Pseudoephedrine for ejaculatory dysfunction after retroperitoneal lymph node dissection in testicular cancer

Conduit, C; Lewin, J; Hong, W; Sim, IW; Ahmad, G; Leonard, M; O&#39;Haire, S; Moody, M; Hutchinson, AD; Lawrentschuk, N; Thomas, B; Dhillon, HM; Tran, B

Author(s): Conduit, C; Lewin, J; Hong, W; Sim, IW; Ahmad, G; Leonard, M; O'Haire, S; Moody, M; Hutchinson, AD; Lawrentschuk, N; Thomas, B; Dhillon, HM; Tran, B;
Details: Publication Year 2024-11,Volume 134,Issue #5,Page 805-817
Journal Title: BJU international
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.
Publisher: Wiley
Keywords: ejaculation; fertility; health‐related quality of life; survivor; testicular cancer
Research Division(s): Personalised Oncology
PubMed ID: 39044467
Publisher's Version: https://doi.org/10.1111/bju.16481
Open Access at Publisher's Site: https://doi.org/10.1111/bju.16481
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2024-07-26 09:22:51

Last Modified: 2024-12-05 10:35:39