Taking a suggestion form Denis Browne's urethroplasty, I have undertaken the following experiment, in which it was found that the pediculated bladder flap posted extravesically has become a complete tube whose epithelialized canal was continuous with the bladder cavity, owing to the regenerative power of the flap epithelium. We called it as “Bladder Flap-Tube”.
Bladder of adult dog was exposed. Two parallel incisions were made at intervals of 1cm through the entire layer of bladder wall, thus forming a flap of 5-6cm length. Lifting up this flap, the bladder was closed by suturing together the outer incision edges with continuous catgut sutures. Closure of the flap roots should be made so as to prevent leakage of urine and to maintain an adequate blood supply to the flap. The abdominal wall was closed as usual, leaving a drainage tube for 2 or 3 days.
Process of development of bladder flap-tube. A few days postoperative, the cut edges of the pediculated flap posted extravesically had become adherent to the opposed bladder wall, which was covered with some granulation tissue.
This adherence became stronger, thus forming a primary tube canal between the flap and bladder wall. At the same time the regenerative growth of the flap epithelium began from its cut edges. And complete circumferential epithelialization of the canal has occured by 12 days.
After 3 weeks the granulation tissue began to take organization and to shrink, so the original cut edges of bladder flap became closer and closer to each other, while the adherence of tube to bladder became decreased. After 4-5 weeks period the separation of the flap-tube from the bladder has become very easy. At 5 weeks the flap-tube had also complete continuous muscle layers around the canal.
As the mucosa of the original bladder flap was continuous with the bladder mucosa, the newly constructed tube canal also had continuity with the bladder cavity. A valve-like action at the entry of the tube into bladder to prevent the backflow of bladder urine was confirmed.
The inner circumference of the tube canal was largest during the first 9-12 days, and owing to the rapid shrinkage in 3-5 weeks came to the width of the original bladder flap, thereafter remained constant for as long as 240 days. (The length of the flap-tube was always about the same as the original flap.)
Utillizetion of Bladder Flap-Tube.
After cutting one end of the tube from the bladder at 4-6 weeks period, we can succeed in the practical urilization of flap-tube for the reconstruction of the lower ureter or urethra in dogs and also in human beings.
As a method of urinary-tract repair, though a preliminary operation is needed 4-5 weeks before the practical application, it has the advantage that one can handle a vivid and completely formed tube made from the urinary tract itself and there are few possibilities for getting urine leakage and atrophy of the tube. Also there occurs a valve-like action at the entry of tube into the bladder.

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Experimental renal homotransplantations were carried out on 10 uremic dogs. Changes of the plasma electrolytes and non-protein nitrogen levels of the uremic dogs were investigated after the transplantation. Besides, the electrolytes and urea nitrogen concentration of the urine excreted by the transplants were measured. Moreover, the functions of the homotransplanted kidney were examined by renal clearance methods.
The results were as follows:
1) Initial urine secretion from the homotransplanted kidney was observed within 11.5 minutes after opening up the cartido-jugular circulation.
2) Urinary secretion from the transplants was observed in all cascs, for 2 to 5 days.
3) It was possible to prolong the lives of bilaterally nephrectomized dogs for 5 to 11 days, i. e. 8.3 days in average, by the renal homotransplantation.
4) A large amounts of urine was secreted by homotransplanted kidneys during the first 24 hours following transplantation but thereafter the urine flow decreased steadily. Urine excreted by the homotransplanted kidneys revealed low specific gravity, low sodium and urea nitrogen concentration, but nearly normal concentration of potassium.
5) The renal homotransplantation in uremic dogs were capable of restoring the blood non-protein nitrogen and electrolytes values to normal levels within one or two days after transplantation.
6) While glomerular filtration rates of the transplanted kidney were slightly reduced, impairments of renal plasma and blood flow were marked. Glomerular filtration rates reduced to a half of normal at worst, but renal plasma and blood flow in most cases were ranged from a half to one third of normal values, with exceptional three cases in which they remained nearly normal.
7) These results indicate that the renal homotransplantation is clinically applicable as a treatment of acute renal insufficiency.

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Histological and arteriographical examinations were made of kidneys homotransplanted into the neck of dogs of uremic condition caused by bilateral nephrectomy and following conclusions were drawn.
1) Most of homotransplanted kidneys revealed as good an arterial circulation as in autografted kidneys on the period immediately after grafting. Intrarenal vasospasm, however beginns 3 or 4 days after homografting and it goes on to extreme grade with cortical ischemia when anuria sets in. This is considered as the main factor of the cease of renal function.
2) Histology in most cases revealed cell infiltration, consisting mainly of lymphocyte in interstitial tissue and accumulation of intratubular secretion, while most glomeruli sustained no pathological changes and tubular cells did not reveal degeneration and/or necrosis to the extreme degree.
3) Less histological change of homotransplanted kidneys to the uremic dogs than that to the healthy dogs was consisted to be based on decreased immunological reaction due to uremia.
4) The series of my experiments proved that the homotransplanted kidney was one of the valuable procedures in case of acute renal insufficiency for temporary compensation.

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