Histological outcome of delayed orchidectomy after primary chemotherapy for metastatic germ cell tumour of the testis.

AIMS: To identify the incidence of viable local tumour in the testis of patients undergoing delayed orchidectomy after initial presentation with advanced germ cell tumour (GCT) treated by primary chemotherapy. PATIENTS AND METHODS: Thirty-three patients presenting with advanced metastatic GCT were reviewed. The median age at presentation was 34 years. All received chemotherapy without previous orchidectomy. The decision to initiate chemotherapy without orchidectomy was based on a heavy tumour load and the patient's condition at initial presentation. A histological diagnosis was available from a biopsy of metastases in 23 patients; treatment in the remaining 10 patients was initiated after diagnosis based on a combination of elevated serum tumour markers, testicular findings and the presence of a retroperitoneal mass. RESULTS: Seminomatous GCT (SGCT) was diagnosed in 13 patients, non-seminomatous GCT (NSGCT) in 17 patients and mixed GCT (MGCT) in the remaining three patients. Bleomycin/etoposide/cisplatin-based chemotherapy was the principle regimen. After initial chemotherapy, all patients with pure SGCT had only scar tissue in the orchidectomy specimen, with no residual tumour. Nine of 17 patients (52.9%) with NSGCT had viable tumour remaining in the orchidectomy specimen. All three cases of MGCT had persistent viable invasive seminoma. Twenty-seven patients (81.8%) were recurrence free and alive after a median of 49 months of follow-up. CONCLUSIONS: Thirty-six per cent of patients had residual tumour locally in the testis after primary chemotherapy for metastatic GCT of the testis. However, in the cases with pure seminomatous disease, there was no residual tumour present. It may not be necessary to undertake delayed orchidectomy in these patients.

Investigation of stimulus position in the production of the strength duration curve of the external anal sphincter muscle in women with anorectal dysfunction.

OBJECTIVE: The strength duration test (SDT) is a minimally invasive test of the innervation of a muscle and has been successfully adapted for use on the external anal sphincter (EAS). The SDT has previously been performed on the EAS placing a stimulating probe in the 3 o'clock position. The aim of this study was to determine whether there was any variation in the strength duration curves (SDC) produced at different positions around the EAS. PATIENTS AND METHODS: Thirty-one patients with anorectal dysfunction attended our Institution for Anorectal Physiology Studies and were recruited to the study. After undergoing anal manometry, pudendal nerve terminal motor latency measurement and endoanal ultrasonography, the SDT was performed in four stimulus positions (3, 6, 9 and 12 o'clock). The sequence of positions was randomly selected. RESULTS: Four SDCs were obtained successfully in 25 patients. There was no significant difference seen between the four positions at the longer current durations (1-100 ms). Significant differences occurred at the shortest current durations (0.3 and 0.1 ms) when comparing adjacent stimulus positions except between the 6 and 9 o'clock positions, which were comparable. When opposing positions were compared (3-9 and 6-12 o'clock) at these short durations no significant difference was found. CONCLUSION: There was no significant difference between the SDC produced at 3 and 9 o'clock. These positions closely correspond to where the pudendal nerves enter the EAS. It therefore appears acceptable to perform the SDT in either of these positions, though 3 o'clock remains our preferred position.