To elucidate the feasibility of surgical enucleation, the incidence of extracapsular tumor invasion in 30 cases of renal cell carcinoma with a diameter less than 5 cm was examined, based on the classification of extracapsular tumor invasion into three patterns, namely microinvasion, nodular invasion, and daughter tumors.
Of the 30 cases of renal cell carcinoma, 22 cases (73%) revealed extracapsular tumor invasion. And the incidence of microinvasion, nodular invasion and daughter tumors was 7 cases (23%), 9 cases (30%) and 6 cases (20%), respectively. But the incidence of these three patterns of extracapsular tumor invasion correlated neither with the size of renal cell carcinoma nor with pT classification.
There was a tendency for extracapsular tumor invasion to occur near the renal hilar site of the renal cell carcinoma, where the tumor vessels were rich, penetrated and twined around the tumor capsule, resulting in the disruption of the tumor capsule. These three patterns of invasion was located within 1 cm in distance from the tumor capsules in all cases.
In conclusion, because of limited radicality achieved by tumor enucleation even in the case of pT1, partial nephrectomy was recommended in the presence of a normal contralateral kidney.

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Primary epithelial and fibroblast cells from benign hypertrophic prostate tissue were established. The prostate tissues were obtained by transurethral resection of the prostate or retropubic prostatectomy in patients with benign prostatic hypertrophy. Growth factors for cultured epithelial cells and fibroblasts were studied. The epithelial cells grew well in the WAJC-404 culture medium with insulin, epidermal growth factor and dexamethasone. Fibroblasts grew well in culture medium containing 10% fetal calf serum. The prostate tissue was stored at 4°C for 7 days and no degenerative change in the stromal cells was seen during this period. Although epithelial cells did degenerate with the passage of time, epithelial cells cultured after storage for 4 days at 4°C behaved similarly to those cultured immediately after being isolated. These primary cultures of epithelial cells and fibroblasts from hypertrophic prostate may be useful for various studies.

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From 1979 to 1989, 269 patients with spinal cord injury were managed by an aseptic intermittent catheterization program during the acute phase of their injuries at the Spinal Injuries Center. One hundred fifty one patients with incomplete cord lesion and 36 males with complete tetraplegia were managed by program I, which protects the shocked bladder from overdistension. In contrast, 82 patients with complete cord lesion excluding male tetraplegia were managed by program II, which allows overdistension of the bladder. Of the 187 patients managed by program I, 137 (73.3%) achieved trigger voiding function, 61.3% of whom were completely dry. Of the 82 patients managed by program II, 62 (75.6%) were put to self- or assisted catheterization, 67.7% of whom were dry. The incidence of a grade I, which means normal bladder configulation, was 88.0% for program I and 87.3% for program II during the follow up course. Upper urinary tract deterioration occurred in only one case. Surgical treatment for urinary tract complications was performed in 14 cases (5.2%).
These results suggest that the patients with incomplete cord lesion managed by non-distension regimen of the bladder (program I) and those, especially female, with complete cord lesion managed by overdistension regimen of the bladder (program II) achieve urinary continence with excellent urinary prognosis.

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We reported the clinical results of radical surgeries for 44 patients with prostate cancer performed between November 1984 and December 1992. The patients were aged from 57 to 79-year-old (mean 67.2) and classified as clinical stage A₂ (6 cases), B₁ (7), B₂ (12), C (16) and D₁ (3) respectively. Radical prostatectomy was performed in 42 cases and radical cystoprostatectomy with urinary diversion in 2 patients, and thirty-nine of 44 cases underwent endocrine or chemoendocrine therapies prior to the surgeries. In all patients with stage A₂-B₁, the operations were curative, on the other hand, more than 80% of clical stage B₂ patients had pT₃ tumors and 33.3% of them had lymph node involvements. With regard to stage C patients, the incidence of lymph node metastasis and positive margin was more frequent. Postoperative adjuvant therapies were added to the patients with pT_{3, 4} tumors and nodal involvements. Patients without residual tumors (n=20) remained disease-free for 8-89 months (mean 32.8). Of 24 patients who had incomplete resection of tumors, 2 died of other diseases, other 2 were alive recurrent and 20 were alive free from disease for 3-99 months (mean 33.8). The surgical indication for low-stage (A₂-B₂) prostate cancer has been widely accepted, however that for high-stage cancer (C, D₁) has remained controversial. It was our belief that radical surgeries for high-stage cancer could become a potentially curative therapeutic modality in combination with pre- and post-operative adjuvant therapies.

