A statistical analysis was made on 400 cases of clinical bladder tumor which were treated in our department during the past 12 years and 9 months from April of 1959.
The highest incidence was found in the 6th decade of the male, including high occurrence rate in the cases over 40 years of both sexes.
Transitional cell type, in grade III (Broders) and in stage A (Jewett), was the significant majority, while the papillary-shaped and thumb-tip-sized tumors in the side wall of the bladder were at the highest rate. Single tumor type was 61.2% in its incidence.
As to the clinical symptoms, haematuria, polakisuria, and urodynia were the main complains. The shadow defect was found in 74. 6% on preoperative cystograms. The obstruction of renal function was ound in relatively many cases by preoperative intraveneous pyelography.
Total cystectomy was performed in 130 cases, partial cystectomy in 168 cases, TUR Bt in 32 cases, and urinary diversion in 32 cases. Furthermore, postoperative chemotherapy was done in 91 cases of total cystectomy and in 100 cases of partial cystectomy.

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The extraperitoneal bilateral nephrectomy through an upper abdominal transverse incision was devised for renal recipients and for those chronic renal failures with malignant hypertension.
The extraperitoneal bilateral nephrectomy through upper abdominal transverse incision has several merits such as good exposure of the operative fields, absence of respiratory or circulatory distress during surgery, excellent wound healing, less surgical stress, and absence of intraperitoneal contamination by the infected kidneys.
Two cases of regularly hemodialyzed patients with malignant hypertension were nephrectomized bilaterally by this new approach. Their hypertension was not controlled by hemodialysis, nor by restriction of sodium and water intake, nor by the antihypertensive medicine. The renal and peripheral venous blood sample analysis demonstrated high renin and no erythropoietin activities.
After uneventful postoperative courses, their blood pressure was lowered gradually to the normotensive level without antihypertensive medicine. Aggravation of anemia was not observed.
Some discussions regarding the indication for bilateral nephrectomy, the comparison between this new approach and the other operative methods, the pre-and post-operative management of the bilateral nephrectomy, the blood pressure response and the erythropoietic activity following nephrectomy were done.

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The author investigated the most suitable conditions in staining both fluorescent X-chromatin and Y-chromatin.
1) Quinacrine mustard (Q. M.) staining was far superior to Quinacrine dihydrochloride (Q. D.) staining on the incidence of X and Y-chromatin.
2) The time factor was found to be the most important for staining, for buccal smear as well as for blood smear.
3) It was also revealed that blood smear without fixation showed high incidence in fluorescent body than that with fixation if the samples were observed within a few days.
4) The incidence of fluorescent X and Y-chromatin was studied in normal males and females by applying the staining conditions described above. The results were as follows:
a) The average incidence of fluorescent Y-chromatin in normal males was 39. 8% in buccal mucosal cells with 0.5% Q. D. and 54.0% with 0.005% Q. M. On the other hand in blood smears, the average incidence was 46.1% with Q. D. and 67.3% with Q. M.
b) The average incidence of fluorescent X-chromatin in normal females was 12.0% in buccal mucosal cells with Q. D. and 17.3% Q. M. A low incidence was observed in normal males: 0.6% with Q. D. and 0.8% with Q. M. respectively.
5) The average incidence of double structure in buccal smear was 3.0±1.1%.
6) In the screening test by this fluorescent staining method for sex check up of 217 female participants in the international Winter Sports Festival held in Sapporo in 1972, one person was found to have sex chromosomal constitution of XY.
7) X and Y-chromatin test by this fluorescent staining method was applied to 15 patients with sex chromosomal anomaly and it was confirmed that this staining method was very useful for inferring sex chromosomal constitution except for mosaicism.

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In prostatectomy, the most important problem is how to decrease bloodloss during and after operation.
“vesical neck closure” is the method which Lower devised for suprapublic prostatectomy first in 1927. We performed suprapublic prostatectomy with this method in 84 cases since 1967. In other words, we studied “vesical neck closure”.
The bloodloss was measured by gravimetry.
1. The bloodloss:
The bloodloss was 1230 c. c. at max., 35 c. c. at min. and 378 c. c. on the average.
2. The relation between bloodless and anesthesia:
The patients operated under S. C. were 55 cases and their average bloodloss was 414 c. c. The patients operated under Ep. were 28 cases and their average bloodloss was 284 c. c.
3. The period when macroscopic hematuria was observed:
In the cases operated by the above mathod, macroscopic hematuria continued for 8.1 days.
4. The postoperative vesical neck stricture:
The postoperative vesical neck stricture was observed in 2 cases out of 84 and both of them were cured by electroresection method by means of sectio alta.

