Recent research trends on carcinoma of the bladder with special references to the current concepts of its pathogenesis, the basic problems on its diagnosis and treatment were reviewed and discussed.
1)The transitional epithelium as the origin of transitional cell carcinoma (TCC) is understandable as an intermediate of squamous and glandular epithelium and the biology on the basal cells is seemed to be the most interesting.
2)Multistage carcinogenesis theory is adapted in the carcinoma of the urinary bladder and the research will be directed to clarify mechanisms to maintain the dormant cell in the state and to develop new technology for quantitative analysis of its promoters and antipromoters.
3)Grading of TCC by the conventional histology is not adequate in the futer that new objective criteria to evaluate the structural atypia is expected other than the current DNA analysis by flow cytometry.
4)Endoscopy for diagnosis of the bladder carcinoma should be available to observe whole urinary system and the recorded images should be analyzed by the objective method developed by new technology.
5)New direction of the treatment of the bladder carcinoma will be headed to find a BRM as an antipromoters in the short range stratesy.

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Clinical trials of the third generation extracorporeal shock wave lithotriptor (TRIPTER X-1) on 30 patients with upper urinary tract calculi were performed from May to July, 1988.
Eighteen patients (60%) were free from stones and 5 (16.7%) had stone fragments less than 5mm, the effective rate of treatment which is sum of both group being 76.7per cent, at one month after the treatment. The effective rate was 72.7per cent for stones in the kidney and 87.5per cent for those in the upper ureter. And the effective rate as to stone size was 100, 66.7 and 71.4per cent, in stones less than 1cm, 1cm to less than 2cm and 2 to 2.5cm, respectively.
Although gross hematuria skin ecchymosis, pain and fever were observed as side effects, none was serious enough to be mentioned. And post operative changes in blood chemistry were mild and transient.
We confirmed extracorporeal shock wave lithotripsy using this machine for upper urinary tract stones is an effective treatment without any serious side effects.

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The cytotoxic effect of interferons on T24 cells, the established cell line from human urinary bladder cancer, the distribution of the drugs in blood, urine and tissues of various organs and histopathological change in the bladder mucosa in dogs following intravesical instillation of the drugs, were studied. These studies were conducted to investigate the possible application of each type of interferons to intravesical treatment of superfitial bladder cancer.
1) The cytotoxicity of Ro22-8181 (recombinant human interferon α), GKT-β (recombinant human interferon β) and KW2202 (recombinant human interferon γ) on T24 cells was examined by colony formation method and growth inhibition assay. Cytocidal effects of interferons were dependent on dose and exposure time, and GKT-β is most effective (GKT-β>Ro22-8181>KW2202). Cytostatic effects of GKT-β were also dependent on dose and exposure time.
2) The interferon levels in blood, urine and tissues were measured by FL-Sindbis system following bladder instillation of GKT-β or KW2202 in beagle dogs with bilateral cutaneous ureterostomy. No interferons were detected in blood and urine. Bladder mucosa and submucosal layer were observed through a microscope 6 and 10 hours after bladder instillation of GKT-β or KW2202 in beagle dogs with bilateral cutaneous ureterostomy. Degeneration of bladder mucosa and submucosal layer was scarcely observed.
The above results suggest that GKT-β is a suitable drug for intravesical treatment of bladder cancer.

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In this paper, we summarize the results of a multicentric controlled study of induction treatment with intravesical BCG in patients with superficial bladder cancer (T_a, T₁) or CIS. The BCG Tokyo 172 strain (Japan BCG K. K.) was given for 8 weeks, as a rule, in a dose of either 80mg or 120mg in 40ml of saline instilled into the bladder.
Sixty-six (90.5%) of the 73 patients registered in the study were evaluable for response. High response rates were obtained in the patients with T_a or T₁ tumors, irrespective of the treatment dose; 65.4% CR, 27.3% PR and 7.3% NC for all. The number of CIS patients is too small to draw any conclusions, but 54.5% CR, 36.4% PR and 9.1% NC were obtained.
Several factors were evaluated in relation to the tumor ablative effects. The CR rate was significantly higher for tumors less than 1cm in size compared with tumors 1-3 or larger in size, although the response rates, including CR and PR, were very similar irrespective of the size. Other factors did not contribute to provoke a significant difference.
Japanese elder people show a high positive rate of PPD reaction. Thus, in our study, 78% of the patients showed positive PPD reactin. In this situation, no significant relation between PPD reaction and BCG efficacy was obtained. In addition, OKT8, OKT7, OKT4, OKT4/OKT8 ratio, Leu7, ADCC activity and NK activity did not show any correlation with tumor ablative effect of BCG.
It should be remarked that 3 out of 4 NC patients with T_a or T₁ tumor were female and they experienced minor bladder irritative symptoms.
The one year disease free survival rate was 80.6% for 42 patients showing CR.
Three patients could not tolerate BCG instillation more than 3 times because of adverse effects. Thus, it is concluded that BCG Tokyo 172 strain is effective both for tumor ablation and prophylaxis.

