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Urologic malignancies in childhood and adolescence are mainly nephroblastomas, neuroblastomas, soft tissue sarcomas, and germ cell tumors. National and supranational treatment studies are the standard of care for pediatric cancer in Germany; they yield 5-year survival rates of almost 90% for nephroblastoma and germ cell tumors and 60% for neuroblastoma (all stages) and rhabdomyosarcoma. The principles of antineoplastic therapy are the same as in adult cancer medicine; the drugs used depend upon the disease. In a multimodal treatment strategy, the role of chemotherapy as well as that of surgery and radiotherapy can differ, as is described for nephroblastoma, infant neuroblastoma, and stage 4 neuroblastoma.

Due to demographic developments malignancies of urogenital origin will gain increasing importance. The urologist will face a growing group of patients with co-morbidities and functional disabilities as these neoplasms increase with age. Optimisation of peri-interventional management successfully reduces the risks of surgery. Integration of taxane-based cytostatic regimes achieves a prolongation of survival in hormone-refractory metastatic prostatic cancer. The introduction of gemcitabine in the management of malignancies of the bladder seems to have reduced toxicity while maintaining anti-tumour activity in comparison to MVAC. The role of haematopoetic growth factors remains to be defined in urologic malignancies - increasing dose intensity for better activity or reduction of toxicity. Individualisation of treatment requires early cooperation of the urologist, the oncologist and the geriatrician for an optimal outcome.

This article describes the necessities, possibilities and limits of psycho-oncological treatment during the rehabilitation of patients with uro-oncologic malignancies. Studies verify the efficacy of educational and behavioral-medicine orientated interventions: improved coping, reduced burden affects, increased quality of life and a better compliance with the medical treatment.

Surgery of diseases of the pelvis minor and retroperitoneum such as inflammatory disease, malignant tumours, or trauma of pelvic organs need the close interdisciplinary collaboration of visceral surgeons, gynaecologists, and urologists. This collaboration begins in planning diagnostic and therapeutic procedures. It has to be clear who performs which operative step and when. Excellent long-term results in malignant disease show that the greater effort is worthwhile. The rate of postoperative morbidity after these multivisceral resections is high also in specialised centers, but mortality is below 5%. Because of the growing number of long-term survivors, preservation of quality of life becomes more and more important.

In the early 1990s, the first reports appeared indicating a disturbingly high incidence (20%) of port site metastases following laparoscopic procedures for visceral and gynecological malignancies. At the same time, animal experiments were performed to investigate the phenomenon of port site metastases. The results were independently and repeatedly verified by different groups. In view of these distressing facts, a controversial, at times emotional discussion arose that evolved at least in part without strict regard to the available data. In the recent past, reports on increased incidence of port site metastases after laparoscopic interventions have completely vanished from the literature. Figures on incidence reported by various authors range between 0.5% and 1.3% and thus are comparable to the rate for surgical wound metastases (0.8-1.6%) as known from open conventional methods. Prospective studies have even shown that the survival rate in comparison to conventional techniques is 20% better, at least for laparoscopically treated stage I-III colorectal carcinomas. At present the discussion on the phenomenon of port site metastases can be considered closed. Port site metastases are thus no longer a fact, but also not fiction, since this phenomenon does occur in a small percentage of patients after laparoscopy just as after open surgery.

We present long-term results (minimum follow-up 5 years) in 145 patients with advanced non-seminomatous germ cell tumours, who underwent radical retroperitoneal lymphadenectomy (RPLA) after chemotherapy. We correlated patients' outcomes (death of disease) to different kinds of chemotherapy and to intraoperative findings. We found that patients who were treated by a modified Einhorn scheme with cisplatin, etoposide and bleomycin have a good prognosis. In all, 90% showed no evidence of disease (NED). The NED rate was significantly lower in patients who were treated by sequential alternative chemotherapy (DOD = 37%). We determined the following prognostic factors which predict a poor outcome: salvage RPLA in the case of progressive disease or tumour marker increase during chemotherapy (DOD = 89%, P < 0.0001) residual tumour in multiple-organ systems (DOD = 41%, P = 0.0006) vital tumour in RPLA specimen (DOD = 53%, P < 0.0001) residual tumour mass > 5 cm (DOD = 41%, P = 0.0188). We found that histopathological findings of the primary tumour and tumour stage IIc-IIIc according to the Lugano classification have no prognostic significance for death of disease.

