This report deals with the histologic and gross anatomy of the upper urinary tract (calyces, pelvis, and ureter) as well as the nerve supply to this region. It also covers the physiological transport of urine from the kidneys to the bladder, which is reviewed on the basis of experimental and clinical studies. A pacemaker system present in the proximal calyces has been found to have an important physiological role in urine transport. However, clinical experience has shown that urine transport is not affected by surgery such as pyeloplasty and pyelolithotomy which impairs the activity of this pacemaker. Electron microscopic and histochemical studies as well as the maintenance of urine transport after renal grafting suggest that the nerve supply to the upper urinary tract is not dominant in regard to this function.
This study also investigated urinary transportation in the presence of urinary tract obstruction due to various diseases, and demonstrated that urine is also conveyed by gravity and not solely by ureteric peristalsis. The use of internal stenting and percutaneous urinary diversion thus appears to be reasonable. Although the detailed etiology congenital hydronephrosis is still unknown, there is no doubt that it involves dysfunction of the ureteropelvic junction, since urine transport is improved by the endoscopic or surgical formation of a physiological tunnel at this junction which can regulate the volume of urine transported according to urine output. It is important for studies of upper urinary tract function to be conducted in close relation to clinical practice and not to simply be confined to esoteric experimental situations.

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Immunohistochemical and ultrastructural studies were performed on cases with hyperparathyroidism. The relationship between histology and cell activity in hyperfunctioning parathyroid glands was studied. Furthermore, the synthesis-secretion process of parathyroid hormone (PTH), which has been more or less elucidated biochemically, was studies by a morphological means. The subjects employed in the present study were 23 cases of primary hyperparathyroidism (PHPT) and 31 cases of secondary hyperparathyroidism (SHPT). Based on the results of the immunohistochemical study using anti-PTH antibody, the histology of the parathyroid gland was classified into 4 types: type A; sporadic cells showing intense yellowish brown staining in their cytoplasm, type B; glandular cells showing intense yellowish brown staining specifically in their cytoplasm, type C; as a whole the cells were weakly stained, but intensely stained cells were absent, and type D; only the cytoplasm of large cells showed uniform and intense yellowish brown staining. In both PHPT and SHPT, type C constituted about 80%. On the other hand, all water clear cell hyperplasia in SHPT showed type D staining. Electron microscopic studies performed on the hyperparathyroidism revealed that the rough endoplasmic reticulum and Golgi apparatus, which are related to the synthesis of PTH, were well developed. Immunoelectron microscopy revealed that only the secretory granules were specifically stained with the anti-PTH antibody. This finding suggests that PTH becomes active once it reaches the secretory granule.

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The relationship between tissue morphology and cellular activity in hyperparathyroidism was investigated by 2-color flowcytometry and an immunohistochemical technique using anti-parathyroid hormone (PTH) antibody. A total of 21 cases were employed, which included 8 cases of primary hyperparathyroidism (PHPT) and 13 cases of secondary hyperparathyroidism (SHPT). The results of 2-color flowcytometry on DNA ploidy pattern revealed that all the 8 PHPT cases were diploids. In SHPT, however, there were 9 diploids (69.2%), 2 tetraploids (15.4%) and 2 aneuploids (15.4%). Electron microscopic studies were performed on the diploid 2c and 4c peak cells, which were obtained by individually sorting the cells from each cycle. As a result, these cells were found to possess well developed rough endoplasmic reticulum and Golgi apparatus. These cells in general showed weak immunostaining. Furthermore, numerous secretory granules were found in the cells obtained from abnormal peak of aneuploid when compared to diploid cells. In tetraploids and aneuploids, the darkly stained cells and glandular cells showed intense immunostaining. These cells contained numerous secretory granules and they were thought to possess high cellular activity.

