This study was undertaken to assess the ureteral peristaltic response to surgery in 30 patients with nephrolithiasis and 70 with ureterolithiasis by means of electromyography.
The ureteral action potential recordings were performed before lithotomy and at varying postoperative days. The results of these recordings were compared with those of clinical and laboratory assessments preoperatively and postoperatively.
1. Results before and during surgery
1) Nephrolithiasis.
Prolongation of the intervals of action potentials was seen in 57.1% and antiperistalsis in 21.5% preoperatively. No significant changes were seen in the amplitude, duration and conduction velocity of the action potentials. Although the presence of stone and hydronephrosis gave adverse effect of the ureteral function, the occurrence of these abnormal discharges was not related to the size of the stone but to the severity of hydronephrosis.
The occurrence of abnormal discharge was more frequent in the group with fistula than in that without fistula.
2) Ureterolithiasis.
Prolongation of the discharge intervals was observed in 20% in the ureteral segment above the site of stone and 41.7% in that below. Antiperistalsis was seen in 10% in the segment above the site of stone and in 12.5% in that below. No significant changes were seen in the amplitude, duration and conduction velocity of the action potentials. The occurrence of these abnormal discharges was not related to the size of the stone.
Comparison was made of the potential recordings in each ureteral segment, i. e., the upper, middle and lower segments according to the location of stone. Prolongation of the discharge intervals was frequently seen in the upper segment below the site of stone. On the contrary, antiperistalsis occurred less frequently in the upper ureteral segment below the site of stone.
Disappearance of the action potentials frequently occurred in the cases of severe hydronephrosis. Even in the cases of severe hydronephrosis with action potentials, abnormal discharge frequently occurred in the segment below the site of stone. The ureteral obstruction could be partly responsible for the occurrence of abnormal discharge.
Prolongation of the discharge intervals was more frequently seen in the ureteral segments both above and below the site of stone in the group with fistula than in that without fistula. It appears likely that the formation of urinary fistula after surgery depends on the preoperative ureteral function.
2. Results after surgery
1) Abnormal discharge in the postoperative urinary fistula formation.
a) Lithotomy for nephrolithiasis:
Abnormal discharge was more frequently seen in the fistula group than in the no-fistula group in the postoperative period of one to 7 days. There was no difference in rate of the occurrence of abnormal discharge between the healing fistula group and the no-fistula group in the postoperative period of 8 to 15 days.
b) Lithotomy for ureterolithiasis:
As compared with the one to 7 days postoperative group without fistula, the fistula group had prolongation of the discharge intervals less frequently in the segment above the site of stone and a lesser number of peristalsis passing through the surgical site to the lower segment. Prolongation of the discharge interavals was less frequently seen in the healing fistula group than in the 8 to 15 days postoperative group without fistula. The healing fistula group less frequently showed prolongation of the discharge intervals and a lesser number of peristalsis passing through the surgical site as compared with the 8 to 15 days postoperative group without fistula. These findings suggest that the healing of urinary fistula takes place concurrently as the ureteral segment below the operated site restores its function.
2) Abnormal discharge in the postoperative hydronephrosis.
a) Lithotomy for nephrolithiasis:
Abnormal discharge was more frequently seen in the presen

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There are many reports on the relationship among malignant tumors, blood clotting and fibrinolytic enzyme system. The present report describes the fibrinolytic enzyme system in plasma of rats with experimental urinary bladder tumor. The plasma was separated into three fractions with lysinesepharose affinity chromatography. The materials were Wistar-Imamichi strain male rats which had been administered a dose of 0.02mg/head/day of N-butyl-N-(4-hydroxybutyl)-nitrosamine (BBN) from 8 weeks old to 16 weeks old and then sacrified at 28 weeks old. Fraction-I did not contain either plasmin (PL) or plasminogen activator (PLg-act). Though the normal rat plasma sometimes has a slight antiplasmic action, the plasma of rats which had been administered BBN had a marked antiplasmic action. However, the action did not correspond with bladder tumor and hyperplasia. The rat plasma had an antiurokinase activity irrespective of BBN-administration. Sometimes fraction-II had also PLg-act irrespective of BBN-administration. On the rats which had been administered BBN, the activity of PLg-act in the bladder tumor-group and in the hyperplasia-group had an increasing tendency which was more marked than that in the unchanged group. Fraction-III revealed mainly the PL-activity. Normal rats had no activated PL, but the animals administered BBN revealed PL-activity. The PL-activity in the unchanged group had a more marked increasing tendency that in the bladder tumor group and hyperplasia group.

