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Background: Seminoma is a testicular tumor type, routinely diagnosed after orchidectomy. As cfDNA represents a source of minimally invasive seminoma patient management, this study aimed to investigate whether cfDNA methylation of six genes from liquid biopsies, have potential as novel seminoma biomarkers. Materials & methods: cfDNA methylation from liquid biopsies was assessed by pyrosequencing and compared with healthy volunteers' samples. Results: Detailed analysis revealed specific CpGs as possible seminoma biomarkers, but receiver operating characteristic curve analysis showed modest diagnostic performance. In an analysis of panels of statistically significant CpGs, two DNA methylation panels emerged as potential seminoma screening panels, one in blood CpG8/CpG9/CpG10 ( KITLG) and the other in seminal plasma CpG1( MAGEC2)/CpG1( OCT3/4). Conclusion: The presented data promote the development of liquid biopsy epigenetic biomarkers in the screening of seminoma patients.

Small renal tumor is a radiologically detected renal mass up to four cm in diameter. Surgery is the main therapeutic option in the treatment of these tumors, but in elderly and comorbid patients ablative techniques are the alternative. The aim of this paper is to report our experience in the treatment of small renal tumors with ablative techniques. We retrospectively analyzed patient records of individuals treated with radiofrequency and microwave ablation at the University hospital center Zagreb in the period from January 2017 to August 2019. An appropriate radiological and preoperative work-up was performed for all subjects, and then tumor biopsy and ablation. Patients were followed using the standard follow-up schedule: three, six, and 12 months after the procedure, and then annually, using radiological methods. Ablation of 32 small renal tumors was performed for 31 patients, 27 of which were radiofrequency and seven microwave ablations. One-year overall and cancer specific survival was 100%. In 12.9% of patients a residual mass was diagnosed – three were retreated with ablation and one underwent radical nephrectomy. We had four ClavienDindo grade 2 complications. Ablative techniques are an oncologically effective and safe treatment option for patients that are unfit for surgery.

Prostate cancer screening has increased the number of patients eligible for radical prostatectomy (RP), but this curable surgery also increases the risk of postprostatectomy erectile dysfunction and urinary incontinence, and although these adverse effects may vary depending on their incidence, severity and duration they are present in most men who undergoing RP, exposing them to psychosocial problems, increasing health care costs and reducing labour productivity, therefor it is of great importance to reduce or even prevent them. Pelvic physical rehabilitation is a relatively simple, non-invasive, outpatient method that, if applied properly before and/or after RP, can significantly reduce adverse effects, increase patient quality of life and satisfaction with surgery, but also reduce health care costs and accelerate return to work. It is therefore important that our patients and physicians are aware of the benefits of a pelvic muscle training program.

We present a case series of 12 consecutive robot- assisted adrenalectomies performed from May 2019 to March 2020 by a single surgeon experienced in laparoscopy using the novel Senhance robotic system. Eleven patients had primary aldosteronism due to an adrenal adenoma, diagnosed by means of endocrinological and radiological evaluation, and 1 had a benign adrenal cyst. The robotic adrenalectomy technique is described in detail. The mean procedure time was 165.1 minutes, with robotic docking time of 11.6 minutes and console time of 98.6 minutes. The mean estimated blood loss was 47 mL, and hospital stay duration was 4.5 days. There was 1 Clavien Dindo IIIB complication and 1 patient underwent conversion to laparoscopy. All patients with adenoma had complete biochemical remission after surgery. In conclusion, the Senhance robotic system is a safe and feasible platform for benign adrenal surgery in high-volume centers.

Intraoperative iliac artery dissection during kidney transplantation is a rare but serious complication that requires prompt intervention. We present a case of right external iliac artery dissection during deceased donor kidney transplantation. A 57-year-old male patient underwent standard pretransplant evaluation and had no signs of either significant aortoiliac occlusive disease or peripheral arterial occlusive disease. Diabetic nephropathy, arterial hypertension and smoking were the underlying causes of the patient’s end-stage renal disease. Transplantation was performed in the standard fashion. The kidney was positioned in the right iliac fossa and the venous end to-side anastomosis was performed first. A significant dissection of the right external iliac artery was found on arteriotomy. Immediate ilio-femoral bypass with a vascular prosthesis was performed. During two years of follow-up the kidney function is stable and there are no signs of lower limb vascular insufficiency.