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Immunotherapy, consisting mainly of interferon (IFN) therapy, has been used to treat renal cell carcinoma refractory to radiotherapy and chemotherapy ever since IFN was reported to be effective against renal cell carcinoma in 1982. The efficacy of IFN is low, with the response rate being only about 20% and the method and duration of its administration have yet to be established. Using viable tumor cells obtained at nephrectomy, we discovered that IFN-α induced killer cells have a cytocidal effect on autologous renal cell carcinoma cells and that assaying the cellular immunity of the peripheral blood lymphocytes of 25 patients with renal cell carcinoma, using ACHN derived from human renal cell carcinoma as the target cells, is useful as a monitoring method during IFN-α therapy. Augmentation of the cytotoxicity of peripheral blood lymphocytes in response to administration of IFN-α was observed in all 25 cases. Cytotoxicity was activated to 5-426 LU compared with the control value of 1 LU or less before IFN therapy, when autologous renal cell carcinoma cells were used as the target cells. Cytotoxicity for ACHN cells in the control value before IFN-α therapy and 4 weeks after the institution of IFN-α administration and autologous tumor lysis in the induction assay were more strongly correlated than in the case of K562 cells. A strong correlation was also found between cytotoxicity for ACHN cells in the induction assay and 4 weeks after the institution of IFN-α administration. Thus, when monitoring immunotherapy with IFN-α, measuring the cytotoxicity using ACHN cells may be more useful than using NK-sensitive cells, such as K562 cells, as the target. No significant difference was detected between the degree of cytotoxicity against autologous tumor cells and pathological findings (Robson's stage 1 & 2 and 3 & 4, Grade 1 and 2 & 3, cell type and lymphocyte infiltration). A significant difference was found, however, between autologous tumor lysis and the cytotoxicity of patients's peripheral blood mononuclear cells (PBMNCs) associated with tumor recurrence. Recurrence was assessed in relation to cytotoxicity for ACHN cells in control and 4 weeks after the institution of IFN-α administration, and a significant difference at the 1% level was found. The above findings indicate that measuring LAK activity using ACHN cells as the target cells is useful as a monitoring method during IFN-α immunotherapy. The results above suggest that a decrease in LAK like activity is likely to lead to progression or recurrence of cancer, and that raising this LAK activity with BRMNCs will prevent recurrence. Precursors and effector cells of IFN-α induced killer were characterized by cell sorting and measuring cytokines in medium with PBMNCs and IFNα. The CD3 (-) CD16 (+) subsets had the highest level of lytic activity against NK-resistant ACHN target cells without increase of LL-2. The above findings indicate that the CD3 (-) CDs6 (+) subsets are the precursors and effector cells of IFN-α induced killer.

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The results of treatment by orchiectomy and radiotherapy for stage I testicular seminoma are excellent with cure rates exceeding 95% and relapse rates less than 5%. However, after the development of successful surveillance programs for stage I nonseminomatous testicular cancers, the role of radiotherapy has been questioned by some authors and they proposed a “surveillance policy” for these patients. The purpose of this study was to determine the percentage of patients cured by orchiectomy alone, percentage who ultimately required therapy for occult metastases, site of recurrence, and over-all cure rate and treatment morbidity. And these data were compaired with those of adjuvant radiotherapy group retrospectively. Twenty seven patients were treated with adjuvant radiotherapy (RT group). Since 1986, 23 patients with stage I testicular seminoma entered the “surveillance only” protocol at our institution (S group) with a follow-up between 14 and 70 months (median 43 months). Informed consent for the policy of surveillance was obtained. Follow up consisted of physical examination, determination of serum tumor markers and chest X-ray bimonthly for 2 years, every 3 months for 1 year, every 6 months for 2 years and annually thereafter to 10 years. CT scans were performed every 4 months for 3 years, every 6 months for 2 years. Two patients in S group (8.7%) relapsed at 4 and 7 months after orhiectomy with nonbulky retroperitoneal disease (less than 5cm indiameter), whereas only 1 (3.7%) irraddiated patients did so after 4 months. Those 2 pts were treated with PVB therapy and were disease-feee 20 and 32 months after chemotherapy. Further follow-up is necessary to determine ultimate survival, because a risk for later relapse exists. But low relapse rate and excellent survival with good results of chemotherapy in the recurred patients encourage the policy of surveillance.

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We performed combined uroflowmetry and external sphincter electromyography in 108 patients (87 males and 21 females); 16 serving as normal controls, 49 with benign prostatic hyperplasia, 16 with overactive type of neurogenic bladder, 27 with underactive type of neurogenic bladder. Urinary flow pattern was classified into 5 categories. All of urinary flow patterns of normal controls showed pattern A which had the form of a bell. EMG showed complete suppression during micturition followed by a few intermittent increases in amplitude. Urinary flow patterns of BPH patients were distributed widely from pattern A to E. Intermittent increases in EMG amplitude during a late phase of micturition were characteristic in patients with BPH. We must pay attention to sex differences to evaluate urinary flow pattern because it could be influenced by abdominal pressure such as stressing or Créde maneuver in female patients with an underactive type of neurogenic bladder.

