Andrology could be defined as reproductive biology from the male side based on multidisciplinary sciences. Organizing process of domestic and international societies of andrology was outlined according to their development. Major topics in andrology were also critically introduced to assist understanding the field and future goal of andrology.

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Intercellular communication (IC) was investigated by a dye transfer method in 5 human bladder carcinoma cell lines, JTC-29, JTC-30, JTC-32, HUB-41 and T-24 which showed various histological anaplasia when transplanted into nude mice. IC was investigated as follows; 1) IC among cells of each bladder carcinoma cell lines, 2) IC between various combination of different cell lines and 3) IC between cells of bladder carcinoma cell lines and fibroblasts prepared from the human skin or prostate. High IC was observed among JTC-30 cells which showed a differentiated pattern when transplanted into nude mice. JTC-32 and HUB-41, of which transplanted tumors showed poorly differenciated patterns, demonstrated lower IC than JTC-30. Statistical significance was present only between JTC- 30 and JTC-32 cells (p<0.05). T-24 which formed histologically anaplastic tumor in nude mice demonstrated markedly poor IC. Second, IC between two different cell lines was demonstrated only between JTC-30 and JTC-32. Third, fibroblass from the skin and prostate had high IC but showed apparent IC with none of bladder carcinoma cell lines. These findings indicate that ICs of bladder tumor cells vary with cell lines tested and appear to decrease with progress of malignant anaplasia. Furthermore, the fact that there is sometimes high IC and sometimes lack of IC between differenciated and undifferenciated tumor cells suggests a possible role of IC in prevention of malignant progression. The present study provides no evidence of IC between bladder tumor cells and fibroblasts, which in some reports have been suggested to be an important phenomenon in evaluating the metastatic capacity of cancer cells.

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We previously reported that the low molecular and uronic acid-rich fractions in the urine from calcium oxalate stone formers promoted aggregation of calcium oxalate monohydrate seed crystals. In this study, we have demonstrated that lyophilized material of the fractions contains hyaluronic acid as a sole glycosaminoglycans, as well as acidic amino acid-rich proteins and urinary pigment which is supposed to combine with protein. It is known that hyaluronic acid is present in stone matrix, that calcium containing stones contain proteins rich in acidic amino acids, and that the external color of calcium oxalate monohydrate calculi is usually brownish. These facts correspond with our present results. Therefore, it is suggested that the urinary material promotes the calcium oxalate crystal aggregation, sticks the crystals together and is incorporated into the stone.

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We have examined by the coulter counter method whether some substances promote or inhibit calcium oxalate monodydrate crystal aggregation. The substances tested were hyaluronic acid, chondroitin sulfate and urinary lyophilized material of <10k dalton fractions having aggregate activity. As a result, hyaluronic acid promoted aggregation at low concentrations but inhibited it at higher concentrations, and chondroitin sulfate only inhibited it. They seem, therefore, to have quite different effects, depending on their urinary concentrations, on calcium oxalate crystal aggregation process. However, urinary fractions only promoted aggregation in a dose-response manner. This promoting effect might be caused by not only hyaluronic acid that was contained in the fractions but also by some other promoters.

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Fifty eight patients who underwent ileal conduit formation in our hospital for the past 14 years were reviewed. Out of them, 11 patietns developed hydronephrosis which should be treated. It occurred due to urolithiasis, recurrent tumor, contracted ileal loop in one patient respectively, and ureteroileal junction stricture in 8 patients (10 ureteral units). The 8 patients consisted of 6 males and 2 females. All of the males underwent total cystectomy because of bladder tumor (T. C. C.), and the females had anterior pelvic exenteration because of uterine cancer (adenocarcinoma). Out of 10 ureteral units, 7 were corrected by surgical intervention, 1 was dilated with endourological procedure, and 2 had no treatment. Six ureteral units including 1 ureteral unit treated by an endourological method resulted in improvement or disappearance of hydronephrosis. Histological examination of the stricture revealed fibrosis in 7 ureteral units treated surgically. According to our clinical studies, infection in the pelvic space seemed to be one of the causes which brought about ureteroileal junction stricture.

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Thirty three cases of prostatic adenocarcinoma treated by total perineal prostatectomy were studied clinicopathologically and immunohistochemically. There were 17 patients with clinical stage B, 12 with stage C and 8 with stage D. Interrelationship of tumor grade, surgical local tumor extent, vessel invasion, perineural invasion and bone metastasis was examined. For the idenitification of the vessel invasion, Ulex europaeus agglutinin l was adopted immunohistochemically. Tumor grade and local tumor extent were respectively correlated with bone metastasis. Vessel invasion was correlated with local tumor extent. Eight of 18 cases (44%) with vessel invasion and none of 15 cases without vessel invasion had bone metastasis. Although correlated with grade, perineural invasion had no significant effect on bone metastasis. The investigation of tumor staining used by monoclonal antibody for prostatic acid phosphatase (PSAP) disdosed that negative stained cases were associated with lower grade tumors and that one of 14 positive stained cases (7%) and 7 of 19 negative stained cases (36%) had bone metastasis. We concluded that vessel invasion may be a new prognostic pathological parameter and that monoclonal PSAP staining is also a useful method to predict malignant potential of prostatic cancer.

