The prostatic carcinoma and prostatic hypertrophy have recently been increasing in number in Japan too; and, an importance is being attached to the correlation between the prostate gland and the testis since the prostatic tissue is dependent mainly on the androgen.
The author made a detailed study of the morphological alteration of the prostate gland and the testis on aging, and the correlation of their senile changes in the 228 cases of the male unselected consecutive autopsies from the new born babies to the 90 years of age, placing great emphasis on the basic changes up to the so-called senile prostatic disease.
1) The growth of the prostate gland and the testis was very slow till the maturation stage, but became rapid from around eleven years of age and was nearly completed by the puberty stage.
2) As for the prostatic nodule, the early nodule developed in 20s, while the genuine nodule developed in 30s; and, the rate of occurrence and the number increased on aging, sharply after 50 years of age. The occurrence was nearly 100 per cent at more than 70 years of age.
3) The secretory function of the prostate gland was observed from 12 years of age; and, the occurrence of the same increased suddenly in the form of the prostatic calculus after the maturation stage; and, the occurrence was observed nearly 100 per cent at more than 30 years of age. The prostatic calculus increased in number and it also showed a definite tendency to the calcification on aging.
4) The prostate gland of the elderly men (those aged over 40 especially) were brought about atrophic changes, topical or systemic, showing a small-sized gland, the cystic change, the catarrhal change (exfoliation of the glandular epithelium), the fibrous change of stroma and so forth; and, these changes progressed gradually on aging.
5) “The adenomatous change (inclusive of the so-called small glandular proliferation)” of the prostate gland and “the proliferative change of the glandular epithelium (inclusive of the squamous metaplasia)” showed a tendency to a slight increase on aging; and, their relationship with carcinoma was not clear.
6) The degenerative atrophy of the spermatogenic series, the hyaline degeneration of the tubular basement membrane, “the focal tubular hyalinization”, the degenerative atrophy of the Leydig's cell and the fibrous change of stroma of the testis progressed gradually on aging from adolescence. Further-more, the relationship between “the focal tubular hyalinization” and arteriosclerosis was inferred.
7) Whereas the degenerative atrophy of the spermatogenic series and the hyaline degeneration of the tubular basement membrane showed a substantial correlation, there was observed relationship to some extent between the degenerative atrophy of the Leydig's cell and spermatogenesis on one hand, and the Leydig's cell and the hyaline degeneration of the tubular basement membrane on the other.
8) The prostatic atrophy and the testicular atrophy showed a considerably high proportional relationship in degree, while the correlation between the prostatic atrophy and the morphological alteration the Leydig's cell on one hand and the number of the prostatic nodule and the Leydig's cell on the other was of a medium degree respectively. Meanwhile, the relationship between the number of the prostatic nodule and the testicular atrophy was complicated.
9) Both the prostate gland and the testis showed slight changes in the acute diseases, and a comparatively high degree of changes in the chronic consumptive diseases. Generally, the influence of basic diseases on the young people was greater than that on the elderly; and, the testis was subjected to stronger influence than the prostate gland.
10) The prostatic carcinoma in the series of the present study numbered 4 cases, of which 2 cases were the so-called latent carcinoma.
By the above, the author clarified the morphological alterat

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From 228 cases of the male unselected consecutive autopsies, we selected 45 cases of the group of the macroscopic non-hypertrophic nodular formation with the maximum diameter of the frontal section of the prostate gland being less than 3.5cm (hereinafter abbreviated as the non-hypertrophic type) and out of which, 43 cases carrying the testis, as well as 36 cases of the group of the macroscopic hypertrophic nodular formation with the maximum diameter being more than 3.51cm (hereinafter abbreviated as the hypertrophic type) and out of which, 32 cases carrying the testis, and examined them together with 39 cases of the prostatic removal group (hereinafter abbreviated as the operation case).
On the question of whether or not there exists the nodule, we made a microscopic examination of the staining microscopic specimen and used two major characteristics—one showing a clearcut boundary on its surroundings and the other showing a distinctive image pressing upon its surroundings—as a basis, but excluded the early nodule and the prostatic carcinoma from the examples of the present study.
In the autopsy cases, many had a few nodule, while the number of the nodules was also small. As for the frequency of nodular formation, however, the rate shown by the group of nodular formation with the maximum diameter (the frontal section of the prostate gland) being more than 3.51cm was higher than that shown by the group of nodular formation with the maximum diameter being less than 3.5cm; but, the rate increased on aging in non-hypertrophic case.
In the operation case, the nodule was big irrespective of the age, and the nodules were numerous.
By devising the nodular tissue type (I. the cystic type, II. the proliferative type, III. the non-proliferaative type, IV. the musculofibrous type) and the nodular classification type (the simple type—one consisting of only one kind; the intermediary type—one made up of two kinds; the diversified type—one composed of more than three kinds as classified from the nodular tissue type), we used them to make a comparative study of each case.
In the operation case, there were observed the complexity, diversity and non-uniformity; and, such symptoms were already seen even in the case where the nodules were small; hence, it was presumed that these symptoms had something to do with the sudden increase in the nodules.
Upon comparing the extra nodular tissue with the intra nodular tissue, mention was made of the prostatic calculus, the prostatic atrophy and the prostatic adenomatous change as a case in which the extra nodular tissue gained an advantage over the intra nodular tissue in properties, degree and number; further, reference was made of the prostatic atrophy, the prostatic adenomatous change, the proliferative change of the glandular epithelium and the cystic change as a case where the operation case advanced more than the autopsy case.
The proliferative change of the glandular epithelium was observed in the case where the hypertrophic case stood at advantage over the non-hypertrophic case. The cystic change alone showed a distinctive on-aging influence.
Cited as what was subjected to the on-aging influence both in the non-hypertrophic case and the hypertrophic case in the testicular histological image were the degenerative atrophy of the Leydig's cell, the hyalinization of the basement membrane and the synthetic atrophic degree; but, as the case in which the difference between the two cases was observed, mention was made of the following.
As a case in which the non-hypertrophic case was more subjected to the on-aging influence, reference was made to the degenerative atrophy of the spermatogenic series.
Furthermore, as a case in which the hypertrophic case advanced more in terms of degree and properties, mention was made of the focal tubular hyalinization.
As a case in which a proportional relationship was observed in conection with the prostate g

