Retro Peritoneal Lymph Node Dissection (RPLND)

If cancer has spread to the lymph nodes in your belly, your doctor may recommend surgery to remove them. This is done under general anaesthesia, so you will be asleep during the operation. 

The doctor will make a cut in your belly to take out the affected lymph nodes.

This surgery can sometimes affect the nerves that help with ejaculation (when semen is released from the penis during sexual activity), which may make it harder to have children naturally (infertility). 

Instead of coming out through the penis, sperm might go backward into the bladder. This is called retrograde ejaculation and doesn’t cause pain, but it can affect your ability to have children. If having children in the future is important to you, your doctor may recommend sperm banking before surgery, so you have options later.

This video explains the process of Retroperitoneal Lymph Node Dissection (RPLND) surgery for testicular cancer and what you can expect if you need this treatment.

• Take your pain medicine regularly as your doctor told you to. This will help keep you comfortable.
• Surgery can sometimes make you constipated, which might make your pain worse. To help with this, eat foods high in fibre and drink plenty of fluids (about 2–3 litres a day). If you're still having trouble, your doctor can give you a mild laxative to help.
• You should try and walk upright without stooping. You may feel tired, but gentle exercise will speed up your recovery. Ideally you should go for a walk – gradually increasing the distance. This will also reduce the risks of clots forming in your legs.
• As you get better, slowly start doing more exercise. Cycling and swimming are okay but try not to lift heavy things or doing intense workouts for about six weeks. This gives your belly muscles time to heal and helps prevent a hernia, which is when tissue pushes through the wound.
• You will need to take a blood-thinning injection to help prevent blood clots in your legs. Your doctor will show you how to inject it yourself.
• You should not drive for 3-4 weeks after surgery because you may not be able to stop quickly in an emergency.
• You can usually go back to work after 4 weeks, but if your job involves a lot of physical activity, you might need more time to heal.
• You can have sex again whenever you feel ready and well enough.
• Contact your doctor or medical team right away if you notice ongoing redness, swelling, or fluid leaking from your wound. Also, let them know if you feel like you have a fever, bad cold, or flu, as these could be signs of an infection.

Asking questions about RPLND surgery is important because it helps you understand why the procedure is needed, what to expect, and how to prepare.

Here are some questions you might want to ask your doctor:

• Why do I need this surgery, and how will it help me?
• Are there other treatment options besides surgery?
• How long will the surgery take?
• What will my recovery be like?
• Will I have pain after surgery? How will it be treated?
• What are the risks and possible complications?
• Are there any long-term effects I should know about?
• Will this surgery affect my ability to have children?
• Will I need more treatment, like chemotherapy, after surgery?
• When can I return to normal activities like work, sports, and driving?

This chapter contains general information about Retro Peritoneal Lymph Node Dissection (RPLND). If you have any specific questions about your own medical situation you should consult your doctor or other professional healthcare provider. No website or leaflet can replace a personal conversation with your doctor.

Last updated: March 2025