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The localization of fibrinolytic activity and plasminogen activator concentration in normal and cancerous tissues of the bladder were investigated by either Todd's method or Astrup and Albrechtsen's method. Specimens were obtained from 28 patients who had undergone partial cystectomy for baldder cancer; 25 cases of transitional cell carcinoma and 3 cases of squamous cell carcinoma. The results obtained are as follows:
1. Lysis areas of fibrin film which were produced by an activator of plasminogen could be demonstrated in relation to the injured or destroyed epithelium and cancer cells, and to the venous channels in the muscular and serosal layers. However, the venous channels distributing over the tumor stroma showed less fibrinolytic activity. Intact bladder epithelium and cancer cells were fibrinolytically inactive.
2. The plasminogen activator concentration of the cancerous tissues of Grade II to IV was significantly higher than that of the corresponding normal mucous membranes and of the Grade I cancerous tissues, p<0.05.
3. Analysis of the literature concerning fibrinolysis activators and inhibitors in cancerous tissues and the present findings permit the suggestion that the canerous tissues are maintained in the depressed fibrinolytic condition due to an excess of the inhibitors over the activators and this condition may contribute to the growth of cancer.

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With a double isotope technique, simultaneous tracing of 131-I-hippuran renogrm and 197-Hg-chlormerodrin uptake curve are routinely carried out. This procedure not only saved the time required for each tracing, but served to quantitatively evaluate renograms in patients with urinary tract abnormalities. The dose of 197-Hg used was over 5 times larger than that of 131-I, since the rate of 131-I counts in the 197-Hg window was experimentally confirmed to be under 10 per cent at these doses.
1) The changes of urine flow from the pelvis to the bladder caused by acute ureteral obstruction, voiding in the presence of vesicoureteral reflux, and bladder filling, altered the hippuran renogram pattern. The alterations were characterized by a delay in excretory phase, a sudden elevation of slow down curve, and a prolongation of renal transit time. However, the chlormerodrin uptake curves were not affected by these urine flow changes.
2) Bladder emptying by catheterization in patients with large amount of residual urine produced the renogram pattern with shortened transit time, and revealed that T 1/2 value of the slow component of blood disappearance curve was also decreased. However, changes of the chlormerodrin uptake curve and its blood disappearance curve after bladder emptying were negligible.
The problems in computer assessment of 131-I-hippuran renograms in patients with urinary tract abnormalities were investigated, and the advantages of simultaneous tracing of 197-Hg-chlormerodrin uptake curve were emphasized.

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Recently, ^99mTc-(Sn)-DTPA has been used for γ-camera renography and reno-scitnigram. In this study, ^99mTc-(Sn)-DTPA and γ-camera was used for a dynamic study of urinary bladder to obtain accumulating cystogram curve, vesico scintigram and voiding cystogram.
The instrument used was Picker's Dynacamera 2C with Data Store Playback System and Hitac 10
II Mini Computer.
1-2 mci of ^99mTc-DTPA was injected intravenously. The radio activity of γ-ray at the skin level of the low abdominal midline was recorded by external body counting after hydration (300-500cc of water by mouth) and urination.
Clinical study was performed on 65 cases. Accumulating cystogram curve was obtained on 8 cases, vesico-scintigram in 22 cases and voiding cystogram curve in 25 cases.
Details of typical cases, including normal, urinary bladder tumor, vesico ureteral reflux, urethral stricture and benign prostate hypertrophy, were reported.
The method of ^99mTc-(Sn)-DTPA and γ-Camera has been proved to be a useful, dynamic study of the urinary bladder, which is done more quickly, simply, safely and non-toxically by external body counting.

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Velocity changes of intraluminal urine flow were recorded by ultrasonic Doppler technique on exposed ureters of 5 adult mongrel dogs. This method served for understanding the behavior of urine flow within the ureter, which was affected by ureteral peristalsis. In addition, simultaneous recording of urine velocity curves and electroureterograms were performed, which provided with a direct relationship between intraluminal urine flow and peristaltic contraction.

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Construction of ileal conduit is a method of urinary tract diversions which are indicated following urethrocystectomy for malignancy or to relieve urologic complications from cancer therapy of pelvic organs. During the period 1968 through 1974, total 93 such diversions were performed at the Department of Urology of Osaka University Hospital; 78 for cancer of bladder, 9 for uterine, 3 for urethral and 3 for colonic cancer.
Postoperative mortality rate was 5.4 per cent, and such postoperative complications as wound infections (28%), hepatitis (11%), fecal fistulas (4%), intestinal bleedings (4%), acute pyelonephritis (3%), transient obstructions of the ureteroileal anastomosis (3%), bowel obstructions (2%), urinary leakage (1%) and urinary calculi with hyperchloremic acidosis (1%) were observed. Five-year survival of the 70 patients with bladder cancer who had received both total cystectomy and ileal conduit construction was 54 per cent.
Benefits and problems of ileal conduit for the treatment of pelvic cancer and pathogenesis of the several complications of ileal conduit are discussed.

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