Urodynamic approach to the disorders of the urinary tract has been based on the knowledge of anatomy and neurophysiology of this abnormality. The development of this field included uroflowmetry, cystometry, urethral profilometry, and electromyogram of the external sphincter. In addition to these investigations new trends in urodynamic field were reviewed. With the advent of muscle biochemistry intra-renal urodynamics has been advocated. These researches would be expected to clarify the mechanism of intra-renal reflux. The another investigation was urophonography. When the urine passed through the posterior urethra the urethral sound occurred. The detecting, recording and analyzing systems were developed. This method would be entirely a new method of urodynamic study.

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As morphological changes of the native kidneys, the presence of acqired cysts, intra-renal calcification and renal tumor was investigated mainly by ultrasonography and computed tomography in 151 patients with chronic renal failure.
1) Among 140 uremic patients caused by medical diseases. 40 patients had simple cysts, and 37 had acquired cystic disease of the kidneys (ACDK). However 4, uremic patients caused by urological diseases were not seen to be with an acquired cyst.
2) The patients with ACDK were with significantly longer durations of dialysis therapy than those with simple cysts or no cysts. Furthermore, the patients with ACDK were younger than those of the other groups.
3) Intra-renal calcification was more frequently found in patients with cystic disease (simple cyst, ACDK and polycystic disease) than in those without cystic disease with statistic significance.
4) Native kidneys became larger after the occurrence of ACDK.
5) Three cases of renal tumor were found.

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The factors which made acquired cysts develope to renal tumors in chronic hemodialysis patients was investigated from clinical and histological findings.
Although three renal tumors were found among 151 patients with chronic renal failure, clinically, one case had acquired cystic disease of the kidneys (ACDK), one case had simple cysts and the other case did not have any cyst. However, the last two cases had multiple small cysts histologically. In ACDK, renal tubules were degenerated and dilated, fused to each other, forming more larger cysts. Furthermore, epithelium of acquired cysts showed columer and dysplastic change, and papillary adenomas were developed into the inner space of the cyst wall. And ACDK kidney without renal tumor also revealed the same findings in histological examinations. It was postulated that renal tumor occurred from the papillary projections of the dysplastic epithelium of cysts. Therefore cysts in uremic patients seemed to be different from the simple cyst in normally functioning kidneys.

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Clinical trials using Extracorporeal Shock Wave Lithotripter (Tripter X-1) were performed on 30 cases for upper urinary tract calculi (16 cases: renal stone, 14 cases: ureter stone) with one trial per individual case from December, 1988 till February 1989. The fragmentation rate of 100% resulted.
One month after treatment, evaluation on the X-ray film showed that 10 cases (33%) were found to be excellent where stone silhouette was no more observed. Effective cases where residual stone having dimension of below 5mm counted 10 (33%), and clinically effective rate, sum of both excellent and effective rates was 67 percent. Effective rate was 75 percent in case of kidney stone, and 57 percent in case of ureter stone respectively.
Side effects of visual hematuria, skin ecchymosis and fever were observed, yet none of them was of serious grade, and post operative changes in blood chemistry were mild and transient. No remarkable side effects due to radiation exposure were observed.
We concluded therefore that Extracorporeal Shock Wave Lithotripsy by this system is an effective therapy for upper urinary tract stones.

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In order to evaluate the clinical significance of S100ao protein, we measured serum S100ao protein in 36 patients with renal cell carcinoma by EIA developed by Kimura et al. In addition, the distribution of S100ao protein was studied by the immunohistochemical method. Previous study demonstrated that mean level of serum S100ao protein in healthy volunteers was 203±107pg/ml, therefore the cut off level was set to 524pg/ml. The results obtained in this study were as follows:
1) The mean level of serum S100ao protein was 1162±2056pg/ml, and its positive rate was 44% in 36 patients with renal cell carcinoma. When the patients were divided into 2 groups according to tumor stage, the mean level of serum S100ao protein in the high stage group was sinificantly higher than that in the low stage group (p<0.01).
2) In the sequential study of serum S100ao protein, patients with progressive disease showed a gradual increase in the level of serum S100ao protein while patients with no evidence of tumor showed a normal level of serum S100ao protein.
3) There was no correlation between the level of serum S100ao protein and the histological grade of renal cell carcinoma.
4) Immunohistochemical analysis (10 cases) showed that S100ao protein was observed in all of 10 renal cell carcinomas.
Thus, the present study suggests that serum S100ao protein might be a useful clinical marker especially in monitoring patients with renal cell carcinoma.

