There were 151 patients of staghorn calculi in our department from 1955 to 1971. Sixty-four cases underwent nephrolithotomy. After April 1968, the continuous pelvic irrigation method was performed on 17 patients after the nephrolithotomy of staghorn calculi. The technique of this irrigation is shown in Fig. 1. The solution used for the irrigation was normal saline 1, 000ml-2, 000ml containing Cephalothin (abbreviation: CET) 1.0g-2.0g per day. The purpose of this procedure is to prevent post-operative complications, such as renal infection, secondary hemorrhage, persistant urinary fistula, secondary nephrectomy, etc.
Of 47 cases without the continuous pelvic irrigation after nephrolithotomy from January 1955 to March 1968, 2 cases of secondary hemorrhage, 7 cases of persistant urinary fistula and 1 case of secondary nephrectomy were observed. But no post-operative complications were seen in 17 cases with the continuous pelvic irrigation after operation.
To evaluate the clinical effects of this method, the following studies were carried out. Continuous pelvic irrigation with normal saline containing CET or Gentamicin (abbreviation: GM) was performed for 24 hours on the left kidney of dogs with bilateral ureterostomy. The urinary recovery of antibiotics from the right kidney, the serum level, the concentration of drugs in the bilatenal renal tissue after irrigation and histological influences on both kidneys were examined.
In group I (normal kidney, CET 1.0g), urinary recovery rate of CET was 0.12% of dosage administered. In group II (experimental Proteus mirabilis pyelonephritic kidney, CET 1.0g), urinary recovery rate was 0.59% of that, which was about 5 times as much as group I. In group III (normal kidney, CET 10.0g) and IV (normal kidney, GM 1.0g), urinary recovery rate was more than that of group I and less than group II. The serum levels of drugs at the end of the irrigation ranged between 0.54mcg/ml and 1.1mcg/ml and the concentration of drugs in the renal tissue at the same time was determined as between 0.36mcg/g and 2.9mcg/g in group III and IV.
Histological examinations of specimens from the irrigated kidneys showed that the moderate degenerative changes of epithelium of tubules were observed in cases of group III (CET 10.0g) and IV (GM 1.0g), but these pathological changes were not observed in the irrigated kidneys in cases of group V (irrigation with normal saline). It may be possible that these changes of tubular epithelium were caused by the pharmaco-dynamic influence of applied antibiotics, the excessive pressure and speed of irrigation or the osmotic pressure of solution.
Nephrotomy with or without the continuous pelvic irrigation was performed on the experimental Proteus mirabilis pyelonephritic kidney in dogs, and the courses of these cases were followed up and examined histologically. Group A: the continuous pelvic irrigations with the normal saline containing CET 1.0g per 1, 000ml were done for 24 hours after the nephrotomy of experimental pyelonephritic kidney. In this group, histological examinations of operated kidneys revealed that pyelitis and the wounds of tissues were apparently improved. Group B: the continuous irrigations with normal saline without antibiotics were done for 24 hours after the operation. In this group, histological examinations revealed that pyelitis was improved, but the wound was less recovered than in group A. In these two groups, post-operative specimens showed that the pre-existing infection did not spread into the parenchyma after the operation. Group C: nephrotomies without the continuous pelvic irrigation were carried out. Histological examination revealed that both pyelitis and inflammation in the renal parenchyma were worsened.

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Histopathological findings of a case of primary hyperoxaluria (6 yrs., male) were presented. Oxalate crystals were observed in the kidney, heart, urinary bladder, lung, liver, pancreas, gastrointestinal tract, testis, lymph nodes, tonsil and aorta. Depositions of the crystals were found chiefly in the distal tubules of the kidney, in the muscle fibers of the myocardium including conducting system and in the media of the small arteries in various organs. A mode of development of oxalosis was discussed with reference to the cause of sudden death in oxalosis.

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Abnormal ureteral peristalsis was induced in 39 mongrel dogs by passing a 2 per cent formalin solution into the left ureter. Vesicoureteral reflux was induced in the dogs by fastening a polyethylene tube at each ureteral orifice. In order to create infection, a piece of gauze smeared with canine feces was sewn to the trigone.
After observation of 4 to 323 days, the dogs were sacrificed. In 87.1 per cent of the dogs, pyelonephritis was present in the left kidney. In only 7.7 per cent, pyelonephritis was seen in the right kidney.
These results suggest that vesicoureteral reflux and abnormal ureteral peristalsis are necessary conditions for inducing experimental pyelonephritis.