A phase III clinical trial is a comparative study in which one assesses the relative efficacy of a treatment or treatments. It generally has one of the following objectives: 1. To determine the effectiveness of a new treatment relative to the natural history of the disease, for example when comparing a new treatment to not treatment or to placebo in an adjuvant setting. 2. To determine if a new treatment is more effective than the best current standard therapy (at the risk of increasing the toxicity). 3. To determine if a new treatment is as effective as the best current standard therapy but is associated with less severe toxicity or a better quality of life (equivalence trial). Clinical trials must be properly designed in order to answer such questions with a high degree of certainty. The purpose of this paper is to present several concepts which must be taken into account during the process of designing a clinical trial.

From 1 September to 1 January 1990, a total of 1232 patients underwent surgery for colorectal cancer. Resection was performed on 1112 (90.3%) patients. It was curative in 917 cases and palliative in 195. Multivisceral resection was necessary 82 times because of tumour infiltration of adjacent organs (curative: 69 cases; palliative: 13 cases). The complication rate (26.7% vs 27.5%) and mortality rate (3.4% vs 2.9%) were similar to those for curative resections without multivisceral extension. The 5-year survival rate was also similar in the two groups (58% vs 55%). These results show that curative multivisceral resections can lead to the same long-term results as conventional curative resections. These data are encouraging, and tumour infiltration of neighbouring organs should not be taken to demonstrate inoperability.

Important data on the occurrence of urological tumours are presented. In particular, the actual values and estimations have been compiled. In the Federal Republic of Germany 19135 patients died of genitourinary tumours in 1988:81.3% of these were male and 47.5% had prostatic carcinoma. Death occurred after the age of 69 years in 71.7%, and in 36.7% after the age of 79 years. It is estimated that 37,000 persons become ill with a urological neoplasm each year, and that approximately 120,000 cancer patients are presently alive in whom a primary tumour has been diagnosed in the urinary system within the last 5 years. This means for instance, a relation of about 80 patients in posttreatment care to one practising urologist and 9% of urology beds are occupied by patients receiving primary treatment for a tumour. The trend in mortality has been inhomogeneous in recent years, insofar as a 50% decline of testis tumour mortality has been observed, whereas an increase of between 15% and 20% has been observed in the mortality of renal cell carcinoma and an increase of approximately 10% in the mortality of bladder carcinoma in women. Altogether, the position with regard to epidemiological data on tumours is still unsatisfactory in the Federal Republic of Germany.

The present study includes 181 patients suffering from metastases of the liver or inoperable gastrointestinal tumors, who received local chemotherapy with 5-FU in the form of loading doses of 6 g over a period of 3-6 days interrupted by intervals of 6-8 weeks. For this purpose the catheter was introducted into the main supply artery of the tumor, it was left in place for 6 days and the cytostatic agent was infused by help of an electric syringe. Remission rates amounted to 58% for liver metastases and 43% for inoperable advanced gastrointestinal tumors, which is quite remarkable. Remission periods up to 50 months were recorded for this type of intermittent treatment. Since the procedure is simple, well tolerated and bears little risk, and the therapeutical result is reasonably good for advanced cases, we feel justified in recommending this treatment in the form of a prospective study at least for cases in which direct surgical establishment of a catheter for implantation of a pump system is not performed. A comparison of treatment results with locoregional chemotherapy is limited to liver metastases, application in inoperable gastrointestinal or even urogenital tumors is still speculative, and this indication wants further observation.

This is an analysis of the incidence and mortality of malignant neoplasms of the urinary system and the male sexual organs in the GDR. Age-specific as well as age-adjusted incidence and mortality rates are subjects of the analysis. It is concluded that there is no convincing evidence for the assumption of an increased cancer risk. The demographic structure of the population of the GDR has changed considerably and cancer incidence rises steeply with increasing age. After adjustment for changes in the age distribution, it seems probable that the observed increase in new cases is due to improvements in detection, diagnosis and management only. The thesis that there exists a true epidemic of urinary cancer is rejected.