To know the present status of use of pyelography which has been widely accepted in urological field and performed usefully for these a half century, the vital statistics on its use are taken from 126 major hospitals in Japan. Along with the statistics, the results of pyelography done in the urological department of Kanto Teishin Hospital for the last several years, is reviewed and analysed.
To minimize the side effect of the retrograde pyelography, some experiments are performed also.
The results are as followed.
(1) The ratio of performance of I. P. and R. P. is 2 to 1 in these 126 hospitals. 88.1% of the these hospitals performed I. P. more frequently than R. P.. I. P. appeares to be much common and practical.
(2) In Kanto Teishin Hospital, plain films of the upper urinary tract were taken more predominantly for the last several years. This is due to increased cases of urolithiasis and of its suspected cases.
(3) Pyelography was done in female more frequently than in male.
(4) As the contrast media, chemicals composed of three Iodine particles in one molecule are commonly used. It is felt that this is due to its little side effect and clear contrast of the photograph.
(5) There are about six different kinds of preparation for I. P. used in these hospitals but as the most common preparation, enema, laxative, and absorbents are used respectively in order of frequent use, however, two combination out of these six are used in some places. It is felt that the definitive manner of use of preparation for I. P. is not determined at present time.
(6) 54% of the hospitals use pressure bandage on abdomen upon performance of I. P. and rest of them use inclining-bed with angle of 20 degrees.
(7) By use of inclining-bed upon performance of I. P. excretion of dye, configuration of renal pelvis, movement of kidney due to change of position, and any disturbance of free flow of upper urinary tracts are easily and clearly seen.
(8) In most institution, numbers of I. P. taken is twice per case at a time.
As to the time intervals of the I. P. taken, 5 minutes after injection, for the first one, 15 minutes for the second, and 25 to 30 minutes for the 3rd, is common.
(9) Clearness of the nephrogram of I. P. is better in 25 minutes one, 15 minutes one and in 5 minutes one in suscessive order. This is due to descent of kidney by change of patient's position and nephrogram of the female is much clears than those of male.
(10) Perfect pyelogram is obtained in 33% of all 5 minute pictures, and in 42.6% 15 minute ones. Pyelogram obtained by I. P. and R. P. in same patients reveals that I. P. is supereior to R. P. in 55% of cases to get clear pyelogram.
(11) As the side effects of I. P. most of them are mild, however, 5.8% of all cases of I. P. done, went into shock after I. P. injection. Hypersensitibity tests before injection were done in 11.9% of all cases and it is felt that this test should be done for nesecessity before injection.
(12) As to the number of ureteral catheter, ch. 5 is proper for the R. P. and the length of the catheter put in is calculated as followed.
X-26.7=0.06 (Y-158.0) X=length of catheter to be put in
Y=height (cm)
X-26.7=0.13 (Y-87.0) X=length of catheter to be put in
Y=sitting hight (cm)
(13) Organic media is more commonly used for R. P.
(14) The amount of the contrast media to be injected through ureteral catheter for R. P. is predominantly, 5 to 10ml. The capacity of the renal pelvis actually determined by author suggests 5.1ml of contrast media being adequate for R. P.
(15) Serial photography taken or determination of the way of filling contrast media in renal pelvis, reveals that the upper calyx appears first, middle calyx, second. and later the lower calyx respectively in dorsal position. In ventral position, the lower calyx appears first.
(16) The frequency of pain appeared on renal area upon performance of R. P. is 10-30% of all cases.
(17) The pye

