This list of questions is intended to help you make the most of your visit to the urologist in discussing an RPLND. It is not an exhaustive list of questions, so be sure to look it over before you see the doctor and add any others that might apply to your specific situation.

The RPLND is a complicated procedure that is done less often today than in the past. These days it is far more likely to be done after chemotherapy to remove residual masses than it is to be done as a primary treatment. That said, this list of questions is pretty generic and might be biased a bit towards a "virgin" RPLND (aka before chemo). Suffice to say that if you have already had chemotherapy and you have many or large residual masses, then you need to have this surgery and your questions should concentrate on what they will be doing and their experience in doing this type of operation. If you have not had chemo or you have had it and there are few or no residual masses, then also ask questions about why the surgery is needed in the first place.

If you have any comments, questions, or suggestions about this list, please feel free to send me an email!

INITIAL QUESTIONS

• What Stage is my cancer?
• What is the significance of cancer found in the lymph nodes?
• Why is RPLND recommended for me?
• Why is it necessary to remove the lymph nodes?
• Can you show me where these lymph nodes are and how you go about removing them?
• What are lymph nodes, and don't I need them?
• What do you hope to find out from looking at the lymph nodes?
• In my case, do you think this operation is therapeutic (Will it cure my cancer) or diagnostic (To see if I have any more cancer)?
• Do I have any other choice of treatment? (Surveillance? Chemo?)
• If surveillance is an option (If you are Stage 1, it is an option), can I see an oncologist before making a decision about the RPLND surgery?
• What are the benefits of having this operation?
• What are the risks of having this operation?
• What do I have to gain or lose by not having the operation now?
• If I do the RPLND and nothing shows up, what kind of follow-up would occur? What is the potential for relapse in this case?
• If I do the RPLND and something does show up, would you do a full dissection (instead of a modified or nerve-sparing dissection)?
• How quickly must I decide about my treatment?
• Have you done this operation before? If so, how often? Was the nerve sparing technique successful?
• If my insurance will pay for me to have the operation done at a center of excellence such as Indiana University or Memorial Sloan Kettering, should I try to use them? (If not, why not?)
• Where can I get a second opinion regarding whether I need this operation?

THE RPLND OPERATION

• How soon should the operation be done?
• I've got to wait a few weeks for tests - won't that let the cancer spread?
• (If the date of the operation is more than 6 weeks after the orchiectomy, ask Why so long before the operation? Won't that let the cancer spread outside of the retroperitoneum?)
• Where will I have to go for the surgery?
• How long is the operation?
• Can you explain the surgical procedure?
• How many lymph nodes are usually removed?
• Will you remove all the lymph nodes separately or as a whole?
• Will residents be participating in the operation?
• What kind of sutures do you usually use?
• What kind of anesthesia will be used?
• Will you use a nasogastric tube?
• What will it feel like afterward?
• What will the scar look like? Will it be wide or narrow?
• What sort of hospital room will I be in?
• What kind of pain medicine will be available after the operation?
• How do I know I'm getting the best treatment?
• How long will I have to stay in the hospital after the operation?
• What type of costs am I looking at?

AFTER THE RPLND SURGERY

• What happens after the operation?
• If only a little bit of cancer is found, will I need to undergo chemotherapy?
• Will I be cured?
• How often are checkups and tests required after treatment is completed and which specialist will manage my care? What kind of tests will be needed?
• Would you be willing to consult with an expert if a problem arises?
• What kind of supplies, equipment, or any other help will I need when I go home?
• Are there any activities I should or should not do following surgery?
• How long will it take me to recover?
• When can I start regular exercise after the surgery?
• How soon after surgery can I go back to work?

RPLND SIDE EFFECTS

• What are the possible side effects of this type of surgery? Are they permanent?
• What are the long-term risks?
• Retrograde ejaculation?
• Infertility?
• Incontinence?
• Diarrhea?
• Constipation?
• Pain?
• Adhesions? (Surgical Scarring)
• Fatigue?
• Lymphocele or Chylous Ascites? (Excess lymphatic fluid in the abdomen)
• Edema? (Swelling)
• What can/will be done to prevent these side effects or reduce their possibility?
• How long will the side effects last?
• What treatments are available to manage these side effects?
• Are there support therapies available and appropriate for me?
• What should I do if I have side effects?
• Which side effects should I report to the health care provider immediately?
• Who do I call if I have severe side effects?
• How will the RPLND affect my sex life and fertility?
• What is my prognosis for fertility following treatment?
• Should I bank sperm before the operation, just in case?
• How can I find out more about the sperm banking service?

RPLND SUPPORT

• Who can I talk to about problems with sex and fertility?

RPLND MISCELLANEOUS

• What are the telephone numbers I should have in order to reach you? the nurse? the hospital?
• When do I next see you?

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