The human kidneys of 45 cases (72 kidneys) which were proved to have the urinary tract obstruction with or without associating infection and those of 60 albino rats being received unilaterall ureteral ligation and given E. coli inoculation either intravenously or transurethrally, were pathologically examined for studies of hydronephrosis, acute and chronic pyelonephritis. Special attention has been paid for morphogenesis of chronic pyelonephritis.
In both the human and experimental cases, the urinary tract obstruction frequently caused stasis or thrombus formation of the intrarenal lymph and venous systems which might predispose following bacterial infection.
There was no specific morphological feature characteristic for chronic pyelonephritis of the human cases, however irregular interstitial fibrosis based upon chronic interstitial infective processes and multiple infarctions along with marked cellular reaction and occasional evidence of chronic thrombophlebitis seen in the chronic pyelonephritic cases would suggest the possibility that some angio-damaging factor might operate upon promoting chronicity of this disease.
In the experimental pyelonephritis cases, the kidneys of the rats groups receiving initial bacterial sensitization later developed rather typical features of the chronic pyelonephritis after second intravenous or transurethral bacterial inoculation than those of the non-sensitized groups.
Those features constituted of perivascular cellular cuffing, occasional necrotizing angitis, medial hypertrophy of the intrarenal arteries and fresh or old infarct formation based upon functional and organic vascular impairments which might quite possibly been related to hypersensitive mechanism.
From the above findings, it was emphasized that some hypersensitive mechanism might have played an important role in experimental reproduction of the chronic pyelonephritis following to initial renal damage by causative bacteria per se.

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It is well known that the adrenal glands play an important role in the homeostatic mechanism of the whole body, and there can be found many reports on the humoral controling mechanism for the endocritic activity of the adrenal glands. Among them, two concepts, the “Interbrain-Pituitary-Adrenocortical System” offered by Selye and the “Sympathico-Adrenocortical System” offered by Cannon, are most dominant in present time. On the other hand, the reports on the nervous controling mechanism for the secretory activity of the adrenal glands are rather few except a theory of the “N. Splanchnicus-Adrenocortical System” offered by Okinaka. While, Sayers assumed that the basal secretion of the adrenal hormones would be controled by the humoral controling system as described above but the additional secretion of it might be influenced by some nervous controling system of that organ, however, the details of these mechanisms are not explained satisfactorily.
Therefore, I tried to clarify the functional mechanism and the characteristics of the nerves on the secretory activity of the adrenal glands. The adrenal vein blood was obtained by the modified technique of the Hume & Nelson's method from the adult dogs which received selective section of various nerves innervating the adrenal glands. The blood flow rate and the concentration of adrenalin, noradrenalin, and 17-OHCS were estimated by Yoshinaga's method and the modified procedure of the Porter-Silber's method one week or one month after the operation. The resection of the nerves was performed on the left splanchnic nerve, and each of left ventral, dorsal, ventral-and-dorsal roots, spinal ganglions, and ventral roots and spinal ganglions of VII-X or XI-XIII thoracic nerves, respectively.
The blood flow rate of the adrenal vein changed corresponding to the kind of nerves resected. It increased following the resection of left ventral roots or ventral-and-dorsal roots of the thoracic nerves, however, it decreased following the resction of left dorsal roots, spinal ganglions, ventral roots and spinal ganglions of that nerves, and the resection of left splanchnic nerve. These changes did not show any relationship to the concentration of adrenalin, noradrenalin, and 17-OHCS in that blood, and it was assumed that these changes were produced due to the resection of nerves described above.
The concentration of adrenalin and noradrenalin in the adrenal vein blood decreased generally after the various nerve section. It decreased significantly following the resection of ventral roots, and ventral-and-dorsal roots of the thoracic nerves, and the concentration of adrenalin decreased also significantly following the resection of ventral roots and spinal ganglions of that nerves, while that of noradrenalin showed marked decrease at the same time. And furthermore, the concentration of both hormones debreased markedly following the section of dorsal roots of the thoracic nerves and the section of the splanchnic nerve, while following the resection of spinal ganglions of the thoracic nerves these increased slightly.
Moreover, the total output of these adrenal hormones following the selective section of various nerves decreased generally. But the total output of 17-OHCS following the section of ventral roots of the thoracic nerves, that of adrenalin following the resection of ventral-and-dorsal roots, and ventral roots and spinal ganglions of that nerves, and that of each adrenalin, noradrenalin, and 17-OHCS following the resection of spinal ganglions of that nerves kept almost normal levels. These changes of the concentration and total output of the adrenal hormones corresponding to the kind of resected nerve, and the results obtained that there could not be found any relationship between the concentration of adrenalin or noradrenalin and 17-OHCS in the adrenal vein blood reveald the fact that these changes were produced due to the resection of nerves desc

