The transitional epithelium of the urinary bladder protects this organ from hypersthenuria, endures the expansion and contraction of the wall with the storage and voiding of urine, and has many other activities in absorption, excretion and secretion. The transitional epithelium of the urinary bladder has been classified into the three layers: the superficial layer, intermediate layer, and basal layer. There are two theories as to the origin of the superficial layer cells of the transitional epithelium; this superficial layer cells divide and proliferate individually or the deeper layer cells migrate and differentiate toward the superficial layer after the division and proliferation. This problem has not been solved. It is not clarified, for each layer cells, how to act in the regenerative epithelium of the urinary bladder after the defection. In order to clarify these problems, the reporter made defectsion in the rabbits' mucosal bladders. These bladders were observed autoradiographically and electron microscopically from the operation for seven weeks.
The results were as follows:
1. The transitional epithelium of the urinary bladder is constituted of four kinds of light cells which constitute four layers; the superficial layer, the upper intermediate layer, the lower intermediate layer and the basal layer, and of the dark cells which exist in all the layers.
2. I confirmed the process, in which the basal layer cells migrated and differentiated into the superficial layer cells, electron microscopically and autoradiographically with ⁸H-thymidine.
3. The dark cells are thought to be the active ones which have the activities such as the protection from the urine, the barrier from water, the secretion of the immune material and others, judging from the arrangement and electron microscopic observations.
4. The polysaccharide stained with the ruthenium red is found in the cell membrane, the basement membrane, the space of the collagenous fiber and the cytoplasm. I am interested in finding the ruthenium red in the cell, for it is said that the membranous organs in the cell have the passage to extra-cells.
5. The morphology of the cells is due to the kinds of the fixing fluid. In the case of formalin fixing fluid, the superficial layer cells are especially flattened and stained well with Eosin and PAS, and many dark-like cells, whose cytoplasm is stained well with Eosin and PAS, exist. The dark-like cells are small and like a pole and exist continuously like a pillar from the basal layer to the superficial layer.
6. I confirmed five kinds of the regenerative processes of the mucosal bladder at different stages after the defection the land slide type migration which is found on the surrounding region at the time of three hours after: the defection, the cell flow type migration and the horizontal type migration at time of the 12 hours, the mitosis at the time of 18-30 hours, and the escalator type migration at the time of one week.
7. The labeling index of the normal epithelium of the bladder by -H-thymidine is 1.06% (basal layer 1.67%, lower intermediate layer 0.61%, upper intermediate layer and superficial layer 0%).
8. After the defection, the first peak of the DNA composition is 12-24 hous (L. I. 16.83-27.95%), the second peak 48 hours (L. I. 3.92%) and the generation time is estimated as 24-36 hour. The L. I. at the time of 24 hous after the defection are 25.37% in the defected region, 46.97% in the surrounding region (basal layer 80.68%, lower intermediate layer 34.61%, upper intermediate layer 10.11%, superficial layer 1.75%) and 11.51% in the remoted region.
9. The life span of the basal layer cells has the two type: long and short.
10. Though the basal layer cells and the lower intermediate layer cells attach to the basal membrane, the superficial layer cells and the upper intermediate layer cells attach to the lower intermediate layer cells and the basal layer cells.
The physi

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A recent report from this laboratory has shown that when the upper and lower segments of the sectioned ureter are communicated through a vinyl catheter (reconstructed ureter), the excitation is caused by urine flow at the connected part of the lower segment, independently of the upper segment, and the normal urine transporting ability is retained, judging from the myogram of ureter (S. Takahashi, Jap. J. Urol., 65(5), 303, 1974).
The primary purpose of the present experiment was to compare the action potentials and the pressure waves of the ureter which was sectioned transversely at the central part and reconstructed between the upper segment and the ureteral orifice (reversely connected ureter) with those of the intact ureter and the reconstructed ureter.
In this experiment, 16 ureters from 8 mongrel dogs were used: first of all, 16 intact ureters were used as control, and then surgery was performed to make a reversely connected ureter in which urine was allowed to pass reversely from the ureteral orifice to the kidney.
The results obtained are as follows: 1) in all control ureters, the peristalsis was observed with a concomitant appearance of pressure waves, except 1 which showed antiperistalsis; 2) in the reversely connected ureters (16), 13 showed anti-peristalsis with a concomitant appearance of pressure waves, and of the other 3, 1 retained anti-peristalsis and the other 2 retained normal peristalsis after surgery; 3) between the reconstructed ureter and the reversely connected ureter, no significant differences were seen in the amplitude, duration, propagation rate, frequency of action potentials and the intraluminal pressure of the ureter.
From these results, together with those previously obtained with the reconstructed ureter, it is suggested: 1) when the muscular conduction of excitation is interrupted physically at some portion of the ureter, peristalsis is caused by the urine flow itself and conducted by muscular propagation to the distal end without any relation to the propagation of excitation from the renal pelvis, and furthermore, 2) the property of ureteral contraction has no influence on the direction of the urine flow.