Mali tumor bubrega je radiološkim metodama utvrđena tvorba promjera do 4 cm. Kirurško liječenje je terapija izbora ovakvih tumora, ali se kod starijih bolesnika s komorbiditetima preporučuju i ablacijske metode. Cilj je ovoga rada prikazati naša iskustva liječenja malih tumora bubrega ablacijskim metodama. Učinili smo retrospektivnu analizu serije bolesnika liječenih radiofrekventnom i mikrovalnom ablacijom u Kliničkom bolničkom centru Zagreb u razdoblju od siječnja 2017. godine do kolovoza 2019. godine. Svim bolesnicima učinjena je odgovarajuća radiološka i preoperativna obrada, biopsija tumora i ablacija. Praćeni su prema standardnom protokolu radiološkim metodama 3, 6 i 12 mjeseci postoperativno te nakon toga jednom godišnje. Ablacija 32 mala tumora bubrega učinjena je kod 31 pacijenta, od čega 27 radiofrekventnih i 7 mikrovalnih ablacija. Jednogodišnje ukupno i tumor specifično preživljenje bilo je 100%, a kod 12,9% bolesnika utvrđen je rezidualni tumor. Troje ih je liječeno ponovnom ablacijom, a jedan radikalnom nefrektomijom. Imali smo četiri komplikacije iz 2. skupine po Clavien-Dindo klasifikaciji. Ablacijske metode su onkološki dobra i sigurna terapija kod bolesnika koji nisu pogodni za kirurški zahvat., Small renal tumor is a radiologically detected renal mass up to four cm in diameter. Surgery is the main therapeutic option in the treatment of these tumors, but in elderly and comorbid patients ablative techniques are the alternative. The aim of this paper is to report our experience in the treatment of small renal tumors with ablative techniques. We retrospectively analyzed patient records of individuals treated with radiofrequency and microwave ablation at the University hospital center Zagreb in the period from January 2017 to August 2019. An appropriate radiological and preoperative work-up was performed for all subjects, and then tumor biopsy and ablation. Patients were followed using the standard follow-up schedule: three, six, and 12 months after the procedure, and then annually, using radiological methods. Ablation of 32 small renal tumors was performed for 31 patients, 27 of which were radiofrequency and seven microwave ablations. One-year overall and cancer specific survival was 100%. In 12.9% of patients a residual mass was diagnosed – three were retreated with ablation and one underwent radical nephrectomy. We had four ClavienDindo grade 2 complications. Ablative techniques are an oncologically effective and safe treatment option for patients that are unfit for surgery.

Introduction & Objectives: Until recently, most of the robotic radical prostatectomies were performed using one available system. Senhance® Surgical System is a novel robotic system, currently used in several centers for Robotic Radical Prostatectomy (RRP). The objective of this study is to present a prospective analysis of our first 77 cases of extraperitoneal RRP (eRRP), analyzing short and long-term postoperative outcomes. Materials & Methods: From November 2019 to November 2020 we performed 77 eRRP using the Senhance® system. Relevant clinical data were collected and analyzed. Complications were reported using Clavien-Dindo classification. Postoperative follow-up of 2-14 months was available for 57 patients. The study has been approved by the institutional ethics committee. Results: Descriptive data are reported in the table. There was no significant difference in operative time when comparing the first 30 cases with the rest of the series. However, there were 150 ml less blood loss in the later series. Grade IV complication was reported in 1, grade II in 3 patients and grade I in 3 patients. The in- hospital stay was on average 5 days and the catheter was removed on average 12 days after surgery. Surgical margins were positive in 23 cases. Two patients underwent salvage radiotherapy because of biochemical relapse. Other patients had postoperative PSA