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We produced polyclonal antibody against human androgen receptor (hAR) by means of immunizing a rabbit with hAR fusion protein that was expressed in E. coli.
In Western blot analysis, this antibody, NH27, recognized two protein bands at the site of 110kDa and 107kDa in androgen-independent human prostatic cancer cells (PC-3), transfected with full-length hAR expression plasmid DNA and at the site of 114kDa and 108kDa in androgen-dependent human prostatic cancer cells (LNCaP).
In immunohistochemical examination with NH27, the nuclei of epithelial and stromal cells in human benign prostatic hyperplasia were mainly stained as did with AN1-15, commercially available hAR monoclonal antibody. Titer of NH27, however, was about five times more high than that of AN1-15. In prostatic cancer cells the nuclei were stained with NH27 as did with AN1-15. Intensity of staining was various between the nuclei of cancer cells.
The polyclonal antibody, NH27, produced in the present study is useful in investigating the characterization of AR in androgen-dependent and -independent prostatic cancers.

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To investigate the characteristics of adrenoceptors of the proximal urethra in female rabbits, we performed the in vitro isovolumetric urethral pressure study and isometric study with three parts of muscle strips of the proximal urethra (whole layers, inner layers and outer layers).
Both alpha-1 and alpha-2 agonist caused dose dependent response in in vitro .isovolumetric pressure study as well as in vivo study. However, the response of alpha-2 agonist in in vitro was small in magnitude compared to in vivo study, suggesting the influence of permeability of drugs from serosa to mucosa in in vitro whole urethra study. The response of the strips of inner layers to alpha-1 agonist is almost the same as that of outer layers and whole layers, while the response of inner layers to alpha-2 agonist is almost twice as that of other layers. These findings are suggestive of predominance of alpha-2 adrenoceptors mediating contractions in the inner layers of the proximal urethra in female rabbits. Alpha-2 adrenoceptors which probably are distributed in mucosal and submucosal layers may have an important role in the mechanism of urinary continence in female rabbits.

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In 29 children with unilateral hydronephrosis who underwent surgery at the age from 2 months to 15 years (27 patients with ureteropelvic junction stenosis and 2 with obstructive megaureter), β₂-microglobulin (β₂-MG), α₁-microglobulin (α₁-MG), N-acetyl-β-D-glucosaminidase (NAG) and albumin were determined in renal pelvic urine from the hydronephrotic kidney to evaluate renal dysfunction accompanying urinary tract obstruction. Moreover, it was also examined whether it is possible to predict functional recovery of the hydronephrotic kidney on the basis of relation between these indices and pre- and postoperative changes in renal dimercaptosuccinic acid (DMSA) uptake rate.
The values of β₂-MG, α₁-MG, NAG and albumin in urine from the renal pelvis were high in 48%, 50%, 75% and 83% of the patients, respectively. Among the patients of one year and up, those with low preoperative DMSA uptake rate tended to have high values of β₂-MG, α₁-MG and NAG. On the contrary, albumin level was high in 78% of patients who had good preoperative DMSA uptake rate.
With respect to the relation between pre- and postoperative changes in DMSA uptake rate and each index, β₂-MG and α₁-MG were high in 73% and 62% of patients who exhibited a marked increase in postoperative DMSA uptake rate. In patients without a remarkable change in DMSA uptake rate before and after surgery, on the other hand, the values of these were high only in 25% and 36%. In contrast, NAG and albumin tended to be high as a whole, regardless of the changes in DMSA uptake rate before and after surgery.
These findings indicate the possibility of the onset of glomerular dysfunction in advance of tubular dysfunction in patients with hydronephrosis. It was also suggested that recovery of renal function on the hydronephrotic kidney can be predicted to some degree by preoperative β₂-MG and α₁-MG.

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Of 160 newly diagnosed cases of prostate cancer during last 11 years, six (3.75%) had a prior subcapsular prostatectomy. Digital rectal examination in these six cases revealed a significant prostatic abnormality and multiple bone metastases were showed. Histological examination by stepsection technique was done retrospectively using surgical materials from subcapsular prostatectomy. Two cases of incidental carcinoma were detected histologically. One showed stage A1 and another stage A2. Continuous observation should be performed after prostatectomy, even if the surgical specimens revealed no carcinoma.

