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

IF 3.7 2区医学 Q1 UROLOGY & NEPHROLOGY

BJU International Pub Date : 2024-07-23 DOI:10.1111/bju.16481

Ciara Conduit, Jeremy Lewin, Wei Hong, Ie-Wen Sim, Gulfam Ahmad, Matt Leonard, Sophie O'Haire, Mary Moody, Amanda D. Hutchinson, Nathan Lawrentschuk, Benjamin Thomas, Haryana M. Dhillon, Ben Tran

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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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伪麻黄碱治疗睾丸癌腹膜后淋巴结清扫术后的射精功能障碍。

目的评估睾丸癌腹膜后淋巴结清扫术（RPLND）后射精功能障碍（EjD；射精失败或逆行射精）对健康相关生活质量（HRQoL）的影响，并探讨盐酸伪麻黄碱的治疗效果：在一项单臂 II 期试验中，邀请 RPLND 术后≥6 个月的患者完成患者报告的结果测量（欧洲癌症研究和治疗组织 [EORTC] 生活质量问卷 [QLQ]-30 项核心内容、EORTC QLQ-睾丸癌-26 和简明男性性功能量表），在随访中评估 HRQoL 和性功能（ACTRN12622000537752/12622000542796）。如果报告有射精障碍，则进行射精后尿液和精液分析。对符合条件的患者口服盐酸伪麻黄碱 60 毫克，每 6 小时一次，共 6 次。主要终点是治疗后精子数量大于 3,900 万个/射精（大于第 5 百分位数）。试验结果显示，有 36% 的患者精子数量大于 3,900 万/射精次数，达到临床相关水平。次要终点包括精液量 >1.5 mL、总活动精子数、安全性和 HRQoL 影响：在 58 名入选患者中，年龄中位数（四分位数间距 [IQR]）为 35（29-41）岁，距离 RPLND 的中位数（IQR）为 37（18-60）个月。33例（57%）报告有EjD，其中27/52例（52%）在本中心接受随访。总体 HRQoL 没有差异；但是，角色功能（P = 0.045）、性问题（P 3,900 万/次射精（P = 0.20），4 人（18%）的精液量大于 1.5 mL（P = 0.20）。精子/射精量平均增加了 1.05 亿个（P = 0.051），精液量增加了 1.47 毫升（P = 0.01）。没有出现安全问题：结论：射精功能障碍在 RPLND 后很常见，但在我们的队列中不会影响整体 HRQoL。伪麻黄碱可改善部分患者的射精功能，但其疗效低于预期。可根据个体情况考虑使用伪麻黄碱。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BJU International 医学-泌尿学与肾脏学

CiteScore

9.10

自引率

4.40%

发文量

262

审稿时长

1 months

期刊介绍： BJUI is one of the most highly respected medical journals in the world, with a truly international range of published papers and appeal. Every issue gives invaluable practical information in the form of original articles, reviews, comments, surgical education articles, and translational science articles in the field of urology. BJUI employs topical sections, and is in full colour, making it easier to browse or search for something specific.