Basic fetoprotein (BFP) was measured by enzyme immunoassay in the urine of healthy adults and patients with benign or malignant urological diseases. Urinary BFP level in 34 healthy donors was very low (2.75±2.27ng/ml). Since the BFP-positive rate is under 5% in healthy donors and, considering diagnostic efficiency for urological malignancies, a urinary BFP-concentration of 15ng/ml was used as the cut off value. Urinary BFP was positive in 17.0% of 106 patients with benign urological diseases, in 51.9% of 52 patients with bladder cancer, in 75.0% of 8 patients with renal pelvic or ureteral cancer, in 25.0% of 20 patients with prostate cancer, and in 19.0% of 21 patients with renal cell carcinoma. In 60 patients with urothelial carcinomas, urinary BFP was higher in invasive diseases (>pT1) than in superficial diseases (p<0.05). The BFP level in urine also increased with a higher histological grade. The positive rate of urinary BFP was 78.9% in patients with invasive diseases and 66.7% in patients with grade 3 diseases. In 44 patients with urothelial carcinomas who underwent urinary cytological examination the positive rate was improved from 38.6% (17/44) to 81.4% (37/44) when measurement of urinary BFP was added.
BFP in urine was found to be useful as a tumor marker for urothelial carcinomas. In addition, it was demonstrated that combined examination of urinary cytology with urinary BFP was more efficient for diagnosis of urothelial carcinomas.

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We studied subsets and cytotoxicity of recombinant interleukin-2 (rIL-2) expanded tumor infiltrating lymphocytes (TIL) from renal cell cancer (RCC) patients. TIL were successfully expanded in 13 of 14 RCC cases using anti-CD3 during initial 48 hours of culture. Percentages of CD8 positive cells among rIL-2 expanded TIL at 1 tp 4 week (s) of culture were 56.2±15.1% (range 26.2 to 79.8%, N=13) and not necessarily predominant over CD4 positive cells. NK and LAK activities of TIL at 3 to 6 weeks of culture were 31.6±15.8% (range 1.4 to 57.4%, N=9) and 16.6±11.6% (range 3.8 to 35.6%, N=6), respectively. Autologous and allogeneic RCC cytotoxicity of TIL at 3 to 4 weeks of culture were 17.9±19.7% (range 0 to 47.6%, N=4) and 18.9±14.8% (range 0 to 47.3%, N=12), respectively. Since there was no statistical difference between them, autologous specific cytotoxicity was not demonstrated.
From these results of present study, it is unlikely that most of effector cells of rIL-2 expanded TIL in autologous RCC lysis are major histocompatibility complex restricted cytotoxic T cells. And we concluded that it is doubtful that TIL is significantly superior over LAK cells in immunotherapy of human RCC.

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Subarachnoid phenol block was applied to four traumatic spinal cord injury patients who had been suffering from urinary incontinence caused by detrusor hyperreflexia. Two were females with complete thoratic cord injury, the others were males with incomplete cervical cord injury. In all patients, detrusor hyperreflexia and urinary incontinence disappeared after 0.3-0.6ml injection of 10% phenol glycerin. Vesicoureterl reflux observed in three ureters of two patients disappeared or improved. Two obtained sufficient bladder capacity for urine storage, while the others who had been treated by contenuous urine drainage for a long time prior to the block could not obtain sufficient bladder compliance. The cause seemed to be organization of the bladder wall.

