Evaluation of the clinical value of urinary NMP22 as a marker in the screening and surveillance of transitional cell carcinoma of the urinary bladder.

PURPOSE: To prospectively evaluate the clinical role of urinary NMP22 as a marker for transitional cell carcinoma of the urinary bladder in screening and surveillance settings. PATIENTS AND METHODS: Single voided specimens were obtained from 211 consecutive patients who presented for flexible cystoscopy. Of these, 96 patients presented with haematuria or irritative symptoms (screening), the remaining 115 were patients with known transitional cell carcinoma on follow-up (surveillance). The urine sample was used for urine microscopy, cytology and for measuring NMP22 levels. RESULTS: Bladder tumours were found in 16 of 96 (16.6%) patients in the screening group and 17 of 115 (15.6%) patients on surveillance. The NMP22 levels were significantly lower in patients with lower stage (Ta vs. T1-3), low grade (G1, G2 vs. G3, CIS) and papillary morphology. The optimum threshold for NMP22 obtained from the ROC curve was 4.75 U/ml, providing a sensitivity, specificity, positive predictive value and negative predictive value of 42.4, 85, 38.5 and 88.6%, respectively. Sensitivity and specificity were better in patients being screened than in those on surveillance. In both groups, urinary NMP22 had similar diagnostic characteristics as urinary cytology. CONCLUSIONS: Urinary NMP22 levels are significantly higher in patients with bladder tumour than in those negative for tumours, and test predictability improves with increasing stage and grade. The overall sensitivity for urinary NMP22 is similar to, but not superior to urine cytology. Our study suggests that the clinical role of urinary NMP22 as a diagnostic marker can be at best supportive only.

Laparoscopic orchiopexy for the intra-abdominal testis.

Laparoscopic orchiopexy was performed in 3 patients with an intra-abdominal testis. The laparoscopic approach provides better exposure of the spermatic vessels and vas deferens, and is less traumatic compared to the open procedure. In 2 patients the spermatic vessels were dissected after incising the posterior peritoneum but in 1 a strip of peritoneum overlying the vessels was left to avoid inadvertent damage to the spermatic vessels. The testicles could be brought down easily to the scrotum and there was no postoperative atrophy in any of the cases. Preliminary results suggest that the laparoscopic approach is a suitable, minimally invasive alternative to open exploration in patients with salvageable abdominal testes.

Laparoscopic condom dissection: new technique of retroperitoneoscopy.

The laparoscopic condom dissection is an advancement on the recently described balloon dissection technique of retroperitoneoscopy. It allows a simultaneous balloon dissection and retroperitoneal laparoscopic dissection using a telescope placed inside a condom balloon. In spite of a mild masking effect by the balloon, the clarity of vision was satisfactory, and adequate dissection could be carried out in all five patients in whom the condom was placed deep to the fascia transversalis or Gerota's fascia.

PIP: The laparoscopic condom dissection technique is an advancement on the recently described Gaur balloon technique for retroperitoneal dissection. The condom device allows for controlled expansion into the required operative area. The authors describe their experience using this technique. Under general anesthesia the patient is placed in a lateral position with the kidney bridge elevated. Two techniques are then described. Using technique 1, the condom cannula is inserted deep to the fascia transversalis through a 2-cm incision, after creating a retroperitoneal space by digital dissection. In technique 2, an 11-mm trocar-cannula is inserted into the retroperitoneal space. The cannula with attached condom is then introduced through this channel. A 10-mm telescope is then inserted. The condom is then inflated to 300 mL. A fiberoptic light source may be inserted through the cannula. Superficial dissection of the retroperitoneal structures may be performed through the balloon itself. Technique 1 was performed on 5 patients with success. Technique 2 was performed on 3 patients with unsatisfactory results. In summary, laparoscopic condom dissection is a new technique that requires further evaluation.

Retroperitoneal laparoscopic ureterolithotomy for multiple upper mid ureteral calculi.

A 30-year-old man presented with upper mid ureteral calculi and gross hydroureteronephrosis. The 4 large and 2 small calculi were removed successfully using Gaur's technique of retroperitoneal laparoscopy.

Retroperitoneal laparoscopic pyelolithotomy.

Retroperitoneal laparoscopic pyelolithotomy was successful in 5 of 8 patients using the recently described balloon technique of retroperitoneal laparoscopy. All patients were considered for this new minimally invasive procedure only on economic grounds. However, with improved technique and instrumentation, the retroperitoneal laparoscopic approach could become a practical alternative for the management of patients with medium sized pelvic stones not amenable to extracorporeal shock wave lithotripsy nor ideally suitable for percutaneous nephrolithotomy, or when both of these facilities are not available.