Despite recent advance of prenatal ultrasonography leading to an increase in the detection of various fetal urological abnormalities, a lot a unresolved problems exist surrounding their diagnosis and management. It is unclear whether an antenatal intervention helps to preserve the renal function, because little has been known about the nephrogenesis of the human fetal kidney associated with congenital obstruction. To find the normal development of the kidney, we studied the fetal kidneys in relation to the gestational weeks.
Of all fetuses autopsied in the Department of Pathology of our Institute from 1982 to 1992, 87 kidneys from 60 fetuses which showed no abnormalities of the urinary tracts on macroscopic inspections were reviewed. Microscopic examination was done to define the radial glomerular count (RGC) and glomerular size according to gestational weeks.
Nephrogenic zone was observed in all kidneys before 34 weeks of gestation, and disappeared in all kidneys after 37 weeks. The RGC increased steadily with gestational weeks, and gradually reached a platean of around 12 counts at about 36 weeks. The RGC was not influenced by the intrauterine fetal growth. The glomeruli were arranged in the uniform fashion on the medullary ray with the smallest in the most superficial cortex and the largest in the juxtamedullary zone. The superficial glomerili remained at the surprisingly same size up to birth. Juxtamedullary glomaruli showed no significant differences before birth, either.
Based on the present studies to know the normal standard of renal development, pathological changes are possible to define. It was thought that an understanding of the morphological cheracteristics of fetal kidneys would give clues to elucidate pathogenesis of abnormal kidneys.

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It is still unclear whether prenatal decompression of the dilated urinary tracts can preserve renal development and function. Following the previous report on the relationship between the nephrogenesis and the gestational weeks in normal fetuses, we studied the hydronephrotic kidneys to find the histological background of the fetal treatment.
Of the fetuses autopsied in the Department of Pathology of our Institute from 1982 to 1992, 32 kidneys from 21 fetuses associated with dilatation of the upper urinary tracts irrespective of the presence of urethral obstruction on macroscopic inspections were reviewed. The underlying disorders causing hydronephrosis included urethral obstruction in 7, vesicointestinal fissure in 3, hydrometrocolpos in 2 and double ureter in 1. The etiology of the hydronephrosis was not clarified in another 8. The position and configuration of the ureteral orifices were not described in the autopsy reports.
Microscopic eiaminatin was done to define the radial glomerular count (RGC), presence or absence of the nephrogenic zone, cortical cysts and dysplastic elements, changes of the collecting tubules and interstitium. Of the kidneys 19 had cortical cysts of various sizes. In some kidneys, the normal cortex was mixed with pathological segments where there were subcapsular small cysts and tubular dilatation. Nephrogenic zone, which was observed in specimens of 33-weeks fetus with moderate hydronephrosis, was already missing by 28 weeks in severe hydronephrosis. Collecting tubules were dilated in 12 kidneys with mild to moderate hydronephrosis. Tubular atrophy and increase in the interstitium were seen in 12 kidneys, eleven of which were of the fetus over 30 weeks. Ten kidneys from 6 fetuses showed such features of renal dysplasia as primitive duct and/or metaplastic cartilage. All fetuses that had dysplastic kidneys were over 30 weeks of gestation. There was no apparent evidence of dysplasia in specimens of around 20 weeks. In severe hydronephrosis, RGC was significantly fewer than normal at around 30 weeks, although it was almost the same as the control before 20 weeks.
The recoverability of renal development and function in the fetal hydronephrosis depends on whether the nephrogenic zone persists and renal dysplasia is completed. From our studies both on the normal fetal kidneys and hydronephrotic kidneys, we can conclude that prenatal intervention be considered until around 20 weeks of gestation.

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Six kinds of assay kits based on different detecting principle for PSA were evaluated. Polyclonal antibody was used in 2 kits (Eiken, Markit-F) and monoclonal antibody in 4 kits (Ball Elsa, Delfia, Markit-M, Tandem-R). To evaluate their characteristics, sera of 12 female patients, 5 prostatectomized patients and 2 high stage prostate cancer patients were measured by these kits. On the female sera the polyclonal assay kits yielded values higher than the defined minimal sensitive value, but the kits of monoclonal antibody detected nothing. Dilution test of sera with high PSA level showed satisfactory results in every kit but the values of 6 assays were different to each other. For monitoring the recurrence or recrudescence of the prostatic cancer, the monoclonal antibody kits may be preferable to the polyclonal antibody kits. These results showed that we must understand the characteristics of every assay kit which is used clinically.

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Attempting to establish more objective grading system of renal cell carcinoma, I studied 104 renal cell carcinoma tissue samples from 52 cases by immunohistochemical technique employing the anti-Leu M1 antibody and the anti-EMA antibody. These 52 cases could be classified into 4 groups according to the reactivity for Leu-M1 (L) and EMA (E), i. e., L+E-, L+E+, L-E+, and L-E-. Considering the expression pattern of Leu-M1 (L) and EMA (E) in normal adult/fetal renal tissue, I speculated that normal cellular characters of the proximal tubules were preserved most well in the L+E- carcinomas, and gradually lost in the L+E+ carcinomas, L-E+ carcinomas, and L-E- carcinomas in this order.
The reactions L+E-, L+E+, L-E+, and L-E- were designated immunohistochemical grade 1, 2, 3, and 4, respectively. In most cases, the immunohistochemical grade corresponded with the conventional histologic grade.
However, dissociation of more than 2 steps of the grade was observed in some cases. I analyzed the cases with such dissociation and discussed usefulness of the immunohistochemical grading system (as a supplemental role for histologic grading) for renal cell carcinoma.

