Preservation Of Ejaculation Research Articles

Ejaculation-Preserving Transurethral Resection of Prostate and Bladder Neck: Short- and Long-Term Results of a New Innovative Resection Technique

Loss of antegrade ejaculation is a risk with conventional resection of the prostate (transurethral resection of the prostate [TURP]). The aim of this study was to determine the short- and long-term preservation of antegrade ejaculation and functional results with the novel ejaculation-preserving TURP (epTURP). Prospective evaluation of 89 consecutive patients with bladder outlet obstructions aged 27 to 78 years, enrolled from June 2001 to January 2005. Endpoints were change in objective (uroflowmetry, postvoid residual [PVR]), and subjective (International Prostate Symptoms Score [IPSS], Life Quality Index [LQI]; International Index of Erectile Function-5 [IIEF-5+] with two additional questions) measures of function. All patients received follow-up examinations at 3 and ≥60 months. Overall, 87 and 63 patients were evaluated after 3 and 60 months, respectively. Antegrade ejaculation was preserved in 79 of 87 (90.8%) patients at 3 months. Significant improvements in maximum flow rate (+14.3 mL/s), micturition volume (+71.6 mL), and PVR (-59 mL; p≤0.002 for all) were observed at 3 months. Micturition symptoms, as measured by IPSS and LQI, were also significantly reduced (mean change of 18.3 and 2.9, respectively; p<0.001). Improvements were maintained at 60 months. No serious adverse events were reported. Eight (12.7%) patients received a second epTURP due to the development of bladder neck scar tissue during long-term follow-up. Antegrade ejaculation was preserved with the use of epTURP with excellent outcome. Observed symptomatic and functional outcomes were comparable with conventional TURP. The results from this study underline the necessity of reviewing the old concept of ejaculation physiology.

Postchemotherapy retroperitoneal lymph node dissection for advanced germ cell tumors at a Japanese single high-volume center.

331 Background: Post chemotherapy lymph node dissection (PCRPLND) plays important role in the management of advanced germ cell tumors (GCTs). Guidelines recommend performing PCRPLND for advanced GCT with tumor marker normalization. The aim of this study is to assess efficacy and preserve antegrade ejaculation at Japanese single high volume center. Methods: One hundred and eleven patients who had PCRPLND at Kyoto Prefectural University of Medicine between June 1998 and August 2011 were studied. Five cases of desperation RPLND and 6 cases of laparoscopic RPLND were also included. Results: Median age was 30 years old (17-68y.o.). Seminoma was 11 cases and nonseminoma was 100 cases at primary site. Good, intermediate and poor prognosis group of International Germ Cell Cancer classification was 48, 35 and 20 cases, respectively. Seventy-four cases were treated after induction chemotherapy and 41 cases were done after salvage chemotherapy. median operation time was 590 min. and median blood loss was 1650ml. Nerve-sparing procedure were performed for 90 cases. Antegrade ejaculation was preserved in 83.5% of this cohort. Especially, antegrade ejaculation was preserved in 93.3% of the patients with bilateral nerve sparing. Necrosi/fibrosis, teratoma only and viable cancer were detected in 54.4%, 32.5% and 13.1%, respectively. Additional procedure such as nephrectomy was performed in 12 cases. Five-year overall survival was 95.1%. In the desperation group, only one case is alive without disease. Conclusions: The results of PCRPLND at high volume center could be satisfied and preservation of antegrade ejaculation could be obtained. On the other hand, indication of desperation RPLND had to be carefully considered.

MP-05.08 Preservation of Ejaculation in Monopolar TUR and Laser Vaporesection of Prostate in the Treatment of Bladder Outlet Obstruction

Potent men with desire for preserved ejaculation are frightened about surgical therapy in case of bladder outlet obstruction. Up to now, in case of transurethral resection they have to consider the lost of ejaculation, depending on the resection technique. Clinical, physiological and anatomical findings have resulted in challenging the current theory about ejaculation mechanism. Due to the revalued and innovative aspects a new technique, so called ejaculation preserving transurethral resection and Laservaporesection of the prostate (epTURP + epLaVaRP), could be established.

