Nerve of the Hypogastric Plexus in Patients with Testicular Cancer Undergoing Retroperitoneal Lymph-Node Dissection for Cure
Bibliographic record
Abstract
Genitourinary applications of nerve reconstruction have recently been brought to the forefront with restoration of sympathetic function conveyed by the cavernous nerves via nerve grafting, in order to restore erectile function in patients undergoing radical retropubic prostatectomy with nerve sacrifice. This successful restoration of autonomic function with nerve grafting procedures prompted these authors to apply these principles to a group of younger men undergoing radical retroperitoneal lymphadenectomy (RPLND) for treatment and cure of testicular carcinoma, with nerve grafting of the postganglionic parasympathetic nerves of the hypogastric plexus that confers anterograde ejaculatory function. Although nerve-sparing RPLND can maintain ejaculatory function, nerve sacrifice may be necessary, depending on the tumor burden. Since 75% of men who have retroperitoneal relapse will still be cured of disease and can have normal fertility, maintenance of anterograde emission can alleviate the need for in vitro fertility strategies in the future for these patients. Nerve grafting of the hypogastric plexus has been carried out in three men (age range: 28–33 years) undergoing RPLND, using genitofemoral (GF) nerve grafts. Reconstructions were bilateral in two cases and unilateral in one case. Multiple grafts were placed in all cases and the nerve gap was usually 10 cm. Nerve coaptation utilized 8-0 nylon sutures. Patients have been followed for 4–15 months. There are no complaints related to sensory disturbance in the distribution of the GF nerves. To date, the first patient who underwent bilateral plexus grafts has developed anterograde ejaculatory function. Follow-up is pending on the remaining patients. These early results demonstrate the feasibility of GF nerve grafting of the hypogastric plexus in young men undergoing RPLND for cure of testicular cancer, in order to successfully restore ejaculatory function for potential fertility after cure.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".