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Ciclosporin (CYA) is now recognized as an effective immunosuppressant to lead to a marked improvement in graft survival in organ transplant recipients. Although the incidence of infection in the CYA group has been decreased compared with that in the azathioprine group, infectious diseases in 400 kidney transplant recipients treated with CYA were noted in our single center.
Treatment strategy for infectious diseases: Antibiotics and/or γ-Globulin were administered to all recipients with bacterial infections. Aciclovir was added in recipients with herpes simplex virus (HSV) infection or varicella zoster virus (VZV) infection. Human interferon-β (HuIFN-β) was used in recipients who had life-threatening viral infection, especially cytomegalovirus (CMV) pneumonitis. Glycyrrhizin was used for acute hemorrhatic cystitis and nephropathy due to adenovirus (AV). Trimethoprim sulfamethoxazole and/or pentamidine were added in recipients complicated with Pneumocystis carinii (Pc) pneumonitis or in order to prevent Pc pneumonitis.
Infectious diseases: One hundred and six recipients had infectious diseases 129 times in this series, seventy-six percent of all infections occurred during the first 4 months after the transplantation. Urinary tract infection (UTI), herpes zoster and pulmonary infection were the most common infectious diseases, occurring in 28.7%, 24.0% and 23.2%, respectively. Septicemia or bacteremia developed in 9 recipients, secondary to UTI in 8 and to surgical wound infection in one. Sixty-one symptomatic viral infections occurred in 57 recipients. A total of 5 recipients (1.3%) died of interstitial pneumonitis.
Infectious organisms: Viral and bacterial infections were most common, occurring in 47.3% and 41.9%, respectively. Viral species detected in these recipients with the frequency were HSV 14 times, CMV 9 times, VZV 31 times and AV 7 times.
1) The incidence of viral infections in kidney transplant recipients treated with CYA is relatively high compared to bacterial infections.
2) HuIFN-β therapy is effective in the treatment of serious opportunistic herpes virus infections, especially CMV peumonitis.
3) Glycyrrhizin therapy is effective in the treatment of acute hemorrhagic cystitis and nephropathy due to AV and hepatic dysfunction.
4) Aerosolised pentamidine therapy is very useful for prophylaxis of Pc pneumonitis.

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Twenty-three patients, who underwent radical cystectomy and pelvic lymph node dissection for bladder carcinoma from November 1985 to November 1987, were studied pathologically. We evaluated the rate, position and morphology of metastasis into the neurovascular corridor or paracystium. The stages of the twenty-three patients were G1 1, G2 10, G3 12 and pT1a 1, pT1b 4, pT2 8, pT3a 2, pT3b 7, pT4 1. Of the 23 specimens, 22 (95%) were found to contain metastasis in the connective tussue of the paracystium. Lymph node metastasis was recognized in four patients (17%). Metastasis in connective tissue around the iliac lymph node was recognized in 5 patients (22%). Of these 5 patients, 3 were free from lymph node metastasis. The morphological pattern of metastasis was ranged from a few tumor cells to massive tumor cells with proliferation of fibloblasts. The existence of metastasis in the paracystium should be evaluated morphologically for urinary bladder carcinoma.

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Computed tomography (CT) was performed in a total 124 cases of renal cell carcinoma to determine perinephric invasion, venous invasion and involvement of the rigional lymphnode. The findings obtained were compared with pathological findings. CT findings for invasion of perinephric fat showed a sensitivity of 82%, specificity of 82 and accuracy of 82%. For adjacent organ invasion CT findings revealed a sensitivity of 90%, specificity of 100% and accuracy of 99%. As to venous invasion CT findings showed a sensitivity of 86%, specificity of 97%, and accuracy of 95%, and for lymphnode involvement CT findings revealed a sensitivity of 80%, specificity of 98%, accuracy of 96%. Although the accuracy is not so high in diagnosing invasion of perinephric fat, CT scan was proven to be a valuable diagnostic measure for detection of adjacent organ invasion, venous invasion and lymphnode involvement, thus helping to select a suitable surgical approach.