Eyaculación anterógrada posterior a linfadenectomía lumboaórtica laparoscópica modificada

Testicular cancer affects young and fertile patients. Half of them are non seminomatous tumors. The management of this cancer in stage I includes: watchful waiting, chemotherapy and retroperitoneal lymph node dissection (RPLND). In the past, classic RPLND produced a high rate of anejaculation with the subsequent compromise to fertility. Currently, antegrade ejaculation is achieved in almost 90% of the cases with the modified technique. The objective of this work is to show the conservation of antegrade ejaculation and some surgical anal cortical features of the modified laparoscopic RPLND.From January 2003 to July 2006 24 patients with non-seminomatous testicular tumors underwent modified laparoscopic RPLND. Patients were asked about preservation of antegrade ejaculation six weeks after surgery. We also analyze surgical and oncological variables in the series.All surgeries where successfully completed laparoscopically. Mean age 29.8 years (15-50). Antegrade ejaculation was preserved in 91.6% (22/24) of the patients. Mean surgical time was 122 minutes (90-215). Mean hospital stay was 1.7 days (1-4). Mean number of lymph nodes excised was 13 (5-22). Metastatic lymph node involvement was found in 29% of the patients 17/24). There were no surgical complications.Laparoscopic approach is as effective as the classic open technique to maintain antegrade ejaculation and subsequent fertility Additionally, it has low morbidity the advantages of a minimally invasive approach and oncological outcomes are similar to the classic approach. For these reasons the laparoscopic approach should be the technique of choice for patients in who decision to undergo surgical staging is taken.

Bladder neck resection with preservation of antegrade ejaculation: Basir technique.

To evaluate a new method of bladder neck resection and to determine if antegrade ejaculation is preserved thereafter. Two groups of patients were treated for their bladder neck obstruction. Group A, composed of 20 patients, was treated by bladder neck resection with preservation of more than 1 cm proximal to the verumontanum. Group B, also consisting of 20 patients, was treated by the old technique. Patients were evaluated before and after resection by semen volume, sperm count, symptoms, and urodynamic testing. In group A, antegrade ejaculation was maintained in 17 of the 20 patients (85%), while in 2 patients, only a small amount of semen was ejaculated and in 1 patient, complete retrograde ejaculation was reported. In group B, only 4 patients (20%) preserved antegrade ejaculation, and retrograde ejaculation occurred in 16 patients (80%). With preservation of >1 cm of the supramontanal part of the urethra during bladder neck resection, we could avoid the complication of retrograde ejaculation in those young patients who wish to preserve fertility.

Open technique for nerve-sparing retroperitoneal lymphadenectomy

Introduction. Retroperitoneal lymphadenectomy (RPLND) is indicated in patients with testicular cancer of all stages for staging, prognostic, and therapeutic purposes. Modification of the classic RPLND to incorporate nerve sparing has reduced the morbidity associated with this procedure with respect to ejaculation and fertility. Technical Considerations. Performance of nerve-sparing RPLND requires an understanding of the anatomy of the sympathetic chains, their branches, and their relationship to the major structures of the retroperitoneum. The key element of this procedure is the prospective identification of the postganglionic nerves, which arise from the lumbar sympathetic chains and form an anastomosing network anterior to the aorta and surrounding the origin of the inferior mesenteric artery. Precise dissection of these nerves allows complete skeletonization of the great vessels and removal of all lymphatic tissue, without compromising cancer control. Conclusions. Nerve-sparing RPLND is the procedure of choice for patients with testicular cancer in whom surgical therapy of the retroperitoneum is indicated. The procedure is associated with minimal morbidity and results in preservation of ejaculation in virtually all patients with low-stage disease and in selected patients with advanced disease or after chemotherapy.