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In order to investigate gonadal development of boys after chemotherapy, testicular biopsy specimens, which were obtained from 16 boys witin 6 months after completion of the therapy for acute lymphoblastic leukemia, were assessed and their gonadal function was examined. More than half of them showed a decrease of Mean Tubular Diameter and Johnsen's Score Count, but no specimen showed a decrease of Tubular Fertility Index.
Seventeen healed patients consisting of 12 biopsied and 5 non-biopsied cases were examined as to the volume of testis, development of the genital organ, skeletal age, plasma LH, FSH, testosterone, LH-RH test and HCG test. The period of follow-up after completion of chemotherapy varied from 1 month to 5 years. All patients showed testis volume, development of external genitalia and skeletal age suitable for their age. Some patients who were examined within 2 years after completion of chemotherapy, showed abnormal endocrine functions, but other patients examined after more than two years showed normal endocrine functions except a case who received testicular irradiation. Semen analysis in one case revealed density and motility within normal range.
These data indicate that chemotherapy of acute lymphoblastic leukemia in boys damages testicular function, but more than 2 years later the spermatogenesis as well as endocrine function is expected to recover gradually.

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Ultrasonotomograms of 546 kidneys were obtained in 280 patients undegoing chornic dialysis. Dialysed kidneys could be detected in 529 of the 546 kidneys (96.9%) by ultrasonic examination. The ultrasonic diagnoses on dialysed kidneys were contracted kidney in 313 kidneys (59.2%) and acquired cystic disease of the kidney in 107 kidneys (20.2%).
Ultrasonic measurement of the size of kidney (length and thickness) revealed that the kidneys in patients with chronic renal failure were much smaller than normal ones. But the kidneys in patients undergoing dialysis for more than 8 years gradually increased in size with incidence of acquired renal cysts. The kidneys in patients with diabetic nephropathy were grater in length and thickness than those with chronic glomerulonephritis.
Sonographic features of dialysed kidneys were unclearness of renal imaging, unidentification of the central echoes, unidentification of the corticomedually border and increased parenchymal echogenicity. Irregularity of the renal contour had a tendency to increase in number with incidence of cysts in long-term dialysis patients. The ultrasonotomograms of the kidneys with diabetic nephropathy showed fewer changes than normal ones.
No major complication of the kidney was detected in the present study. However, two retroperitoneal hematomas and one renal cell carcinoma developed within two years after this examination. We believe that regular screening of the kidneys by ultrasonic examination is mandatory in patients on chronic dialysis for early diannosis and treatment of these complications.

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Ultrasonic examination of the kidney was performed on 280 patients undergoing chronic dialysis. Acquired cystic disease of the kidney (ACDK) was detected in 107 of 529 kidneys (20.2%). This paper presents an analysis of ultrasonotomograms of ACDK.
Ultrasonic measurement of the size of ACDK was 72.5±15.2mm in length and 41.7±9.8mm in thickness. The size of ACDK was significantly greater than that of contracted kidneys by ultrasonographic diagnosis. With regard to sex distinction the length and thickness of ACDK were significantly greater in males than in females. As for laboratory data, patients with ACDK showed significantly higher values of red blood cell count, hematocrit and serum creatinine concentration compared with contracted kidneys.
Prolongation of the dialysis peirod increased the incidence of ACDK. The size of ACDK showed a tendency to increase with duration of dialysis. However, no correlation was noted statistically between the incidence of ACDK and duration of dialysis and between the size of ACDK and duration of dialysis. There was a significantly lower incidence of ACDK in patients with diabetic nephropathy than those with chronic glomerulonephritis.
A sonographic feature of ACDK is irregularity of the renal contour because of cystic transformation. Renal imaging, identification of the corticomedullary border, identification of the central echoes and increased parenchymal echogenicity were similar to other dialyzed kidneys.
The main complications of ACDK are hemorrhage and tumorr formation. We observed two retroperitoneal hematomas and one renal cell carcinoma developed within two years after this examination. The incidence of complications of ACDK was 5.1per cent. We believe that patients with ACDK should be watched carefully by regular ultrasonic examination for early diagnosis and treatment of these complications.

