105 calcium oxalate stones (calcium oxalate content greater than calcium phosphate) which were passed spontaneously from 1983 to 1988 were studied by infrared analysis and divided into 51 COM stones and 54 COD stones according to the content of calcium oxalate monohydrate (COM) and dihydrate (COD). The appearance and consistency of 11 COM stones (21.6%) were like those of the typical COD stone, although the dark brown, firm core suggesting the typical COM stone was found in 3 COD stones (5.6%). The content of calcium phosphate was higher in COD stones than in COM stones (P<0.01). There was no significant difference between the weights of 51 COM and 54 COD stones. However, regarding 73 stones<100mg in weight, COD stones were heavier than COM stones (p<0.05); 48.0±23.8 and 35.4±23.2mg (mean±standard deviation) for 38 COD and 35 COM stones respectively.
COM stones were found in older patients than COD stones (p<0.05); 45.2±12.8 and 39.9±11.2 years old for 51 COM stone patients and 54 COD stone patients. There was no significant difference in the sex distribution and the number of patients with a history of stone(s) between COM and COD stone patients. Fifty-three patients were followed at yearly intervals without any prophylactic treatment for stone recurrence. The follow up periods were 37.6±27.1 and 32.1±20.9mos. for 25 COM and 28 COM stone patients respectively. When stone recurrence was defined as an appearance of a new stone on X-ray or sonography, the recurrence rate was higher in COD stone patients than in COM stone patients: 68.0% (17/25) and 35.7% (10/28) for COD and COM stone patients respectively (p<0.05).
It is noted that it is useful in clinical practice to classify passed calcium oxalate stones into COM stones and COD stones.

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We studied the actual general state of sexual dysfunction in 201 male diabetics (age range: 22-76 years) who were commuting outpatients, using the Sapporo Medical University's Sexual Function Questionnaire. The control group consisted of 6, 426 healthy male subjects. The principal parameters taken into account by the Questionnaire were the libido and ability to achieve/maintain an erection, with consideration given to the factor of the subject's age.
The results were as follows.
1. The diabetic patients who were experiencing neuropathy showed a decrease in the ability to achieve/maintain an erection at an earlier age than the patients without neuropathy. In addition, the number of patients with a decreased ability to achieve/maintain an erection was found to be 30 (45%) of 67 cases with neuropathy compared with 24 (18%) of 134 cases without neuropathy. The severity of that decreased ability was also greater in the cases with neuropathy.
2. In comparison with the healthy male control subjects, the diabetics showed decreases in libido and the ability to achieve/maintain an erection which were not very severe at younger ages, but became striking after the age of about 60 years. Thus, the degree of dysfunction accelerated with increasing age. After the age of 60 years, the erection score was found to decrease in 31.7% of the patients without neuropathy but in 61.1% of the patients with neuropathy.
3. Weighted regression analysis showed that the most important factor involved in the ability to achieve/maintain an erection was the subject's age (contribution rate: 27.2%), followed by neuropathy (7.4%). These two factors represented the explanatory factor of erectile dysfunction in approximately 1/3 of the diabetics. In addition, the factor of age accelerates the progress of damage to the blood vessels, and it is surmised that this deterioration is deeply involved in sexual dysfunction.

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In order to gain the technical skills for performing laparoscopic pelvic lyphadenectomy, we selected the young pigs (12-15kg) as the experiemental model. Five pigs (male 2, female 3) underwent laparoscopic pelvic lyphadenectomy under intravous antethesia. Postoperatively, the pigs were euthanized, and laparatomy was performed to demonstrate the area of dissection. Operation time was from 50 to 80 minutes, and no complication occurred in all cases, mastery came rapidly.
Following experiental operation, 21 cases with prostate and/or bladder cancer underwent laparoscopic pelvic lyphadenectomy for staging operation from Nov. 1991 to Oct. 1993. Operation time was from 60 to 310 minutes (mean 137).
In one of 21 cases, lymphnode metastasis was proved. Eighteen of 21 cases underwent radical prostatectomy or cystectomy between 6 to 24 days after laparoscopic pelvic lymphadenectomy. On radiocal operation, the adhesion of the post-lymphadenectomy was severe in the patients 8 days after laparoscopic pelvic lymphadenectomy, compared with those within 7 days. Radical operation was seemed to be recommanded within 7 days after laparoscopic pelvic lymphadenectomy.

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We investigated changes in the voiding condition with aging in 1476 males 50 years and older, who participated in a field survey for prostatic diseases conducted from 1982 to 1991 in Hokkaido. Voiding conditions were evaluated subjectively with a symptom index (weak stream, intermitency, nocturia, urge incontinence), and objectively with maximum flow rate. Digital rectal examination (DRE) revealed 10.3% (572 participants) of total evaluable participants to have moderate or marked enlargement of the prostate. The incidence of enlargement of the prostate apparently increased with aging. Subjective urinary symptoms, both obstructive and irritative, increased in the incidence and degree with aging. The maximum flow rate and maximum flow rate-nomogram also became worse with aging. the incidences participants having urinary symptoms or decreased maximum flow rate increased in parallel with the size of the prostate on DRE. For each size of the prostate on DRE, the incidence of participants having urinary symptoms increased with aging. The maximum flow rate showed a similar tendency, decreasing with aging, irrespective of the size of the prostate. These results indicate that aging as well as the size of the prostate may affect the voiding condition in males aged 50 years and older.

