Our cystoplasty regenerates and expands the bladder as performed and reported in a case report by the authors in “A Study on Cystoplasty by Regeneration of Contracted Bladder using Novectane (Liquid Synthetic Resin)-sprayed Thin Paper (1)”.
This first case has been under postoperative clinical observation for more than two years and a half. The fact that the bladder capacity has increased from 50-60cc before the operation to 400cc and the residual urine is less than 10cc indicates long-lasting very favorable results of cystoplasty. Even 2 years after the cystoplasty it was not possible to discriminate the regenerated bladder wall from the original bladder wall under the cystoscopic examination. Both urine analysis and cystogram indicate a normal state.
Case 1 has becomes the basis for further cystoplasty being performed by the author, H. Taguchi. Two additional clinical cases with more complicated conditions than Case 1 are reported below.
Preoperative condition and Surgical Method:
Case 2 is a 24 year old female. About 10 years ago she underwent nephrectomy of the right kidney because of kidney tuberculosis. Her main complaint was two-stage urination and micturition accompanied by a continuous sensation of residual urine. The PSP test by insertion of the Nelaton catheter gave a 15 minute value of 30% and a 2 hour value of 75%. Fig. 1 (1), (2) indicates the retrograde cystograms prior to the operation.
Fig. 1. (1) shows bladder form after infusion of 60 cc contrast media.
Fig. 1. (2) shows bladder form after infusion of about 200cc at maximum desire to urinate.
Almost all cystograms indicated the same bladder shadows. Vesico-ureteral reflux was recognized reaching as far as the renal pelvis. Hydronephrosis was evident and the ureter was enlarged. The bladder capacity was less than 20cc.
According to the pathological conditions of the subjects two different operations were applied. One operation (A) was performed to prevent vesico-ureteral reflux and consisted of triangular flap method, 2) according to which ureter was anastomosed to the original bladder. The other, operation (B), was aimed to increase the capacity of the bladder content and composed of cystoplasty, which was performed in the same method as in Case 1 by using an artificial bladder prepared from Novectanesprayed thin paper.
Case 3 is a 50 year-old female. About 3 years ago she underwent nephrectomy of the right kidney because of kidney tuberculosis. And about 2 years ago she underwent nephrostomy of the left kidney because of a stricture in the lower end of the left ureter. Therefore, for more than a year, the bladder had not been used.
Fig. 3 shows a pyelogram (pyelo-ureterogram), in which contrast media was injected from nephrostomy, and a retrograde cystogi am taken before operation. The lower end of the ureter is completely closed ey a stricture. The cystogram was taken at maximum desire to urinate and the bladder capacity was about 50cc. This patient visited our hospital because of urgent desire to urina te from the normal urethra. However, the PSP test revealed an unfavorable condition as with a 15 minute value of 5-10% and 2 hour value of 30-40%. Cystoplasty was performed in Case 3 by the same method as (A) and (B) of Case 2.
The operation time was less than 2 hours in all three cases. The operation was performed under spinal anesthesia in Case 1, which was comparatively simple, and in Case 3 with lowered kidney function. The operation in Case 2 was performed under general anesthesia by tracheal insertion.
In addition, bladder inflammation of these 3 cases were remedied before operation.
Post-operative Observations:
As in Case 1, in both Cases 2 and 3, the artificial bladder, in an utterly unchanged state, fell off completely within the bladder in about 3 weeks, concurrent with the completion of the granulation wall of the regenerated bladder1). It was possible to completely extirpate the

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The author made a study on the renal function before and after operation of staghorn calculi and similar renal stones in 27 kidneys of 25 patients. The cases were divided into the following three groups: Group I (10 kidneys) were subjected to nephrolithotomy (N-L) with clamping (including 2 kidneys in which extended pyelolithotomy (E-P) was also employed). Group II (14 kidneys) were subjected to E-P without clamping. Group III (3 kidneys) were subjected to N-L and E-P without clamping. Renal clearance (GFR, RPF), serum and urinary electrolytes, Fishberg's concentration (Fishberg), isotope renogram, intra-venous pyelography (IVP) and their correlations were studied.
The following conclusions were obtained.
1) Disappearance of gross hematuria was earlier in Group II than in Groups I and III.
2) Postoperative recovery of renal function was earlier and more complete in Groups II and III than in Group I.
3) As to the total renal function after operation, there was a tendency that GFR was more improved than RPF in all of the three Groups.
4) The postoperative decrease of the urinary volume in the contra-lateral non-operated kidney was observed in Group I. On the other hand, this phenomenon was not found in Groups II and III.
From the results mentioned above, the author is of the opinion that the extended pyelolithotomy is the best operation for almost all patients with staghorn calculi of the kidney.

