The normal micturition depends on a highly elaborate control system that comprises central and peripheral nerves. The recent research on the nervous control of micturition has been markedly progressing. This paper reviews the latest understanding of 1) the functional anatomy of lower urinary tract, 2) the peripheral nervous system and nuclei in the spinal cord, 3) the neurotransmitters and receptors, 4) nervous reflex mechanism of micturition, 5) pontine micturition center, 6) pontine urine storage center and 7) neural connections between pons, higher centers and lower centers.

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Ultrasound lithotriptors (USL) and electrohydraulic lithotriptors (EHL) are representative lithotriptors for endoscopic eliminaiton of upper urinary tract stones. However, they have some disadvantages. For example, USL can not be used with flexible scopes and EHL can cause unexpected tissue injury. To overcome these problems, the pulsed dye laser lithotriptor (MDL-1, Candera Co.) was developed. The characteristics of this laser lithotriptor and its direct effects on tissue was investigated.
This pulsed dye laser lithotriptor generates a 504nm wavelength green light beam by using a combination of a xenon flash lamp and the greenish dye composed of coumarin solution. The maximum output energy is 60mJ/pulse and the pulse duration is 1.5 microsecond. The pulse rate can be varied from 1 to 20Hz.
First, the intensity of the shock wave was measured by using a combination of a piezoelectric element and an oscilloscope, and then, the results were compaired with those obtained by a similar experiment with an EHL. The average intensity of the shock wave was 54.4mW under the conditions of 40mJ/pulse of output energy and 10Hz of pulse duration. On the other hand, the EHL generated an average of 54.7W under the conditions of 400mJ/pulse output energy. Then, fragmentation of various kinds of urinary stones in saline solution was performed. The results showed that this lithotriptor could fragment almost all kinds of stones except cystine stones. Then, hen's eggs were used to observe the effect if laser bean influenced on the organism immediately behind the photoradiated object. Only the egg shell was demolished but the egg membrane below the eggshell did not undergo any change. After these experiments, skin, liver, kidney and urinary bladder of nude mice and human prostatic urethral mucosa in case of TUR-P were irradiated by this laser. The results showed that laser energy caused slight penetration and localized hemorrhage from the surface of epithelium to subcutaneous tissue. It was confirmed that these effects were generated when the tip of the quartz fiber was in direct contact with the object.
After these investiagtions, fragmentation using this laser lithotriptor was attempted in thirty cases of upper urinary tract calculi. These 30 cases involved five cases of renal calculi and 25 cases of ureteral calculi. Percutaneous nephrolithotomy (PNL) was performed in 22 cases and transurethral ureterolithotomy (TUL) was performed in 8 cases. Twenty-four stones (80%) were fragmented successfully. However, in six cases, stones which were smooth surfaced, hard and large could not be fragmented. The side effects of laser lithotriptor, slight hemorrhage from the ureteral mucosa, was observed in 2 cases.
We think that this laser lithotriptor is one of the most effective instruments for fragmenting urinary stones by TUL, especially TUL with a flexible scope, because this lithotriptor uses a very thin flexible quartz fiber and it dose not require protection of tissue from injurying while fragmenting calculi.

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In order to investigate more effective treatments for advanced renal cell carcinoma, experiments were performed as to inhibitory effects on the growth of KPK 1 cells derived from a human renal carcinoma. IFN-β, IFN-γ, vinca alkaloids (VBL, VCR, VDS), hyperthermia and irradiation inhibited the growth of KPK 1 cells. Both IFN-β and IFN-γ showed concentration dependent and time dependent inhibitory effects, and IFN-β was significantly more intensive in action than IFN-γ. All of vinca alkaloids inhibited the cell growth remarkably but there was no difference among these three drugs. Hyperthermia was inhibitory over 43°C and irradiation showed a remarkable inhibition at not less than 500 rads. But IFN-α and hormones had no inhibitory effect.
These results imply that multidisciplinary treatments in combination of immuno-chemotherapy with IFN-β, IFN-γ or vinca alkaloids, hyperthermia and irradiation should be applied for advanced renal cell carcinoma.