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A total of 58 cases with prostatic diseases including benign hypertrophy (BPH) (n=10) and adenocarcinoma (n=48) were studied as to prostate-specific antigen (PA) with indirect enzyme immunohistochemistry. The expression of PA in the prostate, as well as the localization of PA in the tissue, was also studied in regard to cell differentiations, clinical stages, serum PA levels, with or without endocrine therapy, and prognosis of prostate cancer. Strong staining of PA was noted in epithelial cells of the gland, particularly on the ductual cavity, except for patients in the poorly differetiated carcinoma group. The overall positive rate for expression of PA was 100% in BPH and 73% (35/48) in prostate cancer. When prostate cancer was classified by cell differentiation, the positive rate was 100% (17/17) in the patients with well, 83% (10/12) moderately, and 42% (8/19) poorly differentiated carcinoma. When divided by clinical stages, the positive rate was 100% (1/1 and 9/9) in stages A and B each, 69% (9/13) in stage C, and 65% (17/26) in stage D. Of 33 cases whose serum PA values were determined, the histochemistry was positive in 67% of 12 patients with normal serum PA levels and in 86% of 21 in the elevated group. The prior to endocrine therapy group showed the presence of PA in 22 of 27 cases (82%) and a positive rate of 62% (13/21) was observed in the group during the treatment. Noting that poorly differentiated carcinoma account for a large percentage of high stages cases and that cases with high serum PA levels did not necessarily prove positive stain, the factors influencing the expression were presumed to be the cell differentiation and the presence or absence of endocrine therapy. Concerning the relations to prognosis, the 5-year survival rate of the PA positive group was 79.9% and that in the negative group was 22.0%, with a significant difference. These findings suggested that the histopathological examination of PA was useful in developing the prognosis of prostate cancer and selecting the therapy, especially in cases with poor differentiation.

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No significant effective therapy has been established for patietns with idiopathic male infertility up to now.
In order to assess the role of androgens in idiopathic male infertility, testosterone (T) and 5α-dihydrotestosterone (DHT) levels in isolated seminiferous tubules (intratubular levels) were measured by radioimmunoassay (RIA) in 100 patients with idiopathic male infertility. RIA of T and DHT levels in the whole tesis (intratesticular levels) were also conducted simultaneously.
Seminiferous tubules were separated by a two step incubation system using collagenase and mesh No. 100.
1. Intratubular T levels were higher than intratubular DHT levels with both azoospermia and oligozoospermia.
2. No significant correlations to either intratubular T or DHT levels were present in the plasma LH, FSH, or T levels and the thickness of seminiferous tubular wall. These data suggest that plasma hormones are not the main regulators for intratubular androgns.
3. Moderate correlation between the intratesticular T and intratubular T levels was noted (r=0.49), but there was no correlation between the intratesticular DHT and intratubular DHT levels (r=0.33). There was no significant correlation to either intratubular T or DHT as to the testicualr volume or the mean germinal epithelium score count method of Johnsen.
Therefore, it is considered that the intratubular T level is partially dependent on endogenous T secreted from Leydig cells. However, spermatogenesis may be regulated by various factors including the intratubular T level.

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We studied in vitro the change in muscle contractility and ion permeability of cell membrane of aged rat urinary bladder (16 and 24 months old) and compared with young rat bladder (6 months old). The results are summarized as follows:
1. In aged rat bladder the contractile resonse to Ca²⁺ was significantly decreased comparing to young rat bladder.
The speed of muscle contractility was also significantly slower in aged rat bladder.
2. There was no significant change in muscle contractility in response to K⁺ and Ba²⁺ among the 3 age groups, which indicated that contractile force of aged rat bladder per se was not impaired.
3. Mg²⁺ relaxed the detrusor muscle in a dose-dependent manner. The magnitude of the response was not different between aged and young rat bladders.
It is concluded that the response of aged rat urinary bladder to Ca²⁺ was decreased in contraction strength and contraction speed. This finding seems to suggest that membrane permeability of Ca²⁺ has been compromised, which may account for the imaired detrusor contractility frequently observed in elderly persons.

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We reviewed 465 cases of ureteral calculi treated at Jomo Urological Hosptial using a Dornier HM3 lithotripter during the period from October 1985 to February 1989. The 336 men and 122 women ranged from 11 to 78 years old with a mean age of 42.2. The stone size ranged from 4mm to 30mm with a mean length of 10.6mm.
Complete stone elimination by ESWL was achieved in 431 of the 465 cases (92.7%). The success rate was best for stones in the lower ureter, which was 98.1per cent (53/54). For upper and mid ureteral calculi it was 92.4per cent (363/393) and 83.3per cent (15/18), respectively. ESWL after pushup made 100per cent (30/30) of patients completely free of stones, while ESWL after bypass 93.0 percent (106/114) and ESWL in situ 91.9per cent (295/321). The rate of residual stone increases in propotion to the age of patients. Minor side effects such as fever and pain were observed. Our results suggest that ESWL currently is the first therapeutic option for the majority of ureterlal calculi.

