A tailored surgical approach to the palpable undescended testis.

INTRODUCTION: Orchiopexy for a palpable undescended testis can be approached through a traditional inguinal incision or trans-scrotally. Despite the possible advantages of the scrotal approach, including reduced postoperative pain and shorter recovery, it is not consistently advocated. OBJECTIVE: The objective of this study was to present the experience with a tailored approach to orchiopexy based on physical findings. STUDY DESIGN: This is an extended case series. MATERIALS AND METHODS: The mobility of the testis as described at examination under anesthesia informs the choice of surgical approach. If a 'low' palpable testis (defined as testis that can be manipulated to the scrotum) was found, a scrotal approach was used. In cases of 'high' palpable testis (testis that cannot be manipulated to scrotum), the inguinal approach was used. Success was defined by location and size of the testis 3 months after surgery. RESULTS: A total of 259 orchiopexies were performed in 181 boys (78 bilateral). Scrotal approach was used in 125 (48%) and inguinal in 134 (52%) orchiopexies. Operative time was significantly shorter for the scrotal approach, 25 min vs. 40 min for inguinal orchiopexy (P < 0.05). The overall success rate was 98% with no statistical difference between the groups. Three children from the inguinal group and two from the scrotal group required an additional procedure for persistent undescended testis. The rates of testicular atrophy and hypotrophic testis were higher in the inguinal group than the scrotal group (5/134 vs. 0/125; P < 0.05 and 17/134 vs. 6/126; P < 0.05, respectively). DISCUSSION: The substantial cohort of patients selected for trans-scrotal orchiopexy experienced success rates and rates of atrophic and hypotrophic testis comparable with those found in the published literature. Furthermore, trans-scrotal operative times were significantly lower than those of inguinal procedures, and less patients required re-operation in the trans-scrotal group. Limitations of this study include significantly higher age at operation in trans-scrotal patients and a difficulty accurately classifying hypotrophic testes. Furthermore, the higher atrophic rate in the inguinal group vs. the scrotal group likely reflects the vulnerability of a testis that is located higher and not the superiority of the scrotal approach. CONCLUSION: This tailored approach to a palpable undescended testis appears simple, safe, and effective, providing high success rate with marginal complications. It is considered a preference in cases of low undescended testis, whereas the standard two-incision inguinal orchiopexy may better serve those with high undescended testis.

The pyruvate kinase isoenzyme M2 (Tu M2-PK) as a tumour marker for renal cell carcinoma.

The M2 isoenzyme of pyruvate kinase (M2-PK) is specially expressed by tumour cells (Tu M2-PK) and has been detected in the peripheral blood of patients with renal cell carcinoma (RCC). We analysed the benefit of using Tu M2-PK as a tumour marker for primary detection of RCC by receiver operating characteristic (ROC) analysis. The area under the curve was 0.674, and the sensitivity, specificity and positive predictive value (PPV) were 44.4%, 87.5% and 88%, respectively, at the ROC optimal cut-off of 28.2 kU/L. We examined 71 patients. Since the marker sensitivity for detection of the early stages T1 and T2 was only 47% it is not suggested to use this marker for primary diagnosis of RCC. Its use as part of the confirmatory preoperative evaluation might be considered in view of its high PPV.

[Screening for early detection of prostate cancer (first experience in Israel)].

Prostatic cancer (PC) is second only to lung cancer as a cause of cancer mortality in men word-wide. In Israel it is the most common cause of cancer mortality in men, after lung cancer and colo-rectal cancer. We screened, for the first time in Israel, for prostatic cancer using serum levels of PSA and a digital rectal examination (DRE). The purpose was not only to diagnose PC but also to increase public awareness of the condition. 300 men in the Haifa area who met statistical criteria for early diagnosis of PC participated. They filled a questionnaire regarding risk factors for PC (age, family history (FH) of prostatic and breast cancer, cigarette smoking, alcohol consumption, previous PSA sampling) and were examined. Those who had out-of-range, age-related PSA values, or a pathologic DRE underwent trans-rectal ultrasound (TRUS) examination and guided biopsy of the prostate. Those with a positive biopsy for PC underwent radical prostatectomy or radiation therapy. 41 (14.3%) had out-of-range, age-related PSA levels and 10 (3.5%) had a pathologic DRE. 39 (13.3%) underwent TRUS and biopsy and 6 (2.04%) had clinically significant PC, all early stages (Gleason 4-6). Correlation between age and PSA has been proven statistically significant (p < 0.05). Symptoms of urinary tract obstruction and nocturia were related to a high PSA (p = 0.035 and 0.002, respectively). Those with PC had at least 1 symptom of urinary tract obstruction; 6 (15.3%) who underwent TRUS and biopsy and a FH of prostate cancer. However, no subject with a FH of PC had biopsy-proven cancer. Those with PC had PSA values from 4.9 to 31.8 ng/ml (9.6 median). Age-related PSA had a positive predictive value of 17.1%. Results of our annual screening for early detection of PC using age-related PSA, and DRE are encouraging: cases detected were clinically significant and treatable. It would appear that screening for PC will result in decreasing the incidence of metastatic cancer and therefore mortality.