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A chemosensitivity test was carried out on superficial bladder cancer using the dye exclusion assay for the purpose of screening chemosensitive drugs for prophylactic intravesical chemotherapy.
Bladder cancer cells of each patients were incubated, in vitro, in the presence of adriamycin, (2″R)-4′-0-tetrahydropyranyladriamycin, mitomycin C, pepleomycin and 4′-epi-adriarnycin (500μg/ml) at 5%, CO₂, 37°C for 2 hours.
The cytotoxic effect of the drugs was evaluated by the ratio of stained cells by trypan-blue. The most effective drug was instilled postoperatively into the bladder 3 times for the first week, and every 2 weeks during the following 14 weeks. In 18 patients followed more than 4 months the prophylactic effect was evaluated. Fifteen of the 18 patients completed the protocol, but the remaining 3 patients failed to complete to the instillation because of severe irritability of the bladder.
Tumor recurrence was demonstrated in two patients. Non-recurrence rates of tumors at 12 and 24 months were 93.8% and 82.0%, respectively.
These results suggested that this rapid and handy assay was useful for the purpose of screening chemosensitive drugs for the intravesical chemoterapy.

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Tiropramide, a tyrosine derivative, has an antispasmodic effect on the gastrointestinal smooth muscles and it is suggested that the effect is mediated by cAMP. Therefore, we studied the effects of tiropramide on the lower urinary tract smooth muscle functions.
In animal experiments, the effects of tiropramide on vesicourethral smooth muscle contraction were investigated and cAMP and cGMP levels following tiropramide administration were measured in the vesicourethral and gastrointestinal smooth muscles. In clinical trials, five healthy volunteers and five patients with neurogenic bladder dysfunction were treated orally with tiropramide 300mg a day for two weeks and examined for urodynamic parameters before and after tiropramide treatment. Tiropramide significantly inhibited contraction of the vesicourethral smooth muscle and the inhibitory effect upon the bladder was remarkable particularly at the lower concentrations. Tiropramide remarkably increased cAMP level but it had no effect on cGMP level in the bladder at the lower concentrations. Tiropramide at the lower concentrations did not affect cAMP and cGMP levels in the smooth muscles of the urethra, stomach and intestines. In the patients with neurogenic bladder dysfunction treated with tiropramide orally, the urine volume at first desire to void and maximum bladder capacity increased significantly, but the volume of residual urine did not significantly increase. In the healthy volunteers, there were no significant changes in urodynamic parameters.
These findings indicate that tiropramide relaxes the urinary bladder smooth muscle via cAMP to increase the urinary bladder capacity.

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There were 970 patients who were diagnosed as having genitourinary cancer at Yamagata Prefectural Central Hospital between 1975 and 1990, and of whom 100 cases (10.3%) had multiple primary malignant neoplasms in addition to their genitourinary cancer. They were compared with 220 patients having single genitourinary cancer and 274 having benign prostatic hypertrophy without past histories of cancer. The genitourinary organs involved with cancers included the prostate (50 patients), urinary bladder (43 patients), ureter or renal pelvis (15 patients) and kidney (7 patients). In the prostate cancer, the incidental carcinomas occupied 30%. The other organs accompanying the genitourinary cancers included the stomach, lung and colon.
In patients of multiple primary cancers, single genitourinary cancer and benign prostatic hypertrophy, positive family histories for cancer were observed in 40.0%, 37.7% and 33.2%, respectively, with no significant difference between these groups. Histories of smoking were observed in 54.0%, 38.2% and 34.3% respectively, with significant difference between the multiple primary neoplasm patients and the other 2 groups (p<0.01). There were two cases in whom the second cancer could be possibly caused by the exposure to radiation for the first cancer. No oncotherapeutic drugs or occupational exposure could be seriously suspected of the cause of the second cancers in the present cases.