Završni stadij kronične bubrežne bolesti zahtijeva liječenje nadomještanjem bubrežne funkcije različitim metodama, od kojih je najbolja transplantacija bubrega, zbog značajno više stope preživljavanja i kvalitete života u usporedbi s dijalizom. U početcima transplantacijske medicine, kada su transplantacije izvođene samo u mlađih pacijenata, a preživljenje presatka bilo relativno kratko zbog visoke stope akutnih odbacivanja, zloćudni tumori predstavljali su manje važan problem. Vodeći uzrok gubitka presatka u vrijeme suvremene imunosupresije je smrt pacijenata s funkcionirajućim presatkom, a upravo su zloćudni tumori, nakon srčanožilnih bolesti i infekcija, na trećem mjestu uzročnika smrti u populaciji pacijenata s transplantacijom koja je sve starija i pod sve dužim kumulativnim djelovanjem imunosupresiva. Prema podatcima Registra za transplantaciju Australije i Novog Zelanda 10 % pacijenata razvije tumor nakon 10 godina, 25 % nakon 20 godina, a nakon 30 godina čak 40 % primatelja bubrega pod imunosupresivnom terapijom razvije tumor. U kohorti od 175 000 primatelja u Sjedinjenim Američkim Državama je identificirano 10 656 tumora, što je 2,1 puta više nego u općoj populaciji. Uočen je značajan porast rizika za više od 30 različitih primarnih tumora te snižena incidencija tumora dojke i prostate u odnosu na opću populaciju., End-stage renal disease requires the replacement of kidney function by different methods, the best of them being renal transplantation owing to significant survival advantage and better quality of life compared to the dialysis. In the beginnings of transplantation medicine, when transplantation was performed solely in young patients, and survival was relatively short due to acute rejections, malignant tumors were not a significant problem. In the era of modern immunosuppression, the leading cause of graft lost is death of a patient with functional graft. Malignant tumors are the third leading cause of death in patients following renal transplantation due to the increasing age of patients undergoing renal transplantation and longer cumulative influence of immunosuppression. Cardiovascular diseases and infections are the first and a second leading cause of death, respectively. According to Australian and New Zealand Dialysis and Transplant Registry, 10% of patients develop tumor 10 years after transplantation, 25% after 20 years, and after 30 years 40% of renal transplant recipients treated with immunosuppression develop malignancy. In a large population-based cohort study of 175 000 United States transplant recipients of solid organs, among those 10 656 developed some kind of a tumor. This is 2.1 times more often when compared to the general population. A significant increase of risk for 30 different primary tumors was reported, whereas a decreased incidence of breast cancer and prostate cancer was noted.

We present a young adult male patient with suspicious lesion in urinary bladder found on routine exam using ultrasound. Urethrocystoscopy was performed and revealed urethral fibroepithelial polyp that was causing partial and total obstruction of urine flow. We have documented this case with a series of high-quality endoscopic images., Prikazan je slučaj dvadesetdevetogodišnjeg muškarca kojem je na redovnom sistematskom pregledu, ultrazvukom je pronađena sumnjiva lezija u mokraćnom mjehuru. Uretrocistoskopijom je potvrđen uretralni fibroepitelni polip, mogući uzročnik potpunog ili djelomičnog zastoja mokrenja. Slučaj je dokumentiran serijom visokokvalitetnih endoskopskih fotografija.

Aim: To compare cognitive fusion targeted and systematic prostate biopsy in patients with repeated negative systematic biopsy but persistent clinical suspicion for prostate cancer. ----- Methods: The study enrolled 63 patients with at least one previously negative systematic biopsy who underwent targeted prostate biopsy using multiparametric magnetic resonance imaging (mpMRI) and transrectal ultrasound (TRUS) in addition to standardized systematic biopsy from July 2016 to May 2018. Multiparametric MRI was performed with 3 Tesla device by uro-radiologists experienced in prostate cancer. Lesions with Prostate Imaging Reporting and Data System 3, 4, and 5 were considered suspicious. Targeted biopsies were performed with cognitive fusion of TRUS and mpMRI. ----- Results: Prostate cancer detection, using either targeted or systematic biopsy, was 60.32%. Targeted biopsies were positive in 52.38% and systematic biopsies in 47.62% of patients. The median highest percentage of cancer involvement per biopsy core was significantly higher in targeted cylinders. The biopsies obtained by using the two techniques did not significantly differ in Gleason score. ----- Conclusion: Cognitive targeted prostate biopsy based on mpMRI presents a valuable addition to systematic biopsy in patients with repeated negative systematic biopsies but persistent clinical suspicion of prostate cancer.