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1) Differential renal test with creatinine- and p-amino-hippuric acid (PAH) clearance was performed in 83 cases (normal: 11 cases, several surgical renal diseases: 72 cases). Seperated urine volume (UV) and urinary concentration of creatinine, PAH, Na, Cl, Ca, P, K, Mg respectively were estimated. The ratio of each of the separated urinary volumes, and creatinine- and PAH-clearance values was calculated in normal cases. Thus a chart was prepared (Table 3 in Japanese text).
2) In the cases of hydronephrosis U_PAH and C_PAH were reduced characteirstically on the affected side. The fact may be considered that the functional impairments are mainly due to the altermations of the renal tubules.
3) In the cases of upper urinary calculi (calyceal and pelvic calculi) without hydronephrosis the renal function is normal, whereas the case with hydronephrosis shows the same pattern of hydronephoris. In osmotic diuresis (loading of 8% urea solution), urinary calcium excretion from the affected side is definitely increased as compared with one from the unaffected side.
4) In the cases of renal tuberculosis the renal function is decreased severely in comparison with renal organic changes.
5) In the cases of movable kidney, even if urinary retention is shown in intravenous pyelography, the renal function remains almost normal.

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Studies on bladder regeneration after total or subtotal cystectomy were made with fifty-two female dogs. The experiments were divided into two groups. The first consisted of forty-two dogs and this group was used to follow up the process of bladder regeneration. In this group, 5cc Foley catheter was placed in the space after cystectomy through the urethra, and the ends of ureters were sutured to the peritoneum or perivesical tissue. Thirty out of the 42 died of peritonitis or other infections within the first two postoperative weeks and most of them were excluded from this study.
The second group consisted of 10 dogs and was used for investigating whether the bladder rest or urethra is necessary for bladder regeneration. The methods employed were various. In 3 dogs, bladder neck or urethra after cystectony were closed with suture and covered with the adjacent perivesical tissue. The ends of ureters were anastomosed to the skin of the lateral abdominal wall. Then, a piece of mucosa from the extirpated bladder was implanted in the remaining perivesical tissue to examine whether new smooth muscle fibers are generated or induced under the cyst which will be formed from the implanted mucosa. Four dogs of this group died within a few postoperative weeks and were of no value in the study.
The following results were obtained.
The source and the process of bladder regeneration:
The surface of the tissue surrounding the bag of retained catheter was lined with granulation tissue in about 7 days after operation and a pounch was formed.
The transitional epithelium spread out over the granulation tissue continuously from the edge of the residual bladder neck or urethra.
The smooth muscle fibers extended through the granulation tissue upward from the musculature of the bladder neck or urethra behind epithelial lining.
There were no signs supporting the theory that new muscle cells develop from the totipotent mesenchymal fibroblastic cells in the perivesical tissue.
The ends of ureters played only a small part in bladder regeneration. Bladder regeneration was not observed in the space after cystectomy shut off from the residual bladder neck or urethra.
Structure and function of the regenerated bladder:
They were almost the same as normal bladder when the regeneration progressed favourably. Such cases were observed in 5 dogs in the first group.
Factors governing bladder regeneration:
It is thought that the essential factor of bladder regeneration is the residual bladder neck or urethra opening into the space, from which new bladder wall develops. Bladder regeneration can not take place without this factor even if epithelial cells and totipotent mesenchymal fibroblastic cells are present in the retained perivesical tissue.
In the course of formation of a hollow viscus, the preservation of the space after cystectomy seems to be an important promoting factor. This is accomplished by means of various molds or bag catheter but these forign bodies should be removed as soon as the abdominal wound has closed completely. After removal of mold or bag catheter, the urine pooling in the pouch serves not only to preserve and enlarge the pouch but also to develop the elements of new bladder wall by mechanical stimulation from micturition. No chemical effect of urine on bladder regeneration was observed in this study.
Infection of the wound is the most troublesome inhibiting factor in bladder regeneration. In the early stage of regeneration, it prevents the growth of granulation tissue, epithelium or muscle layers by inflammatory infiltration and formation of abscess or tissue necrosis and in the later stage, it arrests en largement of the capacity of new bladder through fibrosis. Though foreign bodies such as mold or bagcatheter are necessary for bladder regeneration, they accelerate occurance and persistence of infection. This is the reason why they should be removed as soon as possible.

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