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This report describes the results of clinical trials of the second generation extracorporeal shock wave lithotriptor (Sonolith 2000 Type B) in patients with upper urinary tract stones. The studies were carried out on 101 cases at the Departments of Urology, Juntendo University School of Medicine, Kanto Teishin Hospital and General Daiyukai Hospital from Nov. 1987 to Jun. 1988. The location of stones were renal calyx and pelvis in 84 cases, ureteropelvic junction in 7 cases and upper ureter in 12 cases (2 of them had multiple stones at different levels). The average number of treatment per a patient was 1.25, and that of shock waves delivered per treatment was 1798. Ultrasound localization has been effective in all cases. The rate of destruction of the stones was 100% in the kidney, 66.7% in the upper ureter, with an overall average of 95.0%. On the X-ray film obtained six weeks after ESWL treatment, the stone free rate was 53.5%, and the effectiveness rate was 89, 1%, including the cases of stone free and cases with fragments smaller than 5mm. No serious adverse effect was observed, although there were mild transient hematuria in all cases and pyrexia (more than 38.0°C) in 7 cases (6.9%). The procedure was performed safely in the majority of patients without anesthesia. In 10 cases, we applied anesthesia (epidural anesthesia in 3 cases, and local anesthesia in 7 cases) for the prevention of pain. It is concluded that ESWL treatment using Sonolith 2000 Type B is as effective as other types of shock wave lithotriptor previously applied to urolithiasis without serious clinical complication.

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There are two theories concerning the mechanisms of human penile erection and its maintenance. One theory goes that the artery responsible for blood inflow into the cavernous space relaxes, while the vein responsible for blood outflow actively contracts. The other theory asserts that no active closing mechanism in present in the penile venous system, but rather the erection is totally controlled by the amount of blood inflow. In order to corroborate the vascular construction of the penis, we prepared serial sections of the penis specimens obtained at autopsy and observed these sections by light microscopy, and we investigated the construction of veins which let blood flow out from the corpus cavernosum penis by computer graphics.
As a result, we were unable to find any valves in the blood outflow system. Moreover, efferent vessels were seen to let blood flow from the cavernous spaces, after running immediately below the tunica albuginea for a small distance, to the tunica albuginea, running obliquely through inner veins toward the outside of the tunica albuginea in the direction of the long axis of the penis; then these veins are continuous to the veins on the tunica albuginea.
From the above-mentioned structures we can infer the following mechanism of penile erection. When blood flows into the corpus cavernosum penis at a flow rate greater than usual, the volume of the corpus cavernosum penis increases, the veins running immediately below the tunica albuginea are compressed between the cavernous space and the tunica albuginea, the tunica albuginea extends, and the veins running inside the tunica albuginea are compressed, causing a disturbance in blood outflow and resulting in erection. When the inflow of arterial blood decreases to less than the maintenance rate, the volume of the corpus cavernosum penis decreases, the extension of the tunica albuginea is reduced, and the outflow of venous blood increases, resulting in the termination of penile erection.
From the above, we speculate that the arterial system plays a main role, and the venous system a secondary role, in controlling the human penile erection.

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Between January 1987 and July 1988, 151 cases of renal cell carcinoma were nephrectomized at out institutions. Among them 41 cases (27.2%) were diagnosed incidentally. The ratio of incidental carcinoma has been increasing steadily in the past decade. Thirty-four of these cases (82.9%) were detected by ultrasound, 4 by computerized tomography, and three by excretory urography. Twenty-eight of these cases were found serendipitously during examination for other diseases, while others had no symptoms at all.
Only 8 of these cases (19.5%) showed microscopic hematuria. The stage and the grade of these incidental carcinoma were significantly lower than those of symptomatic carcinoma (p<0.001). The survival rate of the former was better than that of the latter (p<0.01), especially in patients with pT1-2b tumors (p<0.05) or with tumors smaller than 10cm in diameter (p<0.05).