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We previously reported in “A Study on Cystoplasty by Regeneration of Contracted Bladder Using Novectane (Liquid Synthetic Resin)-sprayed Thin Paper (1) and (2)” that we had conducted cystoplasty by regeneration in various cases of contracted bladder Among these cases there was a case in which the bladder capacity increased from 20cc to 400cc.
The period of observation after operation on these cases was from 18-30 months. Favorable results have been maintained in all the cases.
In this paper we report on a case in which this method of cystoplasty was applied to tumor of bladder. Case 1 was a 40-year-old male. For about 3 months macroscopic hematuria was present without subjective symptoms. Clinical observations by cystogram in prone position revealed a large filling defect as shown in Fig. 1 by the arrow.
The cystoscopy revealed a large tumor surrounding the vertux of the bladder. The operation was performed under the spinal anesthesia.
As shown in Fig. 2, we excised 4/5-5/6 of the bladder together with a part of the peritoneum, leaving the neck of the bladder, the trigone of the bladder and the ureteral orifices on both sides. As shown in Fig. 2, the ureteral catheters were inserted from the ureteral of ifices on both sides. This ureteral catheter was removed immediately after excision of the bladder. Then a porous Nelaton catheter No. 15 was inserted into the bladder transurethrally. This method of cystoplasty is the same as that used for cystoplasty of Contracted Bladder. The prepared Novectane sprayed thin paper bladder was sutured to the residual bladder by interrupted sutures using 00 cutgut as shown in Fig. 4. The peritonuem was sutured by interrupted No. 4 silk sutures. We placed the drain on both sides of the artificial bladder and finished this operation by suturing the fascia and skin.
The excised bladder is shown in Fig. 3. The arrow indicates the tumor. The microscopic pathological findings showed that there was a third grade transitional cell carcinoma. The operation time was about 2 hours. We continued the extraction of urine by Nelaton catheter by an aspirator for about 5 days. After 7 days we removed all the sutures and replaced the Nelaton catheter with a bag catheter. Then the patient was allowed to walk. After about 3 weeks the artificial bladder fell off from the regenerated granulation bladder wall. After we had extracted the artificial bladder transurethrally, we made the patient urinate by himself.
Clinical observations by cystogram are given in Figs. 5, (1), (2), (3), and (4). An almost normal cystogram pattern was observed after a month in this case. The residual urine was about 40cc. The cystograms revealed a remarkably increased capacity with the lapse of time. But after a month the cystogram showed a Vesico-Ureteral reflux. This reflux is observed in the cystogram even after a year.
This was an instructive and difficult case, since all the 15 pieces of No. 4 silk suture used for suturing the peritoneum appeared in the bladder and remained as foreign materials as shown by the arrow in Fig. 6. Therefore we extracted all the silk sutures transurethrally. In this method of cystoplasty the cutgut should be used, even for suturing the peritoneum. The entire bladder wall was covered with normal regenerated mucous membrane after 5 months as shown in Fig. 7.
Natural urination at one time was 350-400cc, 15 months after cystoplasty. Residual urine was less than 30cc. The volume of liquid at maximum desire to urinate was 270cc when the inner pressure of the bladder was 21-30mmHg, 5 months after the cystoplasty. The volume of liquid at maximum desire to urinate was 290cc when the inner pressure of the bladder was 40mmHg 12 months after the cystoplasty.
Urine analysis in this case revealed protein +-±, sediment white cell +-±, red cell +, and bacteria-
This patient was treated neither by chemotherapy nor by the radiation thera

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The results of transpubic radical prostatectomy were evaluated from the data on 50 patients with prostatic cancer and 57 patients with other prostatic diseases.
1) The five-year direct survival rate was 39% in early prostatic cancer, 24% in advanced prostatic cancer and 73% in other prostatic diseases.
2) Radical prostatectomy is the treatment of first choice for early prostatic cancer. No further therapy will be necessary if the radical excision has successfully been completed.
3) In advanced cases, removal of the local lesion, if possible, is also a beneficial treatment for their local symptoms.
4) An almost satisfactory improvement has been observed in local symptoms of patients after radical prostatectomy.

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