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Between March 1989 and January 1992, 600 cases (636 kidneys) with upper urinary tract stones were treated with ESWL, using a Lithostar. Of these, 78.6% were carried out in our outpatient service, and in the last two years approximately 90% of cases have been treated as outpatient. We evaluated first 500 kidneys, treated with ESWL as outpatient.
There were 481 cases involving 500 kidneys (19 bilateral cases). The ages of the 367 men and 114 women ranged from 16 to 77 years. There were 227 kidney stones and 273 ureter stones. Most of the stones were less than 20mm.
The average number of sessions and shock waves for each patient were 1.4 times and 6, 988 waves, respectively. While 74% of the patients could be treated in only one session, 9% of them needed 3 sessions or more. Auxiliary measures were needed in 23 cases (D-J stent insertion in 5 cases and ureteral catheterization in 18 cases) and 474 cases (94.8%) were treated by in-situ procedures.
At 3 months after treatment, 470 cases were evaluated and the stone-free rates of kidney stones and ureter stones were 70.3% and 84.5%, respectively with an overall stone-free rate of 78.1%.
With regard to complications, the rate of the clinic visit because of pain after treatment was observed in 4.6% and higher than 38°C in 2.5%. However, no serious perioperative complications occurred.
From these results, outpatient ESWL was considered to be safe and efficient without serious complications. However, caution should be exercised in terms of patient's selection for ESWL and the patient should be fully explained about the possible complications of ESWL.

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To investigate prognostic factors for prostatic cancer, 110 patients who had received hormonal treatment (HT) and 43 patients who had received radiotherapy (RT) were studied. Age of the patients ranged from 49 to 92 years old (median 71 years old) and follow-up period ranged from 3 to 164 months (median 50 months). Survival rate was calculated by Kaplan-Meier method with statistical analysis based upon Cox's proportional hazards regression model. This analysis identified performance status as the most important factor for al patients, followed by histological grade for patients HAVING received HT, and lymph node metastasis for patients received having RT. The result suggests that routine clinical data provide a good indicator as to the prognosis of prostatic cancer.

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The present investigation was designed to study adhesion of calcium oxalate crystals on the surface of intact MDCK cells quantitatively, and to estimate the effects of glycosaminoglycans (GAGs) and cell injuries on these adhesions.
Calcium oxalate monohydrate (COM) crystals adhere to the cell surface by an active force, and the attachment is in a time and concentration dependency with plateau. Pre-treatments with low concentration of GAGs (chondroitin sulphate C, hyaluronic acid, heparan sulphate, heparin and sodium pentosan polysulphate) produce significant reductions of the adhesion.
There are significant decreases of the adhesions with pre-treatments of Triton-X100, 0.1 N HCl and gentamicin. These phenomena might be induced by some alterations of cell surface stuructures or characters.
The current quantitative system on MDCK cells should serve as a useful model for the investigations of interactions with crystals and tubular cells. Our studies may also support the hypothesis of attachment of microcrystals to the cellular membrane, which is one of the most important and the earliest process of the pathophysiology of kidney stone.