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The majority of cases in the present study demonstrated single calculus in unilateral ureter with no marked complication of hydronephrosis or infection. Spontaneous passage of calculus was noted in most cases (115 cases out of 165 cases), and ureterolithotomy was carried out in only 50 cases. Daily intake of large quantities of water and jumping exercise and at times the use of antispasmotic drugs were useful in assisting the passage of calculus.
The 115 cases showing spontaneous passage of calculus were divided into the following three groups according to their radiographic (size: 1) small sized group (not greater than 0.5cm in diameter), 48 cases (41.7%); 2) middle sized group (not greater than 1.0×0.6cm), 56 cases (48.7%; 3) large sized group (larger than 1.0×0.6cm), 11 cases (9.6%). These figures show that if the radiographic shadow of the calculus is not larger than 1.0×0.6cm and if there is any recent sign of movement of the calculus roentgenographically with occasional colic, spontaneous passage of the ureteral calculuc can be expected.
In the small sized group (48 cases) there was spontaneous passage of calculus within one month period after the initial occurrence of colic in 35 cases (72.9%). The percentage rose to 87.3% by the end of the third month and at the end of the sixth month the total percentage reached 93.6%.
The figures in the middle sized group were 25% within the first month, 60.7% at the end of the third month, and 78.6% at the end of the sixth month. It would thus be possible to assume the date of spontaneous passage of ureteral calculus if the date of the initial attack and the size of the radiographic shadow are known beforehand. These results may also prove to be of value as a standard in evaluating the drugs and methods which assist the spontaneous passage of ureteral calculus.

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Observations on reactions of the cholinergic drugs (pilocarpine and bethanechol) to the bladder pressure were performed in 50 cases of normal and abnormal bladder patients.
If patients have the disturbances of the sacral cord or its peripheral nerves innervating the urinary bladder (lower motor neurone), the bladder pressure is more rapidly and more highly raised than normal one by subcutaneous injection of cholinergic drugs. The smooth muscle of such disturbed bladder has the hypersensitivity to cholinergic drugs. On the other hand, in patients without disturbance of the nerves innervating the bladder or with the disturbance upper than the lumbar cord (upper motor neurone), the bladder reacted to the drugs in the same way as the normal one. These findings are entirely in accord with “Cannon's Law of Denervation”.
Such hypersensitivity of the bladder smooth muscle is proportional to the grade and has no relation to the location of the disturbance of the lower motor neurone. The hypersensitivity once acquired, may continue for many years. As regards the neurogenic bladder, the grade of the dysuria is almost proportional to that of the hypersensitivity.
Because of the phenomenon of such hypersensitivity, the application of the cholinergic drugs to the cystometric examination is useful in the diagnosis of the neurogenic bladder, but the treatment of the neurogenic bladder, the cholinergic drugs must be administered carefully.

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Many reports were observed on the urinary tract infection, the main complication of the neurogenic bladder, but there could not be found any of the patho-histological study on the urinary tract following experimental production of the neurogenic bladder. Then, the bilateral section of the pelvic nerve, and furthermore, the bilateral section of the ventral roots, the dorsal roots, the ventral-and-dorsal roots of the sacral nerve, and the resection of the spinal ganglions of that nerve were performed on the adult dog respectively to make the experimental neurogenic bladder, and the histological observation of the urinary tract of these animals was observed corresponding to the vesical function. The results obtained were as follows:
1. The inflammation of the vesical wall was inevitably after the section of various nerves, especially after the section of the dorsal roots of the sacral nerve, and this was increased corresponding to the duration after the operation.
2. The hypertrophic change of the vesical wall was recognized after the section of various nerves and this was also increased corresponding to the duration after the operation. This hypertrophy of the vesical wall was caused mainly by esch of the hypertrophy of the muscle fibers, edema in the whole layers, and the development of the submucosal granulation tissue.
3. The significant hemorrhage in the submucosal layer of the vesical wall was frequently found after the section of the dorsal roots of the sacral nerve.
4. The inflammation of the ureteral wall was observed in the most cases, while it was found in the early stage following the section of the dorsal roots of the sacral nerve.
5. The histological changes in the kidney was rather remarkable and it revealed the significant findings of the pyelonephritis after the section of the pelvic nerve, and the section of the dorsal roots, the ventral-and-dorsal roots of the sacral nerve, especially it had been appeared in the early stage after the section of the dorsal roots.
On the other hand, it was rather slight after the section of the ventral roots and the resection of the spinal ganglions of the sacral nerve, respectively.
6. These inflammation in the urinary tract and its effect on the histological findings of the kidney was rather significant relating to the grade of the vesical disorder.
With these results obtained, it was assumed that there would be some relationship between the findings of the urinary tract inflammation and the vesical dysfunction caused by the injury of the nerve innervated to it.

