Surveying retrospectively the clinical records of patients who visited us for simple bacterial cystitis, we tried to define the term “recurrent” of so-called recurrent cystitis from the side of agents. As a concequence of the survey, our definition for the term “recurrent” resulted in: each case of re-infection within 5 months after effective treatment of the anteceding infection or of repeated infections 3 times or more in one year. And therefore, the treatment for them was considered effective in preventing recurrence when there was no recurrence for over 6 months.
As to the incidence of bacterial cystitis, particularly in females, it was found that in single episode cases, the peak appeared in the 31 to 40 age group and was next highest between 41 and 50, while the average age of those suffering from recurrent cystitis was over 40 years, and still more, it was repeatedly observed by laboratory examinations that the external genitalia was a habitat of enterobacteria common with both infected urine and normal anal region in the patient with recurrent cystitis. Then we presumed that the peak of the incidence in single episode cases would closely be related to their sexual life as generally accepted, but the next highest in the 41 to 50 age group would not only be related to their sexual life but to the acquired abnormal or pathogenic flora of their external genitalia, again which would possibly be reflecting the disposition easily falling in urinary infection in the person who belongs to this age group.
From the viewpoint above-mentioned, we tried out sterilization of the vaginal mucosa associated with a conventional treatment for urinary infection with the hope of preventing recurrence, and some 46% effectiveness for preventing recurrence over 6 months was achieved. Next to be tried out was reconstruction of the normal vaginal flora which consisted of vaginal sterilization and artificial colonization of lactobacilli on vaginal mucosa, and this method proved so effective that nearly 100% prevention of recurrence was achieved in patients who carried the bacilli.
It is deemed that this principle for preventing recurrent cystitis would also be applicable to prevention of recurrence of upper urinary tract infection in some female patients.

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Herein reported is a case of hyperdynamic β-adrenergic circulatory state in a 47-year-old woman with attacks of paroxysmal palpitation, tachycardia, sweating, fatigue and hypertension. Her history dates back to 24 years of her age when the first episode appeared during her first pregnancy. The attack became more frequent and was easily provoked by tightening her waist. She was admitted with the diagnosis of possible pheochromocytoma which was excluded by the fact that the laboratory data and pharmacological tests failed to show the hypersecretion of catecholamines. Careful observation revealed the attack was provoked not only by abdominal compressions but also by quick postural changes. Tilting test showed a transient hypotension followed by severe palpitation and tachycardia with various other symptoms constituting her episode.
It appeared that her symptoms were due to increased β-adrenergic receptor reactivity as had been proposed by Frohlich et al. and Miyahara et al. The administration of adrenergic β-blocking agent, propranolol, was dramatically effective.
Since the elevation of blood pressure induced by left flank massage was consistently higher than that by right flank compression, exploratory laparotomy was performed in order to exclude the pseudopheochromocytoma syndrome. Surgery revealed no abnormal findings including bilateral adrenal gland.
It would be important for the urologists to appreciate this syndrome because some of the patients with paroxysmal hypertension masquerading pheochromocytoma might suffer from this syndrome which could be treated by adrenergic β-blockers.

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The rectal bladder combined with intrasphincteric perineal colostomy was made in the past 8 years in 44 patients.
The present paper is concerned with the review of the surgical technique and its results that have appeared in the literature as well as the technique of the authors' own and several problems still remaining unsolved.
Fine performance in implantation of the ureter to the isolated rectosigmoidal pouch is imperative for satisfactory postoperative courses. Nevertheless no paper has scrutinized and comparatively studied the so far available ureteral implantation techniques. Accordingly the technique of choice has not been determined.
Techniques that the present authors have performed for ureteral anastomosis are:
1. Goodwin's technique
2. Sero-muscular folding technique
3. Cordonnier's technique
4. Others
The best possible pathway of the intrasphincteric sigmoid to be constructed has not yet been determined either, but this problem appears to be essential to achieve a satisfactory defecating function.
Other techniques of urinary diversion, in which the anal sphincter is used to retain separate fecal and urinary continence, were also reviewed.

