The scrutiny of the operative result in those who underwent segmental resection of the bladder, particularly in cases of its tumor, and that of the supplementary experimental result in rabbits led us to the following conclusion.
(1) of total 57 cases operated on, results of 39 cases will be considered here, of which 23 were primary bladder tumors (inclusive of 15 carcinomas) and 16 secondary ones.
1. Operative method: The simple small extent segmental resection was performed in 15 cases, while the complicated one was carried out in 24 cases. The latter cases consisted of 6 cases of broad-extent segmental resection of which 2 combined with the excision of contiguous organs, 4 with the uretero-cysto-neostomy; of 7 cases of total nephro-ureterectomy; of 12 cases of segmental resection combined with uretero-cysto-neostomy (inclusive of broad-extent segmental resection mentioned above); and of 3 cases of trigono-cystectomy combined with the uretero-cysto-neostomy and vesico-urethral-anastomosis. Eventually the uretero-cysto-neostomy was performed in 15 cases in which ureters operated summed up to 17.
2. Operative result:
a) There was no operative death.
b) The urinary fistula was formed in 20 cases (51. 3%), but transient and soon completely cured in all cases except one of uretero-cysto-neostomy in which the nephrectomy was necessitated. A transient formation of urinary fistula would be inevitable after the broad-extent segmentall resection.
c) Restoration of remaining bladder: Even after the broad-extent segmental resection, the remnant bladder regained its normal capacity gradually within a few months, thus making a normal urination possible. In some cases, however, the change in shape of the remaining bladder persisted for a long time.
Even after the trigono-cystectomy, a normal urination was possible, without causing incontinence and dysuria.
d) After the uretero-cysto-neostomy, a renal function was satisfactory.
e) Course after leaving hospital: The following results were those investigated within two years after leaving hospital. The mortality due to original bladder tumor was 17.9%. The recurrence rate was 30.8% as a whole, 12.5% in cases of papilloma, 27.6% in carcinoma, 50% in papillomatosis and 40% in other types of tumor.
(2) Experimental results in rabbits made it clear that it was safe and useful procedure.
1. A bladder of a rabbit did not fall into necrosis even when most of main arteries was ligated. The anastomosis of the regenerated blood vessels was completed about one month after operation. Mucosa fell off about two weeks after operation, and then, was regenerated. Muscularis remained almost unchanged.
2. A rabbit bladder in which the upper part was excised regained its normal capacity and intravesical pressure a few months after operation without leaving deformation of the shape. The sutured potion of the bladder wall was restored to such a degree as hardly distinguishable from the normal potion both macroscopically and histologically.
3. A few months after subtotal cystectomy leaving the trigone with the ureteral orifice intact, the remaining bladder nearly regained its normal capacity and intravesical pressure, accordingly, a completely normal urination was made possible. Only the cystogram revealed somehow distorted oval shape of the bladder being stretched transversely.
(3) With consideration of the above-mentioned clinical and experimental results emphasis may be placed on the following points.
1. The segmental resection of the bladder is a safe and useful procedure.
2. Any potion of the bladder can be removed.
3. If the remaining bladder has no pathologic change, normal bladder capacity and normal urination can be expected even after segmental resection of broad-extent, esp. trigono-cystectomy.
4. The recurrence rate of bladder tumor after excision was about 30%, much lower than expected beforehand.

View full abstract

(1) Renal functional studies were performed in forty cases of lower urinary tract obstruction by means of renal vein catheterization method and clearance tests, and the results were referred to the findings of renal needle biopsy.
(2) In seventy per cent of the cases with lower urinary tract obstruction renal functional damages were observed, most of which, however, were of slighter degree.
(3) The functional damages were chiefly that of the renal tubuli, while the glomerular damages developed in further advanced cases.
(4) Chief findings of renal biopsy were histological changes of the tubuli, which were sometimes accompanied by changes of the glomeruli and the interstitium.
(5) There was a close parallelism between the renal functional findings and the histological evidences.
(6) Perfect improvement of the damaged renal function did not occurred, as one expected, even after operative relief of the obstruction in the lower urinary tract. But it is certain that the relief prevented further deterioration of the renal function.
(7) Though the tubular damages may be the representative feature of renal impairment in cases of lower urinary tract obstruction, the glomerular function may serve as a standard in course of the treatment.
(8) Comparative study of the findings on excretory urograms and the renal functional studies revealed that the degree of the renal functional impairment that was measured by excretory urograms was more severe than what was measured by vein catheterization or clearance tests.

View full abstract

The function of the autotransplanted neck kidney for 3 hours after transplantation were examined by measuring renal clearance and renal extraction ratio.
The results were as follows:
(1) The transplanted kidney began to function shortly after the operation and the renal function was restored considerably within a few hours.
(2) Urinary secretion from the transplanted kidney was perceptible after the operation within a half on an average 26.5 minutes.
The rate of urine output was 0.067 to 1.87cc/min, the specific gravity ranged 1010 to 1028 and the reaction of the urine was alkalin. Though the urine secretion is the most important of the renal function, we cannot justly appreciate the renal function only by the rate of secretion.
(3) The renal blood flow was severely impaired in the transplanted kidney. It amounted only 60% of the normal value 3 hours after the transplantation, even in the most favorable cases. The tubular function was damaged, also. In the favorable cases EPAH was 80% of the normal value. The impairment of glomerular function was minimum, as a normal measurement was obtained in the favorable cases.
(4) Such renal damages may be due to unavoidable renal anoxia during the procedures of transplantation, duration of which lasted 43.0 minutes on an average. Anastomotical techniques of the blood vessels and denervation may be the contributory factors to the renal damages.
(5) These results indicate that the homotransplantation of the kidney is clinically applicable.

View full abstract

We reported a case of tumor of the spermatic cord, which revealed histologically rhabdomyoma.
A man, aged 60, had become aware of the tumor in right scrotum, but because it was painless, he let it alone.
One and half months later, admitted in our clinic as he suspected continued enlargement of the scrotal mass.
The mass was a localized, solid tumor of the spermatic cord.
A high ligation of the cord was done and the testicle and spermatic cord was removed. A bone and chest survey, intravenous pyelogram and cystoscopy revealed no pathological findings. Gross specimen: 6.5×3.5×3.0 (cm), ovoid shaped, elastic mass, adhesive to tunica vaginalis communis. Section revealed grey-white, homogenous with aboundant of interlacing fibers.
Microscopical findings: a moderately cellular tumor with tendency to whorl formation of the interlacing fibrillar bundles.
Scattered throughout were polymorphous cells round small or large, which contain one or more nucleuses shaped ovoid, vacuoles. Some of these cells show many striated structure (Heidenhain's stain) and aboundant of glycogen (Best's carmin stain).
After Graham and O'conor reported a case of ductal hyperplasia of vas deferens and collected 292 tumors of the spermatic cord, Gray and Biorn reported 1 (rhabdomyosarcoma).
In our country 23 cases of the tumors of the spermatic cord have been reported (except Miyagi's case).
We think perhaps rhabdomyoma arised from cremaster externus and spermatic cord has a tendency to grow a leiomyoma and rhabdomyoma, as cremaster has two different muscle fibers, namely glatt and striated fibers.

View full abstract