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To detect the abnormal shadows of renal pelves and calyces in detail, the author applied a high-voltage photofluorographic technique to the upper urinary tract.
The photograms were taken by 60×60mm serial films using Toshiba X-Ray Apparatus KCD-12F type with rotating anode tube and indirect X-Ray Canon Camera. Some 10 serial films in a patient were taken at 120KV and 70cm distance.
Films of 63 cases were examined, which consisted of plain films of the abdomen (10 cases), intravenous urograms (17 cases) and retrograde pyelograms (36 cases). And the results are follows:
1) Owing to the high-voltage photofluorography, bony shadows and intestinal masses became faint without any enema, evacuant or diet restriction.
2) Because of serial photography, stereographic observation was possible when the position was changed gradually.
3) On the intravenous urograms, if the kidney function normally, the calyces and pelvis were visualized within 2-3 minutes after the injection in the supine position. When the patient took upright position, the media were excreted from the pelvis immediately.
4) On the retrograde pyelograms, so-called “emptying times” of the each calyces and the pelvis in the normal kidney were studied. The times of the upper, middle and lower calyces and the renal pelvis were less than 5 minutes, 4 minutes, 5 minutes and 3 minutes in supine position and 2 minutes, 4 minutes, 4 minutes and 3 minutes in upright position, respectively.
5) Photofluorographic changes in 16 cases of essential renal hematuria were dilatation of renal pelvi-calyceal system (68.7%), reflux of media from renal pelvis to calyces (43.7%), Narath's symptom (43.7%), movable kidney (31.2%), flexion of ureter (31.2%) and sustaind small shadow in one calyx (18.70).
6) Photofluorographic changes in 14 kidneys of nephroptosis were flexion of ureter (100%), dilatation of renal pelvi-calyceal system (71.4%), Narath's symptom (64.2%), rotation of the kidney (50%) and reflux of media from renal pelvis to calyces (21.4%).

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The author investigates the modes of development of collateral venous pathways and the effects on general circulation and renal function following ligation of the vena cava caudalis, because in radical surgery of the kidney ligation or resection of the vena cava inferior became sometimes necessary.
In 59 adult mongrel dogs the vena cava caudalis was ligated through following 4 methods: Group I, ligation below the level of both renal veins; Group 2, oblique ligation tying the point above right renal vein and the point below left renal vein; Group 3, oblique ligation tying the point above left adrenal vein and the point below right renal vein; and Group 4, ligation above the level of left adrenal and right renal veins. Modes of development of collateral venous pathways were investigated by venography and autopsy. Circuratory changes were examined by measurements of venous pressure and by electrocardiography. Renal damages were studied by intravenous pyelography, determination of blood chemistry and histological examination.
The results are as followed:
(I) Survival rates of groups 1, 2, 3, and 4 were 75%, 50%, 36.6% and 50%, respectively. Early deaths following the ligation were found to be due to diminition of returning blood volumes to the right auricle and acute renal failure. There was no difference of survival rates between male and female dogs.
(2) Maximal venous pressures of the versa saphena parva were measured within 24 hours after the ligation. They returned nearly to normal within a week. The results of venous pressure, serial venography and chemical data of the blood indicated that collatral venous pathways would be accomplished one to two after the ligation.
(3) Main collateral venous pathways were verified to be vena vertebralis, venae lumbales ascendens, venae lumbales and vena azygos in every group of the experiments. In addition to them, somtimes, vena spermatica interna, veins of the abdominal wall, versa subcostalis, venae intercostales and right and/or left retroperitoneal veins (vena circumflexa ilium profunda-vena phrenica inferioradrenal vein) became also collateral pathways. In the early stage after the ligation dilatations of veins of the abdominal wall and retroperitoneal veins were marked, but they were subsided gradually according to the development of collateral pathways through vena spermatica interna. Dilatation, elongation and tortuosity of vena ovarica were more marked than vena testicularis.
(4) Any difference of histological and pyelogrphic findings between right and left kidneys was not observed after restoration from renal damages by accomplishment of perirenal collateral venous pathways, even if there had been a temporary venous congestion of the kidneys.
(5) Any marked post-ligation sequlae was not observed in all survival cases of the experiment.

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1) A case of tumor of the tunica albuginea testis is reported which occurred on the lower pole of the right testis of a 45 year-old male. Castration revealed the tumor to be unrelated to the testicular parenchym and epididymis. The tumor is firm and 0.9 by 0.7 by 0.6cm. in size and has a smooth surface. The cut surface assumes white color. Histologic diagnosis was benign mesothelioma.
2) Tumors of the tunica albuginea testis are indeed rare. Only one case has been reported by Takayasu (1949) in our country. Review of the foreign medical literature discloses that only 12 cases of tumor of the tunica albuginea testis have ever been reported.
3) The literature of 14 cases of tumor of the tunica albuginea testis is reviewed.
4) The literature of “adenomatoid tumor” of the male genital tract is reviewed.

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