Twenty-eight free amino acids in human semen, which were stood at room temperature (20-25°C) for 3 hours after ejaculation, were analysed both qualitatively and quantitatively in an automatic amino acid analyzer (JLC-5AH). In order to clearly separate Asparagine and Glutamine, lithium citrate buffer's method was used for the analysis of acidic and neutral amino acids.
The ninety-five samples were divided to following 4 groups, 1. fertile, 2. subfertile, 3. infertile and 4. azoospermic groups. Group 1, 2 and 3 were classified according to the sperm counts and sperm motility.
Low contents of almost all amino acids seemed to be demonstrated in the subfertile, infertile and azoospermic groups, comparing with the fertile group. The contents of amino acids between the fertile group and the other 3 groups were significantly different (p.<0.01-0.05), particularly in the contents of Lysine, Aspartic acid, Glutamic acid, Glycine, Alanine, Valine and Phenylalanine. But Asparagine and Glutamine showed almost the same amounts of amino acids in all groups. In addition, Citrulline showed a high content in the azoospermic group than in the non-azoospermic groups.
Seven samples were studied for successive changes in free amino acid contents. The total contents of amino acids in 2 healthy cases increased rapidly within 3 hours after ejaculation and moderately thereafter. In contrast, amino acid contents in 3 cases with sterility increased after 3 hours. In one case with azoospermia, a very rapid increase of amino acid contents was observed during initial a few hours, but no increase was observed after 3 hours. In a vasectomized case, although amino acid contents were quantitatively low, the increasing rate was very steep and constant.
Thus, amino acid contents in normal human semen should increase rapidly in initial a few hours after ejaculation, suggesting that spermatozoa may be protected by these amino acids during penetration through the female genital tract. The low content of free amino acids obtained in initial a few hours after ejaculation in cases with oligozoospermia may play a role in the cause of infertility.

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Plasma proteins, serum CRP, red cell sedimentation rate, fibrinolytic activity and antiplasmin in blood have been studied in 55 patients with urologic malignancies (transitional cell carcinoma of the bladder; 30 cases, secondary carcinoma of the bladder; 11 cases, renal cell carcinoma; 10 cases, transitional cell carcinoma of the renal pelvis and ureter; 4 cases) with special reference to the extent and metastasis of the tumor.
A higher frequency of dysproteinemia and of abnormal level in the other examinations was observed in patients with metastases or wide-spread infiltrating carcinoma, while the indefinite tendency for significant change in their levels was noted in patients with bladder carcinoma of Stages A and B showing relatively localized growth within the bladder wall.
Among the laboratory findings an abnormal increase of plasma fibrinogen level was most closely related to progressive conditions of the carcinomas, including the remote metastases and advanced regional growth. No significant difference was observed between the pre-and post-operative levels of each examination in any group of the carcinomas. However, the levels of serum albumin, α₁-, α₂- and γ-globulins, red cell sedimentation rate, plasma fibrinogen and euglobulin lysis time showed a significant difference between the groups of metastatic and non-metastatic carcinoma, respectively. It was thought that the follow-up study using these 7 laboratory tests may be of predective value for the progressive development of the tumor.

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A γ-globulin fraction from the antiserum prepared in rabbits to a highly purified urokinase preparation was used to immunologically identify the tissue activator activity in the bladder. Using fibrin plates incorporating the fraction at a concentration of approximately 0.015per cent (W/V), the activity of urokinase standards (0.03ml of 1.5 Ploug units per ml) was completely neutralized. In a series of serial dilutions of the fraction, 100per cent specific neutralizing effect on urokinase standards (6 Ploug units per ml) was observed at a concentration of 0.5per cent of the fraction, while γ-globulin from control sera was not inhibitory even at higher concentrations. Local plasminogen activator activity of cells in the bladder tissue section, which was demonstrated by histochemical techniques, received no significant inhibitory effect with fibrin film incorporating the fraction from antiurokinase serum at a concentration of 2per cent. Plasminogen activators extracted with 0.15M KCl, 2M KCl and 2M KSCN from the bladder were assayed with the fraction from antiurokinase serum on fibrin plates. Approximately 40per cent of the activity of soluble type tissue activator (s) extracted with 0.15M KCl as vehicle was due to the activator antigenically identical to urokinase, while the others differed from that of urokinase in immunoassays. References concerning urokinase and its inhibitor are reviewed and their importance in dynamic changes of the fibrinolytic system in various pathological conditions is discussed.

