Long-Term Sexual Dysfunction and Fertility Outcomes Following Post-Chemotherapy Retroperitoneal Lymph Node Dissection in Testicular Cancer Patients

Background Since testicular cancer typically affects relatively young patients, retroperitoneal sympathetic nerve injury following post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) may lead to significant sexual dysfunction. This study aims to assess long-term outcomes related to ejaculatory dysfunction, erectile dysfunction (ED), and fertility in patients who have undergone PC-RPLND for advanced-stage testicular tumors. Methods Patients who underwent PC-RPLND between 2000 and 2021 were retrospectively contacted via telephone or email. Patients' pre-treatment paternity status, sperm cryopreservation, and post-treatment fertility status were evaluated. The impact of factors such as patient age, tumor laterality, surgical approach, and second-line chemotherapy on ED and ejaculatory dysfunction was analyzed. Erectile function was assessed using the Turkish-validated International Index of Erectile Function-5 (IIEF-5). Statistical analyses were performed using SPSS version 23.0. Results The study included patients with a mean surgical age of 28.8 ± 7.7 years and a mean current age of 39.2 ± 9.5 years, with a median follow-up of 116 months (53–290 months). Prior to treatment, 42 patients (38.5%) underwent sperm cryopreservation, while post-treatment, 52 patients (47.7%) expressed a desire for paternity. Paternity status was only predictor for sperm cryopreservation (p = 0.002, OR = 0.186 95%CI 0.062–0.552). Ejaculatory dysfunction (EjD) was reported in 28.4% of patients, with a significantly higher incidence in the fully bilateral template RPLND group compared to the modified template group (67.9% vs. 14.8%, p < 0.001). ED was identified in 37.6% of patients, but no significant associations were found between ED and clinical or surgical variables. Conclusion Long-term sexual dysfunction, particularly ejaculatory disorders, remains a significant issue following PC-RPLND, especially in patients undergoing fully bilateral template dissection. Fertility and ejaculation problems associated with this technique may be mitigated through preoperative sperm cryopreservation.