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Two hundred and twenty patients with prostatic cancer were treated in our clinic during the past ten years between April, 1977 and March, 1987. The age distribution was from 45 to 91 years old and more than half of patients were in seventies. Stages A, B, C and D were 3.5%, 19.7%, 21.2% and 55.6%, respectively. Hormonal therapy was given in 175 cases (79.5%) as an initial treatment. The first therapy showed effectiveness in 181 (83.8%) of 216 cases; in 153 (87.4%) of 175 cases treated by hormonal therapy. Reactivation after the initial treatment was observed in 59 (32.6%) of 181 cases; in 48 (31.4%) of 153 cases treated by hormonal therapy.
The interval between the start of treatment and reactivation for the stage D was significantly shorter than that for the other stages. Elevation of serum alkaline-phosphatase levels, accelerated erythrocyte sedimentation rate and hydronephrosis were significnat risk factors for reactivation. Of the 220 cases, 51 (23.2%) died of advanced cancer. The overall 5-year survival rate was 41.2%. High grade and high stage were significantly related to the poor prognosis. In our studies, as hormonal therapy, maintenance on 100mg of diethylstilbestrol diphosphate daily was found effectivive for the treatment of prostatic cancer.

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Efficacy of reconstructive surgery for the obstructive disease of the upper urinary tract was evaluated. Reconstructive surgery was performed in 75 units of the urinary drainage system of 72 patients between July, 1977 and December, 1987. 44 patients were male and 28 were female. The patients ranged in age 1 to 71, mean±S. D. being 43±14 years old. Original diseases were postoperative scar, scar due to the calcluli, injury, retroperitoneal fibrosis, ureteritis, tuberculosis, amyloidosis and multiple ureteral diverticlum. The surgery consisted of ureterocalicostomy, renal descensus, descent of right renal vein, uretero-ureterostomy, ureteroneocystostomy (to the dome of the bladder), psoas bladder hitch and renal autotransplantation. Renal autotransplantation was chosen instead of ileal substitution to preserve the continuety of the urinary drainage system, when the upper uninary tract was extensively damaged.
The obstructive change of the upper urinary tract improved or disappeared in 66 of 75 units. However, it persisted in 9 units, which were treated with ureterocalicostomy (wrong tequnics; in 4 units), ureteroureterostomy (wrong choice of the procedure; in 4 units) and autotransplantation (sceasion of anti tbc drugs; in 1 unit). In 3 of these 9 units, additional reconstructive surgery was necessary. One patient who was treated with autotransplantation, died of massive bleeding from rupture of arterial anastomosis on 14th postoperative day. No other life-therating complications were observed. Deterioration of the renal function was observed in two severily damaged kidneys which were performed autotransplantation, although the obstructive change of their urinary tract completely disappeared.
These results indicated that (1) reconstructive surgery, which consisted of operative procedures described above, has beneficial effects on the treatment for the obstructive disease of the upper urinary tract. (2) the operative procedure should be chosen to relieve the tension on the anastomotic site. (3) in severely damaged kidney, autotransplantation should not be chosen even when the urinary drainage system was extensively damaged.

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The nuclear and crude nuclear 5α-dihydrotestosterone (DHT) levels were measured in patients with benign prostatic hypertrophy (BPH) and prostatic cancer (PC).
In the fundamental study using BPH tissues, nuclear DHT levels were not influenced by the treatment for nuclear purification such as DTT, Triton X-100 or DNase I. The correlation between DHT levels and androgen receptor contents was found in only the crude nuclear salt extractable fractions (r=0.748, p<0.01).
In the relation of DHT levels to prostatic cancer patients, crude nuclear salt extractable and salt resistant DHT in both the low grade and in early stage group were significantly higher than those in the high grade and in advanced stage. Moreover, DHT levels in the both crude nuclear salt extractable and salt resistant fractions were below 5pg/mg protein in all of clinical non-responders to endocrine therapy, and the total crude nuclear DHT, the sum of the crude extractable and salt resistant DHT, was below 10pg/mg protein in all of the non-responders to endocrine therapy.
When the relation between the total crude nuclear DHT level and the clincial course of 34 prostatic cnacer patients followed for over 12 months was studied, the elevated DHT group (over 20pg/ml protein) responded to endocrine therapy and experienced long-term remissions, but the low DHT group (below 10pg/ml protein) did not respond to endocrine therapy. Therefore, it is suggested that the total crude nuclear DHT levels were appropriate biochemical indicators for androgen dependency in prostatic cancer patients.