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Based on the 89 stones treated by ESWL therapy alone, the factors which influence the number of ESWL shots were analyzed. Stone volume was calculated by summing up the value “length×short axis” for each stone. The value correlated well with the number of shots needed to disintegtrate the stone (p<0.01). The stones below the pelvioureteral junction needed twice shots compared with stones in the pelvis and calyces (80.3: 40.2, p<0.005). Stones formed by a single component of cystine or calcium oxalate were hard to be disintegrated (53.2: 31.6, compared with other complex stones). The radiological figure could not predict the fragility.

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Endocrine-Paracrine cells (EP cells) in prostatic carcinomas were screened by immunohistochemical tests for neuronspecific enolase, chromogranin, and serotonin and by Grimelius method. Formalin fixed, paraffin-embedded sections from 60 prostatic carcinomas were used. EP cells were detected in 16 cases (27%). The number of EP cells in hormone independent prostatic carcinomas were significantly larger than hormone dependent (p<0.05) and latent prostatic carcinomas (p<0.01). Five cases of prostatic carcinomas with abundant EP cell proliferation died of widespread metastases within 4 years, irrespective of hormone treatment. The pathologic finding was classified into the category of adenocarcinoma, partly showing carcinoidal or small cell carcinoma-like features. EP cells were found in perineurally invading cancer cells and also immunoreactive to both prostate specific antigen and prostate specific acid phosphatase. It is suggested that the proliferation of EP cells in prostatic carcinomas is related with the sensitivity to hormone treatment.

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We studied the inhibitory effect of urinary glycosaminoglycans (GAGs), in the natural form, on calcium oxalate crystals.
Control urine was collected from five healthy subjects and filtered by 5μm and 0.22μm membranes. The urine was cut off by a membrane of 30, 000 M. W. and the remaining urine was fractionated into three groups by anion-exchange chromatography on DEAE-cellulose: peak A contained only protein, peak B both protein and GAGs and peak C only GAGs. Peak A and peak B were fractionated again through a Sephacryl S-200 gel column.
Each fractionated sample was examined for the inhibitory effect on calcium oxalate crystal grwoth using the ¹⁴C-oxalate seeded crystal growth assay in a metastable solution developed by Koide et al. GAGs were determined by two-dimensional electrophoresis on cellulose acetate membrane. SDS-polyacrylamide electrophoresis was used to determine the molecular weights of proteins.
Peak A was found to have many kinds of proteins which had low inhibitory effects. Peak B had three kinds of proteins such as those with molecular weights of 130, 000, 45, 000 and 35, 000 as well as uronic acid. These proteins and uronic acid had high inhibitory effect and the highest inhibitory effect was found in the fraction of around 50, 000 M. W. where protein and uronic acid were contained. The molecular weight of this protein was 42, 000 by SDS electrophoresis. Uronic acid was a keratan sulphate by a two-dimensional electrophoresis.
In peak C there were mainly chondroitin sulphate and a small amount of heparan sulfate which had high inhibitory effect.
This study showed that urinary GAGs in the natural form have high inhibitory effects on calcium oxalate crystal growth.

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We experienced a hundred and fifty-six cases of germinal testicular cancer at Osaka University Hospital from 1957 to 1988.
Histologically, 114 cases (73.1%) were simple type, and 42 cases (26.9%) were mixed type. Eighty cases (51.3%) were seminoma, and 76 cases (48.7%) were non-seminoma.
All patients of seminoma were over 20 years of age, and the mean age was 36.1 years. Non-seminoma cases were distributed as to with two peaks, one in 0 to 4 year-old and another in 20 to 39 year-old, and the mean age was 22.9 years.
The seminoma/non-seminoma ratio as to clinical stages were 63 cases/48 cases in Stage 1, 6/9 in Stage 2A, 5/6 in Stage 2B and 6/13 in Stage 3.
The five-year survival rate (by Kaplan-Meier's method) was 98.4% for Stage 1 (71 cases), 72.7% for Stage 2A (11 cases), 0% for Stage 2B (4 cases) and 20% for Stage 3 (5 cases) between 1957 and 1978, and 100% for Stage 1 (40 cases), Stage 2A (4 cases), Stage 2B (7 cases) and 26.8% for Stage 3 (14 cases) between 1979 and 1988.
The five-year survival rate of 20 advanced cases treated mainly by PVB regimen was 100% for Stage 2 (6 cases) and 68.6% for Stage 3 (14 cases). Five advanced cases containing choriocarcinoma elements were treated by PVB regimen and its two-year survival rate was 40.0%, which was statistically worse than that (86.8%) of other histological types (p<0.05).