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To study the bone turnover in patients with bone metastasis from cancers of the kidney, bladder, prostate and other organs, Ca metabolism, vitamine D related hormones and various markers, such as bone glaprotein (BGP) and hydroxyproline, were invastigated. In the group with osteolytic metastasis of non-prostatic cancer patients, BGP which is a measure of bone absorption was significantly increased and urinary excretion of hydroxyproline, Ca and P was elevated. Serum Ca was also higher and 1α25 (OH)₂D and 250HD, measures of the metabolism of vitamine D, were lower. It was shown that bone absorption was promoted with the osteolytic findings by clinical X-ray examination, but osteoblastic changes which did not depend on osteoblast cells, seemed to exist in this group.
On the contrary, in the group with osteoblastic metastasis from prostatic cancer, the level of BGP was not increased, but urinary hydroxyproline was moderately increased. Serum and urinary Ca and P levels were increased. In addition, 1α25 (OH)₂D and 24·25 (OH)₂D were lower than in the control group.
These results indicate that urinary hydroxyproline is a useful marker for patients with bone metastasis, but BGP was correlative with neither the clinical findings of bone metastasis nor the bone turn over and metabolisms.

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In order to examine chronic effects of shock waves on renal structure and blood pressure, normotensive Wistar Kyoto rats (WKY) and spontaneously hypertensive rats (SHR) were uninephrectomized and shock waves were given on the lower half of the residual kidney by Piezolith with the focus pressure of 1020bar. In the first experiment, 36 WKY were divided into 6 groups; Group 1 served as control, Group 2, 4 and 6 received a single session of 1250, 2500 and 5000 shocks, respectively, whereas the animals in Group 3 and 5 received repeated dose of 1250 or 2500 shocks within 3 days after the first session. All the animals in Group 6 died within 48 hours due to remarkable renal hemorrhage, leaving only 5 Groups for the evaluation of long-term study.
The blood pressure, measured by tail-cuff method 60 days after shock wave administration, was not significantly different between the control and shock-waved WKY. Neither was there any remarkable difference between the blood pressures measured prior to and 60 days after the intervention in each Group. At 16th week after the shock wave administration, the animals were sacrificed. There was a slight but statistically significant increase in serum creatinine level in Groups 2, 4 and 5, as compared to the level of control animals in Group 1. On light microscopic sections, there was no remarkable histological change in the kidney of Group 2, however, the renal parenchyma was frequently replaced with interstitial fibrosis in Groups 3, 4 and 5. The extent of this chronic renal tissue damage seems to be dependent on the number of shock waves, but apparently modified by the mode of treatment; the tissue damage observed in Group 3 was lesser than that observed in Group 4 which received the same total number of shocks but in a single session. Furthermore, the adenine nucleotide pool measured in the kidney tissue in Group 5 was decreased to 42% of the level of control animals.
In order to further examine the potential adverse effect of shock waves on the blood pressure, the second experiment was conducted, using uni-nephrectomized WKY and SHR, which is a well-known animal model for essential hypertension. The animals received 2500 shock waves in one session, and the blood pressure was measured 90 days after shock wave administration, which was compared with the level of intact animals. As has been observed in the previous experiment, there was no significant change in the blood pressure in WKY up to 90 days after the intervention. The blood pressure, either systolic or diastolic, significantly increased in intact SHR during this period, which is, however, rather a natural course for this animal. The systolic pressure, measured in SHR receiving shock waves, did not significantly differ from the level of intact SHR, however, the diastolic pressure of the treated SHR was elevated with a remarkably rapid rate of 157%, and this increase was significantly higher than that observed in intact SHR. Plasma renin activity, however, showed no significant difference in the SHR groups examined.
Based on the findings in the present study, it is concluded that shock wave administration is not harmless, but causes chronic damage on the renal tissue. This damage is not exactly dependent on the total number of shocks, but rather on the mode of administration (single vs fractionated sessions). It is highly plausible that this chronic tissue damage of the kidney leads to earlier clinical manifestation of hypertension in subjects with potential risk factors.

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We investigated fifteen patients with partial sacral agenesis who complained of urological disorders. Those with a myelomeningocele were not included. The mean age at the first visit was 13 years old. Bilateral and unilateral sacral agenesis were observed in nine and six patients, respectively. Chief complaints comprised incontinence and/or nocturnal enuresis in 10 patients, pollakisuria 5, recurrent fever attack due to urinary tract infection 5 and difficulty in micturition 2. In 4 cases vesicoureteral reflux was observed.
At an initial urodynamic study bladder compliance varied from 1.4 to 37.0 (mena 10.4)ml/cmH₂O and uninhibited contractions were present in 10 of them. Three patients were judged to have normal or almost normal bladder function. After treatment with clean intermittent catheterization and/or anticholinergics, compliance improved to a mean of 15.1ml/cmH₂O and the uninhibited contraction decreased in its amplitude or disappeared completely in 8 of 10 cases. It was suggested that patients with partial sacral agenesis originally suffered from a lower motor neuron lesion. The severity of the sacral deformities and other neurological symptoms (gait or sensory disturbance) were not related with the urodynamic findings. However, it was found that the more the cystogram was deformed the lower was the bladder compliance.