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Calcium-containing upper urinary stone formers (group SF-A, n=116) and normal controls (group Normals, n=10) were examined for urinary calcium (Ca) and phosphorus (P) excretion (mg/mg creatinine) on usual diet, on Ca-restricted diet and in basal period.
As a result, urinary Ca and P excretion decreased significantly both in group SF-A and in normal controls, as the dietary intake was reduced. As compared with normal controls, group SF-A exhibited significant elevation in urinary Ca excretion and showed a slight, though not significant increase, in urinary P excretion. A significant positive correlation between urinary Ca and P excretion was observed in either mode of diet in group SF-A, while no correlation was seen in normal controls. To examine the legitimacy of the result above obtained, another 40 Ca-containing upper urinary stone formers (group SF-B) were studied on usual diet. Thus, better correlation was obtained between urinary Ca and P excretion.
In conclusion, urinary Ca and P excretion will be strongly influenced by their dietary intake. Stone formers excrete more Ca and P than normal controls.
Finally, a tendency was noted that stone formers excreted the more Ca, the more P.

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The effect of lymphokine-activated killer (LAK) cells on bladder tumor was examined in vivo and in vitro. In the in vitro experiment, ⁵¹Cr-cytotoxic assay was performed for which PBL were used as effector cells. A LAK activity of 26.6% was observed in PBL cultured with IL2 for 4 days, whereas OK-432-induced LAK activity was 22%.
Furthermore, in the in vivo experiment, the anti-tumor effect of LAK cells was evaluated in human bladder tumor transplanted into nude mouse. IL2, OK432-induced LAK cells were injected intratumorally. In the LAK-treated group, inhibition of tumor growth was seen. Histologically, it was demonstrated that infiltrating lymphocytes were scatterd around tumor cells. The augmentation of NK activity in spleen cells was observed in the LAK-treated group.
Although further studies are reguired to establish its full significance, these findings suggest that immunotherapy against bladder tumors is hopeful.

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Recently, a method not requiring high performance liquid chromatography (HPLC) has been developed (Amersham Inc., U. K) for the measurement of levels of 1α, 25(OH)₂D, which demonstrates the most potent physiological effect among the metabolites of vitamin D. Until recently, purification of 1α, 25(OH)₂D fraction with HPLC has been considered indispensable prior to radioreceptor assay of this metabolite. Therefore, we used the Amersham assay system to determine whether it is possible to correclty measure the level of 1α, 25(OH)₂D without the HPLC process. The procedures we used were to extract the serum with an organic solvent, followed by fractionation of vitamin D metabolites through an LH-20 column. The products with or without the use of HPLC were submitted to radioreceptor assay using chick embryo intestinal receptors. As a result, it was found that (1) Separation and yield were improved by changing the column size, (2) Serum values 1α, 25(OH)₂D in healthy subjects obtained by HPLC and non-HPLC methods were in good agreement with the theoretical values. Although the values thus obtained in patients with chronic renal insufficiency (with or without dialysis) were somewhat lower than the theoretical values, the reuslt was consistent because there was no significant difference between the tow sets of measured values, and the correlation coefficient was r=0.990. (3) Variations within the assay were CV=16.5% for HPLC group and CV=21.4% for non-HPCL group. From the above, it was determined that 1α, 25(OH)₂D level in the serum of healthy subjects can be accurately measured by the assay system, and that it is possible to reduce the time and cost of measurement by using the assay system.

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Recently, the seminal plasma transferrin concentration has been reported to be a possible clincial marker of the Sertoli cell function. In the present study we measured the seminal plasma transferrin concentration in patients of male inferitlity by the method of radial immunodiffusion. The results obtained were as follows.
1. The seminal plasma transferrin concentration is significantly correlated to sperm density (p<0.001). However, no significant correlations were obtained to sperm motility, serum LH, FSH and testosterone levels.
2. The seminal plasma transferrin concentration in patients of ductal obstruction was 16.2±4.1μg/ml, which was approximately 20% of pregnancy-proven men (77.5±49.0μg/ml). This indicates that seminal plasma transferrin originates mainly from the testis.
3. The seminal plasma transferrin concentrations in oligozoospermic men associated with varicocele and in patients of spermatid arrest were low and their values were 22.1±7.5μg/ml and 13.0μg/ml, respectively. In these patients the involvement of Sertoli cell dysfunction was suggested.
4. Patients of idiopathic oligozoospermia were divided into two subgroups: patients with high seminal plasma transferrin concentrations (128.3±23.8μg/ml) and those with low seminal plasma transferrin concentrations (29.8±0.9μg/ml). The serum gonadotropins levels in the former group was at the same level as those of pregnancy-proven men and the levels of the latter group were significantly elevated. These observations suggest that the two groups thus divided belong to different categories of the disease.

