Summary

Surgery for retroperitoneal nodal metastases of testicular germ-cell tumors has evolved considerably since its inception. Minimizing injury to sympathetic nerves (and consequential ejaculatory dysfunction) has involved their exclusion from resection boundaries, ''nerve sparing'' by prospectively identifying and preserving nerves within the resection field, or a combination of both approaches. These measures have resulted in dramatic improvements in long-term procedure-related morbidity with equivalent rates of cancer control. We believe that routine nerve-sparing techniques are the standard of care and serve to enforce good principles of surgery by demanding more attention to anatomy and exposure. Experience with this procedure, good knowledge of retroperitoneal anatomy, and thoughtful clinical and surgical decision making are imperative to achieving acceptable results. It behooves urologic oncologists to offer patients maximal therapeutic benefit combined with minimal morbidity and it follows that retroperitoneal lymphadenectomy should be nerve sparing by definition.

5 Secrets to Lasting Longer In The Bedroom

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How to increase your staying power to extend your pleasure-and hers. There are many techniques, exercises and even devices, aids, and drugs to help you last longer in the bedroom. However, in most cases, the main reason most guys don't last long is due to what's going on in their minds, not their bodies.

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