Through an optimal treatment of testicular cancer the life expectancy of patients is improved, but more early and late complications were observed after different therapeutic procedures and mainly fertility problems come to the fore. In 70% of the patients (n = 30) an abnormal spermiogram was found prior to treatment. At this time 54% of all patients with testicular cancer (n = 61) were 20 to 30 years old and 43% of these patients wish to have a child. After radical retroperitoneal lymph node dissection in 71% of cases (n = 45) a total or partial loss of ejaculation was found. The cytostatic chemotherapy and radiation treatment are the cause of reversible or irreversible reduction in spermatogenesis and possibly mutagenic alterations. There are several alternatives to treat the infertility problems of cured testicular cancer patients and autologous insemination is favoured by the half of these patients. In our experience with cryopreserved sperm (n = 22) only patients with appropriate sperm quality (greater than 10 Mill. sperms/ml, greater than 30% mobile sperms, greater than 30% thaw motility) are suited to this method. In consideration of these parameters only 25% of testicular cancer patients are suited for long-term sperm preservation. The technical problems of sperm preparation, storage and autologous insemination are described in detail.

Nach radikaler RLA und hochdosiertem Alkylantieneinsatz ist mit der Infertilität des Hodentumorpatienten zu rechnen. Partielle RLA-Techniken und moderne Zytostatika lassen in zunehmendem Maße geheilte und wieder fertile Patienten erwarten. Damit gewinnen Fragen der mutagenen Wirkung von Zytostatikaeine vordergründige Bedeutung. Bei einer Patientenserie (n = 31) wurden vor, während und nach der zytostatischen Therapie die Chromosomenaberrationsraten bestimmt. Mit Hilfe der Methode der Lymphozytenkulturen konnten pro Patient 100-200 Metaphasen ausgewertet werden.

There are numerous reports on the morphological results after hypospadia operation whereas only few reports do exist on sexual behaviour after this operative treatment. In our experience every fifth patient (18.5%) had psychogenic disturbances of sexual life. The marriage rate was 20% lower than in an age-related group of the normal population and 24% of the patients have had not any sexual contact as yet. Morphological causes of these disturbances were severe penile deviations (3 out of 16 patients); slight deviation occurred in 13 patients. Therefore, an intraoperative artificial erection has been recommended. In two thirds of the patients with psychogenic inhibitions a morphological cause could be verified. In conclusion, patients with hypospadia operation should controlled up to the sexually active life, if necessary under participation of a psychologist.

Obligatory statements on the value of lymphadenectomy in penile cancer are difficult because of the rarity of the tumor. Reservations against a general application of inguinal or ileoinguinal lymphadenectomy in penile cancer are made because of severe complications as long-term lymph fistulas, skin necroses, scar contractures, vascular injuries and restrictions of the leg motility. Measures to reduce these complications are of great value. By a special intraoperative and postoperative regimen in our own patients severe complications could be avoided. With the use of absorbable ligation material the development of long-term fistulas is prevented and by a redon drainage of 15 days the development of wound ruptures and scar contractures are avoided. Although in all cases investigated by lymphangiography a lymph flow obstruction was verified only discrete lymph edemas of the lower extremities were found clinically. Thereby an opening of preformed lympho-venous anastomoses due to outflow obstruction and simultaneous tissue compression should be assumed.

A total of 181 prostatic cancer patients under radiation monotherapy were tested for the therapeutic effect of pelvic lymphadenectomy (PLA). Sixty-seven belonging to the pN0 category formed a highly selective group and presented a 89% rate of 7-year survival. Localized radiation therapy with pelvic irradiation (81 patients) with conventional exclusion of lymphogenic macrometastases in the probable presence of micrometastases produced equally good results. Extended pelvic irradiation in cases of conventionally verified regional lymphogenic macrometastases remained without therapeutic effect. The combination of PLA with pelvic irradiation, when regional metastases have already occurred (23 patients), may be suited for localizing the tumor process, since the survival rates showed no significant difference compared to those of the pN0 group. For that reason and also because of the difficulty in determining the N category accurately by conventional methods, it is recommended to perform PLA prior to radiation monotherapy.