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13 patients with bladder diverticula underwent transurethral diverticulectomy.
Follow-up cystograms were obtained six months after surgery. The diverticulum had shrunk in all cases and had totally disappeared in 11 (85%).
Transurethral diveritculectomy is a simple, effective, and safe procedure. It takes only a short time and can easily be combined with transurethral operations for obstructions of the lower urinary tract.

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We presented 3 cases of renal cell carcinoma with hepatic lesion, for which it was difficult to make a diagnosis preoperatively.
The hepatic lesion was cavernous hemangioma of the liver, liver metastasis of renal cell carcinoma or hepatocellular carcinoma.
To discuss the strategy of treatment for liver metastasis of renal cell carcinoma at the time of nephrectomy, or in the follow-up period after nephrectomy, we reviewed the 188 cases of renal cell carcinoma which were nephrectomized from December, 1962 to June, 1988. At the time of nephrectomy, there was only 1 case that had concurrent liver metastasis. In 4 cases, liver metastasis was found at autopsy, and in 15 cases, in the follow-up period after nephrectomy.
We analysed these 15 cases and classified them into 2 groups. One was “early metastasis group”, i. e., liver metastasis was found within 18 months after nephrectomy, and the other was “late metastasis group”, i. e., liver metastasis detected more than 6 years after nephrectomy.
In the “early metastasis group”, 2 lived 10 months or 57 months, but 5 died within 1 month after the appearance of liver metastasis. In the “late metastasis group”, 4 of 7 lived more than 2 years after the appearance of liver metastasis and the median survival was 21 months. In both groups, when liver metastasis was found, there were metastases in multiple organs and the hepatic lesions were multiple.
Since patients with renal cell carcinoma rarely have liver metastasis at the time of diagnosis, in cases with hepatic lesions not confirmed to be benign, it should be resected simultaneoulsy. The appearance of liver metastasis in the follow-up period after nephrectomy means the end stage in the natural course of renal cell carcinoma. But in some cases of the “late metastasis group”, with slow progression, surgical intervention for liver metastasis may be indicated.

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Experiments were performed to elucidate the effects of amygdaloid stimulation on the urinary bladder and external sphincter in 38 dogs anesthetized with ketamine and α-chloralose and immobilized with gallamine. The hypogastric nerves were severed in all dogs. The bladder was filled with Tyrode's solution under intravesical pressure maintained within a range of 15-20cmH₂O.
The outflows of the pelvic vesical branch (PV) and pudendal urethral branch (PU) were recorded simultaneously with isotonic vesical contractions. Stimulation was applied through a unipolar platinum electrode (50μm, in diameter) inserted into the amygdala from the ventral surface of the exposed pyriform lobe.
When bladder contraction was elicited by amygdaloid stimulation, PV excitation and PU inhibition occurred simultaneously, but when the bladder was relaxed, PV inhibition and PU excitation appeared concomitantly.
The PV excitation (bladder contraction) was elicited from medial parts of the intermediate and medial principal nuclei and parts of the cortical and pericortical nuclei. Inhibition of PV (bladder relaxation) was induced from the medial nucleus, the central nucleus, lateral parts of the medial principal nucleus and parts of the pericortical nucleus.
Electrical stimulation was applied to the excitatory points at varied frequencies (2-100Hz). PV excitation and bladder contraction were produced at 10, 20 and 50Hz, but not at 2Hz. At 5 and 100Hz, the effects varied with the stimulating points. At the inhibitory points, PV inhibition and bladder relaxation were elicited at 10, 20 and 50Hz, but not at 2Hz. When bladder contraction was induced by amygdaloid stimulation, the increased PV and decreased PU appeared after latencise of 110-150msec and 80-114msec, respectively. On the other hand, when the bladder relaxation was elicited by the stimulation, the decreased PV and enhanced PU occurred after latencies of 60-120msec and 50-80msec, respectively.
These results suggest that the excitation and inhibition of the urinary bladder and the external urethral sphincter following amygdaloid stimulation are manifested through the hypothalamus, the pontine micturition center and the sacral segment of the spinal cord.