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We experienced transurethral teflon paste injection for 12 refluxing ureters of 7 patients with neurogenic bladder dysfunction. Preoperative assessment of cystometry showed hypoactive bladder function with normal bladder compliance in 4 patients, and low compliance bladder (<10ml/cmH₂O) in 1. Voiding cystography revealed grade 1 reflux in 2 ureters, grade 2 in 3, grade 3 in 2, grade 4 in 2, and grade 5 in 2. One ureter did not show reflux. Zero point two to 1.6ml of teflon paste was injected on each ureter under cystoscopic observation. These patients were followed for a mean of 25.1 months. Reflux disappeared immediately after the first operations in all patients, however recurrence was observed in 2 ureters, in which improvement of reflux (grade 5 to 2) was achieved in 1 ureter but no improvement (grade 2 to 2) in another. Pyelonephritis was not encountered in any patients after injection. No complication was observed through the follow up period. In conclusion, we advocate that endoscopic teflon paste injection is a useful alternative to ureteroneocystostomy in the treatment of reflux in patients with neurogenic bladder dysfunction.

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Forty-two prostatic carcinoma patients with clinical stage A2, B or C underwent pelvic lymphadenectomy (limited node dissection) as a staging operation.
The relationships among the presence of lymph node metastasis, tumor marker levels and histological findings of primary lesions were examined in 42 patients. Pelvic lymph node metastasis was noted in 18 (43%) of the 42 patients. The incidence of lymph node metastasis tended to be correlated with differentiation and Gleason's primary lesion sum.
The preoperative PSA and PAP levels were significantly elevated in patients with positive lymph nodes for carcinoma than in those with negative lymph node for carcinoma. Patients with higher serum PSA (≥20ng/ml) and PAP (≥10ng/ml) levels were more frequently associated with lymph node metastasis. Thus, when serum PSA and PAP were markedly elevated before treatment in patients with prostatic carcinoma, they should be considered to have a potential of pelvic lymph node metastasis.
Pelvic lymph node metastasis was observed in some cases even without high tumor marker levels, particularly those with poorly differentiated carcinoma.

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The mechanism of increased nocturnal urine production in adult patients complaining of nocturia has seldom been reported. The objective of this clinical study is to investigate the circadian rhythm of both urine production and plasma arginine-vasopressin (AVP) level, and the efficacy of intranasal instillation of 1-deamino-8-D-arginine-vasopressin (DDAVP) in adult patients complaining of nocturia. Eight patients (seven men, one woman) who ranged in age from 44 to 77 years (mean 64.1 years) were examined. Three of them suffered from Shy-Drager syndrome, and no patient had shown any improvement of symptoms in spite of administration of anti-cholinergic agents and restriction of water intake. Nocturnal urine volume was more than bladder capacity in all patients, and no patient showed normal elevation of nocturnal plasma AVP level. Intranasal administration of DDAVP of 5 or 10μg revealed marked decrease in nocturia, and nocturnal urine volume (p<0.01). There were mild side effects (headache, nasal obstruction, and hyponatremia) not requiring any treatment.
In conclusion, DDAVP is a safe and effective treatment for adult patients complaining of nocturia due to hyperproduction of nocturnal urine and inappropriate nocturnal secretion of AVP.

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Abdominal ultrasonic examination (US) was performed in 1556 patients on hemodialysis for 7 years and 6 months from April 1955 to September 1992.
Renal cell carcinoma (RCC) proved histologically by operation was found in 36 patients (41 kidneys).
Among the 36, RCC developed from the contracted kidney in 15, the individual kidney after renal transplantation in 3, and from ACDK (acquired cystic disease of the kidney) in 18.
Among the 18 (ACDK), multiple tumors were found in the unilateral kidney in 8 and in bilateral kidney in 5.
RCC was detected at the rate of 2.3% in patients on hemodialysis (1 out of 43).
It was 29 time as high as in healthy persons (RCC was found in 22 out of 27933 at our Health Check-up Center, 0.079%).
RCC was diagnosed 100% by US, 68% by CT, and 55% by angiography.
US is the most excellent examination for the diagnosis of RCC in patients on hemodialysis.