The first 10-year-treatment results may allow an assessment of various therapeutic methods of localized prostatic carcinoma at which the question of survival rate and the spectrum of complications take as a basis. In localized prostatic carcinoma the individual character of curative therapeutic regimens has been increased. The new UICC classification come up to this development. The radical operation is the standard method in the treatment of curable cancer (T1-T2) with most superior survival rates. A safe intraoperative bladder-urethra anastomosis and the postoperatively possible urethrotomia interna may reduce urinary incontinence and stenosis of the anastomosis. The use of erectile-protective PE-technique should be verified with regard to its radicality. The interstitial radiation therapy using J 125 seeds or Iridium 192 is of superior therapeutic value. Whether the perineal ultrasound-guided implantation of J 125 or Ir 192 are advantageous should be checked by further investigation. A benefit from this method is its safe of potency; it may be used in cancer with low grading and tumor stage, but a close urological-radiological co-operation, a special equipment and radiation protection measures are necessary. Radiation therapy is indicated in older patients with localized tumors (T1-T3), but further reduction of irradiation side-effects and a biological judgement of the tumor by posttherapeutic biopsies be required. Since the prognosis of the prostatic cancer patients is dependent on lymphogenous metastatic spread its determination should be demand prior to localized therapy. In radical prostatectomy the pelvic lymph node dissection is performed simultaneously.(ABSTRACT TRUNCATED AT 250 WORDS)

Early complications after uretero-intestinal anastomoses are above all of inflammatory nature, caused by a pathological intestinal flora and/or a simultaneous urocystitis. 2 groups of treatment with uretero-intestinal anastomoses underwent a different preoperative preparation of the intestine. In a conventional group (n = 30) the preparation of the intestine was carried out by the application of laxatives, neomycin and talisulfasol. In another group (n = 22) the orthograde intestinal lavage was used in combination with an aimed prophylaxis by antibiotics. The advantages of the orthograde intestinal lavage are based on the nearly complete evacuation as well as on a favourable efficacy of the antibiotics in the emptied intestine. The performance, indications and contraindications of the technique are described. The analysis of the postoperative retention time, of the postoperative lethality and the numbers of complications caused by operation as well as infectious disturbances of the wound healing allocate a higher significance to the method of the prograde intestinal lavage compared with the conventional preparation of the intestine concerning the spectre of postoperative complications.

A total of 181 prostatic cancer patients under radiation monotherapy was tested for the therapeutic effect of pelvic lymphadenectomy (PLA). Sixty-seven belonging to the pN0 category formed a highly selective group and presented an 89% rate of 7-year survival. Localized radiation therapy with pelvic irradiation (81 patients) upon conventional exclusion of lymphogenic macro metastases, in probable presence of micrometastases, produced equally good results. Extended pelvic irradiation in cases of conventionally verified regional lymphogenic macrometastases remained without therapeutic effect. The combination of PLA with pelvic irradiation, when regional metastases have already occurred (23 patients), may be fit for localizing the tumour process, since the survival rates, compared to those of the pN0 group, showed no significant difference. For that reason, furthermore for the difficulty to determine the N category accurately by conventional methods, it is recommended to perform PLA prior to radiation monotherapy.

The individual approach in the stress incontinence of the woman requires the consideration of general pathological and social factors, the locoregional topical anatomy of the pelvic organs, results of functional investigations and aimed metaphylactic measures. The possibility of selecting incontinent women for the abdomino-vaginal approach is demonstrated with the help of a model of diagnostics and the tactics of operation as well as metaphylactic measures are described. In 92% of the women with highly pathological topical anatomy of the pelvic organs or recidivations of incontinence of urine a continence could be proved on an average three years after operation. 25% of the female patients showed a component of urgent desire to pass water. The combined approach with application of chorium material contains three operative suspensory steps and the correction of further factors evoking incontinence. The technique tested on account of the results obtained is an alternative method if indication is given.

Histomorphological studies on 40 prostatectomy and 122 lymphadenectomy preparations from patients with carcinoma of the prostate revealed the limits of prostate biopsy in assessing the volume of the tumour preoperatively, of capsule infiltration and of tumour histology in general. Multiple foci, the exclusion of dedifferentiated portions of a tumour and the lack of correlation between the histology of primary tumours and the degree of lymphogenous metastasis are limiting factors in the individual use of the histology of primary tumours for grading purposes. Our studies furthermore revealed the necessity for differentiated consideration of the category T3 and for intraoperative microscopic examination of resection margins in total prostatavesiculectomy.

The formation of metastases of carcinoma of the prostate has become more significant since the introduction of en-bloc pelvic lymphadenectomy using the serial-cut method. Lymphogenous evacuation of the pelvis occurs increasingly with advanced and dedifferentiated primary tumours. However, it can be found with low categories of tumours and differentiated carcinomas. pLA is superior to all other procedures for N-determination. If suitably indicated it allows a localized tumour process to be confirmed. Lymphatic oedemas are the most frequent complications. These can be largely avoided by retention of lacunary lymph nodes or primary fitting of lympho-nodo-venous anastomoses.