The recent development in the treatment of the urinary stones has much to do with underwater shock waves. And urologists have become more agressive in using this modality in the treatment of the complicated stone patient.
However, contoversy persists regarding the extent to which the applied voltage and shock wave number interact to induce both cellular injury and stone fragmentation and also the appropriate timing of repeat lithotripsy treatments.
It is very short time since underwater shock wave has been initially applied to human body. The effects of the shock wave on the microstructure of the tissues are pooly understood. The questions, what happens at the F₂ focus and what happens to the energy after arriving at the F₂, remain unclear. The bioeffects of ESWL should be more and more scrutinized.

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A cis-diamminedichloroplatinum (CDDP)-resistant cell line, CL-7/CDDP, has been established by chronic exposure of a parent human bladder cancer cell line, T24 (CL-7), to CDDP at progressively increased concentrations for 20 months. CL-7/CDDP was 2.7-fold more resistant to CDDP than CL-7 as determined by colony formation assay. Biological and biochemical characteristics were examined in CL-7/CDDP to compare with CL-7. There were no differences in doubling time and plating efficiency between the two cell lines, but a small one in the mode of chromosome numbers. Intra-cellular CDDP amounts after CDDP exposure showed no difference between the two cell lines, but CL-7/CDDP showed a higher glutathione (GSH) and metallothionein (MT) level. It is suggested that the mechanism of acquired resistance to CDDP is attributed to intra-cellular detoxication, but not to the efflux. CL-7/CDDP may be useful for elucidation of the mechanism of CDDP resistance in human bladder cancer.

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A cooperative study of combination of UFT (a compound of FT and Uracil) and human lymphoblastoid interferon (IFN-α) was conducted in the cases of metastatic renal cell cancer. IFN-α was administered over 3 times a week at a dose of 3×10⁶ units in combination with UFT at a daily dose of 600mg FT equivalent. Twenty-eight patients from 16 collaborating institutions were the subjects of the present study.
The antitumor effects of the drugs were clinically evaluable in 25 cases according to the response criteria of Japan Society for Cancer Therapy. Complete responses and partial responses were observed in 3 and 2 cases, respectively, showing a response rate of 20 per cent. One complete responder had bone and liver metastases and has been alive for more than 2 years without any evidence of relapse. All of the other responders had lung metastasis. The survival durations of the other two complete responders were 716 days and 255 days. The two partial responders had been alive for more than 819 days and 471 days.
The adverse effects of this combination therapy were minimal.Combination of a biological response modifier and a cancer chemotherapeutic agent seems to be a way to increase the treatment efficacy of renal cell cancer.

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Effects of cyclosporin (Cs) on male reproduction in rats were examined. A dose-dependent decrease of the sperm counts in the cauda epididymis was observed 6 weeks after Cs was administered. A significant decrease of sperm motility was also observed in the each Cs-treated group in any obsevational period after Cs injection, which suggested an injury to epididymis by Cs. A slight damage of the seminiferous tubules was demonstrated 6 weeks after administration of 40 or 60mg/kg of Cs.
No change in serum levels of luteinizing hormone and testosterone was demonstrated throughout the experiment. But serum levels of follicle-stimulating hormone were significant high in any observational period except 6 weeks after Cs injection.
It was concluded that Cs gave injuries to both spermatogonia and epididymal function in rat.

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Transurethral ultrasonography was used to demonstrate the local extension of prostatic cancer in 18 patients undergoing radical prostatectomy. By ultrasonography, capsular penetration of the carcinoma was judged from irregularity and protrusion of the capsule. Infiltration to the seminal vesicle was determined by asymmetry on the echogram. The ultrasound staging was compared to the pathological findings of the step sectioned specimens obtained by total prostatactecotmy. The accuracy of transurethral ultrasonography in demonstrating the local extension was 94%. The accuracy rates in detecting capsular penetration and depicting seminal vesicle infiltration were 94% and 72%, respectively.
The local extension of prostatic cancer has been evaluated by transrectal and transabdominal scannings. Ultrasonography is considered to be more reliable than digital rectal examination, CT or MRI in the preoperative staging of the prostatic cancer. The present study revealed that transurethral ultrasonography had advantage in demostrating the capsule of the prostate for the following reasons; 1) there is no interposing tissue between the probe and prostate because the probe is inserted into the prostatic urethra, 2) the prostate is observed without deformity caused by the baloon in the rectum, and 3) the beam hits the capsule perpendicularly. The prostatic cancer at the portion of capsular penetration was hypoechoic or anechoic pathologically, these areas corresponded to homogeneous and large cancer nodules. Transurethral ultrasonography is valuable in demonstrating local extension of the prostatic cancer, in particular capsular penetration.