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For the successful cadaver kidney transplantation, it is necessary to preserve cadaver kidney by a simple atraumatic method until consent for removal of kidney from the family is obtained. For this purpose three simple methods of 4 hour cadaver kidney preservation, to be described below, were studied in dogs.
a). b). Selective (a) continuous, b) intermittent) in situ hypothermic perfusion methods: After sacrificing a dog, a two-balloon catheter was retrogradely inserted into the aorta, and two balloons were positioned just above and below the renal arteries. After inflating balloons the kidneys were perfused regionally with hypothermic perfusate for 4 hours through holes located between two balloons. Venous outflow was done by gravity drainage. c). pararenal cooling method: After sacrificing a dog, a cooling fluid (0°C saline) was infused into both peritoneal and retroperitoneal space, and the peritoneal cooling fluid was changed hourly. Kidneys were preserved 4 hours by this cooling method.
Results
1. The temperature dropped below 15°C in 30 minutes in the kidney preserved by the continuous perfusion method. In the intermittently perfused kidney, the temperature was lowered to below 15°C after 15-30 minutes and they were maintained between 10-15°C thereafter. The pararenal cooling lowered the temparature below 15°C in 30 minutes and kept it between 15-20°C thereafter.
2. All the kidneys preserved for 4 hours by any of the above three methods, showed adequate by T. T. B. viability test and excreted urine promptly after establishment of renal blood flow.
3. In the kidneys preserved for 4 hours by any method, no distinct histological change from the normal was demonstrated under the light microscopy. Electromicroscopically the change of proximal tubules (mitochondria, microvilli) was even more obscure than that in the kidney an hour post mortem, which is generally believed to be reversible. The expansion of intercellular space became progressivelly less distinct in the continuous (a), intermittent perfusion (b) and pararenal cooling (c).
4. The pararenal cooling preservation appears to be the simplest and most useful one, although all three methods are practically applicable to the renal transplantation.

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1) In order to exactly evaluate spermatogenesis, germinal cell index was investigated. The germinal cell index is the ratio of germinal cell count to Sertoli cell count in the seminiferous tubule.
2) The average number of Sertoli cells per round seminiferous tubule, which was the denominator of the germinal cell index, was almost invariable in the case of the various grade of spermatogenesis. This means that Sertoli cell count is reliable as a basis of reference for the analysis of germinal cell count
3) The germinal cell index was 7.8±2.1 in the mild hypospermatogenesis, 4.7±2.1 in the moderate hypospermatogenesis, and 3.4±1.3 in the severe hypospermatogenesis.
4) In the cases with germinal cell index 0-3, spermiogenesis was unrecognized. In the cases with germinal cell index from 3 to 6, spermiogenesis was recognized in only 10 out of 22 cases. In the cases with germinal cell index from 6 to 9, spermiogenesis was recognized in 40 out of 42 cases.
5) Significant correlations were found between germinal cell index and sperm count or testicular weight. Correlation coefficients were 0.59 (p<0.05).
6) For the more detailed analysis of spermatogenesis, the germinal cell indices of each of four stages (spermatogonia, primary spermatocytes, secondary spermatocytes and spermatids) of spermatogenesis were plotted on a chart to obtain a curve, which was called spermatogenic curve. This curve is clinically usefull to show the detail of quantitative analysis of spermatogenesis at a look.

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The DNA synthesizing capacity of seminiferous epithelium is a reliable index for estimating the cellular dynamics in spermatogenesis. This DNA synthesizing capacity was investigated by ³H-thymidine corporated into testicular tissue cultured by Trowell's method. Tritium-labeled germinal cells were limited in spermatogonia and preleptotene spermatocytes.
The average value of Tritium-labeled germinal cell counts per tubule in each case was named as spermatogenic activity index.
1) Spermatogenic activity index in normal mature testes indicated the intense DNA synthesizing capacity (11.35, 9.47 and 6.00).
2) In the cases of hypospermatogenesis, spermatogenic activity index was reduced in proportion to the grade of its severity.
3) Significant correlation between sperm count and spermatogenic activity index was found (r=0.63, p<0.05), and relationship between spermatogenic activity index and germinal cell index had also high coefficiency as 0.45 (p<0.01).
4) However, in the cases of more than 50 year-old men, significant correlation was not observed between spermatogenic activity index and germinal cell index (r=0.37, p<0.05).
In high aged men, spermatogenic activity index may be reduced, even if germinal cell index was maintained at a relatively high value.

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A 51-year-old man was admitted on April, 18, 1972, to our hospital to comfirm the diagnosis of calculi in the left ureter. A plain X-ray film showed 4 calculi in the left side of the pelvis. An excretory urogram showed normal function of both kidneys and of the right ureter. The left ureter appeared Y-shaped. However, a retrograde urogram showed clearly that the left ureter was an h-shaped blindending ureter with calculi. An operation was performed under general anesthaesia. The bifurcation was found just below the iliac vessels. The abnormal ureter, which almost reached to the seminal vesicle behind the bladder, was separated from the surrounding tissues, and was removed with calculi inside. No kidney tissues were demostrated near the blindending ureter either by gross or by histologic examinations. Such a blindending bifid ureter with stones in h-shape seems to be extremly rare.

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