The Japanese Journal of Urology

Tomography of the bladder with combination of perivesical and intravesical gas insufflation was performed on 30 patients (twenty cases of primary bladder tumor, a case of secondary bladder tumor, a case of prostatic carcinoma, three cases of prostatic hypertrophy, two cases of prostatic calculi and three normal cases) with intention to evaluate the usefulness in diagnosing the site and extent of bladder tumors.
In eighteen cases of primary bladder tumor, a case of sigmoid colon carcinoma with vesical invasion and a case of prostatic carcinoma with vesical invasion, the radiologic data were investigated in comparison with physical and cystoscopic findings, operative specimens and pathological findings. The results are as follows:
(1) When the growth is limited to the mucosa, there is no thickenig of the bladder wall and the outline of the wall is smooth.
(2) When the growth is limited to the mucosa and submucosa, the thickening of the bladder wall is slight, but the outline remains smooth.
(3) When the growth shows muscle invasion, the thickening of the bladder wall becomes marked and the outline shows an irregularity.
(4) When there is perivesical invasion, the bladder thickens irregularly both inwards and outwards, and in most cases the perivesical insufllation cannot be achieved.
(5) Tomography of the bladder combined with gas insufflation has a usefulness in preoperative evaluation of the extent of bladder tumors.

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In 1957 Malvin first described stop flow technique as one of investigative methods of renal physiology. Though many experimental information regarding this method appeared since then, there has been no description of stop flow pattern in human kidneys. The author applicated this technique in man and fundamental stop flow patterns of several substances in osmotic diuresis through intravenous loading of hypertonic glucose solution were investigated. Objects of the investigation were 12 cases, 7 males and 5 females.
They were divided into 2 groups: in Group 1, the investigation was done on 6 kidneys during the course of urological surgery, namely ureterolithomy or nephropexy under spinal anesthesia according to the original technique of Malvin and in Group 2 it was done on 6 kidneys, utilizing endoscopic insertion of ure teral bag catheter.
The results are as follows:
1) There was no significant difference of stop flow patterns between Group 1 and Group 2, except that urine flows in the former were less than in the latter.
2) The stop flow pattern of sodium resembled very much to that of chloride, showing uniform distal reabsorption.
3) Acidification of urine was done in the relatively narrow portion of the most distal tubuli.
4) Concentration of creatinine reached to the maximum at the distal portion, indicating an intensive water reabsorption.
5) The pattern of PAH showed its secretion in the proximal segment of the nephron.
6) The stop flow pattern of potassium did not show any definitive tendency, when the value was expressed by (u/pK)/(u/pCr.). Typical tubular secretion of potassium in the distal portion was verified only in 2 of 12 kidneys.
These findings did not much differ from the findings ascertained in dogs, except that the stop flow pattern of potassium showed no difinitive tendency of tubular secretion.
Posibility of clinical application of stop flow method was discussed.

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