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Immunological studies were performed in 87 patients with chyluria referred to our clinic from January 1982 to December 1988. White blood cell count in 78 patients was 5210.3±1440.9/mm³. The fraction and the number of lymphocyte were 18.7±9.5% and 934.1±521.6/mm³, respectively: they were lower than normal limit. The percentages of T and B lymphocytes studied in 46 patients were 79.3%±11.2% (normal range: 76-86) and 10.4±7.9% (normal range: 8-16), respectively: both lymphocytes tended to decrease in percentage. Lymphocyte blast formation stimulated with phytohemagglutinin (PHA) was carried out in 20 patients. The mean of the blast formation was 17410.0±10275.1c.p.m. (normal range: 377700-62400), and much lower than normal value. Of 22 patients who had PPD skin test, only 9 (40.9%) were positive. These findings signified that cellular immunity was suppressed in patients with chyluria. On the other hand, the value of immunoglobulin was within normal range (IgG: 1325.3±475.6mg/dl, IgA: 242.0±98.3mg/dl, IgM 130.4±95.9mg/dl). Study on the values of laboratory examinations showed statistically positive correlation between total lymphocyte population and T cell number, and between total lymphocyte population and lymphocyte blast formation.
In patients with chyluria, serious sequelae have not been reported. However, care should be taken for possible opportunistic infection and, particularly, malignant tumors because suppression of cellular immunity may be one of the promoting factors of malignant tumors

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The study of prognostic factors in patients with prostate cancer (Pca) may be of value in understanding the natural history of the disease and may also assist in planning and analyzing the results of clinical trials. Moreover some information through this study would be beneficial to assessing the prognosis and decision of better therapy form of individual patients.
The significance of items studied was evaluated from the two viwe points, survival rate and Pca death rate. Stage, pathological differentiation and acid phosphatase were significantly related to them, in the category grade depending manner. Past history and complication, and age were also significantly related to them but higher category grade as a survival factor showed lower Pca death rates. ESR, gait disturbance and hematuria were related to only survival rate. Any significant relationship was not observed in serum testosterone, voiding disturbance and cancer-pain. Prognostic factors should be clinically used through the well understanding of each characteristics. This paper also showed that statistical significance not always provide a wide difference between categories compared.

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Between September 1982 and May 1984, combination chemotherapy with cis-platinum, peplomycin and adriamycin was administered to 12 patients with histolgically confirmed adenocarcinoma of the prostate and progressive disease with evaluable parameters. Cis-platinum (CDDP) 20mg/sqm was administered intravenously on Days 1-5, peplomycin 5mg/sqm by 24-hour continuous drip infusion on day 1-5 and adriamycin 25mg/sqm on Day 1. This course was repeated every 28 days. The dose and schedule were modified by hematologic toxicity or other side effects. One patient refused therapy because of severe nausea and vomiting; therefore 11 patients were eligible for response evaluation.
Of the 11 patients, two had a documented PR, five had SD and four had PD. Ten patients whose disease eventually progressed recieved a second line of therapy consisting either of estramustine or estrogen. Of these ten patients, 6 had a documented PR, one had SD and three had PD. It is concluded that this combination chemotherapy regimen may prime advanced prostatic cancer to respond to hormonal therapy, even though it has only a limited effect on advanced prostatic cancer

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Sixty-seven patients underwent a resection of renal cell carcinoma in our hospital beteen July 1984 and Mar. 1989. Out of them 31 patients with small renal cell carcinoma less than 4cm in diameter were examined. The proportion of small renal cell carcinoma to all renal cell carcinoma was 36% (14 patients) in the first half period (July 1984-July 1987) and 61% (17 patients) in the last half (Aug. 1987-Mar. 1989), i. e. in total more than half of all the carcinomas. The patients diagnosed by ultrasonographic screening were 25 (80%) out of the 31 patients. The incidence of small renal cell carcinoma was 4 (0.06%) out of 6892 patients in our health check-up center and 6 (1.0%) out of 610 hemodialysis patients, and they were found by ultrasonic examination. The carcinoma was protruded from the renal contour in 24 patients (77%) and was inside the renal parenchyma (23%) in 7 patients. The carcinoma in the 24 patients was associated with the deformity of its outline. The patients with a positive IVP were 5 out of 31 patients and the carcinoma in 4 out of the 5 patients was inside the renal parenchyma. Of all patients with protrusion of to renal contour, only one patient was with a positive IVP. The above findings indicate that ultrasonic examination is a useful metod for the early diagnosis of small renal cell carcinoma.

