In order to study the pathogenesis of vesicoureteral reflux, and particularly to test the accuracy of Sampson's passive valve theory, several experiments were devised. From these experiments, and as demonstrated in a model bladder and ureter, it is concluded that the ureter remains closed except at the time of efflux.
The question of conditions of ureter pathology conductive to VUR is considered and illustrated schematically.
Experimental and clinical refluxes are classified and it is noted that prior to surgical intervention, the following must be considered: 1) Peristalsis of the ureter must be normal; and 2) The intraluminal portion of the ureter must be normal, i. e., free of inflammation, edema, or atrophy.

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A model of ischemic kidney was produced in rats by temporary occlusion of the renal pedicle. Occlusion was maintained for 30, 60 and 90 minutes. Then, ultrastructural changes of the renal tubules during developmental sequence following subsequent reflow of blood to the kidney were studied by electron microscopy. Blood reflow was permitted for 30, 60 or 120 minutes or 24, 48 or 72 hours or 7 days.
The main changes were as follows:
1) Brush border was fragmented and absent from the apical membrane. Considerable amounts of brush border debris could be seen in membrane bound vacuoles within the cells.
2) Early changes of mitochondria were marked swellings. Then, mitochondria showed temporarily normal structure, and became pyknotic.
3) Myeline-like structures were seen in apical and basal region of the cell in the early stage.
4) Extracellular compartments were extended especially by a 90 minutes occlusion.
These changes may be related to necrosis of the cell. But, we still think that they show an abnormal metabolic system of the organelle in the cell and that they are related to the renal function.

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The present experiments were carried out with an object to morphologically examine the changes of some enzymes of proximal tubular cells when renal tubular necrosis induced by Mercury, Glycerol and Kanamycin (KM) with 10% Low-Molecular-Dextran (LMWD).
The results were summarized as follows:
1) The degeneration and necrosis of proximal tubular cells were observed 24 houres after administration of Mercury, Glycerol and KM-LMWD.
2) Three hours after administration of Glycerol, the appearance and formal change of formazan deposits and the decrease of succinic dehydrogenese activity in proximal tubular cells were observed.
3) Three hours after administration of Mercury, histochemical change of succinic dehydrogenese was the same as in Glycerol renal injury, but that of glucose-6-phosphatase was particular evident, so that aggregated droplets which had glucose-6-phosphatase activity appeared in proximal tubular cells.
4) Six hours after administration of KM-LMWD, the decrease of acid-phosphatase locality and the absence of acid-phosphatase activity within vacuoles were observed. The above results indicate that tubular necrosis following Glycerol is mitochondrial origin, tubular necrosis following Mercury is a primary disturbance of microsome and secondary disturbance of mitochondria due to anoxia, and tubular necrosis following KM-LMWD is the release of lysosomal enzyme due to autolysis.

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The role of VCU in the management of various urological conditions was discussed after retrospectively analyzing 197 voiding cysto-urethrograms performed on 167 cases.
1) The normal voiding is initiated when the base plate breaks open by virtue of its own contraction and continues smoothly while detrusor contraction follows toward the trigonal canal which is progressively transformed from the base plate.
2) In vesical neck contracure, inadequate contraction of the base plate presents a poor opening of the internal urethral orifice.
3) In benign prostatic hypertrophy, the base plate is distorted by the enlarged prostatic adenoma so that the dynamic of the internal urethral orifice is evaluated poorly from VCU. Meanwhile postoperative VCU offers an excellent diagnostic tool to obtain various informations as regards both anatomical and functional status of prostatic urethra.
4) In mechanical obstruction of both anterior and posterior urethra, i. e. either stricture or valve, it is an indispensable diagnostic method to obtain both anatomical and physiological features of the obstruction.
5) VCU is a must examination for the management of ureteral reflux. When it is used in combination with various urodynamic examinations, an improved pathophysiological understanding of the lower urinary tract and uretero-vesical junction is possible.
6) Because of the high incidence of both falsely negative and falsely positive diagnosis of distal urethral stenosis (DUS), the cysto-urethrographic diagnosis of DUS must be conjoined with careful calibration of the distal urethral segment.
7) The patients with infrequent voiding habit show atomically capaceous bladder which contracts poorly on voiding.
The role will be expanded when it is performed as an adjunctive diagnostic method with other endoscopic and urodynamic examinations, frequently referring to the basic anatomy and physiology of the lower. urinary tract.

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We investigated the effect of prostaglandin (PG) on the renal function in order to study the physiological roles of PG. In this paper we report the effect of the administration of PGA₂ (0.4μg/kg/min) on the renal blood flow.
The infusion of PGA₂ started 5 minutes prior to the injection of PSP, and continued for twenty minutes. All the subjects did not have any disturbances of passage through the upper urinary tracts, edema, or hematuria. The renal blood flow was estimated from the PSP excretion value in 15 minutes, as the latter value has a very high correlation with the former value. At the same time, the change in the urine volume caused by the administration of PGA₂ was also measured.
The results thus obtained are as follows:
1) The administration of PGA₂ caused a 23.8% increase in PSP excretion value in 15 minutes (n=32, p<0.001), and a 77.2% increase in the urine volume in 29 cases (n=29, p<0.01).
2) Based on their control PSP excretion values in 15 minutes, the subjects were divided into four groups; that is, a)≤15%, b) 15%<≤25%, c) 25%<≤35%, and d) 35%<. The rates of increase in PSP excretion value in these groups were 87% (n=2), 38% (n=7), 21% (n=12), and 5% (n=11), respectively. Thus, the subjects with lower PSP values, hence with worse renal function, showed a better response to PGA₂ (p<0.01). The identical tendency was observed in the increase in the urine volume.
3) The subjects were, then, divided into five groups according to their funduscopic findings; namely, a) normal, b) KW_I, c) KW_IIa, d) KW_IIb, and e) KW_IIc. The rates of increase in PSP excretion value in these groups were 12% (n=), 31% (n=6), 32% (n=4), 20% (n=2), and 34% (n=4), respectively. Although statistically not significant, the groups with abnormal funduscopic findings revealed a better response to PGA₂. Almost the same tendency was observed in the increase of the urine volume.
4) The subjects were further divided into three groups as follows; a) the normotensive, b) the mild hypertensive who do not use depressants, and c) the relatively severe hypertensive whose hypertension was persistent even under the administration of drugs. The group with relatively severe hypertension showed a higher increase in PSP excretion than the groups with normotension and mild hypertension (p<0.05). The groups with hypertension regardless of their severeness were observed to have the tendency to a greater increase in the urine volume than the group with normotension.
From the results and the observations mentioned avove, we conclude that the renal vascular bed is highly sensitive to PGA₂. This was drawn from the fact that the increase in PSP excretion value in 15 minutes was remarkable while the decrease of the blood pressure was not observed. The subjects with lower PSP excretion values in 15 minutes showed higher rates of increase in PSP excretion.
Therefore, it seems that the more serious the pathologic state of blood vessels, the more sensitive to PG. Thus, these observations may naturally lead one to recognize both the physiological and the clinical importance of PG.

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A case of bilateral ureterocele associated with multiple upper urinary tract calculi was reported.
The patient was a 57 year-old man with the chief complaints of fever and rigor. Bilateral ureterocele with multiple stones was diagnosed by urological examinations.
He was operated on for bilateral ureterocelectomy and uretero-cystoneostomy by Paquin-Marshall method. Postoperative course was uneventful.
Literatures on 210 cases reported in Japan were reviewed and a new original classification of the form of co-existence with complete double ureter was proposed.

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