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From August, 1989 to July, 1991, we carried out transabdominal ultrasonograpy for screening of abdominal and pelvic disease in regular health check-up at Mito Saiseikai Hospital. Of 5, 706 screened examinees were ultrasonographically suspected of bladder tumor and subsequently received a cyctoscopic examination. Cystoscopy confirmed bladder tumors in 9 of the 11 patients. Eight of the 9 cases showed no urological symptoms, while the remaining 1 case showed microscopic hematuria objectively. All of the 9 cases revealed a transitional cell carcinoma of low grade and low stage. The smallest tumor detected by ultrasonography was 5mm in diameter. Transabdominal ultrasonography proved useful for diagnosis of the bladder tumor at its early stage in the mass screening. Therefore, it is recommended to perform lower abdominal ultrasonography as a routine examination of the multiphasic health testing and services.

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We studied 48 patients who underwent renal transplantation during the period of July, 1983 and May, 1988 and were free of episodes of neurogenic bladder in the past history. The average age was 27.6±9.5 years old, and mean 24 hour urine output was 249±396ml.
Cystometry was performed preoperatively in 39 patients. The average bladder capacity decreased to 112±69ml (n=39) and only 29.0% of the patients exhibited normal compliance (>50ml/cmH₂O) (n=35).
Biopsy of the bladder wall was performed in 22 patients during the operation. The purpose of this study is to ascertain what physiological and pathological change may occur in the disused human bladder with low capacity and low compliance. Response of muscle tissue to carbachol were examined in 7 specimens and that of isoproterenol were examined in 9 patients. The minimum concentration of carbachol at which muscle contraction was exhibited did not differ from that of the control group.
The minimum concentration of isoproterenol at which autonomous muscle activity was completely inhibited increased in cases with decreased 24 hour urine output. ED50 value of inhibition by isoproterenol to the muscle contraction during field stimulation exhibited that the inhibitory action of isoproterenol on muscle contraction declined in the cases with decreased 24 hour urine output.
Pathological change of the smooth muscle layer were observed in 17 patients. Muscle cell atrophy was recognized in 29.4% of the patients and vacuolar change of smooth muscle cells was seen in 64.7%. Muscle bundle atrophy was observed in 23.5% and fibrosis was seen in 52.9%.

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Among 24 patients with confirmed left renal bleeding, 11 were diagnosed of having nutcracker phenomenon (NP) on the basis of the results of renal venography and pullback pressure from the left renal vein to the inferior vena cava. Renal CT scan was performed for these 11 patients, and its usefulness as a means of diagnostic analysis was studied. The following results were obtained.
1. The left kidney was scanned at 5-mm intervals. The mean distance between the anterior surface of the abdominal aorta (Ao) and the posterior surface of the superior mesenteric artery (SMA) was 4.5±0.6mm in the NP group, while it was 13.9±6.4mm in the control group (p<0.01).
2. Regarding the morphology of the left renal vein (LRV), tapering dilatation, i. e., funnel-like dilatation, from the left side of Ao was seen in the NP group. In the control group, the left renal vein showed a club-like shape continuing to the inferior vena cava and showed no dilatation.
3. Vascular structures indicative of collateral vessels were observed around the LRV in the NP group.
If renal CT scan is performed at 5-mm intervals, the following CT finding are thought to be indicative of the nutcracker phenomenon; (1) a distance of 5mm or less between Ao and SMA and (2) tapered dilatation of the LRV. This study suggests that renal CT scan is useful for diagnostic analysis of the nutcracker phenomenon.

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MR angiography using a gradient-echo, pulse sequence FLASH (fast, low-angle shot) method during breath-hold with a “MAGNETOM H-15” scanner (1.5 Tesla; Siemens Medical System) was performed on 27 patients with renal tumor at our clinic between February 20, 1990 and September 30, 1991 and we studied to evaluate its usefulness.
Of these 27 patients, 22 patients including one patient under hemodialysis treatment had renal cell carcinoma and one patient had oncocytoma pathologically proven from the excised specimens. The remaining four patients including two patients associated with inferior vena caval tumor thrombus were clinically diagnosed as renal cell carcinoma based on the result of imaging examinations such as excretory urography, ultrasonography, computed tomography and conventional angiography. However, they could not be operated on because their tumors were too advanced.
By reconstruction of the data of consecutive coronal scans of the abdomen with Maximum Intensity Projection (MIP), the MR angiography could in all cases delineate abdominal blood vessels such as the abdominal aorta, inferior vena cava and renal arteries and veins simultaneously without any intravenous contrast materials. Our present study revealed that MR angiography has some advantages, especially with regard to preoperative angiographic information about the abdomen of patients with renal tumor. That is, MR angiography can delineate many kinds of arteries and veins of the abdomen simultaneously and in a broader range, as well as it can be performed on the patients with hypersensitivity to iodinated contrast materials or renal insufficiency in a usual fashion. Furtheremore, our present study suggested that the MR angiography is useful for assessing the presence and extent of inferior vena caval tumor thrombus of renal cell carcinoma and for clearly distinguishing tumor lesion and the surrounding normal renal parenchyma in the patients with renal tumor.

