(Background) The alalysis of cell kinetics of germ cells have been implicated as important clue to investigate the etiololgy of infertile patients. We examiend the germ cell kinetics of varicocele testis using proliferating cell nuclear antigen (PCNA) immunostaing by image cytometry (CAS 2000), which is very accurate and useful method to evaluate the staining intensity.
(Patients and Methods) Testicular biopsy specimen obtained from 28 cases of male infertility with left varicocele and 5 normal controls were quantitatively examined concerning PCNA expression. Positive rate of PCNA (PR) was expressed as the percent of nuclear area positively stained with PCNA monoclonal antibody compared with total nuclear area analyzed in more than 20 seminiferous tubules. A hematoxylin and eosin-stained sections, which were fixed in Bouin's solution were used to examine Johnsen's mean score by photomicroscopy.
(Results) PR of right and left testes of varicocele patients were 11.3±4.8% and 11.3±4.1%, respectively. PR of normal testes was 21.7±3.1%. PR of each side were reduced similarly and the difference of PR between right and left testes of varicocele patients were not significant. Bilateral PR was 11.4±4.1%. Bilateral PR was significant lower than that of normal testes (p<0.001). Concerning varicocele grade, sperm concentration of seminogram, Johnsen's mean score and the improvement of seminogram, no significant correlations between PR and those were observed.
(Conclusion) PR evaluated by image cytometry is very useful biological parameter to assess the germ cell kinetics. In varicocele patients, not only left side but also right side of testes were deteriorated in the cell kinetics and the decrease in DNA synthesis is one of the causes that have deleterious effects on spermatogenesis.

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(Purpose) To evaluate the treatment of grade 3 superficial bladder tumor, retrospective analysis of superficial bladder tumors was performed with special references to tumor progression and prognostic factors.
(Materials and Methods) From 1976 to 1994, 247 cases with pTa-pT1 superficial bladder tumor were treated. Mean duration of follow up 77.3 months. These patients were divided into pTa (196), pT1 (52), grade 1 (61), grade 2 (196) and grade 3 (62). The prognostic factors were calculated with multivariate and univariate analysis. Tumor progression was defined as muscle invasion or distant metastasis.
(Results) G3 tumor showed poor prognosis and was more frequent in tumor progression compared with G1 and G2 tumors (19.4% vs 0% and 1.6%). According to multivariate anlaysis, significant variables for actual survival rate were patient age and tumor grade. Tumor grade, recurrence and tumor configulation were also significant risk factor for cause-specific survival rate. By univariate analysis, patient age, tumor configulation, tumor size, multiplicity and concomitant CIS in G3 group were different from the other two G groups. In the G3 group, only recurrence was the predictable factor for progression. Analysis of prognosis and therapeutic modality revealed that G1 and G2 tumors were sufficiently controlled by endoscopic treatment. On the other hand, 21 cases (33.9%) of G3 tumor required total cystectomy after all. 11 cases of G3 group died of bladder cancer. Lymphatic involvement was detected in some cases of G3 tumor even if superficial. This factor showed a little relevance to poor prognosis of G3 tumor.
(Conclusion) Tumor grade was thought to be the most important risk factor of superficial bladder tumor. These results suggested that total cystectomy should be considered for the treatment of superficial G3 bladder cancer when recurrence occures or conservative treatment is though to be failed.

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(Background) We performed macro and micro-autoradiographic studies using ¹⁴C-oxalate in normal and hyperoxaluric rats in order to elucidate intrarenal distribution of oxalate and to determine where calcium oxalate crystal can be adhere in the kidney.
(Methods) Macro and micro-autoradiographic studies of the kidney in normal rats were carried out at intervals of 15, 30 and 90min after intravenous administration of ¹⁴C-oxalate (37MBq/kg BW). Hyperoxaluria was induced by vitamin B₆ deficient diet. The procedure of macro and micro autoradiography is the same as that in normal rat.
(Results) In normal rats, macroautoradiogram showed that the radioactivity of ¹⁴C-oxalate exists in the whole kidney, and macroautoradiogram identified this radioactivity mainly in the extraluminal space of renal tubules at 15min. Macro and micro-autoradiograms taken 90min after the injection showed practically no radioactivity of ¹⁴C-oxalate in the cortex or the medulla, but it was located in the extraluminal space of the papilla. In hyperoxaluric rats, macroautoradiogram showed some spotty accumulations of ¹⁴C-oxalate in the inner medulla and papilla. Microautoradiogram revealed that these accumulations are mainly seen in the extraluminal space.
(Conclusion) These results indicate that in normal rats the injected ¹⁴C-oxalate remains in the renal papilla, especially in the extraluminal space, when nearly all oxalate was excreted by urine, and in hyperoxaluric rats ¹⁴C-oxalate exists there as calcium oxalate crystal or microlith.