SEXUAL FUNCTIONING AFTER MULTIMODALITY TREATMENT FOR DISSEMINATED NONSEMINOMATOUS TESTICULAR GERM CELL TUMOR

SEXUAL FUNCTIONING AFTER MULTIMODALITY TREATMENT FOR DISSEMINATED NONSEMINOMATOUS TESTICULAR GERM CELL TUMOR

Preservation of anterograde ejaculation after transurethral resection of the prostate (TURP) and the bladder neck (TURBN)

The authors present the results of TURP performed on patients with small obstructive adenomas, which allowed anterograde ejaculation to be preserved in over 80% of the cases. The technique, involving supramontanal prostate tissue sparing, was developed following new findings using endorectal ultrasonography during ejaculation, which revealed the absence of the accumulation stage. Contraction during ejaculation of the preserved portion of the prostate enables anterograde ejaculation to be preserved without causing a significant obstacle to micturition.

Nerve Sparing Post-Chemotherapy Retroperitoneal Lymph Node Dissection for Advanced Testicular Cancer

Purpose Nerve sparing techniques are used routinely during retroperitoneal lymph node dissection in patients with low stage testis cancer in an attempt to preserve postoperative ejaculation. Preservation of ejaculation without an increased retroperitoneal recurrence rate in such patients prompted us to reevaluate the role of nerve sparing techniques in select patients undergoing post-chemotherapy retroperitoneal lymph node dissection. Materials and Methods Of 472 patients who underwent post-chemotherapy retroperitoneal lymph node dissection between March 1988 and January 1995, 93 (19.7 percent) underwent a nerve sparing procedure. Two patients died of disseminated cancer within 6 months after post-chemotherapy retroperitoneal lymph node dissection. In 10 patients the ejaculatory status could not be established from the clinical notes and the patient was lost to followup. The remaining 81 patients form the basis of this report. Disease status, complications and ejaculatory status were evaluated. Mean followup was 35.5 months. Results Of the patients 76.5 percent reported normal ejaculation after post-chemotherapy retroperitoneal lymph node dissection. Testis cancer recurred after nerve sparing surgery in 6 patients but no tumor was retroperitoneal. Ten pregnancies have been reported to date with uneventful term deliveries in 7. Conclusions Select patients are candidates for nerve sparing post-chemotherapy retroperitoneal lymph node dissection. Although indications for nerve sparing techniques in the post-chemotherapy population have expanded, the local recurrence rate has not increased. Nerve sparing post-chemotherapy retroperitoneal lymph node dissection can preserve the inherent fertility potential of the patient without increasing retroperitoneal relapse rates.

An intra-operative seminal and prostate emission test as a control for nerve-sparing procedures in primary and secondary retroperitoneal lymphadenectomy.

To determine the value of an intra-operative electrostimulatory test of post-ganglionic nerves for the preservation of ejaculation in primary and secondary retroperitoneal lymph-node dissection (RLND). Between 1991 and 1994, 21 patients with non-seminomatous testicular cancer of clinical stage A and 15 patients with bulky or clinical stage C disease underwent primary or secondary RLND, respectively. During surgery, post-ganglionic nerves were electrostimulated at 30 Hz and up to 20 V, for 3-10 s. Emissions were recorded simultaneously by suprapubic ultrasonography of the seminal vesicals and bladder neck (in 36 patients) and by endoscopy of the posterior urethra (in 11 patients). A positive intra-operative emission test in 15 pathological stage A (with bilateral nerve-sparing) and six pathological stage B (with contralateral nerve-sparing) patients predicted the post-operative preservation of antegrade ejaculation. In the group undergoing secondary RLND, the test allowed the identification and sparing of the emission-related nerves in four of 15 patients with a residual mass consisting of necrosis/fibrosis, and preserved antegrade ejaculation after surgery. A positive result in the seminal emission test predicted the preservation of antegrade ejaculation after surgery. The test is not necessary in patients with clinical stage A disease, but improves the chances of reducing morbidity. If the residual mass consists of necrosis or fibrosis, then electrostimulation during secondary RLND can help to identify important nerve structures when their origin is unknown initially. However, attempts to retain nerve function must not jeopardize the patient's survival. The test can be an option for clinical stage B disease with initial bilateral RLND, to identify and preserve emission-relevant nerves while the retroperitoneal space is removed radically. The test may also give additional information about the physiology of emission.

