Intracavitary radiation and chemotherapy with cytotoxic agents are usualy indicated for tumors of the bladder with, reportedly, some success in attaining complete disappearance, or contraction of the tumor and prevention of neoplastic regeneration. However, laboratory studies published concerning these techniques of therapy as yet are few. The present investigation was undertaken to determine blood and vesical tissue levels of the antitumorgenic agent mitomycin C (referred hereinafter to as MMC) and of radioisotope ³²P following intravesical instillation as well as to follow histological changes of the bladder and tumor. A clinical study was also performed in a series of 25 patients to determine whether the intracavitary treatment might be beneficial in ameliorating the grade and stage of the vesical tumor.
I. Concentrations of MMC and Radioactive Phosphorus in the Blood Following Intravesical Administration.
1. Plasma levels of MMC were found to in no instances exceed 0.002mcg/ml either after a single dose or over 20 days of administration of every 48 hours at dosage level of 2ml of a 1, 000mcg/ml solution in mature rabbits.
2. After the instillation of ³²P solution of a 0.1mci, the highest plasma levels of 20 cpm approx. were observed at 1 and 3 hours respectively with a subsequent diminition to the lowest levl at 12 hours. Re-elevation of the radioactive phosphorus in the plasma to 1/2 and 1/3 of the peak level were evident at 24 and 48 hours post administration respectively. There existed a tendency for the intracavitary instilla-ted ³²P to accumulate in the blood over 20 days of administration at every 48 hours. The plasma levels of ³²P after 10 doses of the solution given at 48-hour intervals were approximately six times as high as the peak levels after a single dose.
3. Management of MMC in combination with ³²P produced plasma levels of the chemotherapeutic agent again lower than 0.002mcg/ml, whereas radioactivity in the blood was slightly greater in these instances than after administration of the radioisotope alone and, moreover, the rate of elevation of radioactivity in the blood increased with the increase in number of doses. The finding appears to indicate possible enhancement of ³²P absorption due to alterations in vesical mucosa arising from the concomitant use of MMC.

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There was observed a case of 17 years old male with a dominate ureteral and pelvic dilatation in spite of no anomalies of urinary bladder and no demonstrable anomalies of the ureter per se.
The ureter represented normal size at the part 6cm from ureter orifice and dilatation in the upper part from there.
According to operative and histological findings complete abscence of the Waldeyer's sheath was defined. From the fact, it was concluded that extravesicalisation of intravesical ureter, change of urinary flow and next hypertrophy of ureteral muscular wall occured, as a result of imcomplete supporting of ureter by bladder wall, and furthermore intravesical ureter was dilatable longitudinally only for the reason that it consisted of only longitudinal musculature, while extravesical ureter was also dilatable smooth muscle fibers, so extravesical ureter dilated as a whole.
Although such a case has been called megaloureter or hydroureter because of no definition of the cause, it is considered that the word Hydroflux named by Hutch is the most suitable.

