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治疗的疗效。单组、II 期试验，RPLND 后 ≥6 个月的患者被邀请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、EORTC QLQ -睾丸癌-26 和简要男性性功能量表）评估随访中的 HRQoL 和性功能 (ACTRN12622000537752/12622000542796)。如果报告 EjD，则进行射精后尿液±精液分析。符合条件的患者每 6 小时口服盐酸伪麻黄碱 60 mg，共 6 剂。主要终点是治疗后精子计数>3900万个精子/精液（>第5个百分位）。该试验检测到临床相关的 36% 的精子数量达到了 > 3900 万/精液。次要终点包括精液量 >1.5mL、总活动精子数、安全性和 HRQoL 影响。在 58 名入组患者中，中位（四分位距 [IQR]）年龄为 35（29-41）岁，中位（IQR）年龄) 37 (18-60) 个月，来自 RPLND。 33 例 (57%) 报告 EjD，其中 27/52 (52%) 在我们中心接受随访。总体 HRQoL 没有差异；然而，如果存在 EjD，角色功能（P = 0.045）、性问题（P < 0.005）和性享受（P = 0.005）会较差。总的来说，24/33 (73%) 的 EjD 患者同意接受伪​​麻黄碱治疗。在 22 名可评估的患者中，4 名 (18%) 的精子数量达到 >3900 万/次射精 (P = 0.20)，4 名 (18%) 的精液量>1.5mL (P = 0.20)。每精液平均增加 1.05 亿个精子 (P = 0.051)，精液量平均增加 1.47mL (P = 0.01)。没有出现安全问题。RPLND 后射精功能障碍很常见，但不影响我们队列中的总体 HRQoL。伪麻黄碱改善了某些人的 EjD；然而，其功效低于预期。伪麻黄碱可根据个体情况予以考虑。© 2024 作者。 BJU International 约翰·威利 (John Wiley) 出版

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.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.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.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.© 2024 The Author(s). BJU International published by John Wiley & Sons Ltd on behalf of BJU International.