Treatment effect of "ryu-wei-ti-huang-wan" (a Chinese herbal prescription) on the sexual performance of male rats with streptozotocin-induced diabetes.

The treatment effect of "ryu-wei-ti-huang-wan', a Chinese prescription composed of extracts from six plants, on diabetic impotence was evaluated in the present study. Adult male Wistar rats were divided into three groups: (1) rats rendered diabetic with a single intraperitoneal injection of streptozotocin (60 mg/kg body weight); (2) rats with streptozotocin-induced diabetes treated with a ryu-wei-ti-huang-wan powder preparation at a dose of 30 mg powder/kg body weight twice a day, and (3) control rats. A male rat was caged with an adult ovariectomized female rat during the dark cycle. Infra-red-light-illuminated video recording was utilized to evaluate the sexual performance. The diabetic rats exhibited depressed mounting activity and no intromission or ejaculation. After ryu-wei-ti-huang-wan treatment either for 1 day or 2 weeks, the diabetic rats showed significant improvement in mounting performance with preservation of intromission and ejaculation. No significant difference in the blood sugar level was noted between the treatment and non-treatment groups. In conclusion, the diabetic rats showed impairment in sexual arousal, erectile as well as ejaculatory functions. Ryu-wei-ti-huang-wan was effective in preserving these functions with a rapid onset. It is evident that the extracts exert the therapeutic effects not through a lowering of blood sugar. These substances are potentially useful in the clinical treatment of male diabetic impotence.

Laser Prostatectomy Performed with a Right-angle Firing Neodymium: Yag Laser Fiber at 60 Watts Power Setting

A total of 50 patients with symptomatic bladder outlet obstruction due to benign prostatic hyperplasia was entered into a prospective trial of laser prostatectomy performed with the right-angle firing neodymium:YAG laser fiber at 60 watts power setting. Mean estimated resectable prostatic weight was 30 gm. with a mean prostatic urethral length of 3.3 cm. Nine patients (18 percent) were in urinary retention requiring catheterization before treatment. Mean energy delivery was 30,834 joules (range 14,400 to 127,800) with a mean operative time of 31 minutes. Efficacy of treatment was assessed at 3, 6 and 12 months postoperatively by standardized American Urological Association symptom scores, peak urinary flow rates and post-void residual urine volumes. At preoperative baseline the mean symptom score was 20.8, mean peak urinary flow rate 7.6 cc per second, and mean post-void residual urine volume 353 cc. At 1 year postoperatively mean symptom score was 8.4, mean peak urinary flow rate was 18.7 cc per second and mean post-void residual urine volume was 175 cc. Two patients required retreatment for residual tissue. There were 6 complications including 5 bladder neck contractures requiring incision (10 percent) and 1 case of postoperative prostatitis requiring antibiotic therapy (2 percent). Of 37 evaluable sexually active patients 31 (84 percent) reported preservation of antegrade ejaculation postoperatively.

Preservation of antegrade ejaculation in retroperitoneal lymphadenectomy due to residual masses after primary chemotherapy for testicular carcinoma.

We report 18 consecutive patients with testis cancer and retroperitoneal residual masses with normal tumor markers, who underwent lymphadenectomy. Aiming to preserve the antegrade ejaculation, we carried out surgical modifications which basically attempt to preserve: (1) both sympathetic lumbar trunks, (2) the superior hypogastric plexus and (3) some of the postganglionic branches. With a mean follow-up of 28.1 months (range 6-62 months), 15 (83.3%) of the 18 patients preserved ejaculation, without significant differences between ejaculation volumes before and after lymphadenectomy. At the present time, 3 of 4 possible patients have fathered children. Mass size seems to be an important predictive factor of ejaculation preservation. One patient relapsed in the retroperitoneal dissection area, representing a recurrence rate of 5.5%. The disease-free survival rate was 94.4%, and 1 patient died due to disease progression with lung recurrence. Thus preservation of ejaculation was possible in most of these patients.