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Using a 0.5 tesla superconducting magnetic system, magnetic resonance imaging (MRI) studies were performed in 42 patients (27 prostatic carcinoma and 15 benign prostatic hyperplasia) and 2 healthy volunteers. Spin echo images were produced in the transverse, coronal and sagittal directions. T₁ and T₂ relaxation times were calculated from these images. The images of 2 normal prostates showed 2 separate zones: an internal zone and an external zone. The images of 8 of the 15 prostates with benign prostatic hyperplasia showed 3 zones: an internal zone, a band of low intensity and an external zone. Most of the cases of prostatic carcinoma showed extracapsular extension, so we could not detect zonal distinction of the images in 25 cases out of the 27 prostates with prostatic carcinoma. Most of the images of prostates with prostatic carcinoma showed irregular and asymmetric shape and inhomogeneous signal intensity. MRI had an accuracy of 85.7% in differentiating prostatic carcinoma from benign prostatic hyperplasia. A good correlation (r=0.936) was observed between the weight of the whole prostate as predicted by MRI and the actual weight of the adenoma enucleated by retropubic prostatectomy. The change in volume of the prostate after hormone therapy was well evaluated by MRI. We were not able to differentiate prostatic carcinoma from benign prostatic hyperplasia on the basis of the T₁ and T₂ relaxation times alone. The serial measurements of the T₁ and T₂ relaxation times might be value in following therapeutic response of prostatic carcinoma.

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It is suggested that cyclic AMP and cyclic GMP play regulatory roles in smooth muscle function. In order to clarify the role of cyclic AMP and cyclic GMP in the function of the lower urinary tract, I examined the effects of isoproterenol and sodium nitroprusside on contractile force and tissue content of cyclic AMP and cyclic GMP.
Isoproternol (10^-8-10^-4M) caused a relaxing effect in the rabbit urinary bladder dome, the bladder base and the urethra. The relaxation response by isoproterenol was mediated by cyclic AMP. The relaxation response and the increase in the cyclic AMP level were marked in the bladder dome.
Sodium nitroprusside (10^-8-10^-4M) also caused a relaxing effect in the rabbit urinary bladder dome, the bladder base and the urethra. The relaxation response to sodium nitroprusside was mediated by cyclic GMP. The relaxation response and the increase in the cyclic GMP level were marked in the urethra.
The external addition of derivatives of cyclic AMP and cyclic GMP (dibutyryl cylcic AMP and 8-bromo cyclic GMP, 10^-8-10^-3M) also caused a relaxing effect in the bladder dome, the bladder base and the urethra.
These results demonstrated that both cyclic AMP and cyclic GMP were related to relaxation of the rabbit lower urinary tract smooth muscle. It seems that cyclic AMP may be mainly related to relaxation of the bladder dome and cylcic GMP may be mainly related to relaxation of the urethra.

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In 46 patients treated with PNL in our hospital, the intervals from PNL to removal of a catheter indwelled in the nephrostomy were studied. The intervals were longer in the cases with ureteral stones than those with renal stones probably because of the different degrees of obstruction.
To investigate the degree and the interval of upper urinary tract obstruction after PNL, Pressure-flow Studies were performed every or every other day after PNL in 5 cases with renal stones and 5 cases with ureteral stones, selected from 46 cases. In Pressure-flow Studies, intrapelvic pressures were measured while saline mixed with pigment was being dripping at a rate of 5ml/min into the renal pelvis through the nephrostomy catheter.
Saline initially reached into the urinary bladder at an average of 4.8 days after PNL (range 3 to 7 days) with a mean intrapelvic pressure of 37.6cmH₂O (range 28 to 52cmH₂O) in the cases with renal stones and at an average of 9.2 days (range 7 to 12 days) with a mean intrapelvic pressure of 27.0cmH₂O (range 9 to 43cmH₂O) in the cases with ureteral stones.
Pressure-flow Studies were performed again a few days after the initial passage of saline into the urinary bladder in 2 of 10 cases. The intrapelvic pressures, 16cmH₂O and 13cmH₂O, respectively, several days after the initial passage of saline were lower than those, 35cmH₂O and 43cmH₂O, respectively, at the initial passage of saline.
Therefore, it was likely that the proper interval of indwelling catheter after PNL was about 7 to 8 days, in the cases with renal stones and about 11 to 12 days in the cases with ureteral stones.

