[Primary carcinoid of the testis]. / Primäres Karzinoid des Hodens.

A primary carcinoid tumour of the testicle without carcinoid syndrome was recorded from a patient aged 48 years. The tumour was made up of solid and acinar structures which exhibited strongly pronounced argyrophilia. Teratogenic structures were not established. Neuron-specific enolase (NSE) and chromogranin were immunohistologically recorded from tumour cells. The carcinoid had not spread metastases. Semi-castration was chosen as therapeutic approach. Orchidectomy was not followed by complications.

[Autologous frozen sperm--an alternative in infertility in the patient with invasively treated testicular tumor?]. / Autologes Kryosperma--eine Alternative bei Infertilität des invasiv behandelten Hodentumorpatienten?

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.

[The effect of plastic corrective measures in penile hypospadias on sex behavior in the fertile age]. / Der Einfluss plastischer Korrekturmassnahmen bei Hypospadia penis auf das Sexualverhalten im fertilen Lebensalter.

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.

Radical pelvic surgery and radiation therapy in the management of localized carcinoma of the prostate.

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.

Assessment of the regional lymph node status in radiation monotherapy of prostatic cancer.

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.

[High-voltage therapy of prostate cancer]. / Hochvolttherapie des Prostatakarzinoms.

High-voltage therapy is becoming increasingly important as a form of individual differential therapy of carcinoma of the prostate. Around 40% of all patients with a diagnosis of carcinoma of the prostate can be treated with high-voltage therapy. The precondition is the absence of bone and soft-tissue metastases and of juxtaregional lymph-node metastases. Individual carcinoma therapy is based on pre-therapeutic tumor classification according to the TNM system. The 5-year survival rates are presented from a retrospective study carried out using primary radiation monotherapy and a combined hormone and radiation therapy; these figures were calculated by the life-table method. The study revealed no significant differences between the two forms of therapy as regards 5-year survival rates. The 5-year survival rates of all patients of the classifications T0-T3Nx-N2M0 irradiated (n: 198) (72% +/- 11% for hormone plus radiation therapy and 74% +/- 11% for radiation monotherapy) did not differ greatly from those of a normal male population of the same age (77%). High-voltage therapy of carcinoma of the prostate can thus be classified as a curative method of treatment.

[Therapy of detrusor hyperactivity with propiverin (mictonorm)]. / Zur Therapie der Detrusorhyperaktivität mit Propiverin (Mictonorm).

In the context of treating hyperactivity of the detrusor the newly developed preparation Propiverin (Mictonorm) is presented. It is postganglionic and anticholinergic and mainly acts peripherally and selectively on the bladder. At the same time a musculotropic relaxing effect with a specific affinity to the unstriated musculature of the bladder can be demonstrated in experiments on animals. In our urodynamic investigations the application of the medicament resulted in an increase in bladder capacity, a reduction of urge symptoms, a decrease in bladder tension and a depression of the uroflow. These results justify the clinical use of Propiverin after appropriate urodynamic diagnostic checks.

[Aspects for hormone therapy in prostate cancer]. / Aspekte zur Hormontherapie des Prostatakarzinoms.

At present the antiandrogenic hormone therapy is a main form of the treatment of the carcinoma of the prostate. It is a palliative treatment. With reference to the testosterone metabolism the extra- and intraprostatic effect is explained. The present state of the hormone receptor research is critically explained, and by reason of the still uncertain prognosis of the effectiveness of the hormone treatment the necessity of a curative therapy (radical operation, radiotherapy with curative aim) is evident.

[Effect of anticholinergics on bladder tonus and on the voiding function]. / Die Wirkung von Anticholinergika auf den Harnblasentonus und auf die Funktion der Harnentleerung.

When the anticholinergic drugs with an effect which above all peripherally and selectively affects the urinary bladder the following may be proved: 1. Increase of the capacity of the urinary bladder according to the initial situation, 2. no influence on the intravesical pressure in maximum filling of the bladder, 3. decrease of the maximum intravesical pressure during the miction, 4. decrease of the rate of the flow of the urine and 5. increase of the maximum urethral pressure as well as no influence on the functional length of the urethra. From these parameters the adequate clinical application in diseases of the urinary bladder may be derived and at a strong indication good successes in treatment can be achieved.