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There has been no useful treatments for chronic vascular rejection (CVR) after kidney transplantation until now. Recently, however, some reports have suggested that the thromboxane A₂ synthetase inhibitor, OKY-046, is useful in reducing proteinuria in nephrotic symdrome and preventing progression of CVR.
Five patients with CVR (serum creatinine range: 1.7-2.6mg/dl) were treated with OKY-046 for over one year and the effect of OKY-046 was evaluated. One patient developed acute rejection and another renal hypertension during this study.
Except for the cases of acute rejection and renal hypertention, serum creatinine slightly decreased in 1 case and remained unchanged in 2 cases. Urinary excretion of protein and thromboxane B₂ decreased significantly but prostaglandin E₂ did not change in the treatment of the deterioration with OKY-046.
We concluded that OKY-046 was effective in preventing graft function and decreasing urinary protein excretion in kidney transplant recipients with CVR.

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We investigated 663 patients with renovascular hypertension (349 males and 314 females), who were surgically treated at 73 institutions of Urology or Surgery in Japan from 1963 to 1988. There were 294 cases with fibromuscular dysplasia (FMD), 178 with atherosclerosis (SC), 104 wih aortitis syndrome (AO) and 87 with other causes. The mean age was 27 years old for FMD, 52 years for SC and 29 years for AO. Thirteen % of FMD, 19% of SC and 38% of AO had stenoses in both renal arteries. Since percutaneous transluminal angioplasty (PTA) has begun in early 1980's, the number of operative cases has been decreased, especially in the case of FMD due to a good result by PTA. Nephrectomy was done in 38% of 704 operations. Aortorenal bypass and autotransplantation were performed in 49% and 26% of the rest, respectively. Recently, autotransplantation has increasingly been applied for complicated vascular lesions. As regards prognosis of the surgical treatment, 77% of FMD, 59% of SC and 50% of AO presented normal blood pressure with or without antihypertensive drugs at least for 10 years after an operation. However, among the patiens with normal blood pressure who were observed for more than 5 years, 30% of FMD, 56% of SC and 44% of AO had taken antihypertensive drugs. Eleven patients (1.7% of all) died within one month after the operation, 5 patient of whom had bilateral stenoses. In concluion, PTA is th first choice for renovascular hyprtension and surgery has been done for more difficult and complicated cases in which PTA is ineffective. Aortitis syndrome has been still a troublesome disease because of poor reuslts by surgery or PTA and also ineffectiveness of antihypertensive drug. Therefore, systemic control for this diseae may be more important before surgery.

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A case is presented of a 40 y. o. female with Cushing's syndrome. Her plasma glucocorticoid values were elevated (11-deoxy-cortisol: 3.46ng/ml, cortisol: 25.6μg/dl and cortisone: 35.7ng/ml) with loss of diurnal variation. Urine 17-OHCS value failed to b suppressed by high dose dexamethasone and was unchanged after metyrapone administration. Her plasma mineralcorticoids and androgens were within normal limits. There were 3 separate tumors in the right adrenal on CT and the left adrenal had no uptake on ¹³¹I-adosterol scintigram. We, therefore, diagnosed her illness as Cushing's syndrome due to unilateal multiple adenomas. Gross and histological examination of the right adrenal revealed one compact cell dominant adenoma and two clear cell dominant adenomas.
This is the 4th case of Cushing syndrome due to unilateral multiple adrenal adenomas in Japan.

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The patient was a 63-year-old woman who visited our hospital with the chief complaints of swelling, chills, fever and right lumbago. Fifteen years ago, she received surgical exploration for right renal stones at another deparment of urology.
A large, soft and round kidney was palpable from the right upper quadrant of the abdomen to the right lower abdomen. The parenchyma of the right kidney was thinned and inside the kidney there was a huge amount of yellowlisch mucin. The histological diagnosis was mucin-producing cystadenoma (borderline malignancy) of the renal pelvis and ureter.
Mucin-producing cystadenoma of the renal pelvis and ureter origin was very rare, and only 4 similar cases to our patient were so far reported.

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