility of this complication even in patients receiving minimally invasive treatment.

Orgasm after radical prostatectomy.

To evaluate the ability to obtain and the quality of orgasm after radical prostatectomy. The orgasms experienced after undergoing radical prostatectomy were evaluated in 20 men (median age 65 years, range 56-76) using a semi-structured interview and a self-administered questionnaire. In addition, the patients were asked to write a brief statement about their experiences and sensations during orgasm before and after the operation. Eighteen patients returned the questionnaire and 17 completed a statement indicating what their orgasm was like before and after radical prostatectomy. After the operation, no patient was able to maintain a completely rigid erection, but for five patients the erection was sufficient for sexual intercourse. Nine patients used a vacuum device or intracavernosal self-injection. Half the patients reported diminished sexual desire (libido) and arousal after the operation and reported the same to occur in their partners. During their "dry' orgasm post-operatively, none of the patients experienced the exquisite sensation of inevitability, the so-called "point of no return'. Seven of the 14 patients experiencing orgasm complained that their orgasmic sensation was weakened. Four patients reported normal pleasure and sensation compared to that experienced pre-operatively. Surprisingly, nine of the 14 patients had involuntary loss of urine at orgasm; for five of them this was sufficient reason to avoid any sexual contact with their partner. Radical prostatectomy may have serious consequences on libido and erectile function but sometimes other important factors, such as the absence of prostate and seminal vesicle contractions, the loss of ejaculation and involuntary loss of urine, may also compromise the orgasm.

Immunohistological Detection of Lymph Node Metastases in the Testicular Center as Quick Section Diagnosis During Retroperitoneal Lymphadenectomy

The object of this study was to determine whether the immunohistochemical detection of cytokeratin (CK)-positive cells is useful as quick section diagnosis, and whether the retroperitoneal lymphadenectomy (RLA) can be reduced by this method without any disadvantage for the patient. The RLA represents a combined diagnostic and therapeutic procedure for staging as well as removal of regional lymph node metastases in patients with malignant testis tumors. The disadvantage of the radical RLA is a 40 to 90 % loss of potency. The risk of the reduced RLA is the relapse. The metastatic affection of the first retroperitoneal lymph node station, the so-called “sentinale” lymph nodes, allows a judgement for the remaining lymph nodes, and, therefore, for the extent of the necessary operation. The conventional frozen technique has a limited reliability, whereas the paraffin technique needs too much time. We used the immunohistochemistry as alternative method for the rapid as well as reliable evaluation of metastases. A group (7 cases) of 35 patients with non-seminomatous tumors of the testis was only treated by radical RLA after detection of CK-positive cells in the sentinale lymph nodes. The other patients were treated by modified RLA (20 cases) or reduced RLA (6 cases). The results were compared with a control group (48 cases) which was treated by radical RLA only. Using the modified RLA the relapse-free interval was not affected and the loss of ejaculation as a consequence of radical treatment could be avoided. Besides the conventional quick section technique (frozen section) of testicular center lymph nodes, a simultaneous intraoperative immunohistological investigation (detection of CK-positive cells) is a prerequisite for this kind of operation.

Ejaculatory Dysfunction after Retroperitoneal Lymphadenectomy

The effects of retroperitoneal lymphadenectomy on ejaculation have been examined in 186 patients who had removal of residual masses after chemotherapy for metastatic non-seminomatous germ cell tumours. The results were analysed for significance using a chi 2 test of independence. Forty-one men (22%) permanently lost ejaculation postoperatively. The larger the size of the mass removed, the more likely the patient was to have ejaculatory failure (< 4 cm = 4%, 4-8 cm = 17%, > 8 cm = 58%; p < 0.005). Removal of bilateral masses was more likely to result in loss of ejaculation than unilateral masses (45 and 12%, respectively, p < 0.005). There has been significantly less postoperative ejaculatory dysfunction since 1984 when a nerve sparing dissection was introduced (before 1984 36%, since 1984 16%, p < 0.005). The incidence of ejaculatory dysfunction following retroperitoneal lymphadenectomy is therefore determined by the size and position of residual lymph node masses after chemotherapy and can be kept to a minimum by a careful nerve sparing operative technique.

Transurethral Resection Versus Transurethral Incision of the Prostate: A Prospective Randomized Study

In this ongoing study, patients with an estimated prostate size of no more than 20 gm are randomized to undergo either transurethral resection of the prostate (TURP) or transurethral incision (TUIP) at the 6 o'clock position. To date, 93 patients have been included, and 3 months postoperatively, 80 to 90 per cent of the patients in each group reported improvement. There was also a significant decrease in symptom scores and a significant increase in maximum urinary flow rate, with great variation within each group but without difference between the groups. In both groups, there appears to be some deterioration over time. Operating time, estimated blood loss, time to catheter removal postoperatively, and duration of postoperative hospital stay were all significantly in favor of TUIP. Loss of ejaculation was reported by 37 per cent of patients after TURP and by 13 per cent after TUIP (not statistically significant). There was no difference between the groups in the need for further surgery. Therefore, TUIP is recommended as an alternative to TURP in patients with small prostates.

