Histological examinations were given on the sepecimens of horizontal and vertical sections of the bladder necks and posterior urethras prepared from 7 autopsied cases of congenital idiopathic bladder neck obstruction (their ages ranging from 1 day to 4 years and 3 months) and from 10 normal cases (their ages being almost similar), with a veiw to elucidating the entity of this disease.
1) The vesical sphincter in normal cases was distinctly separated from the muscle layers, when seen on the horizontal specimens, and their muscle fibers were fine and even and that they were in close contact with connective tissues but were lacking in elastic fibers. The sphincter was observed to terminate in the vermontanum.
2) The vesical sphincter of congenital idiopathic bladder neck obstruction was observed to have intense fibrosis in 6 cases and fibroelastosis in 1 case. These changes were seen to have reached the vermontanum, decreasing in intensity gradually.
Judging from those findings the entity of congenital idiopathic bladder neck obstruction can be concluded to have originated from congenital fibrosis in the vesical sphincter, and this disease is better called “congenital vesical sphincter sclerosis”.

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Neurogenic bladder is definited as one of the micturition dysorders due to some organic disturbances of the nerve innervating the urinary bladder, and many clinical and experimental observations were presented by today. However, the pathological physiology of this disease is so much complicated and it is not clear enough yet, so that we could not find out any reasonable planning of the therapies for this disease.
Since the obstructions for this is that it is very difficult to find out the natures of the nerve injuries so exact by the neurological examinations, we are in unavoidable situation to know clinically not only the characters of nerve injury but also the micturition condition only throughout the cystometrogram.
On the other hand, it was believed that storing of urine in the urinary bladder should be depend upon the stretch reflex of the vesical wall through the sacral micturition reflex arc, and voiding of urine from the urinary bladder should be depend upon the nervous control of higher center to the sacral cord. However, we can sometimes find out some reports that such bladder function is some part depend on the purely physical nature of the vesical wall itself, such as elasticity and so on, and some biophysical factors such as mural tension is also very important factors affecting the cystometrogram.
Here, the author had assumed that the cystometrogram should be depend upon at least two factors, namely, the effect of the innervating nervous system coming from outside of the urinary bladder, and some biophysical properties of the vesical wall itself including the activities of the intramural nervous elements and also physiological characters of the other constituents of the vesical wall, mainly the smooth muscle. Therefore, to make the relationship between these two factors and the effects of them upon the cystometrogram so clear, several experimental observations were made as follows.
At first, various experimental neurogenic bladders were produced on adult dogs, and its cystometrogram and cystoadaptometrogram were examined. The latter is recently developed procedure as one of in vitro examination of bladder function relating to the cystometrogram.
Next, using normal adult dogs, the effect of some drug administration or electrical stimulation to the spinal cord were examined by the cystometrogram and cystoadaptometrogram.
Furthermore, the adapting pressure curve, which was new concept developed from the results of cystodaptometrogram was analysed each other regarding to the experimental conditions such as the kind of drug administration or the kind of nerve resected. And following results were obtained.
First in normal animals, the micturition contraction curve, which appears in the last part of the cystometrogram, reveals the existence of the innervation of the sacral cord activity coming from outside of the urinary bladder, especially the centrifugal fibers relating to the ventral root of the sacral nerves.
Next, with the results of pharmacological experiments on normal animals, it was clarified that the most part of the cystometrogram, except the last one as described above, should be depend upon the biophysical properties of the vesical wall, including xylocainsensitive intramural nervous plexuses and other nervous elements as well as the other constituents of the vesical wall. And it was assumed that the cystometrogramm obtained would reveal the over-all characters of these factors of the vesical wall.
And furthermore, with the analysis of the cystometrogram as well as the cystoadaptometrogram obtained from the animals in which various nerves innervating the urinary bladder were resecged, it was clarified that various alterations in cystometrogram should be depend upon almostly the changes of such a biophysical property of the vesical wall after the nerve section. And at the same time, some physiological activity of the sacral spinal ganglions on such alteration was assumed.

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The animal and clinical experiments of studies on the action potential of the ureter were performed with an improved extraluminal electrode, which the author has deviced (Fig. 1 in Japanese text). At first thus recorded wave of the action potential of the ureter was compared with the theoretically induced wave (Table 9 in Japanese text), and the accordance with each other was fairly confirmed. The important indicators that represent physiological conditions of the ureter are period of the wave (P), velocity (v), amplitude of the spike (Vp max), polarization power of smooth muscle fiber of the ureter (K) and the interval between spike maximums in the action potential wave (T″).
The results are as follows:
1) The ureteral peristalsis of the rabbit is not distinctly affected by administration of some drugs acting on the autonomic nerve system (vagostigmin, besacholin, buscopan, atropin sulphate, opistan and papaverine hydrochloride).
2) In the normal ureter of the morphologically and functionally normal upper urinary tract, fairly constant action potential waves of the antegrade peristalsis are recorded, but waves of the antiperistalsis do not appear. In general tendency, P is small when K is big and the reverse phenomena.
3) The action potential in the hydroureter due to urinary obstruction is not, or only weakly recorded. If recorded, the value of P and v is inconstant, and the action potential generally has a tendency to show big T″ and small K and Vp max. Whereas, in the action potential wave of the ureter below obstruction, the antiperistalsis is recorded at a pretty high rate.
4) Particularly, in cases of the renal calculi (calculus in calyx or pelvis of the kidney, staghorn calculus), antiperistalsis is frequently recorded, if the ureter is functionally and morphologically normal. The antiperistalsis can be also evoked with ease by means of operative procedure, e. g. lithotomy. The appearance of antiperistalsis is calssified into two types: (i) antiperistalsis alone, (ii) antiperistalsis co-existing with antegrade peristalsis. In the transition between antegrade peristalsis and antiperistalsis, distinct regularity can not be confirmed. But when both antegrade peristalsis and antiperistalsis coexist, v, Vp max, K of the latter are smaller than those of the former.
5) Although linear incision is added on the ureter and the most possible of the urine is permitted to flow out, action potential of the ureter below the incision can be recorded, if action potential exists above the incision.
6) In severe ureteritis, especially in tuberculous ureteritis, the action potential wave is not recorded.

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Two cases of bacterial shock were observed in one patient, 77-year-old with prostatic hypertrophy while a catheter was implanted and the other patient, 72-year-old with a bladder stone after a bladder irrigation with caliculi solvent. The patients were cured of the shock with antibiotics, vaso pressor drug, cardiac stimulants were steroid hormones.
The causes and therapies are discussed.

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The fetal cases experienced in our department were observed with reference to the original urologic diseases, age, and complications. The results obtained were as follows:
Original Urologic Diseases: Majority of the cases of prostatic hypertrophy were died of the diseases of the alimentary tract, especially of gastric or duodenal ulcer, and those with renal tumor and bladder, of cachexia and those with renal diseases other than tumor, of renal insufficiency.
Age: The young patients showed a tendency to die of diseases of the respiratory organs and the aged, of diseases of both circulatory and respiratory organs.
Causes of death: Majority of the cases fatal with cardiac diseases were those with abnormal E. C. G. findings and the aged cases.
Death due to pulmonary diseases was seen in the cases of poor risk and in the wet cases. Many of the cases who died of alimentary diseases were those with prostatic hypertrophy, particularly 1 or 2 weeks after operation. Majority of the cases who died of renal failure were those which had shown at admission an impaired renal function.
It was found that cachexia could be divided into two grops; carcinomatous cachexia and non-carcinomatous cachexia, and that the principal cause of the latter was infection.

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