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The urinary level of N-acetyl-β-D-glucosaminidase (NAG) was reported to be a useful marker for the assessment of renal funciton. This enzyme was also detected at a high activity in seminal fluid. In our preliminary report, seminal NAG activity was 1, 000 times higher than urinary NAG level in healthy volunteers. Moreover, the fraction ratio A to B isozymes was changed in seminal fluid independently from that in urine. In order to study the source of seminal NAG, NAG activity and the isozomal fraction were determined in the tissues of the genital organs (prostate, testis, epididymis, and seminal vesicle) as well as the urinary organ (kidney). Various levels of NAG activities were obtained, the mean tissue concentration (Unit/g protein) being 26.7±2.4, 43.3±30.5, and 8.75±0.72unit/g, respectively, in the testis, epididymis and seminal vesicle. In particular the mean concentration of 97.7±23.3 was significantly high in the prostate. In regard to the isozyme fraction of NAG, B fraction (%) accounted for 15.1±5.5, 33.6±8.2, 37.7±0.1, and 70.6±4.5 percent, respectively, in the testis, epididymis, seminal vesicle and prostate. It was to note that the A to B fraction ratio in the prostate corresponded to that in the seminal fluid. These results suggest that seminal NAG is mainly from the prostate.

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The combination antitumor effect of three kinds of biological response modifiers (lentinan, PSK and juzentaiho-to) was evaluated in the treatment of IMC solid carcinoma with CDDP (9mg/kg) and/or radiation (1000rad). Remarkable antitumor effects were observed in the lentinan (2mg/kg, daily) group to which a single dose of CDDP was given 24 hours before irradiation. On the other hand, combined therapy with CDDP and radiation alone showed less antitumor effect. No antitumor effect was observed in the groups treated with biological response modifiers (BRM) alone.
Winn's test was performed to investigate the level of immunity on each treatment group. Mice were inoculated with the admixtures of immunized spleen cells and IMC carcinoma cells at a ratio of 200:1. Tumor growth was completely suppressed in the groups of CDDP and lentinan with or without radiation even on the 41st day after inoculation. These results are strongly suggestive of potentiation of the immunity of tumor bearing mouse by the combined use of lentinan.
Histopathological evaluation also revealed a potent antitumor effect of combined use of lentinan.
Since host immunity is known to be suppressed in the tumor bearing state, combined use of BRM in chemo-radiotherapy must play an important role in the treatment of malignant tumor.

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From May 1987 to April 1988, 7 male patients, 43-69 years old in age, underwent enterocystoplasty after total cystectomy. In 5 of them, a selected intestinal segment, consisted of the terminal portion of the ileum, the cecum and the proximal part of the ascending colon, was freed and detubularized for construction of “bladder” substitution. In the remaining two patients with a previous history of cholecystectomy, having severe intestinal adhesions, the ileum or the sigmoidcolon were used.
At 3 months after operation, 6 patients had a vesical capacity of 300ml or more and the maximum volume of urine excreted at one voiding was 200ml or more. Daytime continence had been achieved in 6 patients at 3 months after operation, whereas nighttime continence had been achieved in 5 patients at 6 months after operation. Serum electrolytes, pH value of arterial blood and renal function, were all normal during the follow-up period (5-13 months). Potency was preserved in 2 patients. All the patients, except one whose “bladder” was constructed with ileum and who was performing daily intermittent selfcatheterization, were able to enjoy almost the same activity of daily life as before operation.
The final shape of the “bladder” and its position in the pelvic space seemed to be an important factor for the “bladder” function after operation. By our hand, however, postoperative cystogram revealed a sigmoid shape in all cases, though the reservoirs had an oval shape at the time when they had been constructed. The mucous excreted from the mucosa of the reservoir sometimes caused dysuria. In such occasions, patients were obliged to perform selfcatheterization. For better “bladder” function, further minor modification of the operative procedures seems necessary for construction of detubularized segment of intestine. However, this method seems to be a promising, new type of internal diversion.