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(Background) Due to the advancement of prenatal and postnatal ultrasound screening in addition to better understanding by pediatricians, more infants have been detected to have vesicoureteal reflux. There are still debates, however, about their management whether to take conservative or surgical treatment.
(Methods) We analysed clinical courses of 51 children with primary reflux undergoing antireflux surgery when they were under 1 year.
(Results) A total of 41 infants (80%) presented with febrile urinary tract infections. The first UTI was seen as early as 7th day after birth, with the average age of 2 months. Seven infants had hydronephrosis detected by prenatal ultrasound, and 2 were identified by neonatal screening ultrasonography. Sixty-eight of 86 reflux ureters (79%) showed high grade reflux (grade IV-V). All the other 18 ureters with mild to moderate grade of reflux except one accompanied with contralateral high grade reflux. One ureter with grade II reflux was associated with contralateral obstructed meganreter. Renal parenchymal abnormalities, either with scarring and/or small kidney, were identified in 64 kidneys (74%) at or before the reimplantation.
The operation was done as early as 1 month-old with the average age of 5.6 months. Among the children, 24 (47%) underwent anti-reflux surgery before 6 month-old. Smallest infant weighted 2500gr at the time of operation. Reimplantation was done by the Cohen transverse advancement technique in 75 ureters (87%). The modified Politano-Leadbetter method in 6 with Hutche's diverticulum, and the Glenn-anderson advancement method in 5 with moderate to mild reflux. Two dilated ureters were treated with folding of the intravesical segment. Follow-up voiding cystourethrogram of 49 children at 6 months revealed no evidences of persistent reflux. There were no patients with obstruction of reimplantation except one with slight upper-tract dilatation. One infant revealed new low grade contralateral reflux, and he is being observed. Two children presented pyelonephritis after the operation.
(Conclusion) Our success rate of 100% in antireflux surgery enables us to continue our policy to perform early operative interventions in infants with high grade reflux. In addition to the meticulous and careful technique, the conditions for successful results include;
1) A through checkup of the lowre tracts by VCG and endoscopy.
2) Find the better operative instruments for the small bladder.
3) Do not hesitate to perform the ureteral tapering.
4) Make good use of operative loupe.

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We reviewed 105 patients with adrenal tumor diagnosed at our institute from January 1984 to December 1993.
In 74 patients tumors were symptomatically diagnosed (the symptomatic group), while in the remaining 31 patients tumors were incidentally detected (the incidental group). In 5 cases of the incidental group, tumors were found at a routine health examination, whereas in the remaining 26 cases tumors were found during the examination or treatment for unrelated diseases.
On both the incidental group and symptomatic group, higher right-to-left side ratio was noted in the laterality of tumors detected by ultrasound scanning. The size of tumors in the incidental group was significantly larger than that in the symptomatic group, but there was no significant difference in size between the tumors detected by ultrasound and those detected by CT scan in either the symptomatic group or in the incidental group.
In the symptomatic group 71 patients (95.9%) were found to have functioning tumor, where the most common diagnosis was primary aldosteronism (44 cases), and 68 of the 71 patients received adrenalectomy.
While in the incidental group 12 patients (38.7%) were found to have functioning tumor, where the most common diagnosis was pheochromocytoma (7 cases), followed by Cushing's syndrome (3 cases) including one case with so-called pre-Cushing's syndrome, and all of the 12 patients received adrenalectomy. Of 16 primary incidental adrenal tumors which did not have any hormonal functions, 5 tumors larger than 30mm in diameter were resected and the remaining 11 tumors were followed up without operation. Since the incidence of incidental adrenal tumor may increase in the future, careful diagnosis and decision of indication for surgery are required.