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The present authors made clinical studies on nephrostomy (122 cases including 38 cases of temporary nephrostomy) and cutaneous ureterostomy (33 cases), which had been carried out for the last 10 years (1958 to 1967) in our department, from the standpoints of complication, prognosis and rehabilitation.
The results obtained were as follows:
1. According to the findings obtained by the histological sections of the kidney at autopsy or of the removed kidney, by renal arteriograms before and after the operation in clinical cases and by microangiograms of canine kidney undergoing nephrostomy, the injury of the kidney due to the insertion of nephrostomy tube was insignificant.
2. In both operations, the catheters used as the conduits were an important factor in the pathogenesis of urinary infection occurring after the operation. However, a proper position of nephrostomy tube for good drainage of urine was obtained with relative ease, and in this case the urinary infection was reduced to a minor problem. Whereas, in cutaneous ureterostomy, the disappearance of ureteral peristalsis following the operation, which was demonstrated with electro-ureterography and urometry, could produce the state of poor drainage of urine.
3. A disadvantage of nephrostomy was, in a high incidence, to note pyrexia caused by the exchange of nephrostomy tube, While, in cutaneous ureterostomy, the development of the ureteral dysfunction and urinary infection was a serious drawback as a cause bringing about renal failure to a greater extent than that in nephrostomy.
4. It was suggested that a preventive measure against the urinary infection was to maintain urinary osmotic pressure below 300 mOsm by the administration of fluids in a sufficient degree and/or an osmotic diuretic, with appropriate chemotherapy.
5. In general, urinary diversion for the patients with hydronephrosis resulted in good drainage of urine and the recovery of renal function. However, care must be taken to prevent the poor drainage and urinary infection in the patients with the normal function, because they were readily afflicted with acute pyelonephritis after the operation.
6. According to the results obtained by the questionnaire, an inconvenience due to the collecting appliance for urinary fistula was pointed out as a main complaint. Moreover, it has reduced the social activity of the male patients in connection with the occupational and economical problems. Therefore, an improvement on the surgical procedure and collecting device should be first accomplished.
7. Comparative studies of both operations in all aspects showed that nephrostomy was a more advisable method than cutaneous ureterostomy.

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In 105 male patients with sterility recently visiting our Department (81 cases of idiopathic sterility and 24 cases of sterility with complications), thyroid function tests and urinary steroid hormone determinations were carried out, to investigate the relationship of these data with male gonadal function.
The following results were obtained. (1) Thyroid ¹³¹I uptake was studied in 97 cases, 18 of which (18.6%) gave subnormal values, and 79.4% gave values below the average in healthy subjects. None gave result suggesting hyperfunction. The average of ¹³¹I uptake in the whole series was 16.0%, cases of idiopathic sterility giving somewhat lower values than complicated cases. (2) Thyroid weight calculated from scintigram findings showed a tendency similar to that of ¹³¹I uptake. (3) Triosorb test was conducted in 93 cases, but failed to give a significant difference from that in healthy subjects. (4) Sperm examination was carried out in 101 cases. Azospermia was found in 38 cases (37.6%). Histological examination of the testes revealed complete absence of spermatogenesis in 21 cases (22.8%), and hypospermatogenesis in 68 cases (73.9%). (5) In 99 cases urinary 17-KS was determined. Subnormal values were obtained in 36 cases (36.4%), although the average of urinary 17-KS in the whole series was within normal range. In 98 cases urinary 17-OHCS was determined. Supernormal values were obtained in 31.6%. Estrogen was frequently high. Average total estrogen in the whole series was above normal, 40.1γ/day. In the estrogen fractions, estriol showed absolute and relative increase along with the increase of total estrogen. Urinary gonadotropin was determined in 21 cases. In 20 cases in which FSH was determined, high values were seen in 9, normal values in 9, and low values in 2. In 18 cases in which LH was determined, 9 gave unmeasurably low values.
(6) Thyroid function and spermatogenesis
As the disturbance of spermatogenesis was milder from findings in sperm and histological findings of testes, ¹³¹I uptake was lower. Thyroid weight gave similar results. Triosorb tests failed to show an intimate relationship.
(7) Thyroid function and urinary steroid hormone
In cases with low ¹³¹I uptake 17-KS tended to give lower values. No particularly intimate relationship was noted between 17-OHCS and 17-KS. In cases with ¹³¹I uptake of less than average value in healthy subjects, total estrogen value was above 40γ/day in almost one-half of the cases. No special correlation was noted between Triosorb values and urinary steroid hormone values.
(8) Thyroid function and gonadotropin
In cases with idiopathic cases, cases with high FSH values gave low ¹³¹I uptake. In LH, on the other hand, the group with normal and high values tended to give lower values of ¹³¹I uptake.
(9) In summary, ¹³¹I uptake was decreased in male sterility and the decrease was especially pronounced in hypospermia than in azospermia and in those in which the spermatogenetic function was rather well maintained in view of the histological findings of the testes. The urinary 17-KS excretion was generally low in these cases, while estrogen was high and gonadotropin was normal or elevated.

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