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The renal function before and after operation and histological findings were studied on 16 kidneys of 16 cases with staghorn calculi and similar renal stones, which were subjected to nephrolithotomy, extended pyelolithotomy, and extended pyelolithotomy plus nephrolithoyomy without clamping renal vessels.
From the results of the postoperative segmental renal function (GFR, RPF, urinaly volume, Fishberg, renogram and IVP) and histological findings, the following conclusions were obtained.
1) The gross appearance of the operated kidneys, presenting the preoperative renogram of obstruactive and delayed pattern, was normal. Histologically, the cellular infiltration in the stoma and increase of the connective tissue were hardly recognized. After operation, Fishberg showed lower values, but GFR and RPF were normal.
2) The gross appearance of the operated kidneys with the preoperative renogram of hypofunctional pattern, was almost normal. Histologically, the cellular infiltration in the stoma and increase of the connective tissue were observed.
Fishberg, GFR and RPF after operation were low, but urinary volume was within normal limit.
3) The gross appearance of the operated kidneys with the preoperative renogram of non-functional pattern showed remarkably uneven shapes. Histologically, there were seen the cellular infiltration in the stoma, increase of the connective tissue and moreover, arteriosclerosis. Fishberg, GFR and RPF after operation were low, and excretion of urine was inhibited.
From the results mentioned above, the author is of the opinion that the kidney having the preoperative renogram of non-functional pattern should be severed if the function of the contral ateral nonoperated kidney is normal.

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Experimental Observations
Adult dogs, anesthetized with sodium isomital, were used in the experiments. The partial cystectomies were performed as closely as possible to the right ureteral orifice. In all dogs, the cystography was performed under anesthesia at the 2nd, 3rd and 6th months postoperatively, and the kidney were removed and histologically studied.
Reflux was demonstrated in 5 of 10 cases. The histopathological observations of the kidney were performed.
Clinical Observations
The author encountered 43 adults with vesicoureteral reflux. The studies on vesicoureteral reflux in children were well accomplished but those in adults were little attentioned. Recently the vesicoureteral reflux is recognised as an important etiological factor in various disturbances of upper urinary tract. Reflux was diagnosed by voiding cystography.
The series were divided into three groups as follows.
1) unilateral reflux.
2) bilateral reflux or reflux into unilateral kidney (another kidney has been extirpated)
3) iatrogenic reflux.
The changes of upper urinary tract were examined by several methods as described below.
1) open renal biopsy.
2) pyelography.
3) indigocarmin-test
4) PSP and blood urea nitrogen determination.
5) ureterometry.
6) urine culture.
The grading based on the ascending degree of reflux and on the results of those examinations has been performed. The grades are as follows.
Three cases with co-existence of histological pyclonephritis and 8 cases with co-existence of radiological pyelonephritis were obtained in 43 patients with reflux.
In proportion to the ascending degree of reflux, the excretion of indigocarmin was inpaired. The histological changes were minimal in the renal biopsy specimens obtained from the patients with Grade I Reflux, but the histopathological changes were always observed in all patients with Grade III Reflux. It was suspected that the findings of renal biopsy were affected by upper urinary tract dilatation and obstruction rather than pyelonephritis. The positive urine culture was observed in about a half of the patients. PSP and blood nitrogen determination remained within normal limits, but were more or less impaired in a few cases with Grade III Reflux.
In proportion to the duration of the existence of reflux, the value of indigocarmin-test, the ureteral pressure and the ascending degree of reflux were impaired. Blood nitrogen level remained low in the first few years. The changes on upper urinary tract in the cases with iatrogenic reflux were minimal and progressed slowly.
Eight patients with iatrogenic reflux were spontaneously free from it in 6 months to 60 months after the appearance of reflux.
Whether the changes on upper urinary tract or re flux comes first is not clear, but being based on the long term observation of iatrogenic reflux, it is believed that reflux may cause the impairment of upper urinary tract. The author considers that the long standing reflux and co-existing changes on upper urinary tract promote the aggravation of themselves each other.