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A total of 13 patients received intravesical bacillus Calmette-Guerin (BCG) therapy for superficial bladder cancer and were followed for at least 6 months (range 6 to 50 months). Of the patients 7 had carcinoma in situ and 6 had recurrent tumors following intravesical mitomycin C therapy. Of the 7 patients who had carcinoma in situ, 4 (57%) are free of disease and 3 (43%) have required cystectomy for recurrence or progression. Of the 6 patients who had recurrent tumors following intravesical mitomycin C therapy, 3 (50%) remain free of tumor after BCG therapy alone, 2 (33%) had superficial recurrences but no progression and 1 (17%) has required cystectomy for prostatic involvement.
After intravesical BCG therapy, transitional cell carcinoma of the prostate was identified in 4 of the 13 patients, and tumors in the upper urinary tract were detected in 2 of the 4 patients with prostatic involvement. Of the 4 patients 2 have local recurrence or distant metastasis. In patients treated with BCG therapy the prostate and upper urinary tract represent a potential site of progression or recurrence.
Patients treated with intravesical BCG therapy for superficial bladder cancer should be monitored closely for the development of transitional cell carcinoma of the prostate and upper urinary tract.

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Specimens obtained by open prostatectomy from patients with benign prostatic hyperplasia were used for primary stromal cell culture. Cell were treated with nonepinephrine and alpha-1 blocker, prazosin. The cell proliferation was measured by ³H-thymidine incorporation and cell number. The cellular hypertrophy was assessed by flow cytometric analysis. Norepinephrine did not stimulate cell proliferation and prazosin did not induce to inhibit cell growth. Prazosin also did not have any effect on the hypertrophic stromal cell stimulated by serum.
Our results suggested that alpha-1 adrenoceptors had no relation to the cellular hypertrophy or hyperplasia in the prostate

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We report on a case of renal cell carcinoma in a functionally solitary kidney, treated by ex vivo partial nephrectomy and autotransplantation.
A 62-year-old woman was admitted for examination of a left renal mass and right hydronephrosis, incidentally detected on echography and CT scan. The right hydronephrosis was caused by congenital ureteropelvic junction obstruction, associated with severely impaired renal function. A solid tumor was found in the left kidney, located in the upper pole and extending to the hilus, and was suspected to be renal cell carcinoma. The patient was treated by ex vivo partial nephrectomy, of the left kidney followed by autotransplantation. The tumor was 35×55×40mm in size and diagnosed histologically to be renal cell carcinoma. Hemodialysis was unnecessary since good urine output was obtained postoperatively from the transplanted kidney. The patient was discharged 3 months after surgery, following interferon-α therapy, with serum creatinin level of 1.4mg/dl.

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This report describes a case of teratoma with retroperitoneal lymph nodes involved with malignant teratoma (enteric adenocarcinoma) after extensive chemotherapy for the original testicular cancer. A 18-year-old man with a mixed cell tumor (embryonal carcinoma+teratoma+yolk sac tumor) received three courses of VAB-6 chemotherapy for bulky mass following inguinal orchiectomy.
He was referred to Tochigi Cancer Center for treatment of a residual mass. He was treated with resection of the mass combined with left nephrectomy due to severe adhesion and pathological diagnosis of the resected lymph node was mature teratoma with a massive necrotic tissue.
Two courses of BEP chemotherapy were given to the patient following the surgery. Six months after completion of chemotherapy, a retroperitoneal mass of 1.5cm in diameter, was detected by CT scan. Standard retroperitoneal lymph node dissection was performed and the pathological diagnosis of the lymph node was teratoma with malignant transformation containing enteric adenocarcinoma. Teratomatous portion of the primary lesion was precisely re-examined and adenocarcinoma, similar histology to the retroperitoneal mass, was identified. He received two courses of EAP chemotherapy (Cis-platin + etoposide + doxorubicin) as an adjuvant chemotherapy following the surgery and he is alive with no evidence of recurrence for 21 months.
Presence of non germ cell malignancy after chemotherapy in testicular cancer has been regarded as a rare phenomenon. Flow cytometric DNA analyses of both embryonal carcinoma and teratoma in the primary lesion, mature teratoma and teratoma with malignant transformation of the retroperitoneal lymph node disclosed that these tumors were all aneuploid tumors.
Mature teratomas histologically resemble normal-like structure, however, they have been proven to have potentially malignant biological characteristics in terms of DNA aneuploidy, chromosomal abnormality, malignant transformation and local extension. Thus, residual tumors developing after chemotherapy, should be resected when teratomatous element was identified in the primary lesion.

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A 40-year-old man was admitted to our hospital with a fat-density extrarenal tumor and intrarenal nodules which were detected by ultrasonography (US) and CT scan obtained the general health check. After his admission, US, CT, MRI and angiography were performed. As the final diagnostic procedure, we performed a US-guided percutaneous needle biopsy of the extrarenal tumor, because this tumor was difficult to distinguish from liposarcoma and angiomyolipoma (AML). The pathological study revealed a well-differentiated liposarcoma, and the extrarenal tumor and the left kidney were removed en bloc. Pathologically, the tumor not only invaded into the renal parenchyma directly but also have metastasized independently to the intrarenal region. Postoperatively, he received a tumor dose of irradiation of 50Gy.
Liposarcoma arising in the perirenal space should be considered in the diferential diagnosis of exophytic AML. If radiological studies can not confirm the appropriate diagnosis, we consider that biopsy of the tumor should be selected as an alternative diagnostic approach. And, we think that this is the first case report dealing with intrarenal metastases of liposarcoma.

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