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In order to evaluate vesicourethral dysfunction in diabetic patients, urodynamic studies, IVP and urinalysis were performed on 173 diabetic patients (male 78, female 95) and 17 nondiabetic control cases. In addition to the classical findings as increased volume at the first desire to void and decreased muximum vesical pressure, diabetic patients showed varieties of vesicourethral dysfunctions such as overactive bladder (14.5%), low compliance bladder (11.0%) and loss of detrusor-external sphincter coordination (31.7%). Vesicourethral function of diabetics was classified in following 5 types by analysing the volume at first desire to void, volume at muximum desire to void, muximum vesical pressure, residual urine volume and bladder compliance.
1. Type 1, normal vesical function, 13 cases. 2. Type 2, vesical dysfunction with minimal residual urine, 49 cases. 3. Type 3, vesical dysfunction with residual urine, 66 cases. 4. Type 4, low compliance bladder, 20 cases. 5. Type 5, overactive bladder, 25 cases. Pyuria was observed in 59.8%, hydronephrosis was found in 10.9% and ectasia of lower ureter was found in 17.8% of diabetic patients. The highest incidence of pyuria and abnormality of the upper urinary tract were noted in Type 4 and followed by Type 3 and by Type 2 in decreasing order. Extent of pyuria and ectasis of the upper urinary tract showed statistically significant correlationship with residual urine volume and detrusor-external sphincter coordination. When vesicourethral function was compensated by abdominal strain, the volume of residual urine is not elevated, but when the mechanism of compensation is lost or in the abscence of detrusor-external sphincter coordination results in gradual accumuration of residual urine. In cases with long standing chronic urinary tract infection may results in fibrosis of the bladder wall with low compliance bladder. Fibrotic obstruction of uretero-vesical junction can cause hydroureteronephrosis and followed by renal function impairment. As vesical damage become irreversible at this end stage, proper management during early stage is crucial for management of diabetic patients. Cholinergic agent were effective to reduce residual urine volume in Type 3. α-blocking agent were effective to reduce residual urine volume in Type 3 and some cases of Type 4. In cases in which medication therapy failed to reduce residual urine, the clean intermittent cathetelization was successful in control of urinary tract infection and upper urinarytract ectasis. Tranceurethral resection of the prostate and the bladder neck is indicated in the male patients with a large amount of residual urine in Type 3 and 4.

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We determined the serum concentrations of IgA and IgG antibodies specific for Chlamydia trachomatis (C. trachomatis) by an indirect immunoperoxidase assay (IPAzyme kit, Savyon Diagnostics, Ltd., Bee, Shova, Israel) to evaluate their diagnostic significance in latent infections in males. Forty-five asymptomatic males whose wife or partner was suspected to be infected with C. trachomatis were studied and the incidence of serum IgA (titer≥6) and IgG (titer≥64) antibodies for C. trachomatis was compared with that in a healthy group, a group with non-gonococcal urethritis (NGU) patients. Changes in IgA titer during treatment were also examined.
The incidence of IgA and IgG antibodies in the healthy group was found to be 2.4% and 11.9% in males, and 4.8% and 18.1% in females, respectively. In patients whose wife or partner who was positive to C. trachomatis, the incidence of IgA and IgG antibodies was 42.2% and 75.6%, respectively. In the NGU patients the incidence of IgA and IgG antibodies was 56.3% and 62.5%, respectively. The incidence of IgA and IgG antibodies in patients whose wife or partner was antibody-positive were significantly higher (p<0.01) than the corresponding value in healthy men and women, but there was no significant difference from NGU patients or the elderly group. The IgA antibody titer during treatment of C. trachomatis infection showed no reduction in some cases.
This study revealed frequent latent incidence of C. trachomatis infection in male patients. Determination of C. trachomatis IgA and IgG antibodies is considered to be supplemental for diagnosis of chlamydial latent infections.