Preservation of Ejaculation Through a Modified Retroperitoneal Lymph Node Dissection in Low Stage Testis Cancer

We studied ejaculatory function in 47 patients who underwent modified retroperitoneal lymph node dissection for nonseminomatous germ cell tumors of the testis from 1983 to 1989. Our goal was to assess the effectiveness of a modified node dissection in preserving ejaculatory function while eliminating the risk of retroperitoneal recurrence. There were 13 left and 34 right tumors. Of the patients 45 had clinical stage A cancer, and 2 had clinical stage B2 disease and received preoperative chemotherapy. The template method of dissection was used, which spares the preaortic area below the inferior mesenteric artery, including the sacral promontory. Average operating time was 3hours 40 minutes. There was no operative mortality. Spontaneous recovery of ejaculation occurred in 38 patients (81%), more commonly with right (88%) than with left dissections (62%). The mean interval to recovery of ejaculation was 5 months (92% within 12 months). Five patients (10%) had recurrence, with a mean followup of 28 months. All recurrences were in the lungs 4 to 8 months after retroperitoneal lymph node dissection, and all patients were salvaged with chemotherapy and are disease-free. We confirmed that a modified template-type retroperitoneal lymph node dissection can be accomplished safely with preservation of ejaculation in more than 80% of the patients without increasing the risk of local recurrence.

Preservation of sexual function after salvage retroperitoneal node dissection following chemotherapy for testicular tumors

Salvage radical retroperitoneal node dissection for large residual masses remaining after chemotherapy for testicular cancer was performed in 41 patients. In 10 instances it was possible to carry out a radical removal and attempt to preserve the sympathetic chain on one side. Ejaculation was preserved in 8 of these cases. Where removal of the mass was complete (33 cases) active cancer was present in 6, only one of whom developed tumor recurrence. Salvage node dissection is worthwhile, and in about 25% of cases can be performed with preservation of ejaculation.

Is adjuvant chemotherapy necessary for patients with stage B1 testicular cancer?

Controversy exists concerning the role of adjunctive chemotherapy in patients with regional nodal involvement. A randomized study reported a 48% relapse rate for patients with positive nodes (stage B1 or stage B2), all of whom were salvaged by full-dose platinum-based chemotherapy. In a series of patients with positive nodes who received two cycles of adjunctive chemotherapy postoperatively, the relapse rate was only 2%. In order to evaluate the effect of retroperitoneal lymph node dissection on relapse rates in patients with stage B1 testicular cancer, a retrospective review of a series of 39 patients was performed. Criteria for inclusion included pathologic stage B1 (less than six positive nodes, located in the primary landing site, with no node greater than 2 cm in diameter and no extracapsular lymph node extension). Patients who fulfilled the criteria along with normalization of tumor markers were followed-up expectantly after retroperitoneal lymph node dissection. Thirty-nine patients were followed from 1 to 10 years with the median duration of follow-up of 3.5 years. Ten of the 39 patients had modified retroperitoneal lymph node dissections with preservation of antegrade ejaculation. The other 29 had full retroperitoneal lymph node dissections. Three relapses were seen, one patient with retrocrural and pulmonary metastases and two patients with pulmonary metastases only for a relapse rate of 8% (three of 39). Patients with stage B2 disease received adjunctive chemotherapy with two or three cycles of platinum-based chemotherapy. We conclude that retroperitoneal lymph node dissection alone is adequate treatment for the majority of patients with pathologic stage B1 testicular cancer. In that subset of patients, adjunctive chemotherapy should be reserved for relapse.