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One hundred and four children (48 boys and 56 girls, ranging in age from 3 months to 15 years, and follow-up period of more than 2 years in all) with “primary” vesicoureteral reflux (VUR) were retrospectively analyzed with particular emphasis on resolution of VUR and occurrence of renal scar. All underwent cystoscopic examinations which failed to demonstrate any organic vesicourethral obstruction, and all were neurologically normal. The patient population was divided into 2 groups based on cystometric findings. Group 1 consisted of 74 patients with unstable bladder and Group 2 consisted of 30 patients without unstable bladder. Although both groups were initially kept under antibacterials, in Group 1 frequent voiding and anticholinergics were maintained until the bladder stabilized by itself. There was no difference in the grade of reflux between the two groups. The rate of spontaneous resolution of reflux was 18% in group 1 in which more than 60% of the patients were with high grade reflux, while in Group 2 it was 17%, similarly to Group 1, but all were with low grade reflux. The presence or absence of renal scar and its subsequent evolution were determined in 73 patients in whom serial urograms were available enough to evaluate nephrographic renal outline. The incidence of renal scar at the first visit was 26% in Group 1 and 36% in Group 2. New formation of renal scar was not found in either group. The progression of preexisting renal scar was seen only in Group 1 (5/55 patients, 9%), and not in Group 2 (0/18 patients, 0%). Retrospectively, all the progression occurred within 2 years of follow-up and were seen either in the poor-compliants to anticholinergics (2 patients) or in those detected relatively late with advanced reflux nephropathy (3 patients). These data suggest that there was a high incidence of unstable bladder in “primary” VUR, even a high grade VUR has a chance to resolve by itself with stabilization of the bladder, and its early detection and initiation of proper managements are mandatory to prevent the formation and progression of renal scar. Even when antireflux surgery precedes, control of unstable bladder is mandatory.

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Fifty-two patients with obstructive diseases of the upper urinary tract were treated by percutaneous endoscopic surgery between May, 1986 and July, 1989. Fifty-nine procedures consisting of endopylotomy (24 procedures), endopyeloureterotomy (29) and balloon dilation under direct vision (6) were performed in 54 units of the urinary draingae system. Causative diseases were congenital in 24 units, scar due to calculi in 17, scar due to previous surgery in 11 and tuberculous ureteritis in 2. The postoperative follow-up periods ranged from 3-41 months, mean ±S.D.; 12.2±7.3 months. Of the 59 procedures, 49 (83.1%) achieved improvement but 10 could not on the postoperative excreatory pyelogram and/or TcDTPA renogram. Three procedures (5.5%) required blood transfusion. Retroperitoneal leakage of the perfusate was observed in 3 procedures (5.0%). No other severe complications were observed. These results indicate that this procedure may be used for the reconstructive surgery in obstructive diseases of the upper urinary tract such as the ureteropelvic junction and the proxymal 1/3 ureter.

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An unusual case of 2 concurrent primary renal tumors within the same kidney is reported. A 70-year-old woman presented with gross hematuria when she was in the hospital for cerebral infarction. Excretory urography revealed a marked expansion of the right kindey with no renal function. CT scan showed a mass arising from the right kidney, the hydronephrotic right reanl pelvis, and a mass in the lower right ureter. Selevtive renal angiogram showed marked neovascularity of the mass. There was an encasement of the intrarenal artery to the lower pole.
Angiographic findings were highly suggestive of a renal cell carcinoma with a second neoplasm in the renal pelvis. Subsequently, the patient underwent right radical nephroureterectomy and partial cystectomy. Section of the removed specimen revealed a 4.0×3.8cm solid tumor confind to the kidney in the upper pole and a transitional cell carcinoma arising from the renal pelvis. In addition, transitional cell carcinoma was present in the distal ureter.

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A 60-year-old man visited our hospital with complaints of micturition pain and interruption of urinary stream.
X-ray examinations were performed, showing no bladder and urethral stone. However, KUB revealed bilateral multiple renal stones. Excretory urography showed a horseshoe kidny and a concentration of the contrast medium in the ectatic tubules at the pyramidal apices. Calculi were also located in these ectatic tubules.
Thus, we considered that this was a very rare case of meudllary sponge disease associated with horseshoe kidny.
So far there has been no case report of medullary sponge disease with horseshoe kidny in our country.

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