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Nineteen cases of sexual disturbance caused by endocrine dysfunction were surveyed for the clinical features. In hypogonadotropic hypogonadism ejaculatory failure was observed in 12 out of 13 cases. On the contrary, 2 of three hypergonadotropic patients preserved their ejaculation. The serum testosterone levels of hypogonadotropic and hypergonadotropic hypogonadisms were less than 200ng/dl. When the testosterone level decreased to less than 100ng/dl, nine patients out of 13 complained loss of libido and 12 patients complained loss of ejaculation, but six patients preserved erectile function.
Hyperprolactinemic patients showed loss of libido in 4, erectile failure in 4 and loss of ejaculation in 2.
When good response to hCG test was present or the testicular volume was more than 4ml, patients with hypogonadotropic hypogonadism showed good response to hCG therapy.

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Twenty-one cases of posterior urethral valves experienced in the last 26 years were reported with special references to the morphological and functional sequelae of the upper and lower urinary tracts after the valve ablation. Furthermore, several problems, such as transient urinary diversion, vesicoureteral reflux (VUR), lower ureteral obstruction, transurethral valve ablation, bladder function and renal insufficiency, were also discussed.
The age at the first examination ranged from 0 day to 13 years. Eight boys were first examined under one year of age. Although the most frequent complaint was urinary infection, some characteristic features were observed in each age group. In all of the children the valves were classified as type I (Young). Seven children had severe ones. Endoscopic examination was thought to be essential to find mild ones. VUR was found in 16 children (28 ureters). Grade IV was encountered most frequently (13 ureters) with prominent laterality to the left side. The severity of the renal scar paralleled to the grade of VUR. Most of the dwarf kidneys were thought to be hypodysplastic. Valve ablation was performed immediately after the diagnosis in 17 of the 21 children. Eight children were under one year of age when their valves were ablated. As a principle, VUR was followed conservatively after the valve ablation. VUR highly tended to disappear or improve when it was of low grade or valve ablation was performed under one year of age. However, when the ureteral orifices were craniolateral, disappearance of VUR was rare and recovery of renal function was not observed. In 5 children antireflux surgery was added. Although a dilated upper urinary tract without VUR was found in 2 children (2 ureters), it disappeared promptly after the valve ablation. No urethral stricture was encountered in our series. Five of 12 children, who are over 5 years of age now, have incontinence and/or bed wetting. Urodynamic evaluation revealed detrusor-sphincter dyssynergia in one and uninhibited bladder in 3. Four children showed impaired renal function and 2 of them developed the end-stage renal disease after puberty.

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The results of clinical trial using a TOSHIBA piezolectric extracorporeal lithotripter are presented. The advatages of this machine are the installation of an anti-miss-shot control device (AMCD) to prevent miss-shots to the renal tissue and the improved ultrasound stone localization by an over-head type applicator. AMCD functions so that shock waves are generated only when the stone is in the focal region.
Forty patients with urinary tract stone were treated by this machine from October 1989 to March 1990 at the Department of Urology, Tohoku University School of Medicine. Almost all patients could be treated with an analgesic only. The X-ray film obtained three months after ESWL treatment showed that 23 cases (57.5%) were stone-free and 10 cases (25.0%) had stone fragments of less than 4mm. The succesful rate of ESWL using this machine was 82.5%, the result was better than that using other piezoelectric machines. No serious complication was observed, except mild hematuria in all cases. Milder postoperative hematuria suggested the decrease of renal tissue injury.
It is concluded that the treatment with this machine is safe and seems to be more favorable than the conventional ones.

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Acquired cystic disease of the kidney (ACDK) with carcinoma in the original kidney is one sensational complication of long-term hemodialysis patients. The rate of incidence is about forty times higher than that in the general population and especially high in the young male group.
From Dec. 1978 to Nov. 1990, we identified 8 patients of ACDK by computerized tomography (CT) scan, sonographic examination and angiography. Most patients had no clinical symptoms. The mean term of hemodialysis of the patients was 8yrs. And one patient was diagnosed as having ACDK and tumor 8yrs after kidney transplantation and then the kidney was removed. Their mean age was about 32 y. o. and the tumor size 1-3cm in diameter. All tumors were inside the renal capsule. (Robson-1) Pathohistologically, the tumor area consisted of mainly clear cell carcinoma and the epithelium of the cyst wall showed multi-layered or papillary hyperplasia.
In the 1st and 7th cases, simple nephrectomy was performed by transperitoneal approach. In the other cases it was performed by flank incision. All cases have had no recurrence and no metastasis of renal carcinoma.
The etiology of ACDK and carcinoma occurrence has not been clarified yet, but it is suggested that uremic metabolite and deficiency of immuno-surveillance may cause the pathological changes in kidney tissue.