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A clinical study was conducted to evaluate the efficacy of combination therapy with interferon (IFN) α and γ in 16 patients with advanced renal cell carcinoma whom we observed between August 1986 and June 1992. Eight patients had already had stage IV disease when they were seen first and five of them underwent nephrectomy. The other eight patients developed metastases after nephrectomy. The time to occurrence of the metastasis was 4-110 months. The dosage of the regimen was IFNα, 3 ×10⁶ U, intramuscularly for 7 consecutive days at weeks 1, 3, 5 and 7 and IFNγ, 6×10⁶ JRU by intravenous drip on days 2, 4 and 6 of weeks 2, 4, 6 and 8. At and after week 9, the combined use of IFNα, 3×10⁶ U, and IFNγ, 1-6×10⁶ JRU, was continued at least on a once-a-week basis as maintenance therapy as long as possible. The effect was evaluated as PR in 2 patients, MR in 2, NC in 3 and PD in 9. The response rate was 12.5% and the efficacy rate including MR was 25%. The time to onset of the effect was 8-24 weeks. Of the four patients showing MR or better responses, three had stage IV disease and one had metastatic disease after the operation. The duration of effect was 2-8 months. Side effects were fever, general malaise, anorexia, leukocytopenia and impaired liver function, and were noted frequently. It was, therefore, considered in the present study that the IFNyα and γ combination regimen we tried for the treatment of advanced renal cell carcinoma showed no synergistic effects.

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Ten patients having a uretero-ileocecoproctostomy (ileocecorectal bladder) were evaluated by ^99mtechnetium diethylenetriaminepantaacetic acid renoscintigraphy, which was repeated at an approximately 1 year interval in 7 patients. The computed total glomerular filtration rates at the 1st and 2nd surveys were 100±23.2 and 92.7±23.0ml/min (mean±S. D.), respectively indicating a minimal change with no statistically significant difference. The normal or incompletely obstructive renogram patterns were consistent with the pyelographic findings in 27 of 28 renal units, and 5 of 6 renal units with dilated nonobstructive renograms subsequently became normal both on the renograms and pyelograms. Comparing the data in the 1st and 2nd surveys, the frequency of colonic reflux decreased from 8/10 to 3/7 of the patients, the rectal bladder capacity increased from 82±18.8% to 92±20.8% of the excreted urine, and the total residual urine rate decreased from 40.4±12.9% to 28.0±16.6% (p=0.1298), respectively. The results indicate that the ileocecorectal bladder, though it has no antireflux mechanism against colonic regurgitation, well functions as an internal continent urinary reservoir. Also, since this comprehensive information is obtained by a single procedure, the radionuclide evaluation can be practiced as a costbeneficial measure for follow-up of patients with urinary diversions.

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Of 65 cases of renal pelvic and/or ureteral tumor treated at Department of Urology, The University of Tokyo, during the period from January 1975 through December 1991, 26 had bladder tumors as well.
These cases were divided into three groups; 1) bladder tumor preceding upper urinary tract tumor, 2) bladder tumor found simultaneously with upper urinary tract tumor, and 3) bladder tumor following upper urinary tract tumor.
In group 1 (nine cases), the last bladder tumor preceded renal pelvic and/or ureteral tumors by 3 to 42 months (mean 14.6 months), and in seven cases, bladder tumor recurred 3 to 29 months (mean 9.0 months) after nephroureterectomy. The interval between the diagnosis of preceding bladder tumor and upper urinary tract tumor was highly correlated with the latent period of postoperative recurrence of bladder tumor (r=0.948).
Highly malignant pathological grade of bladder tumor featured seven cases of group 2, with the survival rate being significantly (p<0.01) lower than that of other groups.
In the group 3 consisting of ten cases, bladder tumors subsequently developed 6 to 37 months (mean 15.0 months). The latent period of bladder tumor was significantly (p<0.01) longer than that in group 1.
These results indicated that the bladder tumors associated with renal pelvic and/or ureteral tumors have distinct characteristics depending on the sequence of association.