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To clarify the mechanism for reflux nephropathy to progress to irreversible or marginal renal damages, this study was conducted. We studied 57 cases of VUR in children followed-up more than 3 years after anti-reflux operation and investigated the correlation between changes of urinary protein excretion and clinical data.
In general, proteinuria is the most important feature heralding a poor outcome in patients with reflux nephropathy. 9 cases (15.8%) in our series were positive of proteinuria postoperatively. In this positive group, scarring grade had been higher and renal size had been smaller significantly before operation than in other group. From these facts, it would appear that prognosis of refluxing kidney was determined by volume of remnant kidney, and glomerular hyperfiltration of remnant nephron would affect the progression of reflux nephropathy.
According to the relationship between changes of urinary protein excretion and scarring grade or renal size, poor prognosis (proteinuria will worsen) would be more than 5 of scarring grade score (cumulation of bilateral scarring grades, Smellie's a=1, b=2, c=3, d=4) and less than -4S. D. in cumulative renal ratio preoperatively. Then border to progression in reflux nephropathy was between 2 and 4 of scarring grade score, and between -2S. D. and -4S. D. in cumulative renal ratio. In this marginal progression urinary protein excretion and GFR were found to be 100-300mg/day and 60-75ml/min, respectively.

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We established a new cell line (TC-1) from primary site of a renal cell carcinoma (RCC) patient. Its doubling time in tissue culture was 20 hours at 45th passage and mycoplasma contamination test was negative. The karyotypic analysis demonstrated a human karyotype with a modal number of 70. A consistent chromosomal abnormality was noted such as No. 4 monosomy, No. 7 trisomy and a loss of Y chromosome. Electron microscopic examination showed a brush border, vacuoles and abundant glycogen granules in the cytoplasm, which was compatible with RCC cells.
This cell line was transplantable to nude mice and the grown tumor closely resembled the original tumor, i. e. clear cell type and hypervascularity. High titer of interleukin-6 (IL-6) was detected in the supernatant of TC-1 cell culture (approximately 5ng/ml) as well as in sera of nude mice bearing this tumor (260pg/ml). Exogeneous IL-6 did not enhance the TC-1 cell proliferation as determined by cell count. Flow cytometric analysis could not demonstrate the existence of IL-6 receptor on the cell surface.
These results suggested the produced IL-6 did not act as an autocrine growth factor in the cell line. Additional IL-1 alpha to the culture medium induced 3-4 times higher concentration of IL-6 in the culture supernatant compared with that of non-stimulating cells, while exogenous TNF alpha did not stimulate IL-6 production.