The Madigan Prostatectomy

A total of 59 patients with bladder outflow obstruction underwent the Madigan prostatectomy. The method, results and complications are described. For select patients with large benign adenomas without a median lobe or hematuria we believe the technique to be the operation of choice, particularly in younger patients. Advantages include absence of postoperative hematuria and clot retention, a decreased requirement for blood transfusions, a 16F postoperative catheter with early removal, avoidance of post-catheter stricture, a low rate of postoperative urinary infection, a short comfortable period of hospitalization and, in the long term (median followup 6 years), preservation of potency and antegrade ejaculation.

Clinical Stage 1 Testicular Cancer: The Role of Modified Retroperitoneal Lymphadenectomy

A total of 85 patients underwent modified retroperitoneal lymphadenectomy for clinical stage I nonseminomatous germ cell tumor of the testis from 1982 to 1989. The technique was a modified bilateral dissection via a thoracoabdominal approach. A full bilateral dissection was done above the level of the inferior mesenteric artery but unilateral dissection was performed below the inferior mesenteric artery using a template method. Of the 85 patients 64 had pathological stage A and 21 had stage B1 disease. Relapses have occurred in 4 of 64 stage A cancer patients (6%) and 3 of 21 stage B1 cancer patients (15%). Antegrade ejaculation was preserved without pharmacological therapy in 75 of 85 patients (88%) and 5 others were converted to antegrade ejaculation with imipramine. Therefore, 80 of 85 patients (94%) have recovered antegrade ejaculation. With a median followup of 38 months 7 relapses have been noted. We conclude that modified retroperitoneal lymph node dissection allows for preservation of ejaculation, decreases concern about retroperitoneal understaging and represents the preferred alternative to surveillance protocols for patients with low stage testicular cancer. (J. Urol., 144: 1160–1163, 1990)

Nerve-Sparing Retroperitoneal Lymphadenectomy with Preservation of Ejaculation

The feasibility of sparing postganglionic fibers of lumbar sympathetic nerves during the course of retroperitoneal lymphadenectomy has been investigated at our university medical center beginning in 1978. We selected 75 patients for nerve-sparing retroperitoneal lymphadenectomy in an effort to preserve ejaculatory function postoperatively. This cohort of patients was selected on the basis of clinical stage. Of the 75 patients 73 had clinical stage I disease. However, 14 of these 73 patients had pathological stage II cancer. No patient was treated with adjuvant chemotherapy after nerve-sparing retroperitoneal lymphadenectomy. Of these 14 patients with pathological stage II disease 4 had relapse: 1 with proved retroperitoneal recurrence, and 3 with serological elevations of tumor markers and questionable clinical findings as to anatomical site of relapse. All 4 patients are free of disease after chemotherapy and/or surgical (1) rescue. There were no local recurrences in the 61 patients with negative nodes. All 75 patients ejaculate and had no evidence of disease more than 2 years after nerve-sparing retroperitoneal lymphadenectomy.It is clear that nerve-sparing retroperitoneal lymphadenectomy is a feasible technique. As noted, it can even be applied to selected patients with low volume positive nodes, yet maintaining relapse and survival figures that are acceptable. Ejaculation is reliably preserved when this nerve-sparing technique is applied accurately in retroperitoneal lymphadenectomy. (J. Urol, 144: 287-292, 1990)

69 - Retroperitoneal Lymphadenectomy with Preservation of Ejaculation

No AccessJournal of Urology1 Jun 1987Retroperitoneal Lymphadenectomy with Preservation of Ejaculation N. Javadpour, J.D. Young, and H. Smith N. JavadpourN. Javadpour More articles by this author , J.D. YoungJ.D. Young More articles by this author , and H. SmithH. Smith More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)75219-6AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Retroperitoneal Lymphadenectomy with Preservation of Ejaculation." The Journal of Urology, 137(6), p. 121A © 1987 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 137Issue 6June 1987Page: 121A Advertisement Copyright & Permissions© 1987 by The American Urological Association Education and Research, Inc.MetricsAuthor Information N. Javadpour More articles by this author J.D. Young More articles by this author H. Smith More articles by this author Expand All Advertisement Loading ...