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The renal cell carcinoma often involves directly the inferior vena cava. The method of the curative treatment for such a case is radical nephrectomy with en bloc resection of the inferior vena cava containing tumor. However, excision of the vena cava extends above the contralateral renal vein, results in passive renal congestion and failure when adequate venous collaterals are not developed.
As one of the surgical methods to cure completely such a case without injuring the function of the remaining kidney, we studied on an resection of the inferior vena cava and on an end-to-side renoportal venous anastomosis.
Using 7 mongrel adult dogs, we resected the left kidney and the inferior vena cava en bloc from above the left suprarenal vein to just above the iliac bifurcation, and made an end-to-side anastomosis between the right renal vein and the portal vein. At the same time, we ligated and divided the left spermatic (or ovarian) vein emptying to the left renal vein, the lumbar vein, the left suprarenal vein and the right spermatic (or ovarian) vein entering the resected vena cava.
Five of these 7 dogs maintained excellent health and were followed up for 12 to 14 months. Two dogs died of bleeding and shock, 6 hours and 17 hours after the operation respectively.
Renal and liver functions of the 5 dogs were examined for 12 to 14 months after operation. The examinations proved that the renal functions (blood urea nitrogen, serum creatinine level, PSP test and excretory pyelography) were normal and proteinuria was negative. In addition microangiogram revealed no irregularity in the vascular system of the kidney and histological examination disclosed that glomeruli and renal tubules were normal.
As liver function tests, alkaline phosphatase, bilirubin, GOT, GPT, and LDH were determined and they were all found normal. Also, histological tests revealed that the liver was normal.
Concerning the collateral blood flow after excision of the inferior vena cava, the vertebral vein, azygos vein, hemiazygos vein, lumbar vein, deep iliac circumflex vein and right suprarenal vein were examined.
Judging from above findings, we consider our method worthy to apply to selected patients, as one of the curative treatments for the renal cell carcinoma which involves the inferior vena cava.

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During the past 12 years, 60 partial colocystoplasties for bladder enlargement and 47 total colocystoplasties for bladder substitution after total cystectomy have been performed. The chief lesions which necessitated these procedures were 56 tuberculous contracted bladders and 45 bladder cancers.
The results during 3 to 12 years after the colocystoplasty were as follows.
1. The 5 year survival rate was 93 per cent in 59 partial colocystoplasties for benign disease and 48 per cent in 45 total colocystoplasties for malignant disease. The major causes of deaths were renal failure in the former and cancer recurrence in the latter.
2. The postoperative condition of micturition was nearly satisfactory on 47 partial colocystoplasties and 17 total colocystoplasties, but nocturnal incontinence was observed in 7 cases (41 per cent) in the latter. According to the observations of cystometry, uroflometry and voiding cineradiography of the sigmoid bladder, it was estimated that micturition occurred with abdominal straining and contraction of the sigmoid bladder. The ratio of residual/capacity decreased by bladder neck resection or urethral bougie in some cases with sigmoid bladder dysfunction.
3. To evaluate the renal function, intravenous pyelography, BUN and serum Cr had been tested in 56 cases. The data remained within normal range in most of patients and serum Cr was found to be a more important index of renal function than BUN because of possible reabsorption. Of 79 ureterosigmoidal anastomoses performed, there were 29 Kerr-Colby, 22 Nesbit, 10 Warwick and 18 Leadbetter. Among these, Leadbetter's technique was considered to be the most reliable one as judged by the findings of IVP. The obstruction following ureterosigmoidal anastomosis was treated by reanastomosis with consecutive good passage. The ureteral stricture at the anastomosed site after Kerr-Colby's technique resulted from a nodule, bud or nipple which formed on the intraluminal portion of the ureter. This fact was observed on autoptic and bioptic specimen.
4. Serum electrolytes were measured in 61 cases postoperatively. Abnormality in potassium and chloride was observed in some cases with renal or sigmoid bladder dysfunction. But severe imbalance was not experienced except one case of hypokalemia with metabolic acidosis and 2 cases of osteomalacia.
5. The sterility in urine culture was observed on 15 patients of 25 partial colocystoplasties and 6 of 13 total colocystoplasties. Biopsy of sigmoid bladder more than 8 years postoperatively revealed mild inflammatory changes in mucosa.
In conclusion, colocystoplasty is a valuable reconstructive surgery without external urinary diversion not only for benign contracted bladder but also for some bladder cancers.

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The complete stopping of bleeding during operation and postoperation is considerably difficult in the prostatectomy. Benign prostatic hyperplasia (abbreviation: BPH) is not infrequent among older males. More careful attention is needed during operation and/or rehabilitation as than with young patients because of the poor risk. It was very important that to control the bleeding during operation and after operation, and to shorten the period for complete wound healing.
In the present paper, 53 cases are reported who suffered from BPH and received retropubic prostatectomy in our Department in the period of 3 years from 1970 through 1972. Trans aminomethyl-cyclohexane-carboxylic acid (abbreviation: t-AMCHA) was the only coagulant used by intravenous injection during and after operation. The relationships of total doses of t-AMCHA used to the duration of gross hematuria during and after operation and the time to complete wound healing were studied. The results were as follows.
It was found that the duration of hematuria was shortest at total doses ranging from 41g to 50g. The mean value was 8.6 days. The time to complete healing shorter at total t-AMCHA doses of 51-60g. The mean value was 8.5 days. We believe that the suitable total doses of t-AMCHA for retropublic prostatectomy is from 41g to 60g.

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