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Subcutaneous use of mistletoe lectin as adjuvant treatment after transurethral resection does not seem to affect the time to first recurrence, total number of recurrences or recurrence-free outcome.

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Skin infiltration and locoregional lymph node extension in metastatic penile cancer leads to destruction in the inguinal and perineal region. Efficacy of systemic polychemotherapy based on cisplatin, methotrexate, and bleomycin (CMB scheme) is limited with an objective remission rate up to 30% only. The obligatorily superinfected defects require tension-free and extended coverage with immediate myocutaneous flaps after surgical resection. Pedicle flaps, consisting of skin, fascia, muscle, and the supplying vessels, are used to cover the post-resection defects. In the field of surgical uro-oncology the following myocutaneous flaps listed with the supplying vessels have proved themselves: M. tensor fasciae latae flap (A. circumflexa femoris lateralis), M. rectus abdominis flap (A. epigastrica inferior), M. gluteus maximus flap (A. glutea inferior). Data concerning a prospective study for neoadjuvant chemotherapy with CMB followed by surgical tumor resection with immediate myocutaneous flap reconstruction are presented. In 15 patients (median age: 69.7 years) suffering from squamous cell carcinoma of the penis (Tx, N3, M1 cutis), a surgical excision of the tumor was performed after neoadjuvant chemotherapy (median:2.4 cycles) and antibiotic pretreatment. All patients received coverage of the femoral vessels with a musculus sartorius transfer on both sides. An extended (up to 45x30 cm) tension-free coverage of groin defects was performed in two patients with a unilateral M. tensor fasciae latae flap (TFL) and in eight patients with a bilateral TFL. One patient received a M. gluteus maximus flap (GMFL) on both sides, three patients were treated with a combination of M. rectus abdominis flap (RFL) and TFL, and one patient received a combination of two TFL, one GMFL as well as one RFL. Of 31 myocutaneous pedicle flaps, 2 developed distant necrosis of the flap, in which one GMFL and one TFL were affected. No complete necrosis of the pedicle flap occurred. Primary wound healing was found in 29 of 31 myocutaneous flaps. The covering of groin defects by the use of myocutaneous flaps, such as the M. tensor fasciae latae, M. rectus abdominis, and M. gluteus maximus flap, is a method of first choice in the primary treatment of even bacterially contaminated wounds or after radiation therapy. The techniques of pedicle flaps are comparably applied in oncology and traumatology.

Background: Known influence of the immune system on metastases of renal cell cancer (RCC) has led to the development of several therapeutic approaches for further stimulation of the host immune system by cytokines and the retransfusion of tumor-infiltrating lymphocytes (TIL). Based on observations in human prostate adenocarcinomas and transitional cell carcinomas, we have investigated the presence of TIL in different stages of RCC in correlation to vascular endothelial growth factor (VEGF) expression as a parameter for tumor progression and adverse survival in RCC patients. Methods: Samples from surgically obtained RCC (n = 28) and benign renal parenchyma (n =10) were snap-frozen and processed by double-immunofluorescence staining with CD4/CD8 and VEGF antibodies. Results: In 20 of 28 RCCs a coexpression of TIL-specific markers CD4 and/or CD8 and VEGF was demonstrated. Control tissues were VEGF-negative and showed only negligible infiltration by CD4- or CD8-positive lymphocytes. Conclusion: The results indicate that at least 71% of TIL produce VEGF and may promote tumor progression rather than represent an abortive antitumor response of the host immune system.