Psychological Aspects of Testis Cancer Therapy: A Prospective Study

We examined the impact of testis cancer and its curative therapies on the outlook of life, working activity, partner relationship and sexual function in 31 consecutive patients 18 to 51 years old (mean age 29.3 years, median 28 years) who already had undergone orchiectomy. Of the patients 13 subsequently were treated with chemotherapy alone, 6 with retroperitoneal lymph node dissection alone, and 7 with chemotherapy and an operation, while 5 seminoma patients were treated with radiotherapy. The patients were examined 3, 6 and 18 months after orchiectomy. Each patient was required to fill out a questionnaire to gather information relative to their work activities, emotional relationship with the partner and sexual life. The patients also completed an assessment form on the quality of life (Spitzer QL-Index) and a series of horizontal analogues to evaluate anxiety, mood, nausea, weakness and general health status. The statistical analysis of the linear and quadratic components for the variables under study was done with the general linear model for block design.Psychosocial adaptability of these patients, regardless of the treatment they underwent, in time became progressively less problematic and the development of psychosocial problems during the long-term adjustment was low. Only 2 patients reported worsening of the emotional relationship with the partner after treatment: 1 underwent chemotherapy and an operation, and 1 underwent radiotherapy. With regard to sexual life, no serious dysfunction was noted apart from the loss of ejaculation in 11 of 13 patients who underwent retroperitoneal lymph node dissection. Of our sample patients who had lost ejaculation only 2 suffered from a high state of anxiety. The anxiety scores on the last completed linear analogue were 2.6 and 4.1, whereas at the same time the mood scores were 1.9 and 4.4. Therefore, it is important for the clinician to assess the psychogenic aspect of this side effect when this type of operation is proposed.

Neurological correlations of ejaculation and testicular size in men with a complete spinal cord section.

This study was of 135 patients with a complete spinal cord section suffered from loss of ejaculation. The spinal cord injuries were classified following the upper and the lower limits of the lesion. The volume of the testes of the patients and of 13 normal control subjects were measured. Physostigmine allowed 75 patients to ejaculate and 15 of them procreated. The possibility of ejaculation after physostigmine mainly depended on the integrity of the T12-L2 metamers. The testicular volume was significantly smaller in patients with a lesion including the T12 metamer than in patients with a lesion sparing the T12 metamer. Six patients with a lesion including the T12 metamer had testicular atrophy. This suggests that T12 segment plays a role in testicular function in paraplegic patients.

Diagnostics and therapy of germinal testicular tumors.

Based on experience in the treatment of 627 patients with germinal testicular tumor and referring to recent literature, the age distribution (children, 3.6%, men over 50 years, 6.3%), importance and possibilities of early detection as well as sensitivity, specificity and accuracy of tumor markers, ultrasonography and X-ray examinations are described. In N0M0 stage seminomas, cure can be effected by radiotherapy in almost 100% of the cases. An alternative 'watch policy' is discussed. In N1-2M0 stage seminomas, cure can be achieved by irradiation in more than 90% of the cases. Primary polychemotherapy is needed in stage N3M0 or M1 as well as in stage N4M0 and N1-4M1 seminomas. Complete remission can be obtained in more than 90% of the patients if salvage operation, further chemotherapy or radiotherapy is performed in cases without complete remission after semicastration and primary chemotherapy. In N0M0 stage non-seminomas (excluding pT4 cases, choriocarcinoma, and patients with persistently elevated markers following semicastration), 'watch policy' has the disadvantage of requiring optimal monthly follow-ups and progression in 20% of the cases. While modified lymphadenectomy reduces the progression rate to 10% with low operative morbidity, it leads to an irreversible loss of ejaculation in 12% of the patients. With both modalities, if progression is detected, full recovery can be expected with immediate polychemotherapy. In stage N1-2M0 non-seminomas, a tumor-free condition can be obtained in close to 100% of the cases by lymphadenectomy and adjuvant chemotherapy. In stage N3,4 and/or M1, first primary polychemotherapy is carried out. In the case of a residual tumor this is followed by salvage operation and, if active tumor is found, by salvage chemotherapy. With this treatment, recovery can be achieved in 70-80% of the cases depending on the involvement of surrounding organs.

Thoracoabdominal Retroperitoneal Lymphadenectomy for Nonseminomatous Testicular Cancer

Retroperitoneal lymphadenectomy remains a mainstay of the management of patients with nonseminomatous testicular cancer. The operation provides accurate information regarding stage and prognosis, which current preoperative staging studies cannot duplicate. The therapeutic value of lymphadenectomy has been demonstrated more clearly for testicular tumors than for any other cancer. Properly performed, the operation results in complete removal of all node-bearing tissue at significant risk of harboring metastases. Yet the morbidity and mortality are low in these young, generally vigorous patients. The only long-term sequela is loss of ejaculation. Efforts are currently underway to determine limits to the operation that will preserve ejaculation while maintaining the efficacy of the procedure.

Sexual dysfunction in patients with multiple sclerosis

In patients with multiple sclerosis many different types of sexual problems may exist. Paraesthesiae and decreased sensibility in the genital region may interfere with the perception of pleasurable sensations and diminish the sexual response. Lesions especially of the spinal cord may also result in impotence or loss of ejaculation. Brain lesion may cause a decrease in libido and alter the sensation of orgasm. Symptoms of sexual dysfunction are fairly common even among early and mild cases of multiple sclerosis. In advanced cases sexual problems are very common. In such cases different psychological mechanisms may play an important role. The importance of sexual counselling and sexual rehabilitation in patients with multiple sclerosis is discussed.

Loss of Ejaculation Following Bilateral Retroperitoneal Lymphadenectomy

No AccessJournal of Urology1 Sep 1967Loss of Ejaculation Following Bilateral Retroperitoneal Lymphadenectomy Leiter Elliot and Herbert Brendler Leiter ElliotLeiter Elliot More articles by this author and Herbert BrendlerHerbert Brendler More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)62894-5AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 1967 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 98Issue 3September 1967Page: 375-378 Advertisement Copyright & Permissions© 1967 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Leiter Elliot More articles by this author Herbert Brendler More articles by this author Expand All Advertisement PDF downloadLoading ...