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(Purpose) This study was carried out to determine the effectiveness of intravesical oxybutynin hydrochloride on urinary urge incontinence in elderly people.
(Methods) The subjects consisted of 13 patients with an average age of 75 years who demonstrated uninhibited detrusor contraction on cystometrogram. The trial protocol consisted of a pretreatment cystometrogram followed by the intravesical administration of 10ml solution containing 5mg oxybutynin hydrochloride (pH 5.85). The urodynamic studies were repeated one hour later.
(Results) The mean bladder capacity before and after one hour of intravesical oxybutynin hydrochloride was 161±62ml and 196±71ml (mean±1 S. D., n. s.). The rate of improvement was 15.4% (2 cases) in all 13 patients. Four patients out of 13 patients continued intravesical administration of the solution twice daily. Urinary incontinence disappeared in two patients and incontinence was markedly decreased in one. In the remaining patient, urinary incontinence did not change because of increased residual urine. Three patients have continued this therapy over one years and no side effects were observed. In these patients, residual urine volume did not increase.
(Conclusion) It is suggested that intravesical oxybutynin hydrochloride is an effective option of therapy for intractable urge incontinence in elderly people, however, the immediate posttreatment cystometrogram was not predictive of the response to intravesical therapy on overactive bladder in the elderly.

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(Background) In an attempt to define the effects of combination therapy with interferon α and γ, lymphocyte subsets in tumor site and peripheral blood have been studied.
(Methods) Tumor Infiltrating Lymphocytes (TILs) and Peripheral Blood Lymphocytes (PBLs) from 13 interferon-treated and 11 untreated patients with primary renal cell carcinoma were characterized by two color flowcytometry. Interferon-treated patients received interferon α and interferon γ before radical nephrectomy; Interferon α was administrated intramuscularly at a dose of 3×10⁶ units every other day from a week before nephrectomy. Interferon γ was administrated as intravenous drip infusion at a dose of 10⁶ units after interferon α administration.
(Results) In both groups, both TILs and PBLs comprised about 70% of CD3-positive cells and CD3-positive TILs comprised significantly larger number of HLA-DR positive (activated T) cells compared to CD3-positive PBLs. Although TILs showed smaller number of CD4-positive cells compared to PBLs, TILs comprised more CD4⁺ Leu8^- (helper T) cells than PBLs. Only in interferon-treated group, TILs comprised larger number of CD8⁺ CD11b^-(cytotoxic T) cells than PBLs and CD16-positive cells (natural killer cells) than TILs in untreated group.
(Conclusion) These results suggest that antitumor effects of interferon α and γ combined administration may be concerned with natural killer cells and cytotoxic T cells in tumor site.

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(Purpose) Clinical significance of DNA ploidy pattern and its DNA heterogeneity is examined in prostate cancer.
(Methods) Fresh needle biopsy specimens were analyzed with flow cytometry and were compared with histopathological findings in 42 patients.
(Results) Seven patients had stage B (1 case of B1, 6 cases of B2), 14 had stage C and 21 had stage D disease respectively. Histopathologically, 18 of the cases were well, 12 were moderately and 12 were poorly differentiated adenocarcinoma. Diploid was observed in 20, aneuploid in 22. Though 22 cases showed no DNA heterogeneity, 14 had type A heterogeneity with aneuploid in association with diploid pattern, and 6 cases had type B heterogeneity in which multiple aneuploid patterns with different D. I. values were observed. The heterogeneity was observed in 28% of well, 58% of moderately and 67% of poorly differentiated adenocarcinoma, respectively, and also in 14% of stage B, 50% of stage C and 57% of stage D patients, respectively.
(Conclusion) We conclude that DNA heterogeneity in prostate cancer is more frequently seen in poorer differentiated ones on histologic grade and in more advanced ones on clinical stage.

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Three patients with lung metastases of urogenital tumors were treated by bronchial arterial infusion therapy.
Case 1: A 52-year-old man who had multiple lung metastases of right renal cell carcinoma fell into a dyspnea at 5 months after right radical nephrectomy. Though the effects of resection or laser coagulation with bronchoscopy were temporary, two sessions of BAI therapy with radiation improved the symptom of dyspnea for at least 3 months. Case 2: A 53-year-old man who had multiple lung metastases of right renal cell carcinoma was treated with systemic chemotherapy after right radical nephrectomy. Because the systemic chemotherapy showed only minor response, two sessions of BAI therapy were performed. No lung metastasis was detected in radiographs for 2 years after BAI therapy. Case 3: A 69-year-old man who had multiple lung metastases of left ureteral tumor was treated with 3 sessions of systemic chemotherapy. Though the systemic chemotherapy was effective, 2 sessions of BAI therapy with radiation showed a more suppressive effect, and the regrowth was not detected for 7 months after the therapy was performed. We concluded that BAI therapy was an effective therapeutic method not only for cases with no operative indication, but also for cases in which systemic chemotherapy was not effective.

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