Novel presentation of retroperitoneal germ cell tumor with loss of ejaculation but preservation of erection in two patients.

OBJECTIVE: To examine the effect of large-volume retroperitoneal germ cell tumor on nerve fibers required for erection and ejaculation.

DESIGN: Retrospective case reports.

SETTING: Cancer treatment center.

PATIENT(S): Two male patients presenting with loss of ejaculation but preservation of erection.

RESULT(S): Retroperitoneal lymph nodes lie very close to the sympathetic nerve fibers that control ejaculation. Large-volume tumors would encase the sympathetic plexuses at L1 to L3, making ejaculation impossible. Parasympathetic fibers arise from S2 to S4, so they would not be damaged, preserving erection.

CONCLUSION(S): Thorough history taking is important in the investigation of infertility. Presentation with these symptoms requires further investigation at an early stage to exclude retroperitoneal tumor.