Benign prostatic hyperplasia (BPH) is characterized with proliferaton of glandular and stromal components of the prostate. BPH can produce prostate enlargement and caused lower urinary tract symptoms (LUTS). The growth of the prostate depends on patent’s age and influence of sexual hormones, specially dihydrotestosterone. Symptoms can be divided as irritatve, obstructve and postmicturation symptoms. The basic evaluation included medical history, symptom score questionnaire, bladder diary, physical examinaton, urinalysis, creatinine and prostate specific antigen serum concentraton, uroflowmetry and postvoid residual urine. The modality of treatment depends about patents symptoms and results of diagnostic evaluaton. The inital step in the treatment are behavioural and dietary modificatons. In the patients with mild symptoms watchful waiting is first line treatment. In the other patients medicamentous treatment is recommended. Pharmacological management included: alpha adrenoreceptor antagonists, 5-alpha-reductase inhibitors, muscarin receptors antagonists, vasopressin analogue – desmopressin, beta-3 agonists, phosphodiesterase 5 inhibitors, phytotherapy and combinaton therapy. If the medicamentous therapy failed or the complicatons of BPH are present surgical treatment is recommended.

Purpose The study aims to evaluate the impact of recipients’ and donors’ polymorphisms in multidrug resistance-associated protein 2 (MRP2) gene ABCC2 -24C>T and 1249G>A on disposition of mycophenolic acid (MPA) and their interaction with cyclosporine (CsA) (compared to tacrolimus, TAC) in stable de novo adult renal transplant patients of Croatian origin. Methods A total of 68 recipient-donor pairs were genotyped. Steady- state pharmacokinetics of MPA was assessed by the model-independent method. Results Adjusted for MPA formulation, renal function, type of calcineurin inhibitor and recipients’ and donors’ genotypes at the two loci, donors’ A-allele at 1249G>A was associated with a reduced peak (29%) and early (AUC0–2, 33%) exposure and increased MPA clearance (26%). Donors’ A-allele combined with CsA was associated with 78% higher MPA clearance, 49% lower early and 48% lower total exposure as compared to wild type homozygosity + TAC. Recipients’ SNPs per se did not reflect on MPA disposition. However, A-allele at 1249G>A + CsA (compared to wild type + TAC) was associated with a numerically greater increase in MPA clearance (59 vs. 41%), reduction in total exposure (36 vs. 27%) and increase in absorption rate (C max/AUC) (56 vs. 37%) than observed for the main effect of CsA. Less pronounced effects were observed for the combination of variant allele at -24C>T and CsA. Conclusion Considering MPA disposition, data indicate: donors’ ABCC2 1249G>A polymorphism increases clearance and reduces exposure ; CsA increases clearance and reduces exposure by inhibiting MRP2 in the gut, the liver, and the kidney ; donors’ ABCC2 1249G>A polymorphism enhances the renal CsA effect, while recipients’ polymorphism seems to enhance the liver and the gut CsA effects.

Objectives To analyze p53 mutations and gene expression of p53, ∆40p53, and ∆133p53 isoforms in renal cell cancer (RCC) tissues and normal adjacent tissue (NAT) and to associate them to clinical features and outcome. Patients and methods Forty-one randomly selected patients, with primary, previously untreated RCC, with complete clinicopathohistological data were analyzed. NAT samples were available for 37 cases. Expression of p53, ∆40p53 and ∆133p53 was determined using RT-qPCR. A functional yeast-based assay was performed to analyze p53 mutations. Results More than half (56.1%) of patients harbored functional p53 mutations, and they were significantly younger than those with wild type (WT) p53 (P = 0.032). Expression of p53, ∆40p53, and ∆133p53 was upregulated in mutant (MT) p53 RCC compared to WT p53 RCC tissues. However, there was no difference in expression of these isoforms between MT p53 RCC tissues and NAT. Expression of ∆133p53 was significantly downregulated in WT p53 tissues compared to NAT (P = 0.006). Patients that harbored functional p53 mutation had better overall survival (hazard ratio 4.32, 95% confidence interval 1.46–18.82, P = 0.006). Multivariate analysis demonstrated that tumor stage and p53 mutation might be used as independent prognostic marker for overall survival in RCC patients. Conclusions Our findings support the specific events in the carcinogenesis of RCC. p53 isoforms can be differentially expressed depending on p53 mutational status.