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The enzymatic properties of N-acetyl-β, D-glucosaminidase A (NAG A) partially purified from the tissues of seven cases of human renal cell carcinomas were studied individually and compared with those of normal renal tissues. In the carcinoma tissues, the Km value of the enzyme toward a synthetic glucosaminide substrate was 0.180±0.07mM, the optimal pH of the enzyme ranged from pH 4.7 to 4.9 and the enzyme showed fairly stable for metal ions. These enzyme characteristics were similar to those of the normal tissues. On the contrary, the sugar-chain structures of the enzyme from the carcinoma tissues studied by lectin affinity chromatographies, were statistically different from those of the normal tissues. Namely, both complex type of sugar-chains as well as hybrid type sugar-chains without fucose linkage to the innermost N-acetylglucosamine (G1cNAc) were significantly increased in the enzyme from the carcinoma tissues, while high mannose type sugar-chains and hybrid type sugar-chains with fucose linkage to the innermost G1cNAc were significantly decreased in the carcinoma tissues compared to the normal tissues. These results indicate that the processing of sugar-chains of the enzyme has possibly changed in the carcinoma tissues.

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We herein report three cases of primary carcinoma in situ (CIS) of the upper urinary tract. The significance of urinary cytology and pathological study by means of mapping of isolated specimens was investigated in cases reported in Japan, including our cases.
1. The most common clinical symptom of CIS of the upper urinary tract was hematuria. Particularly, gross hematuria showed a high incidence.
2. In cases of CIS involving the ureter, hydronephrosis frequently resulted from ureteral stenosis and obstruction.
3. Urinary cytology was a useful diagnostic examination, in particular, the cytology of catheterized urine or washings increased the diagnostic accuracy. It appeared that for definite diagnosis, positive urinary cytology should be obtained repeatedly.
4. The mapping analysis of isolated specimens revealed that it was characterized that CIS was multiple and coexistent with dysplasia.
5. Total nephroureterectomy is the treatment of first choice. And investigation of the distribution of CIS and dysplasia by mapping and grading of CIS seemed to be useful for following up the postoperative course.

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A 24-year-old man presented with gross hematuria and pain on micturition. Cystoscopically the prostatic urethra appeared to be pale, edematous and partly elevated mucosa, from which multiple biopsy specimens were taken by TUR-P. A pathological diagnosis of malignant lymphoma (diffuse and large-cell type, according to the LSG classification: B-cell origin according to immunohistochemistry) was established. The results of the physical examination and imaging studies were compatible with the diagnosis of primary lymphoma of the prostate. The patient underwent a combination chemotherapy consisting of vincristine, cyclophosphamide, adriamycin and prednisolone. After completion of 6 courses of chemotherapy over 7 months, another TUR biopsy of the prostate confirmed complete remission. Now, 1 year after completion of chemotherapy, he remains free of the disease. To our knowledge, this is the 21st clinical case of lymphoma of the prostate ever reported in the Japanese literature.

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A 67-year-old man was admitted to the orthopedic ward, complaining of severe pain in his right greater trochanter. He was diagnosed as spinal cord tumor and underwent laminectomy for extirpation of the tumor. Histological examination revealed bone metastasis of unknown origin. Laboratory data revealed hypokalemia and hyperglycemia. Endocrinological data showed elevation of plasma cortisol and ACTH, and increased excretion of urinary 17-OHCS. Ten specimens needle biopsy of the prostate showed poorly differentiated adenocarcinoma, thus patient was diagnosed as prostate cancer with bone metastasis (stage D₂) and perhaps ectopic ACTH production. Castration was performed, however 2 days after the surgery he died suddenly. We suspected that cerebral hemorrhage was the cause of his death. On autopsy ectopic ACTH production in the prostate was confirmed.

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We have studied a 32-year-old patient who was infertile because of azoospermina. We made the final diagnosis of non-classical congenital adrenal hyperplasia (CAH) caused by 21-hydroxylase deficiency with adrenal rest tumor of bilateral testes and bilateral adrenal myelolipoma. The patient was given 1.5mg/day dexamethasone. Decreases in the levels of 17 OHP and adrenal androgen were rapidly observed. After 5 months of treatment, semen analysis showed a sperm density of 2×10⁴/ml with 50% motile spermatozoa. His wife became pregnant and delivered of a healthy daughter.
We conclude that chronic suppression of gonadotropins secretion caused by overproduction of adrenal androgens in CAH would appear to be the cause for the failure of testicular development and spermatogenesis.

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