Lymph node surgery - RPLND
RPLND is a surgery used for testicular cancer that removes lymph nodes in the back of your tummy area.
Why might I have RPLND?
Occasionally when cancer has spread to the lymph nodes, these nodes may not shrink back to normal size after chemotherapy. It is often difficult to tell on a CT scan why they are enlarged:
- It may be due to a collection of dead cells in the glands, known as necrotic tissue.
- It may be because the nodes contain cells that may turn cancerous in the future.
- It may be due to cancer cells that remain.
The only way to know for sure why the glands have not shrunk back down is to take them out and send them to be looked at under a microscope. This surgery is called retroperitoneal lymph node dissection (RPLND).
About RPLND surgery
You will need to have a general anaesthetic for this operation. It is a long operation, usually lasting a number of hours. It involves a cut from the top of your abdomen down to below your belly button to allow the surgeon to remove the lymph nodes that are behind your organs. These nodes lie alongside your kidneys and the main blood vessels in your abdomen.
All operations have a risk of complications such as bleeding and infection. In RPLND there is a risk of needing to have your kidney removed or you may need a graft to the main blood vessels in your abdomen (tummy area). Before your operation, your surgeon will discuss these possible complications with you.
- You may stay in an intensive care or high dependency unit (HDU), sometimes called PACU (post-anaesthesia care unit), where the staff will keep you under close observation for a day or 2.
- After surgery, you will have a wound and drips will be attached to your body. These are normal in an operation like this.
- The wound will be along your tummy. The line of stitches will go from below your breastbone to your pubic bone. Stitches or staples are usually removed 7 to 10 days after your surgery.
- After the operation, it may be 7 to 10 days before you and your doctor feel you are ready to go home. How long you need to stay in hospital will depend on how quickly you recover. For example, if your bowels are slow to move afterwards, you may need to stay a little longer.
- It can take a couple of months before you are fully recovered and ready to return to normal activity after this operation.
Sex and fertility after RPLND
Dry orgasm
RPLND surgery does not affect erections or the sensation of orgasm. But removing nerves during surgery may mean that you have a ‘dry orgasm’ (anejaculation). This means that when you climax, no semen comes out of your penis. Instead, when you ejaculate, your semen goes into your bladder and passes out with your urine. As semen contains sperm, this will affect your fertility.
If you want to start a family or have more children, ask your doctor about ways that your sperm can be collected.
Your surgeon may be able to do an operation that spares the nerves near the lymph nodes to reduce the risk of this happening.
If you develop sexual dysfunction after RPLND, let your oncology team know. They can refer you to a specialist team for assessment and treatment. You will also be given the chance to save your sperm beforehand and freeze it for later use.
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