The purpose of this paper was to outline the development of short peptide targeting of the human prostate specific antigen (hPSA), and to evaluate its effectiveness in staining PSA in human prostate cancer tissue. The targeting of the hPSA antigen by means of antisense peptide AVRDKVG was designed according to a three-step method involving: 1. The selection of the molecular target (hPSA epitope), 2. the modeling of an antisense peptide (paratope) based on the epitope sequence, and 3. the spectroscopic evaluation of sense&ndash, antisense peptide binding. We then modified standard hPSA immunohistochemical staining practice by using a biotinylated antisense peptide instead of the standard monoclonal antibody and compared the results of both procedures. Immunochemical testing on human tissue showed the applicability of the antisense peptide technology to human molecular targets. This methodology represents a new approach to deriving peptide ligands and potential lead compounds for the development of novel diagnostic substances, biopharmaceuticals and vaccines.

Manuscript describing initial experience with novel robotic platform the Senhance. We describe the technical aspects of surgery and the operative technique.

Primatelji solidnih organa imaju 3-4 puta veću pojavnost zloćudnih tumora, no osim tumora vlastitog tkiva, primatelji organa mogu razviti i zloćudnu bolest povezanu s darovanim organom. Prema istraživanjima izvan Republike Hrvatske, udio bolesnika koji razviju zloćudni tumor prenesen s darovatelja iznosi 0,01-0,05 %, što bi u hrvatskim uvjetima značilo 0,02-0,1 bolesnika s prenesenim zloćudnim tumorom godišnje. Rizičnima za prijenos tumora smatraju se darovatelji stariji od 45 godina te oni s preboljelim zloćudnim tumorom u anamnezi. Jasne smjernice još nisu razvijene pa svakom bolesniku treba pristupiti individualno i procijeniti rizike i boljitke postupaka. Četiri slučaja transplantacije bubrega s moždano-mrtvog darovatelja za koje se autopsijom doznalo za malignu bolest zabilježena su i na KBC-u Zagreb., It is known that the incidence of malignant diseases is increased 3 to 4 times when the population of solid organs recipients is observed. Apart from the tumours developed from one's own tissues, tumour recipients may develop a malignant tumour related to the donated organ. The chance of developing such a disease is far smaller than the one of developing a malignant disease originating from one's own tissues but the chance is not non-existant. It is necessary to examine whether such a risk is worth taking and whether the donated organ should be explanted in the case of discovering a malignancy in donor. Another problem is the fact that a portion of such tumours is discovered not before the deceased donor's obduction. Acorrding to researches outside of Croatia, 0,01-0,05% of kidney recipients develop a malignancy transmitted from the donor. In Croatian terms, that would be equivalent to 0,02-0,1 persons per year. Increased risk groups would be donors over the age of 45 and donors with a history of malignant disease. There are no clear guidelines developed yet but there are some widely-accepted procedures in certain situations. Each patient must be individually evaluated and cost-benefit analysis must be taken into account. Four cases occured in the Hospital University Center Zagreb when the autopsy discovered a malignancy in kidney donors.

Prostate cancer is responsible for the largest number of cancer-related deaths in male population in many countries of the world. Aggressive forms of the disease are associated with an increased risk of local recurrence and death. Treatment of high-risk local prostate cancer most commonly involves radical prostatectomy (RP) or external beam radiation therapy (EBRT ) combined with androgen deprivation therapy (ADT ) with or without the addition of brachytherapy (BT). The use of surgery for high risk prostatic carcinoma (HR PC) is on the rise, because of its advantages including the possibility of cure with surgery alone without the risk of toxicities from prolonged ADT, accurate staging, and avoiding the influence of PSA originating from benign prostatic hyperplasia on future therapy. Oligometastatic prostate cancer may be considered as the last border of possibly curable disease. Radical prostatectomy in oligometastatic prostate cancer can significantly decrease the risk of local complications but only multimodal approach in selected group of patients may offer opportunities to eradicate tumor or delay its progression. Surgery for oligometastatic disease most commonly targets lymphatic disease with salvage pelvic lymph node dissection, whereas it rarely targets distant metastases. Further prospective, randomized studies are necessary to define the role and value of therapies in oligometastatic prostate cancer., Rak prostate ostaje najčešći uzrok smrtnosti od karcinoma u mnogim zemljama svijeta. Bolesnici s agresivnijom bolešću izloženi su većem riziku od neuspjeha lokalnog liječenja i smrti. Liječenje visoko rizične lokalne bolesti najčešće uključuje radikalnu prostatektomiju, radioterapiju (EBRT ) s androgenom deprivacijskom terapijom (ADT ) ili EBRT plus brahiterapiju (BT) i ADT . Kirurško liječenje karcinoma prostate visokog rizika (HR PC) je u porastu zbog svojih prednosti koje uključuju mogućnost izlječenja samo operacijom, točno određivanje stadija bolesti, uklanjanje dobroćudnog izvora PSA koji je čimbenik za određivanje buduće terapije, te mogućnost izbjegavanja toksičnosti dugotrajne primjene ADT-a. Čini se da je oligometastatska bolest posljednja barijera potencijalno izlječivog karcinoma prostate. Radikalna prostatektomija u oligometastatskom karcinomu prostate može značajno smanjiti rizik od lokalnih komplikacija, ali samo multimodalni pristup odabranoj skupini bolesnika može pružiti mogućnosti za potpuno uklanjanje tumora ili usporavanje njegovog napredovanja. Kirurško liječenje oligometastatske bolesti najčešće je usmjereno na limfogeno širenje s disekcijom zahvaćenih zdjeličnih limfnih čvorova, a rjeđe može biti usmjereno na udaljene metastaze. Potrebna su daljnja prospektivna, randomizirana istraživanja za definiranje uloge i vrijednosti terapije oligometastatskog karcinoma prostate.

