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    • Ejaculatory Dysfunction (ejd) after Retroperitoneal Lymph Node Dissection (RPLND) for Testicular Cancer (TC)

    C. Conduit,J. Lewin,W. Hong,G. Ahmad, I. W. Sim,M. Leonard,S. O'haire, M. Moody,A. Hutchinson,N. Lawrentschuk,B. Thomas,H. Dhillon,B. Tran

    Bju International（2024）SCI 2区

    Peter MacCallum Canc Ctr | Walter & Eliza Hall Inst Med Res | Royal Childrens Hosp | Monash Hlth | Australian & New Zealand Urogenital & Prostate Ca | Univ South Australia | Royal Melbourne Hosp | Univ Sydney

    Cited 0|Views9
    Abstract
    Objective To assess the impact of ejaculatory dysfunction (EjD; failure of emission or retrograde ejaculation) on health-related quality of life (HRQoL) after retroperitoneal lymph node dissection (RPLND) for testicular cancer and explore the efficacy of pseudoephedrine hydrochloride as treatment. Patients and Methods In a single arm, phase II trial, patients at >= 6 months after RPLND were invited to complete patient-reported outcome measures (European Organisation for Research and Treatment of Cancer [EORTC] quality of life questionnaire [QLQ]-30-item core, EORTC QLQ-testicular cancer-26, and Brief Male Sexual Function Inventory) evaluating HRQoL and sexual function in follow-up (ACTRN12622000537752/12622000542796). If EjD was reported, post-ejaculatory urine +/- semen analysis was undertaken. In eligible patients, pseudoephedrine hydrochloride 60 mg was administered orally every 6 h for six doses. The primary endpoint was sperm count >39 million sperm/ejaculate (>5th centile) following treatment. The trial was powered to detect a clinically relevant 36% achieving sperm count of >39 million sperm/ejaculate. Secondary endpoints included semen volume >1.5 mL, total motile sperm count, safety, and HRQoL impacts. Results Of the 58 patients enrolled, the median (interquartile range [IQR]) age was 35 (29-41) years, with a median (IQR) of 37 (18-60) months from RPLND. EjD was reported in 33 (57%), including 27/52 (52%) receiving follow-up at our centre. There were no differences in global HRQoL; however, role functioning (P = 0.045), sexual problems (P < 0.005), and sexual enjoyment (P = 0.005) was poorer if EjD was present. In all, 24/33 (73%) patients with EjD consented to pseudoephedrine treatment. Of 22 evaluable patients, four (18%) achieved a sperm count of >39 million/ejaculate (P = 0.20), and four (18%) had a semen volume of >1.5 mL (P = 0.20). There was a mean increase of 105 million sperm/ejaculate (P = 0.051) and 1.47 mL increase in semen volume (P = 0.01). No safety concerns arose. Conclusion Ejaculatory dysfunction is common after RPLND but did not impact global HRQoL in our cohort. Pseudoephedrine improved EjD for some; however, its efficacy was lower than expected. Pseudoephedrine may be considered on an individualised basis.
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    testicular cancer,survivor,ejaculation,health-related quality of life,fertility
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    【要点】：本研究探讨了睾丸癌患者行腹膜后淋巴结清扫术后射精功能障碍对生活质量的影响，并评估了伪麻黄碱治疗射精功能障碍的效果。
    

    【方法】：通过单臂II期临床试验，使用欧洲癌症研究与治疗组织的生活质量问卷和简短男性性功能量表来评估患者的生活质量和性功能，并对报告射精功能障碍的患者给予伪麻黄碱治疗。
    

    【实验】：共58名患者参与，年龄中位数为35岁，从腹膜后淋巴结清扫术到参与研究的时间中位数为37个月。射精功能障碍的发生率为57%，其中73%的患者同意接受伪麻黄碱治疗。在22名可评估的患者中，18%的患者精子数量超过39百万/射精，18%的患者精液体积超过1.5毫升。治疗后精子数量平均增加105百万/射精，精液体积平均增加1.47毫升。未出现安全问题。