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To characterize the cellular architecture of papillary and nonpapillary transitional cell carcinoma. 2 normal ureters, 6 papillary bladder cancers and 5 nonpapillary bladder cancers were subjected to light and electron microscopic study as well as three dimensional reconstruction by 0.5μm thick serial sections.
Normal urothelium consisted of three cell layers of the basal, intermediate and superficial cells, each of which was morphologically characterized in terms of cell shape and development of cell organelles. Over 90% of the epithelial cells were proved to be connected to the uniform basement membrane directly or with long, fine cytoplasmic processes, forming hemidesmosomes at the junctional portion.
Papillary tumors had, as a rule, the same cellular architecture as that of normal epithelium in terms of the regularity of cellular polarity, arrangement and differentiation, and the connection to the basement menbrane. But, in G2 tumors, the connection between the intermediate and superficial cells and the basement membrane failued to be confirmed in 7 to 44% of the cells, suggesting the heterogeneity of the tumors.
In contrast, nonpapillary tumors showed a high irregularity of the cellular architecture in both lesions of stromal and intra-epithelial invasion. The development of the basement membrane was indefinite, often showing thinning or disruption where occasional cytoplasmic protrusion of the tumor cells into the lamina propria was found. Nearly all of the intermediate and superficial cells in the intraepithelial lesions proved not to communicate with the basement membrane.
The present results indicate distinct differences of cellular architecture between the papillary and nonpapillary urothelial tumors. which may reflect not only the growth pattern but also the biological behaviour of the individual tumors.

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In order to evaluate flow cytometric deoxyribonucleic acid measurement (FCM) of bladder washing in the diagnosis of bladder carcinoma, the sensitivity of voided urine cytology, bladder washing cytology and bladder washing FCM was tested in 76 samples from 56 patients with historically proven bladder carcinomas.
The positive rates were 43.2% and 75.7% in bladder washing cytology and bladder washing FCM, respectively. On the other hand, 36.5% and 57.1% positive rates for once- and three-times-voided urine cytology, respectively, were obtained. Bladder washing cytology and bladder washing FCM were positive in 20% and 70% patients with a histological diagnosis of atypia or dysplasia, respectively.
The sensitivity of bladder washing FCM according to the tumor grade was 33.3%, 81.9% and 88.9% for grade-1 (G-1), G-2 and G-3 tumors, respectively. The sensitivity of bladder washing cytology according to the tumor grade was 0, 40.9% and 77.8% for G-1, G-2 and G-3 tumors, respectively. The sensitivity of three-times-voided urine cytology was 25.0%, 55.6% and 83.3% for G-1, G-2 and G-3 bladder tumors, respectively, and it was superior to that of single bladder washing cytology. These results indicate that FCM is more sensitive than voided urine cytology and/or bladder washing cytology in patients with bladder carcinoma. FCM may indicate urothlial neoplasia before it is apparent on urine cytology, especially against a background of inflammation. Therefore, FCM is valuable for case finding in suspect populations or for follow-up cases with diagnosed bladder cancer.

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From March 1978 to May 1987, 22 cases of primary adrenal tumors were examined by ultrasonography. The patients ranged in age from 21 to 79 years with an average of 42.6 year, including 11 cases of pheochromocytoma, 6 cases of primary aldosteronism, 4 cases of Cushing's syndrome and 1 case of ganglioneuroma. Visualization of tumors was successful in 19 of the 22 patients (86.4%). The detecting rate of right adrenal tumors was 100% (12/12), while the rate of the left was 80% (8/10). The sizes of detected adrenal tumors were larger than 10mm on the right and larger than 20mm on the left. Obesity and bowel gas degraded the image of left adrenal tumors, resulting in a lower detective rate of the tumors. The suprarenal area and small lesions were best demonstrated by a lateral intercostal approach using longitudinal scanning plane and by a right subcostal approach using transverse scanning plane. In pheochromocytoma, cystic lesions (echo free space) existed, and the fact that no cystic lesion in other adrenal tumors was helpful for diagnosis of pheochromocytoma. It is concluded that ultrasonography is a very useful method for diagnosis of adrenal tumors as an initial imaging procedure, because it is totally non-invasive, rapid and less expensive than all of the other techniques.

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A survey was performed on 277 cases of bladder tumor including 221 males and 56 females (3.9:1), treated in the Department of Urology, Kyoto Prefectural University of Medicine. The result was as follows.
The age distribution was from 24 to 86 years old with the average of 65.7.
Histologically, 2 cases were diagnosed as transitional cell papilloma, 53 cases as transitional cell carcinoma G1, 111 cases as G2, 88 cases as G3, 16 cases as GX, 5 cases as squamous cell carcinoma and 2 cases as adenocarcinoma.
As to the relationship between the grade and the stage, all cases of papilloma or G1 were superficial, while 7.2% of G2 and 45.5% of G3 were invasive, showing a close correlation.
As to the relationship of cystoscopic findings and the stage, invasive tumors occupied 1.7% of tumors less than 1cm in diameter, 16.7% of those 1 to 3cm, 48.0% of 3 to 5cm and 41.7% of more than 5cm in diameter. Also 7.1% of papillary pedunculated tumors, 57.1% of non-papillary pedunculated, 21.7% of papillary sessile and 53.5% of non-papillary sessile were invasive. Thus cystoscopic findings of tumors correlated with the stage.
The 5 year survival rates were 61.7% in all cases, 81.4% in pTa, 70.5% in pT1, 58.7% in pT2, 50.0% in pT3a, 32.6% in pT3b and 25.0% in pT4. The stage of tumors reflected the prognosis well.
Careful cystoscopy and accurate grading were thought to be helpful for correct staging and for choosing a suitable treatment.