Twenty to thirty percent of patients with clinical stage I testicular tumor have metastases in the retroperitoneum. The aim of this study was to evaluate the role of OCT4 immunohistochemistry in histopathologic diagnosis of lymph node metastases in patients with nonseminomatous germ cell testicular tumors. All clinical stage I patients with staging laparoscopic retroperitoneal lymphadenectomy from 2001 until 2009 were included. Archived materials of dissected lymph nodes were reassessed and additional immunohistochemical staining with OCT4 antibody was performed in patients diagnosed as free from metastases. Each slide was visually estimated for the percentage of tumor cells showing nuclear immunoreactivity for OCT4. The study included 93 patients, of which 30 (32.3%) had initially positive retroperitoneal lymph nodes. Of the remaining 63 patients, materials were missing for 5 patients, so additional immunohistochemical staining was performed in 58 patients. Of these, two (3.4%) patients were OCT4 positive, suggesting a conclusion that they were initially misdiagnosed as stage I and metastasis free. OCT4 proved its value in detecting retroperitoneal metastases. Staging laparoscopic retroperitoneal lymphadenectomy for nonseminomatous germ cell testicular tumors in clinical stage I is a reasonable option for selected patients., Dvadeset do trideset posto bolesnika s tumorom testisa kliničkog stadija I. ima metastaze u retroperitoneumu. Cilj ovoga istraživanja bio je utvrditi vrijednosti OCT4 u patohistološkoj dijagnostici metastaza u limfnim čvorovima dobivenih laparoskopskom retroperitonealnom limfadenektomijom za utvrđivanje proširenosti bolesti. U istraživanje su uključeni bolesnici kliničkog stadija I. koji su operirani u razdoblju od 2001. do 2009. godine. Učinjena je ponovna procjena arhiviranih patohistoloških materijala pričem su uzorci bolesnika za koje je prvobitno utvrđeno da nemaju metastaza dodatno imunohistokemijski obrađeni protutijelima OCT4. Za svako stakalce vizualno je procijenjen postotak tumorskih stanica jezgre kojih su pokazale imunoreakciju za OCT4. Istraživanjem su uključena 93 bolesnika od kojih je 30 (32,3%) inicijalno imalo metastaze u retroperitonealnim limfnim čvorovima. Od preostala 63 bolesnika pet ih nije imalo dostupne materijale za analizu te je imunohistokemijsko bojenje učinjeno za 58 bolesnika. Među njima dijagnosticirali smo dva (3,4%) bolesnika koji su imali limfne čvorove pozitivne na OCT4. Njima je inicijalno utvrđen krivi stadij bolesti, čime smo zaključili kako je OCT4 potvrdio svoju vrijednost u otkrivanju retroperitonealnih metastaza. Laparoskopska retroperitonealna limfadenektomija u svrhu utvrđivanja stadija bolesti predstavlja razumnu opciju za probrane bolesnike u kliničkom stadiju I. neseminomskih tumora zametnih stanica testisa.