Two hundred and forty-six cases of bladder tumor and 14 cases of bladder tumor with or suspected history of the pelvic tumor from 1950 to 1970 at Tokyo. Teishin Hospital were reviewed in this report, using P histopathological category of UICC. There were 42.3% of PIS group in this series. The patients with high P should be treated by various operative or radioactive procedures.
Five year survival rate calculated by actuarial method after partial cystectomy was 70.2%. An especially good result was obtained by radioactive therapy with operation rather than by operative therapy only. After total cystectomy, survival rates were lower in all groups.
Ten year survival rate of the patients with pelvic tumor or its suspected history revealed excellent results (64.7%).
Topical instillation of Mitomycin C was expected to yield good results from PIS to P2.

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Statistical studies were made on 43 cases who died of urinary bladder cancer during the period of 10 years from 1961 to 1970. Special attention was paid to the causes of death and complications. A similar study was done on 690 cases recoreded in the Annual of the Pathological Autopsy Cases in Japan during the past 9 years from 1961 to 1969.
1) Direct causes of death:
i) 15 (34.9%) in our cases and 39.4% of the cases of Ann. Path. Aut. Cases Jap. died of urinary bladder cancer itself.
ii) 8 (18.6%) in our cases and 18.8% of the cases of Ann. Path. Cases Jap. died of renal insufficiency.
2) Complications:
In our cases pyelonephritis was seen in 39.5%, hydronephrosis in 34.9% and, in the cases of Ann. Path. Cases Jap., the former in 44.6% and the latter in 27.1%.
An autopsy survey of the bladder cancer was made on 8 of our autopsized cases. Pyelonephritis or hydronephrosis was seen in 6 of the 8 cases: 2 in cancerous death and 4 in noncancerous death, wherein all of the 4 noncancerous deaths were complicated with either or both of these complications.
The high incidence of complications in the upper urinary tracts was verified in our autopsiy cases. This will alarm us for the sincere necessity of examination for and treatment of these complications, hydronephrosis and pyelonephritis, in the cases of bladder cancer.

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Between April 1966 and March 1971, we treated 54 cases of urethral stricture. Among these cases, 2 pediatric cases were found, in whom the stricture was caused by traffic accidents.
Traumatic and gonococcal cases were found at about the same frequency and they together composed 75% of all the cases.
The result of the internal urethrotomy was good in 46% of the cases, but when it was evaluated after further observation, the percentage was found to be lower than before. This is because the operation was not a radical one and not aimed at removing the scars. The operation, however, was the least destructive and indicated for the senile and poor-risk patients.
Intubated urethrotomy was performed 15 times and its result was good in 73%. The operation is recommended as an easy, one-stage operation which has the advantage of leaving no foreign materials, being applicable for long strictures and forming no dead space.
Michalowski and Modelski methods have the disadvantage of impossible dilatation of the urethra, but should be resorted on when other methods fail to accomplish their purposes.
It is emphasized that the selection of the operative methods depends on the site and degree of the strictures, but in general, the least complicated procedure should be the first choice.

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In order to obtain a clue to appreciate the method of the renal preservation, which is of prime importance in renal transplantation, electron microscopic studies have been made on 50 canine kidneys stored under hypothermia (1 to 4°C) and hyperbaric oxygen (3 atm.) at intervals of various times, ranging from 12 to 168 hours. In addition, functional disturbance was estimated by urinary output time after connecting the stored kidneys by the method of autotransplantation. The polyethylene tube was used to combine the blood vessels.
The canges following the renal preservation were predominantly found in the tubular epithelia. The epithelial cells of the proximal convoluted tubuli revealed the initial signs of alteration at 12 hours preservation. The mitochondria swelled, showing less uniform shape and reduced electron density in the matrix. There was an increase in the number of cytoplasmic bodies which were identified with the membrane-limited structures containing dense granular aggregates and homogeneous materials. At 56 hours preservation, similar changes appeared also in the epithelial cells of the distal convoluted tubuli. With increasing preservation time, the mitochondrial swelling became more conspicuous and frequently the cristae showed partial disintegration, although the outer membrane remained apparently unchanged. The cytoplasmic bodies also increased in size and number and displayed more complicated contents, such as flocculent, granular and quite compact materials. Occasionally they also contained mitochondrial remnants.
Changes in the rough-surfaced endoplasmic reticulum were, in general, not pronounced throughout the experiment. In some cases, however, it showed slight dilatation of the lumen at 24 hours, and partial denudation of ribosomes attached to its surface at 72 hours.
At 48 hours preservation, the apical region of the proximal convoluted tubular cells lost cytoplasmic density in association with partial disintegration of the brush border. Concomitant with these changes, a number of vesicles resembling multivesicular bodies appeared just beneath the brush border. The number of the vesicles increased in 72 hours and thereafter decreased. At 168 hours, the brush border was transformed into membraneous projection.
Alterations of the glomeruli were less prominent than those on the tubular epithelia. At 48 hours preservation, however, the glomerular epithelia showed mild changes, consisting of the mitochondrial swelling and dilated lumen of the endoplasmic reticulum. Similar changes were found in the mesangial and capillary endothelial cells. In some cases, thin portions of the endothelial cells exhibited a cytoplasmic irregularity and in part underwent fragmentation.
No remarkable changes were observed in the basement membrane of both the glomeruli and renal tubuli.
The functional test revealed that the kidney had the ability of urinary ouput up to 72 hours preservation.