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Pre-and post-operative urethral pressure profile in various lower uropathies, obtained by Brown's method was analyzed for urethral length and pressure in the external sphincteric area.
1) The posterior urethral length in normal male was 3.6cm (2.0-4.5cm) on the average, and pressure in the external sphincteric area was 30mmHg (20-42mmHg).
2) The average posterior urethra was lengthened to 4.3cm (3.0-7.0cm) and the average pressure at the external sphincteric area increased to 39mmHg (20-50mmHg) in 16 cases of benign prostatic hypertrophy and 3 cases of prostatic carcinoma. There was a marked reduction in both length and pressure in postoperative profile.
3) In vesical neck contracture, preoperative urethral length was 4.0cm (3.0-4.5cm) and pressure was 35mmHg (28-50mmHg). The postoperative reduction in length and pressure was less marked comparing to the prostatic hypertrophy group.
4) In chronic paraplegic patients the length was 1.8cm (1.3-2.5cm) and the pressure was 23.9 (10-36mmHg). The profile was independent of the level of cord lesion and the duration after injury. No difference in profile was observed between the groups with or without subarachnoidal phenol block. The wave and the spike in anterior urethral profile, which were scarecely found in nonparaplegics, were frequently observed.
5) The urethral pressure profile offered valuable clues to the identification of the position and the size of anterior urethral diverticulum and urethral stricture, which helped the diagnosis, selection of operative approach and evaluation of postoperative result.
6) Pressure at the external sphincteric area of patients with post-prostatectomy incontinence is lower than 10mmHg. No patient with pressure above 14mmHg at this area was incontinent.
This is on easily performable method even in the outpatient clinic, and yet the careful analysis of the curvature gives valuable informations as to the management of various lower uropathies.

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The clinical course of 44 patients with vesicoureteral reflux was analysed. The patients were folowed for at least one year and on the average for 3 years and 10 months after diagnosis. Of these 44 patients, 29 had primary reflux and 15 had reflux secondary to neurogenic bladder, urinary tract tuberculosis, radical hysterectomy for cervical carcinoma, ureteral re-implantation or cystoplasty. The age and sex distribution are given in Table 1. The chief complaint, X-ray findings and urinalysis at diagnosis are presented in Table 2.
Nineteen patients who had recurrent attacks of acute pyelonephritis were treated by sulfonamides (sulfamethizole 2 to 3gm per day) for more than 6 months. Twelve patients with primary reflux responded well to the medication and experienced no fever and no urinary infection during the follow-up period (Table 3). All patients with successful long-term sulfa-therapy except one had normal upper urinary tract on urography.
Anti-reflux operations were performed in 15 patients. Though the reflux was stopped in all cases at the time of discharge, it recurred in 8 out of 10 patients who underwent cystographic check-up more than 6 months after the operation (Table 4). However, successful eradication of pyelonephritic attack and urinary infection was obtained in 7 out of 10 patients with primary reflux (Table 5).
Despite medication, 12 patients had presistent pyuria, 10 of which showed pyelonephritic or hydronephrotic changes on X-ray examination (Table 6). In 4 patients with persistent pyuria the reflux was completely asymptomatic without demonstrable progressive changes on pyelograms.
Progressive damage to the refluxed kidney during the follow-up period of an average of 5 years and 7 months was noted in one patient with primary reflux and 5 with secondary reflux (Table 7). Renal deterioration of these patients was due to hydronephrotic change.
The results of this study would suggest that presence of non-obstructive reflux, even with urinary infection, is not always noxious to the kidney and primary reflux does not damage the kidney in the majority of cases though it may cause recurrent acute pyelonephritis. It seems likely that the pyelonephritic contracted kidney due to reflux rarely develops.
Long-term sulfonamides medication will be the treatment of choice for the patients with primary reflux suffering from pyelonephritic attacks when the upper urinary tract is nearly intact. If the medication fails or progressive renal damage is demonstrated, surgical measures will be indicated. Patients with asymptomatic reflux and persistent urinary infection must be kept under close surveillance, since progressive damage to the kidney may occur occasionally.

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Clinical statistics of general patients and A-bomb exposed patients in the Red Cross Nagasaki A-Bomb Hospital was carried out during the 10 year period from 1964 to 1973 to study the number of outpatients and inpatients by year, sex ratio and the incidence of malignant tumors.
Concerning bladder tumor, prostatic cancer and testis tumor that were highly frequent among malignant tumors in A-bomb exposed patients, the incidence in the general group and the A-bomb exposed group was analyzed by the number of outpatients, the number of inpatients and sex ratio, and was also compared with the frequency in the clinical statistics in Japan.
The incidence of bladder tumor showed no difference between general patients and A-bomb exposed patients. The incidence of prostatic cancer in A-bomb exposed patients was approximately three times as high as that in general patients but it was much lower than the statistical value in Japan. The incidence of testis tumor in A-bomb exposed patients was twice as high as that in general patients as far as male outpatients were concerned, and was nearly equal as far as male inpatients were concerned. However, it was noteworthy that the incidence ranked high in the national statistics of testis tumor in Japan.

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