Editing Retroperitoneal Lymph Node Dissection (section)

== Nerve-sparing ==

* '''For successful antegrade ejaculation''', several processes need to occur in coordinated fashion:
*# Smooth muscle contraction in the vasa deferentia, seminal vesicles, and prostate resulting in seminal '''emission''' and prostate glandular secretion
*# '''Closure of the bladder neck''' to prevent retrograde ejaculation
*# Rhythmic contractions of the ischiocavernosus, bulbospongiosus, and levator ani muscles expelling semen from the urethra.
** '''Processes 1 and 2 (emission and closure of bladder neck) require''' '''efferent neurologic input from the L1 through L4 postganglionic sympathetic fibers, which coalesce with their contralateral counterparts in the superior hypogastric plexus'''. From the hypogastric plexus, these nerve fibers continue caudally to the seminal vesicles, ampulla of the vasa deferentia, vasa deferentia proper, bladder neck, and prostate
* Nerve-sparing should be offered in select patients desiring preservation of ejaculatory function.
* Nerve-sparing RPLND results in preservation of antegrade ejaculation in 90-100% of patients
* Nerve-sparing should not compromise the quality of the lymph node dissection.