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The purpose of this study is to demonstrate the localization and distribution of keratin-positive cells (KPC) in the various pathological types of prostatic cancer, and to investigate the correlation between the basal cell and KPC. The localization of keratin was immunohistochemically investigated in 20 benign prostatic hyperplasia (BPH) and 33 human prostatic adenocarcinomas by the indirect immunoperoxidase technique, using anti human keratin rabbit serum on frozen sections. In BPH, strongly positive staining for keratin was detected in the cytoplasm of basal cells. Glandullar epithelial cells were positive. In the cancer sections, no KPC was observed in all 6 cases of the large acinar type, all 10 cases of the small acinar type and all 12 cases of the column and cord type. On the other hand, KPC remained around the cancer cell populations in all 10 cases of the cribriform type. In the fused gland type, KPC was localized in 3 of 9 cases and in the medullary type 3 of 7 cases.
If KPC was regarded as the marker of the basal cell as shown in BPH, it would be speculated that the absence of KPC occurred in some type of prostatic cancer showed the disappearance of basal cell. That is, KPC could not be detected in large aciner, small acinar and column and cord type, while KPC remained completely or partially in the cribriform, fused gland and medullary type. These histochemical alteration would suggest the different degree of malignancy in the various histological type of prostatic cancer.

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As a first step of investigating male predominance of bladder cancer incidence, we have studied relationships between rat bladder carcinogenesis, induced by BBN, and changes of pituitary-testicular axis, induced by a LH-RH analogue.
The rats were divided into the following five groups. The first group (Age matched control group) was given normal drinking water for 30 weeks. The 2nd group (BBN group) was given a drinking water containing 0.05% BBN for 6 weeks. The 3rd group (LH-RH group) was given subcutaneous injections of a LH-RH analogue depot every four weeks. The 4th group (LH-RH+BBN group) was given subcutaneous injections of the LH-RH analogue depot every four weeks and a drinking water containing 0.05% BBN for 6 weeks. The 5th group (castration group) was castrated and given normal drinking water. The results were summarized as follows. 1) Serum LH, FSH and testosterone levels reached their peaks one day after the LH-RH analogue injection and decreased afterwards. Testosterone marked a castration level one week after the LH-RH analogue injection. 2) There was no significant difference between the BBN and non BBN groups in serum LH, FSH and testosterone levels. Thus, BBN did not influence the pitutary-testicular axis and the action of the LH-RH analogues. 3) Incidence of cancer was higher in the group of BBN+LH-RH than in the gorup of BBN 8 weeks after the start of the experiment. Then, the incidence was reversed between 20 weeks and 26 weeks; finally it became almost the same at 30 weeks. This phenomenon may be explained by the experimented schedule we applied; that is, BBN and LH-RH analogue were administered simultaneously. 4) Thus, changes of the pituitary-testicular axis induced by the LH-RH anlaoue seemed to have influence on blader carcinogen.

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A 52 year-old man, being pointed out as with microscopic hematuria and suspected of carcinoma of the urinary bladder at another institution, visited this hospital for further examination. DIP demonstrated an irregular right lateral wall of the urinary bladder. CT of the pelvic cavity revealed a protrusive mass lesion inside the urinary bladder. Cystoscopy proved a circular, edematous and irregular mass lesion around the urinary bladder neck. The pathological examination of TUR specimens showed a proliferative chronic cystitis.
However, after about half a year, there was a recurrence of mass lesions in the urinary bladder. Moreover, right non-functional kidney and left hydronephrosis were observed. For preserving renal function, total cystoprostatectomy was performed. Nerve sparing technique for sexual function, and total bladder replacement using a detubularized sigmoid colon to obviate the need for a stoma were adopted.
Postoperative course was uneventful and the function of both kidneys was recovered. Normal urination from the urethra and sexual funciton are both preserved. Pathological examination of the cystectomized specimen confirmed only proliferative cystitis with extensive deep ulceration and thick connective tissues. A rare case in which obstructive nephropathy was caused by proliferative cystitis is reported and discussed.

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A 28-year-old man with back pain visited a near hospital on October, 1987. Afterwards he was referred to our hospital on November 11 for detailed examination of the kidneys. The blood chemical analysis showed marked renal hypofunction. The abdominal USG and CT showed bilateral calcification of the cortices. Biopsy specimens of the kidneys revealed bone formation containing bone marrow tissue. Afterwards he had been treated as an outpatients, but he admitted again on June 3, 1988. He is now being hemodialized.

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