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The incidence of bacteriuria in patients with benign prostatic hypertrophy was studied at 8 National Hospitals. Among 1, 542 patients, urinary infection was the reason of visit in 63 patients (4.1%). After open and transurethral prostatectomy, one-third of patients developed bacteriuria (30 of 59 subcapsular enucleations, and 252 of 776 transurethral resections). When a catheter is placed without prophylactic antimicrobial, all patients developed bacteriuria within 10 days, and within 30 days even if they received antimicrobials. The incidence of bacteriuria increased with age.

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We examined the effects of dimethyl sulfoxide (DMSO), hyaluronidase and saponin on drug absorption through the bladder mucosa. Female Wistar rats underwent intravesical instillation of each agent prior to the administration of lanthanum solution or anticancer drug; 4′-O-tetrahydropyranyldoxorubicin (THP). The absorption of lanthanum was recognized as dense grain in bladder tissue under electron microscope. The concentration of THP in bladder tissue and plasma was measured by high performance liquid chromatography. The ultrastructural change caused by instillation of DMSO, hyaluronidase and saponin was also investigated by transmission and scanning electron microscopy.
The electron microscopic study of the bladder treated with DMSO revealed the exfoliation of superficial cells, and the electron-dense grains of lanthanum were observed in submucosal layer. The concentration of THP was twice as high as that of untreated animals in both bladder tissue and plasma.
The treatment with hyaluronidase caused no severe histological change of bladder mucosa, and lanthanum was observed only in the cytoplasma of superficial cells. The increased concentration of THP was slightly exhibited in plasma but not in bladder tissue.
The treatment with saponin caused vacuolization and swelling of superficial cells, and many grains of lanthanum were observed between superficial cells and intermediate cells. The concentration of THP in bladder tissue was significantly higher than that of untreated animals, but in plasma no difference was revealed.
These findings indicate that each three agent caused an unique effect on drug absorption of bladder mucosa and such characteristic of each agent must be considered for clinical application. Saponin is thought to be useful on intravesical chemotherapy because of increased concentration of anticancer drug (THP) in bladder tissue without that in plasma.

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In this series, we investigated the efficacy and advantage of laparoscopy for management of nonpalpable testis. Laparoscopic examination was performed in 10 boys, involving one with bilateral nonpalpable testis and 9 with a unilateral nonpalpable testis and a contralateral normal one, between August 1991 and September 1993 in our institution.
Three testis were diagnosed as intraabdominal and 8 testis were diagnosed as probably intracanalicular with laparoscopy. Two boys with 3 intracanalicular testis underwent laparoscopic clipping of testicular vessels, and about 6 months later, they underwent the second stage of 2-stage Fowler-Stephens orchiopexy. Eight boys, diagnosed as probably intracanalicular type by laparoscopy, underwent surgical exploration with inguinal incision. Of 8 patients, only 1 boy underwent 1-stage orchiopexy, and the other 7 boys underwent orchiectomy because their gonads were extremely hypoplastic. About 1 year after orchiopexy, 3 testes were normal in both size and location.
Laparoscopy seems to be useful for both evaluation and treatment of the nonpalpable testis.

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To evaluate endoscopic trigonoplasty compared to open trigonoplasy for vesicoureteral reflux, we analyzed clinical results, complications, the use of analgesics for postoperative pain and bladder irritability and postoperative length of hospitalization. One of six patients undergoing endoscopic trigonoplasty subsequently underwent open trigonoplasty due to failure of trocar placement, therefore, 7 patients having vesicoureteral refluxy renoureteral units underwent open trigonoplasty and 5 patients with vesicoureteral reflux 7 renoureteral units underwent endoscopic trigonoplasty. Mean operative time was 143±48 minutes for open surgery and 185±54 minutes for endoscopic surgery. Vesicoureteral reflux disappeared in 8 renoureteral units but was worse in one unit after open trigonoplasty, while vesicoureteral reflux subsided in 6 units and improved in one unit from grade II to grade I after endoscopic trigonoplasty. There were no intraoperative complications after open surgery, while one patient had pneumoperitoneum due to inadequate placement of a trocar during endoscopic surgery. There were no early postoperative complications after endoscopic surgery. However, 2 patients developed hematuria after open surgery. The degree of postoperative pain and irritability following endoscopic trigonoplasty was lower than that after open trigonoplasty and analgesics were used less frequently after endoscopic surgery. The mean postoperative hospital stay was 16.7±3.2 days for open surgery and 14.4±2.9 days for endoscopic surgery. These results indicate that endoscopic trigonoplasty is a useful procedure for vesicoureteral reflux because it is minimally invasive.