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The compositions of the 191 stones obtained from the genito-urinary tract were analysed by the method of infrared spectrophotometry utilizing potasium bromide (KBr) pressed-disk preparations of the materials.
The compositions of calculi of the urinary tract were investigated with respect to their clinical manifestations; namely, localization, recurrence, urinary infection or apparent metabolic disorders.
1) The compositions of the 184 urinary tract calculi were as follows: Calcium oxalate + calcium phosphate stones 44.0%, calcium oxalate stones 20.7%, and magnesium ammonium phosphate + calcium phosphate stones 13.0%. Oxalate stones comprised 20.7%, phosphate stones 14.1% and oxalate + phosphate stones 49. 5% respectively. Calcium stones comprised 64.7% and calcium salt + magnesium ammonium salt stones 17.8%.
Uric acid and urate stones were found in 7.1% and cystine stones in 4. 9%, respectively. These incidences were higher, compared with other Japanese reports.
2) Prostatic calculi were all multiple and composed of phosphate (in four cases, magnesium ammonium phosphate + calcium phosphate and in two cases, calcium phosphate).
3) The calculus in the as deferens was a so-called “soft stone”, composed mainly of protein with deposition of calcium phosphate.
4) Crystals deposited on the in-dwelling catheters of nephrostomy, ureterocutaneostomy and cystostomy were composed of magnesium ammonitun phosphate and calcium phosphate, accompanying urinary infection.
5) In calculi of the upper urinary tract, calcium oxalate + calcium phosphate stones comprised 43.5% and calcium oxalate stones 22.4%, about two thirds of which were ureteral calculi. On the contrary, about three fourths of renal calculi were phosphate-containing stones arid especially most staghorn calculi contained magnesium ammonium phosphate, accompanying marked urinary infection. Calculi of the lower urinary tract were accompanied by chronic urinary infection and were complicated with bladder neck obstruction.
6) Recurrent calculi revealed the same (in ten cases) and similar (in four cases) composition as the former calculi. This suggested that condition of stone formation in the recurrent stone-formers might remain the same.
7) Urinary infection was accompanied by about a fourth of calcium oxalate stones, whereas about a half of calcium oxalate + calcium phosphate stones and all stones containing magnesium ammonium phosphate were always demonstrated to be complicated with infection.
8) Calculi due to metabolic disorders were as follows: Five cases with hyperparathyroidism, whose calculi were mainly calcium oxalate + calcium phosphate. Eleven cases with uric acid and urate stones did not showed any symptoms of gout, but most of them showed hyperuricemia. Two cases in six cases of cystine stones were revealed to be in brotherhood.

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A study was performed on the alterations with time of the serum alkaline phosphatase, total acid phosphatase, prostatic acid phosphatase and leucine aminopeptidase activities following massage of the prostate in patients with carcinoma or benign hyperplasia of the prostate having a premassage control activities of a definite range. The statistical significance of the results obtained were tested by the F-test. The results are as follows. i) Following massage of the prostate an increase of total and prostatic serum acid phosphatase activities in patients with benign hyperplasia was significantly higher than those in patients with carcinoma, and these elevations serve to differentiate between benign hyperplasia and carcinoma of the prostate. ii) Alterations after massage of the prostate, serum alkaline phosphatase and leucine aminopeptidase activities between both experimental groups all failed to show any significant changes in their behavior and level following massage of the prostate.

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We made qualitative and quantitative analyses of free amino acids in human ejaculates with an automatic analyser.
We used two different buffers: sodium citrate and lithium citrate.
Results were as follows:
1. We observed 22 amino acids in human seminal plasma after 3 hours in room temperature. They were Cysteic acid, taurine, Aspartic acid, Hydroxyproline, threonine, Serine, Asparagine, Glutamic acid, Glutamine, Proline, Glycine, Alanine, Cystine, Valine, Methionine, Isoleucine, Leucine, Tyrosine, Phenylalanine, Lysine, Histidine, and Arginine.
2. Comparison between a healthy group and a group of infertility with normozoospermia revealed no differencies.
3. This might be the first observation of Asparagine in human seminal plasma.

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