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The incidence of occupational urothelial tumor and the accompanied problems were studied on the workers who had manufactured or handled aromatic amines at a certain chemical factory.
Twenty-five out of 398 dyestuff workers, who were examined at regular intervals, were found to have urothelial tumors and the incidence rate was 63%. The mean age at onset, the mean period of aromatic exposure and the mean latent period from the initial exposure until tumor development were 61 year-old, 7.2 years and 30 years, respectively.
A high incidence rate was found in the long exposed workers and the smoking group. The negative correlation was observed between the age of first exposure to carcinogens and the latent period. The workers who had been exposed to two or three kinds of aromatic amines had the highest incidence followed by those exposed to benzidine and those to alfa-naphthylamine. No urothelial tumor occurred in the workers exposed to beta-naphythlamine.
Ninety-four percent of the initial tumors were superficial and transurethral resection of tumors was performed as the initial surgery for the patients with bladder tumors. The recurrence rate in the bladder cavity after the surgery was 39%, which was almost the same rate as that of non-occupational baldder tumors, however, the recurrence rate in the upper urinary tract was high (26%).
The positive rate in the examination of urine cytology was 60% for initial tumors, 74% for recurrent tumors. The urine cytology was a significant method for the detection and monitoring of the patients with occupational urothelial tumors.
The 5, 10, 20 year-survival rates were 92%, 72% and 47%, respectively. Three out of eight cancer death patients died from double cancer. Malignant tumors in other organs than the urinary tract developed in 5.7% in the dyestuff workers. It is indicated that close observation is necessary for dyestuff workers.

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During a 5-year period between April 1984 and March 1989, we were unable to palpate 62 testes (56 child patients) at the time of diagnosis. An average of 10 months later, 51 testes (48 patients) still remained impalpable preoperatively.
Of the two imaging techniques, computed tomography and ultrasonography, the former is rather superior to the latter for verifying the existence of the impalpable testis. However, careful palpation under anaesthesia results in the accurate location of the testis more often than either of those two imaging techniques. On the other hand, as an aid in management of the impalpable testis, laparoscopy offers the most useful information for use in later surgery. This is because we are able to see the spermatic vessel and the vas deferens intraabdominally, in addition to the abdominal testis.
Thirty-six patients (39 testes), whose testes remained impalpable even under anaesthesia, underwent laparoscopy. In two cases, we were unable to perform laparoscopy successfully due to failed pneumoperitoneum. However, in all the other cases, the information which could be obtained was fully utilized during subsequent management. Of a total of 37 instances, 8 testes which were abdominal or just canalicular (pendulous) could be recognized. In addition, 4 more were found to have no spermatic vessel in the visual field and a further 4 had a vessel disappearing before reaching the internal ring. In the remaining 21, we were able to detect the spermatic vessel and the vas deferens.
At 59 instances of exploratory surgery, a mere 11 testes, among 27 testes, could be fixed to the bottom of the scrotum, resulting in scrotal dimples lasting for several months in 2 cases. Another 14 testes were placed in the upper scrotal region, while 2 were left in the groin region subcutaneously for lack of any alternative site.
Among the 31 instances where the testis could not be seen macroscopically, complete absence of testis, vessel, epididymis and vas deferens was recognized in 9, and pathological evidence of cicatrical processes, which was highly suspected as being the vanishing testis, was determined in 13.

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We studied whether detrusor-sphincter synergia during micturition was obtained by means of urethral anesthesia with lidocaine hydrochloride in five thoracic spinal cats and eight clinical cases with detrusor-sphincter dyssynersia. In thoracic spinal cats with detrusor-sphincter dyssynersia, urethral anesthesia produced detrusor-sphincter synergia, an increase in the maximum bladder pressure and a decrease in the residual volume. In clinical cases with detrusor-sphincter dyssynergia, urethral anesthesia produced detrusor-sphincter synergia or a decrease in the external urethral sphincter activities during micturition, and a decrease in the maximum urethral closure pressure and the residual volume. There were no remarkable changes of the external urethral sphincter activities during urine storage phase before and after urethral anesthesia in both spinal cats and clinical cases. These results suggest that urethral anesthesia blocks the urethro-urethral contraction reflex and secondarily activates vesico-urethral relaxation reflex. The block of urethral sensory nerves is thought to effectively treat detrusor-sphincter dyssynergia.

