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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