Nebojsa Bojanic

Testis sparing surgery in the treatment of bilateral testicular germ cell tumors and solitary testicle tumors: A single institution experience.

To assess the oncologic and functional outcomes of testicular sparing surgery (TSS) based on a single institution experience.

Testis sparing surgery for treatment of small testicular lesions: Is it feasible even in germ cell tumors?: Testis Sparing Surgery

To evaluate the results of testis‐sparing surgery (TSS) in patients, with small testicular lesions and a normal contralateral testicle.

The Correlation of Biochemical and Morphologic Parameters in the Assessment of Sperm Maturity

OBJECTIVE To examine the relationship between biochemical markers and morphologic sperm characteristics, including head, neck, and tail changes. METHODS The study evaluated 154 patients who went to the Andrology Laboratory of the Clinic of Urology, Clinical Center of Serbia. Patients were divided into 4 groups: normozoospermic, oligozoospermic, severe oligozoospermic, and asthenozoospermic, according to the sperm concentration and motility. RESULTS The differences in creatine kinase (CK) and CK-M levels between normozoospermic and the 2 groups of oligozoospermic patients were significantly different (P <.01). The CK and CK-M levels correlated negatively with sperm concentration and sperm motility, but correlated positively with the pathologic sperm form. Patients with CK values >0.093 have a total number of pathologic forms higher than 0.40 (87.5% sensitivity, 77.3% specificity, the area under the curve was 0.832, P <.001). Patients with CK values <0.09 U/L have normal spermatogenesis and pathologic disorder of the head <15%, neck <12%, and tail <10%. CONCLUSION The relation between sperm morphology and biochemical markers included in the maturation process is established during the sperm genesis process. If the results of these markers are used together with the morphology of the spermatozoa in the interpretation of infertility, it would lead us to better insight of the fertility potential of the each patient.

Reninoma as a cause of severe hypertension and poor pregnancy outcome in young woman

Introduction. Juxtaglomerular cell tumor (JGCT) or reninoma is a very rare cause of curable hypertension among young people. The early diagnosis is the most important based on the clinical presentation, hormonal and radiological findings observed on computed tomography (CT) and/or magnetic resonance imaging (MRI). The final confirmation of the JGCT is the lateralization of the plasma renin activity (PRA) during the selective renal venous sampling. Case report. This report presents a typical case of young women with JGCT which was manifested for the first time with severe hypertension during the pregnancy and was the reason of fetal death. After the miscarriage, the diagnosis of JGCT was made by the CT scanning and confirmed by the selective renal venous sampling. After the partial nephrectomy, the blood pressure and serum potassium normalized without the medications. Conclusion. Reninoma should be considered in the differential diagnosis as a cause of severe hypertension in pregnancy and also should be suspected in young hipertensives (especially females) with hypokalemia and secondary hyperaldosteronism after the exclusion of other causes particularly renal artery stenosis. A dynamic contrastenhanced CT, MRI and selective renal venous sampling are the most important tools in the diagnosis of JGCT.

In response to: “Is testis sparing surgery an acceptable option for small testicular malignant tumor with normal contralateral testicle?”

We would like to thank Bokarica et al for their comments on our trial. Radical orchiectomy (RO) is the standard of care treatment for testicular cancer patients. Testis sparing surgery (TSS) could be offered in highly selected patients with germ cell tumors (GCT) and a normal contralateral testicle only in a setting of a clinical trial, as we stated in our article. The perquisite for TSS is a well-informed and a complaint patient willing to participate in a frequent follow-up schedule. Frequent follow up visits provide safety from an oncologic point of view because of possibly high local recurrence risk. Local recurrence after TSS could be considered as a consequence of tumormultifocality and presence of TIN.Multifocality is defined as a distinct tumor focus with a diameter ≥ 1mm, separable from the main tumor mass, and is found in 8.7% of tumors less than 2 cm. Size and localization of multifocal tumors can possibly affect the sensitivity and value random biopsies. Secondly, themodern view is that TIN is almost invariably present in testicular parenchyma adjacent to a GCT. However, recent data suggest that prevalence of TIN could be decreased in the presence of a tumor lesion smaller than 1 cm. Multiple testicular biopsies can adequately identify the presence of TIN. Local radiotherapy is the treatment of choice, once the TIN is diagnosed, but application of radiation can result in loss of fertility and hormonal function. Fertile patients who wish to father children may delay radiation therapy and be followed by regular testicular ultrasound. Since no local radiation therapy was planned in our protocol, in the setting of normal contralateral testicle, and in regards of conserving fertility and hormonal function, we did not provide information concerning TIN. Testicular cancer survivors treated with RO can experience changes in body image, sexual dysfunction and fertility issues. There is a potential positive effect of TSS and active surveillance on these issues, howevermore data is needed regarding the risks and benefits of this type of treatment. In our study, we have shown that it is possible to achieve at least 65 months without tumor recurrence, with all of the potential benefits of preserved testis in patients in their sexual and reproductive prime.