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Forty-four patients underwent an operation for rectal bladder combined with intrasphincteric perineal colostomy during the past 8 years. Of these, 20 were operated by Lowsley-Johnson procedure, 11 by Staehler's, 12 by Duhamel-Boissonnat procedure, and the remaining one by Heitz-Boyer Hovelacque procedure.
Thirty-seven patients had a malignant disease.
The results are given below.
1) Early mortality (within 30 days of operation) was 6.8% (3 cases), and late mortality (beyond 30 days) was 22.7% (10 cases). The latter was always due to carcinomatosis.
2) The most frequent complication that had developed in both early and late postoperative courses was pyelonephritis. Hyperchloremic acidosis with manifest clinical signs was noted in 3 patients (7.3%) and was transient.
3) Three different techniques mentioned in our preceding paper were used for ureteral implantation, and the results of these three were compared one another. Patients were followed by periodic excretory urography (IVP) and retrograde rectosigmoidography. The findings in this study suggest that the cause of upper urinary tract infections after construction of an isolated rectosigmoid bladder is urinary stasis due to stricture of the ureter at the anastomosed site, rather than intestino-ureteral reflux. Accordingly, the authors believe that mucosa-to-mucosa anastomosis is the most reliable technique for ureteral implantation.
4) Urination in the postoperative course was nearly satisfactory, but bed wetting was recorded in 18 cases (51.5%), including 5 (15.2%) who suffered every night, of the 35 patients who were successfully followed up.
5) Restoration of defecating function was described. From the point of view of this function, the “retroanal (-rectal) sigmoid pull through” is advantageous over other techniques. In pulling through the sigmoid colon, one must pay attention not to damage the puborectal sling.
6) One half the patients undergoing this operation returned to preoperative activities. Of these, all the patients with benign disease returned succesfully to their work.

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Eleven cases of true hermaphrodites were investigated with special reference to the relationship between differentiation of gonads and development of sexual duct systems. On most of them were performed studies of the sex chromatin, fluorescent body and chromosomal analysis. Also, reported cases in Japan as well as in foreign countries were collected and reviewed.
Chromosomal analysis on 9 cases revealed chromosomal constitutions of 46, XX in 3 cases, 46, XY in 4 and 46, XX/46, XY in 2.
Four cases out of 5 patients with a testis at one side and an ovary at the opposite showed Y-bearing chromosomal constitutions. Most of reported cases with a similar type of gonadal developement as the above mentioned were proved to have Y chromosome in their stem cells.
Analysis of chromosomes in myelocytes and lymphocytes from a patient with 46, XX/46, XY revealed an interesting result. Twenty-one myelocytes out of 24 had chromosomal constitution of 46, XY and only 3 had 46, XX, whereas almost all of lymphocytes investigated after culture of peripheral blood had 46, XX constitution. It may be suggested from the above finding that cell populations are different from one tissue to another and may influence the differentiation of the primordial gonad toward a testis or ovary. It was another interesting finding that the fluorescent body was observed in 19% of lymphocytes from the patient mentioned above. The observation indicates the importance of examining Barr body as well as fluorescent body on more than two kinds of tissues, because native cells without cell-culture can be utilized for the examinations.
Six true hermaphrodites investigated for both Barr and fluorescent bodies consisted of two of 46, XX, 46, XY and 46, XX/46, XY, respectively. Both bodies were positive in each case with mosaicism 46, XX/ 46, XY, although their frequencies were at lower percentage than normal female or male. On the other hand, only a few Barr or fluorescent bodies were recognized in each case of 46, XY or 46, XX, respectively. It is difficult to decide whether the above results were caused by an unrecognized mosaicism or not.
From the observations of true hermaphrodites and XX-males, there has been raised an assumption that a sex-determining factor may locate on one of autosomes to which Y chromosome may affect as a regulating factor. This assumption, however, appears not sufficient to explain the differentiation of the ovarian tissue in the case of 46, XY.
Testes in the foetus stimulate the differentiation and development of the Wolflian duct and suppress the Mullerian duct. The former function appears to be controlled by one of androgens secreted from the foetal testis. From the observation of clinical cases and animal experiments, the latter function seems to be closely related to the chromosomal constitution of cells composing the ductal tissue, while this function must be mediated by a chemical messenger produced from the foetal testis.

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In order to evaluate urethral sphincteric function, urethral pressure profile (UPP) was studied by the method of Brown-Wickham with modifications in 18 patients with stress incontinence, and 22 normal females were used as control. Concomitantly, cystourethrography combined with the insertion of a watch chain into the urethra was studied in 13 patients with stress incontinence.
The results obtained are as follows:
1. The greatest urethral pressure (UPmax) was found in the middle portion of the urethra.
2. In the control group, the mean value of UPmax was 86.1cm H₂O with standard deviation of ±15.9. In general, UPmax showed a tendency to decrease with increasing age. The physiological urethral length determined with UPP was 3.6±0.4cm.
3. In the stress incontinence patients, UPmax was 46.7±9.5cm H₂O, being significantly lower than that of the controls. The physiological urethral length was 3.1±0.5cm and it was significantly shorter than that of the controls.
4. Posterior urethrovesical angle on cystourethrography exceeded 120° in the stress incontinence patients.
5. It is of considerable practical significance that bladder pressure rose above UPmax by abdominal pressure during a deep cough in most patients with stress incontinence.
These findings indicate that the UPP examination is of actual value in diagnosis for stress incontinence.

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