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It is often difficult to follow the postoperative renal function in the urological cases, because urinary stasis, urinary leakage, hematuria and so forth make the test using urine impossible. In these conditions, renal function test using blood instead of urine is desirable. Renal function test using blood serum after intravenous administration of radioisotope was studied.
1) Value of single injection method of radioisotope to observe the changes of postoperative renal function was studied. Several problems were found in the so-called half life method in which the serial serum levels of radioisotope (radiohippuran or radioiothalamate) determine the isotope-disappearance rate which was thought to reveal renal function. It was found that the accuracy of the half life method in clinical use was limited to dividing renal function into only 3 or 4 grades despite rather troublesome technique. This led us to search simpler method of same accuracy.
2) The first trial was to use the ratio of serum concentration of radioisotope at fixed time (40 minutes in Hippuran; 40, 80 and 200 minutes in Iothalamate) after administration to calculated serum concentration at 0 minute. The correlation between this ratio and urinary excretion rate of isotope was poor, probably due to obstructive uropathy of upper urinary tract, individual variation of blood volume, extra-vascular transudation of radioisotope and so forth. But the ratio showed good correlation with 24 hours Ccr which was little influenced by obstructive uropathy.
3) To adjust the individual variation or postoperative change of blood volume and to make the calculation simpler, RHISA was injected with radioactive Hippuran or Iothalamate. And the ratio of
200 minutes' I¹²⁵-RHISA/I¹³¹-Iothalamate (or 40 minutes' I¹²⁵-RHISA/I¹³¹-Hippuran) to
0 minute's I¹²⁵-RHISA/I¹³¹-Iothalamate (or Hippuran) was examined to see its usefulness
as a renal function test. Apparent correlation was found between this ratio and 24 hours Ccr as follows:
200 minutes' I¹²⁵-RHISA/I¹³¹-Iothalamate
-was above 12 when Ccr was above
0 minute's I¹²⁵-RHISA/I¹³¹-Iothalamate
100l/day, and arranged in order between 6 and 12 when Ccr was between 35 and 90l/day. It was 3.12 in two anephric patients under chronic hemodialysis.
40 minutes' I¹²⁵-RHISA/I¹³¹-Hippuran
-was above 6.5 when Ccr was above 100l/day.
0 minute's I¹²⁵-RHISA/I¹³¹-Hippuran
When the ratio was under 6.5, Ccr was under 100l/day. But it was above 6.5 in some cases even if Ccr was between 70 and 100l/day. It was 3.5 in two anephric patients.
4) In some clinical cases, “RHISA/Hippuran” method was used. It was found that this method was simpler and required less time to obtain a result than the so-called half life method, and useful to observe the serial changes of renal function postoperatively or during rejection crisis after renal transplantation. When the period of 40 minutes was not enough to show obvious difference of the “RHISA/Hippuran” ratio because of poor renal function, longer period (80 minutes and 200 minutes) made the difference more distinct and it made it possible to see even the slight change of renal function.

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While scintillation cameras have been extensively used for examinations of the kidney, the information obtained has not necessarily been applied effectively to clinical diagnosis. We have attempted to enhance the clinical value of these examinations by using a computer to record and process all the radioisotope images from the scintillation camera.
The apparatus used in our research is a new digital data processing system. It is assembled of the following components: a data acquisition unit, a data display unit with a light-pen, a central processing unit having an 8 kiloword core memory (1 word=24 bits), a direct memory access channel, a high-speed burst channel, a magnetic drum (100 kilowords), a high-speed digital magnetic tape recorder, and a teletypewriter. The apparatus is capable of continuously recording at certain time intervals up to 100 frames of radioisotope image changes with time. The collected data are reproduced on an oscilloscope for smoothing, three-dimensional display and drawing profile curves. With regard to any given region of interest, changes of radioactivity can be expressed in curves, which we call regional renogram.
Radioistopes used were 200μCi of ²⁽³Hg-chlormerodrin, 200μCi of ¹³¹I-hippuran, and 4-10mCi of Na ^99mTcO₄, and 1 or 2 kinds of them were selected depending on the case. About 10-40 frames of scintigrams were obtained at 5-90 second intervals immediately following intravenous injection.
Sixteen cases with space occupying lesions were examined and 5 cases of them were explained in detail.
Processing and studying of these data gave the following findings:
1) From the profile curves, split renal and regional functions can be appraised semiquantitively.
2) Changes of radioactivity with time in any given region of the kidney can be obtained as what may be called regional renogram.
3) The three-dimensional display enables cold areas to be readily located.
4) Renal lesions can be discriminated by selective use of various radioisotopes and adjusting programs.

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