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Eleven patients with advanced bladder cancers (T2-4) were treated by intra-arterial CDDP infusion therapy and intratumoral Pt concentrations were measured. The following results and suggestions were obtained by comparing the histological effects and intratumoral Pt conc.
1) By calculating cross section areas from diameter of blood vessels, the blood flow distributions of tumor feeding arteries were estimated. Based on this distributions, the distributed CDDP dosage flowed into the tumor feeding arteries was calculated. The distributed CDDP dosage of histologically effective group (N=5, Grade IIb<by Shimosato histological evaluation) were significantly higher than that of ineffective group (N=6, Grade IIa>). (p<0.02, Student t test).
2) A good correlation was obtained between the revised intratumoral Pt value by distributed CDDP dosages and intervals from intra-arterial infusion therapies to operations. (r=-0.90, p<0.001). Intratumoral Pt conc. declined with a half life of 12 weeks.
3) Based on the declined linear line calculated from 2), theoretical intratumoral Pt conc. which was presumed value on day 0 (just after intra-arterial infusion therapy) were calculated. Theoretical Pt conc. of effective group were significantly higher than that of ineffective group (p<0.01), although no significant difference was seen between two groups compared by net intratumoral Pt conc.
4) A good correlation was seen between theoretical intratumoral Pt conc. and distributed CDDP dosage (r=0.89, p<0.01).
5) Five of 6 cases with above 5μg/g of theoretical intratumoral Pt conc. were histologically effective, and 5μg/g of theoretical Pt conc. corresponded to 31mg of distributed CDDP dosage.
6) From these results, it was suggested that an useful information could be obtained to decide the optimal CDDP dosage with getting histological efficacy from the blood flow distributions of tumor feeding arteries.

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The hCGβ-like immunoreactivity (IR-hCGβ) in the sera and urine of three patients with transitional cell carcinoma of the bladder was charcterized by enzyme-immunoassay which specifically recognized the hCGβ-related molecular species (whole hCG, free hCGβ and β-core fragment). There was a qualitative difference in IR-hCGβ between the serum and the urine in all of the patients. Free hCGβ was exclusively detected in the serum, whereas both free hCGβ and β-core fragment (β-CF) could be detected in the urine. Whole hCG could not be virtually observed in the sera and the urine from all the patients examined. The concentrations of urinary β-CF were consistently much higher than those of urinary and serum free hCGβ in all the patients. The immunohistochemical study was performed by using two kinds of the antibody against the core and the carboxyterminal portions of the hCGβ molecule. Immunoperoxidase staining was positive not only in the syncytiotrophoblastic giant cells but also in the trasnsitional cell carcinoma cells for both antibodies.
The present results suggest that free hCGβ is secreted from the tumor cells and metabolized into β-CF may provide a new index to detect a transitional cell carcinoma of the bladder.

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A case of primary carcinoid tumor of the right testis with metastases to the cervical and thoracic vertebrae and epidura is reported. A 53-year-old man was first recognized as being with dysthesia of the left arm and shoulder in April 1986. In June, 1987, he was admitted to the Neurology service, complaining of sudden occurrence of abasia. Myelography and computerrized tomography demonstrated an epidural mass and several high density areas in the vertebral bodies of Th₁ and Th₂. The patient underwent laminectomy from C₇ to Th₂. At operation, the neurosurgeons noticed a tumor mass in the right scrotum and requested our consultation. Thus right high orchiectomy was performed. Pathological examination including Grimerius' and Fontana-Masson's stain revealed carcinoid tumor of the right testis associated with metastases to the spinal columm. Postoperativery, tumor maker studies revealed elavation of blood 5-hydroxytryptophan and marked increase of urinary 5-hydroxyindoleacetic acid excretion. They showed remarkable decreases after a course of PVB chemotherapy. The patient has been under our observation as an out-patient for the past 27 months with metastases.
This is the first case of primary carcinoid tumor of the testis with metastases so far reported in the domestic literture.

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The HTLV-I infection was endemic in south western Kyushu. This human T-lymphotropic virus type I may cause HTLV-I associated myelopathy (HAM), a neurological disease characterized by a spastic paraparesis. And one of the minor diagnostic features of HAM is the presence of cystorectal disturbance. We experienced 35 HAM patients with a neurogenic bladder. A gradually progressive contracted bladder was observed in 3 of them. The main pathological finding in these patients was submucosal infiltration of lymphocytes.
These findings suggest that immunologic mechanisms account for the development of bladder lesions.

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