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The present study was designed to clear the pathogenesis of diabetic neurogenic bladder. The cystometric observations of the urinary bladder as well as histologic examination of Langerhans' island of the pancreas and blood sugar tests were done in the dogs in which experimental diabetes was developed.
1) Severe diabetic condition of long duration developed in dogs with intravenous injection of alloxan at a dose of 60-70mg/kg. The blood sugar level increased slightly within several hours, and then, after slight decrease, it increased markedly with positive urine sugar test in 24 hours. In 48 hours typical symptoms of diabetes mellitus appeared with higher blood sugar level. Thus, a triphasic blood sugar curve was obtained.
2) Regressive changes were pronunced in the islands of Langerhans, particularly in β-cells. With administration of alloxan, α-cells increased slightly in number, while β-cells decreased rapidly to 1/8 of the normal number. With lapse of time β-cells showed a gradual regeneration.
3) In several dogs abnormal findings were noted on the cystometrogram over 43 days after the onset of severe diabetes. In majority of the cases the cystometrogram showed a low pressure curve, with either absence of spike of the first sensation to void or delay in it's occurrence. A marked increase in the bladder capacity and decreased intravesical pressure were also noted on the beginning of voiding. From this finding it is assumed that the vesical dysfunction may have a close relationship between the severity of diabetic condition and the duration of it.
4) Cystometrograms obtained were very similar to those in dogs in which either posterior roots or both posterior and anterior roots of the sacral nerves were cut off, or to those seen in tabes dorsalis. From this finding it is assumed that in the diabetic neurogenic bladder there could be some lesions found in the peripheral nerves innervated to the bladder or in the spinal cord, and that the lesions could play an important role in developing the vesical dysfunction.

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Sixty-six patients admitted to our clinic with hypertrophy, cancer, lithiasis and inflammation of the prostate and urinary bladder cancer were examined with special reference to vasoseminal vesiculography from July, 1962 to December, 1963. The prostatic carcinoma pattern by criteria of Vestby was most commonly seen in prostatic cancer and hypertrophy pattern in prostatic hypertophy. These patterns were not specific in the two lesions but were often seen in lithiasis and chronic inflammation of the prostate. A typical characteristic carcinoma pattern was observed in a case of cancer of the urinary bladder. The vasoseminal vesiculography gave us indispensable clues to estimate the extent of the malignant infiltration, when it showed the carcinoma pattern, such as stenosis of the ejaculatory ducts and seminal glands with irregular outline, although they appeared in malignancy of the surrounding organs. The hypertrophy pattern, especially distention of seminal glands was seen in several cases of cancer of the prostate.

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1. The skin incision is started just below the lower edge of the 11th rib and a little anterior to the tip of the 12th rib. It is then carried straightly downward until reaching to the iliac crest.
2. The underlying fascia is exposed enough to visualize the direction of the muscle fibers and is opened just between the latissimus dorsi and external oblique muscle.
3. Then Fascia transversalis will easily be exposed by reflecting the latissimus dorsi muscle backward and anterior oblique muscle forward.
4. Fascia transversalis is incised vertically and one enters the retroperitoneal space without difficulty. Care must be taken not to injure the 12th intercostal nerve and vessels.
5. Adipose capsule and Gerota's fascia are incised and opened.
6. Then the peritoneum is reflected foreward, the ureter will usually be carried with it and may be visualized with the aid of deep retraction.
7. The ureterolithotomy will be performed thru a small longitudinal incision in usual manner.
8. Before closing the ureteral incision, a ureteral catheter or small rubber catheter will be passed upwards and downwards to exclude any other ureteral obstructions. It is convenient to have a small catheter in the ureter upon suturing the ureteral incision.
9. This incision is most applicable to the ureterolithotomy at the level of L₂-L₅.
10. This incision is applicable not only to the ureterolithotomy, but also, as showed in the Table 2, to the nephropexy, nephrostomy, open kidney biopsy and nephrectomy, if there are no marked adhesions to surrounding tissues.

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