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Of 12 children who had undergone augmentation ileocystoplastuy for treatment of neurogenic bladder, 3 developed bladder calculi 9 to 19 months after the operation. All these 3 children had simultaneously undergone procedure to ensure urinary continence together with ileocystoplasty, and postoperative persistent bacteriuria was found in these 3 children. Component of bladder calculi was magnesium-ammonium phosphate in 2 and calcium phosphate in the other child, and all were successfully removed by endoscopic lithotripsy. These data suggest that postoperative persistent bacteriuria as well as procedures to ensure urinary continence might play a role in the formation of bladder calculus after augmentation cystoplasty.

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At present, no sufficient therapy for advanced renal cell carcinoma is available.
Interferon (IFN) therapy has been used to treat renal cell carcinoma, but the efficacy of it is low, with response rate being only about 20%.
We experienced two patients with advanced renal cell carcinoma had marked response to IFN-α therapy in proximity effect.
Using monoclonal anti-bodies of each subset of lymphocytes, the peripheral blood lymphocytes (PBL) in these patients were evaluated by two color flow-cytometry. And these results and clinical course were assesed.
The lymphocyte subpopulatlon that change of clinical course is been similar to in these patients were Tc (CD11b-CD8+), T_SI (leu8+CD4+), _AT_S/C (CD8+HLA-DR+) and _AT_H/SI (CD4+HLA-DR+).
And the pretherapeutic immunological status of these patients was characterized by significantly increased CD4+/CD8+ and T_H/T_S ratio.
In conclusion, the clinical response of advanced renal cell carcinoma to IFN therapy might be found if CD4+/CD8+ and T_H/T_S ratio are increased at pretherapeutic immunological status.
In addition, assessement of T_SI, T_C, and _AT_S/C, as immune parameters for monitoring the actual immune status of patient is found to be necessary part of immunotherapy.

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The effects of chemotherapy on the metastasis of retroperitoneal lymph nodes from testicular cancer have been generally evaluated with bi-dimensional imaging methods. Since the structure of these lymph nodes seems to be complicated, it is expected that three dimensional imaging methods could achieve more correct evaluation of the disease extension and the treatment effects when compared with bi-dimensional ones. The present study was undertaken to reconstruct the three dimensional imaging from CT films using personal computer system. Twenty one patients with bulky retroperitoneal nodal metastases were examinated before and after chemotherapy.
The evaluation of treatment effects based on three dimensional imaging method reflected the clinical course more adequately than the bi-dimensional one. When shrinkage rate of the tumor volume was less than 65%, viable tumor cells remained in all cases. Only one of six cases with more than 90% shrinkage revealed viable tumor cells.
All patients in whom the metastases were estimated to be more than 100cm³ in volume before chemotherapy and less than 50cm³ after chemotherapy were shown to have completely necrotic tissues.
In conclusion, three dimentional imaging was useful to estimate the post-treatment volume and shrinkage rate which correlated to the effects of treatment and prognosis.

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An 8-year-old boy who had undergone excision of the left appendix testis for torsion of the left appendix testis about one and a half years previously was brought to our department on February 18, 1991 because of right scrotal pain of 4 days' duration. Palpation revealed induration with tenderness of the superior portion of the right testicle. A scrotal ultrasonographic tomogram revealed a shadow probably representing an enlarged appendix testis. The patient was diagnosed as having torsion of the right appendix testis. There was refractory pain, and there was possibility of reactive epididymitis. So the patient underwent excision of the right appendix testis, two right appendices testis, which had enlarged to 5mm in diameter were found, histopathological examination revealed slight bleeding and marked edema of the stroma, which may have been caused by torsion of the appendix testis. Scrotal pain subsided postoperatively. Bilateral torsion of the appendix testis is very uncommon, and our case is the 14th case reported. Torsion of the appendix testis occasionally develops. Torsion of the appendix testis occasionally develops bilaterally. When a small, tender mass at the superior pole of testis, torsion of the appendix testis shoud be considered.

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We reported three cases of neurogenic bladder due to neuro-Beçhet disease. Case 1 (24-year-old male) and case 3 (54-year-old male) had complaint of urinary frequency and urinary incontinence. Case 2 (35-year-old male) had a complaint of urinary retension. Uro-dynamic study were performed repeatedly in each case. Two cases showed overative detrusor activity in storage phase and normal or hypo detrusor activity in voiding phase. One case (case 2) showed normal detrusor activity in storage phase and acontractile in voiding phase. All cases showed detrusor-sphincter dyssynergia (DSD). All cases were managed with clean intermittent catheterization. Six months later case 2 complained of urge incontinence. Repeated uro-dynamic study revealed that bladder function changed from normal detrusor to overactive detrusor in storage phase.
These findings suggest that neurogenic bladder due to neuro-Beçhet disease is characterized uro-dynamical by overactive detrusor in storage phase and DSD in voiding phase.

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Two cases of Fibroepithelial polyp in 47- and 74-year-old males complaining of gross hematuria are described. In the foreign literature, this polyp most commonly occurs in infancy and childhood in the first decase of life, but rarely occurs in aged male. Ten cases of this disease could be accumulated in the Japanese literatures, in which this polyp more commnly occurs in older generation compared with younger one. Urethral polyp should be considered in the differential diagnosis of gross hematuria.

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