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Kock and associates have made a major contribution to the ideal continent urinary diversion by developing a method for creating a continent internal reservoir for urine using the ileum. However, substantial problems have unfortunately resulted due to early and late postoperative complications. In an effort to further elucidate this problem, we herein summarize the incidence of early and late postoperative complications following a series of technical modifications made in patients who underwent Kock continent ileal reservoir construction from our ongoing experience to develop more suitable modifications of this procedure.
From January 1985 through December 1991, 47 patients have undergone Kock pouch construction for continent urinary diversion. Our basic technique utilized in this study was slightly modified from that described by Skinner et al. Based on our earlier experience, several changes in the technique were made. One major change is that one row of surgical staples fixes the created nipple to the back wall of the reservoir for the efferent limb, and a further 3-cm longitudinal mucosal incision is made through the outer layer of the intussuscepted ileal nipple and the opposite wall of the reservoir which are sewn to the reservoir edge.
A total of eleven patients (11/47) suffered one or more early surgical complications. A 31.8% (7/22) morbidity with an operative mortality rate of 4.3% (2/47) and a 16.0% (4/25) morbidity were observed in the early phase and late phase, respectively. Prolonged urinary leakage from the ileal reservoir and/or through a pin hole in the afferent limb made by surgical staples was observed in six patients (27.3%) in the early phase. The urinary leakage was significantly reduced to 4.0% (1/25) by adequate urine drainage directly from the kidneys utilizing a single-J ureteral stent in late phase cases. The difference was statistically significant (p<0.05).
A total of 17 patients (37.8%) developed one or more late complications during a mean follow-up period of 33.8±21.1 months.
During a mean follow-up period of 48.6±21.3 months in 20 patients of the early phase excluding two cases of surgical mortality, efferent limb malfunction resulting in urine leakage from cutaneous stoma and/or difficulty in catheterization was observed in seven out of 20 patients (35.0%). Also, afferent limb malfunction resulted in urinary reflux and/or stenosis of the efferent limb was evident in three patients (15.0%) in the early phase. Moreover, three patients (15.0%) developed stone formation in the ileal reservoir surrounding exposed surgical staples or migrated nonabsorbable materials such as the collar.
On the other hand, during a mean follow-up period of 21.9±11.4 months in 25 patients of the late phase, observed were 8.0% (2/25) efferent limb malfunction, 8.0% (2/25) afferent limb malfunction, and 8.0% (2/25) stone formation in the reservoir.
These results indicate that early and late complications of Kock pouch urinary diversion are significant. Thus, whether or not the Kock pouch will prove to be clearly technically superior to other forms of urinary diversion remains unresolved. Further technical modifications based on fundamental studies should clearly be undertaken to improve the method for constructing urinary diversion.

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A 32-year-old man who had bilateral non-palpable testis underwent microsurgical orchidopexy of the right abdominal testis. Inferior epigastric vessels were used for the recipient vessels. Ischemic time during the operation was 40 minutes.
Postoperative doppler readings revealed excellent blood flow to the testis, and HCG-stimulating test revealed good response. Now, 2 years after surgery, no sign of atrophy is found.

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We report a case of Noonan syndrome with neurogenic bladder. The patient was a 33-year-old man with a chief complaint of difficulty in urination, urinary frequency, and incontinence of urine. He had also various malformations, as deformities of the face, skull and hard palate, webbed neck, nail abnormality, edema of the lower extremities, contraction of visual field, deafness, malrotation of the intestine and so on. The case was diagnosed as Noonan syndrome because his karyotype of chromosome was 46, XY. Malformations of the urogenital organs were mild malrotation of bilateral kidneys, a right renal cyst, left cryptorchidism and pseudo phimosis. The uroflowmetrogram of the case showed a saw-like and flat pattern, with urination starting by tapping lower abdomen by himself. The cystometry and electromyogram of the external sphincter revealed neurogenic bladder with uninhibited contraction and detrusor-external sphincter dyssynergia. This is the first case of Noonan syndrome with neurogenic bladder.

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Tranilast, an antiallergic drug, is well known as a causal drug of cystitis, and a report is made here of our exeperince of 1 case of drug-induced cystitis ascribable to ketotifen fumarate.
A 13-year-old female had been taking antiasthamatic drugs orally since the onset of athmatoid attacks, from age of 5. The attacks intensified from the age of 12, because of this she began to take various antiathmatic drugs orally. She visited another hospital, due to pollakisuria, in November, 1990, and received treatment for cystitis. However, the symptoms were not alleviated, and she visited our department on January 9, 1991. By urinalysis, large counts of leukocytes and erythrocytes were observed in a visual field of the sediment. Remarkable reddening was observed over the urinary bladder in the patient's cystoscopic findings. Treatment was given at our department, on an outpatient basis, with various antibacterial drugs for approximately one month, but her symtoms were not alleviated, pollakisuria and aseptic pyuria persisted. The patient had never taken tranilast; oral intake of ketotifen fumarate and saibokutou was discontinued on February 13, due to a suspicion of drug-induced cystitis, and her symtoms subsequently disappered. On February 22, she took ketotifen fumarate orally again, on her own, due to asthmatoid attack, and her symtoms returned. The oral intake of ketotif en fumarate was again discontinued, and alleviation of the symptoms and normalization of the urinary findings were again observed. As a result, lymphocyte stimulation tests on all the drugs the patient had ever taken, only ketotifen fumarate turned out to be positive. Based on this, the case was considered to be drug cystitis due to ketotifen fumarate.
Our case is the first one, as far as we know, in the literature in Japan and overseas.

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