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Between 1960 and 1988, 65 patients with grade 1 renal cell carcinoma were nephrectomized in our institutions. To delineate potentially curable cancer, the host and tumor factors influencing the prognosis were analyzed. Factors that had unfavorable effects were the presence of tumor thrombi in renal veins, fever, and elevation of erythrocyte sedimentation rate (ESR), serum α2-globulin and C-reactive protein (CRP). Patients who were under 39-years-old or with pT1-2a tumor had excellent prognosis. The ratio of tumor thrombi, pT, fever, ESR, serum α2-globulin and CRP levels all increased with age.
In conclusion, patients with normal levels of fever, ESR, serum α2-globulin, CRP and no tumor thrombi and/or with pT1-2a tumor were considered to be the potentially curable cancer patients.

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Unusual mode of renal duplication may be confused with supernumerary kidney. The presented adult female complaining left flank pain had bilateral duplication of collecting system with ectopic opening in one of the left-sided ureter. Since the ureteral opening to the bladder neck resulted in giant hydronephrosis in the upper half segment responsible for her complaint, surgical resction was perfored. The duplication of the left renal mass and collecting system was regarded as “unusual” in several points. First, the lower half segment of the left kidney looked a normal complete kidney, because it had upper, middle and lower calcies. Second, the lower half segment was located rather superior to the upper one. Third, the parenchyme of the upper segment which was a rudimentary small mass of several grams was separated from the lower one.
But the left renal artery was single, which supplied blood to not only the lower segment but also the upper one, and the two segments were connected tightly each other by loose areolar tissue. These facts prevented to categorize this case as supernumerary kidney.
This case suggests that there may be many transitional cases between fused kidney and supernumerary kidney.

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A rare case of renal cell carcinoma associated with renal artery aneurysm in solitary kidney is reported. The patient is a 63-year-old woman with asymptomatic macrohematuria as CC, who previously received left nephrecotmy (for which underlying disease is unknown). Excretory pyelography, abdominal CT and right renoarteriography revealed a 6×6cm-tumor at the center of the right kidney, comprssing the middle calices and a 16×18mm-saccular aneurysm at the first bifurcation of the renal artery. No remote metastasis was revealed. Aneurysmectomy and partial nephrectomy (three-quarter of right middle and lower calices) were simultaneously performed in situ. The reanl cell carcinoma was pT₂b, of clear cell subtype and grade 1, and no calcification of the aneurysmal wall was observed. Anuria lasted for 21 postoperative days, but thereafter diuresis appeared. Renal function after 3 post-operative months remains kept as follows: BUN, 26±7mg/dl; serum creatinine, 26±0.6mg/dl; creatinine clearance, 20.1ml/min. Now, after 18 postoperaitve months, the patient is already returning to work, with neither relapse nor need of dialysis.

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A 36-year-old woman with diabetes mellitus complained of left flank pain and high fever. Drip infusion pyelogram (DIP) did not visualize the left kidney, but revealed crescent-shaped gas formation within the left renal shadow. Abdominal computerized tomography showed a subcapsular shadow in the left kidney. Because her symptoms was aggravated, left nephrectomy was performed under the diagnosis of emphysematous pyelonephritis. There was no mainfestation of her prior symptoms after the operation, and she was discharged on the 19th postoperative day. In Japan, 43 cases of emphysematous pyelonephritis have been reported in the literature. These 43 cases were studied clinically and in comparison to the cases reported in Western countries. The male-to-female ratio was approximately 4 to 1, in contrast to the Western ratio of female preponderance.
The age of the patients showed its peak at the 50-60's, the mean age being not significantly different from that of Western patinets. 37% of the patients had the affected side on the right, 56% on the left, and 7% bilaterally. This was comparable to the results of Western countries. 93% of the subjects suffered from diabetes mellitus as the basal malady, which was comparable to that in Western studies. However, patients afficted with urinary pasage impairment accounted for 14%. This incidence was lower than that reported in Western studies. The phlogogenic bacteria of this disorder were E. coli (58%) and Klebsiella (23%), being similar to what was found in Western studies. As treatment, chemotherapy was administered in 30% of the cases and surgery was performed in 60%. The surgery performed was nephrectomy (49%), drainage through incision (12%) and for ureterocutaneous or nephric fistula (5%). Fatality rates were 23% after chemotherapy, 11% after surgery, and 100% in non-treated subjects. Although the difference was not as marked as that observed in Western studies, surgical treatment gave better results.

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