ObjectiveTo evaluate the impact of cancer therapy on post‐treatment ejaculation in patients with testicular cancer.MethodsA total of 74 testicular cancer survivors provided completed International Index of Erectile Function‐15 questionnaires before and after treatment between 2010 and 2017. Sexual function, particularly ejaculatory function, was evaluated before and after treatment. In this study, patients who answered “1 = almost never/never” or “2 = a few times” for questionnaire number 9 (ejaculation frequency) were defined as having “ejaculation disorder.”ResultsOf 74 testicular cancer survivors, 50 (68%) had no ejaculation disorders before treatment. Four (44%) of nine survivors, who received chemotherapy and retroperitoneal lymph node dissection, developed ejaculation disorders after treatment. On multivariate analysis, retroperitoneal lymph node dissection was a significant predictor of post‐treatment ejaculation disorder (P = 0.042). Of 60 survivors with evaluable ejaculation function after treatment, 24 (40%) did not attempt sexual intercourse, and multivariate analysis showed ejaculation disorder had a significant negative impact on having sexual intercourse (P = 0.035). Furthermore, the mean International Index of Erectile Function‐15 scores in the groups with and without ejaculation disorders after treatment were 24.0 and 51.9, respectively (P < 0.001).ConclusionEjaculation disorders occur at high rate after retroperitoneal lymph node dissection. Many testicular cancer survivors reporting no sexual intercourse have ejaculation disorders, suggesting an adverse impact on sexual life. Urologists should provide proper counselling regarding the risk of ejaculation disorder and its possible impact on sexual life.

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Background Many elderly men suffer from benign prostatic hyperplasia (BPH). Recently, chronic ischemia in the prostate has been suggested to be related to BPH. Thus, the impact of chronic ischemia on the development of prostatic hyperplasia and the efficacy of phosphodiesterase type 5 (PDE5) inhibitor for hyperplasia were evaluated in a rat model with chronic ischemia induced by local atherosclerosis. Methods Eighteen male Sprague‐Dawley rats were divided into three groups: sham operation, regular diet, placebo (SRP); arterial endothelial injury, high cholesterol diet, placebo (AHP); or arterial endothelial injury, high cholesterol diet, and tadalafil as a PDE5 inhibitor (AHT). The endothelial injury in the common iliac arteries was performed using a 2‐Fr Fogarty arterial embolectomy catheter through an incision in the femoral artery into the common iliac artery. Diet and oral drugs were administrated for 8 weeks after surgery. At 8 weeks, blood flow to the ventral prostate (VP) was measured using laser speckle blood flow analysis, and the VP was histologically evaluated. Results In the AHP group, prostatic blood flow was reduced, and mean VP weight and the interstitial area were significantly enlarged compared with the SRP group. In the AHT group, tadalafil administration obviously ameliorated the reduction of prostatic blood flow relative to the AHP group. Importantly, mean VP weight and the morphological changes in the AHT group were significantly smaller than those in the AHP group. Conclusions Enlargement of the VP resulted from chronic ischemia induced by local arteriosclerosis. Also, administration of tadalafil attenuated VP enlargement. Chronic ischemia in the prostate might thus contribute to the development of BPH, and PDE5 inhibitors might provide an innovative approach to preventing BPH.

This study demonstrated that PBP could reliably identify patients with BPH who could benefit from tadalafil treatment. Patients with low PBP could be better responders to tadalafil.

ObjectiveTo evaluate sexual function after treatment using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire‐Testicular Cancer 26 (EORTC QLQ‐TC26) questionnaire in Japanese testicular cancer (TC) survivors in a multi‐institutional, cross‐sectional study.MethodsThis study enrolled TC survivors who visited any of eight high‐volume institutions in Japan from 2018 to 2019. After obtaining informed consent, participants completed the EORTC QLQ‐TC26 questionnaires. We evaluated sexual function after treatment for TC using the EORTC QLQ‐TC26 and analyzed the impact of treatment on sexual function in TC survivors.ResultsA total of 567 TC survivors responded to the EORTC QLQ‐TC26. Median age at the time of response was 43 years (interquartile range [IQR] 35–51 years), and median follow‐up period after treatment was 5.2 years (IQR 2.2–10.0 years). Sexual function, particularly ejaculatory function, was significantly lower after post‐chemotherapy retroperitoneal lymph node dissection (PC‐RPLND) than after Surveillance or Chemotherapy groups (p < 0.05). In the PC‐RPLND group, nerve‐sparing procedure preserved postoperative ejaculatory function after RPLND compared with the non‐nerve‐sparing and offered improved ejaculatory function with time. On multivariate analysis, RPLND was a significant predictor of post‐treatment ejaculatory dysfunction, particularly without nerve‐sparing (odds ratio 3.0, 95% CI 1.2–7.7, p < 0.05). In addition, TC survivors with nerve‐sparing RPLND had higher sexual activity than those without.ConclusionThis survey of the EORTC QLQ‐TC26 showed that sexual function and activity in TC survivors after RPLND was reduced in the absence of nerve‐sparing techniques.