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For the purpose of elucidating the role of oncogenes like c-myc in renal cell carcinoma, the methods of introducing exogenous genes into human cells might be powerful tools. In the present study, the electroporation gene transfer method was investigated for its application to human renal cancer cells. A mixture of ACHN cells (human renal cancer cell line, which cannot grow in the presence of neomycin) and DNA of neomycin-resistant genes with SV 40 promoters was exposed to electric pulses from an electroporater (Bio-Pulser 101, UNISOKU). And the cells were cultured in a medium containing Geneticin (neomycin analog) for 3 weeks. Then, the number of formed neomycin-resistant neo^R colonies was counted. In the cells of neo^R colonies, the existance of neo^R genes and their expression were confirmed by Southern and Northern blot gene analyses. The transformation efficiency (number of neo^R colonies/inoculated cells) was positively correlated with cell densities, DNA concentrations, and discharged voltages under our experimental conditions. The transformation effeciency was 1.3-3.3×10^-4/cell in the condition of 1×10⁷cells/ml, 1μgDNA/10⁶ cells, and 2kV/cm. These results suggest that the electroporation gene transfer method is applicable for the study of phenotypic alterations after introducing oncogenes into human renal cancer cells.

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Precusor incorporations into DNA, RNA and protein fractions of the human testicular tissue were examined at 28°C-43°C in vitro to study the optimal temperature for DNA, RNA and protein synthesis in the human testis. The results suggest that the DNA synthesis shows delicated temperature sensitivity and is at a maximum at 31°C, whereas the RNA and protein syntheses are at a maximum at 37°C-40°C. The slight variation of the testicular temperature may cause spermatogenic dysfunction because of delicate temperature sensitivity of the testicular DNA synthesis.

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Le Duc-Camey antireflux ureteroileal implantation was evaluated clinically; by applying to various types of urinary reconstruction utilizing the ileum. Nineteen ureters in 10 cases including five Kock continent ileal urinary reservoirs (Kock pouches); five ileal conduit urinary diversions and one Goodwin ileocystoplasty were performed from March 1987 to August 1988. Male and female ratio was 8 to 2 and the average age was 61.7 years old. The post operative observation period was 13.9 months on the average. The outline of the operative procedure was as follows: a 3cm sulcus was created in the mucosa along the long axis of the ileum; the ureter was passed from the serosal surface to the luminal surface and the adventitia of the ureter and the mucosa were sutured at three points in each side using 3-0 absorbable ligature to implant the ureter in the mucosal sulcus. The ureteral end was spatulated 3mm in the upper wall and it was fixed to the mucosa by three stitches. A ureteral stent catheter, 7-8 Fr. in diameter, was indwelled in the ureter. Additional stitches were placed to strengthen the fixation on the outside surface of Kock pouches or a Goodwin ileocystoplasty. The afferent limb was not fabricated in Kock pouches because ileoureteral reflux could be prevented by the implantation technique on the pouch. Radiological evaluation was done taking IVP, loopography, pouchgraphy and cytography periodically after the operation. Ileoureteral reflux was not observed in all cases studied and the upper urinary tracts were maintained satisfactorily, though unilateral hydronephrotic change could not be improved after the operation in one Kock pouch. We concluded that Le Duc-Camey antireflux ureteroileal implantation was advantageous.

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A case of inverted papilloma with subsequent heterotopical recurrence of inverted type transitional cell carcinoma is reported. A 24-year-old man had a medical examination of our hospital with chief complaint of asymptomatic macroscopic hematuria on October 23, 1982. Cystoscopy revealed a smooth surfaced and finger-tip sized tumor at the bladder neck. Because of the large bulk and the location of the tumor, the tumor was resected through cystotomy. After histological examination, the tumor was diagnosed as inverted papilloma. Cystoscopy was repeated every 3-6 months. The tumor recurred 4 times heterotopically, 19, 35, 43 and 53 months after the initial surgery. The pathological examinations of these tumor specimens showed transitional cell carcinoma mostly of inverted growth. Most of the urologists and pathologists believe inverted papilloma to be a benign neoplasm, but several reports and this case suggest the possibility of recurrence and malignant transformation of inverted papilloma.
In this content, we may suggest that meticulous follow-up is indispensable in inverted papilloma cases.

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