The present authors showed the 5-year survival rate of 47 of the 51 patients with bladder tumors undergoing total cystectomy (and radical total cystourethrectomy) for the past 10 years. Four of the 51 patients, comprising 3 operative deaths and 1 whose histopathological data were missing, were excluded from analysis. Years of the authors' steady improvement in the technique of suprapubic urinary diversion have made it possible to attain an actual 5-year survival rate as high as 83.1 per cent in patients with low-stage bladder carcinomas. This performance, however, applies to cases of low-stage cancer alone, and still defies the access of high-stage carcinomas.
The authors came to consider that the factors governing the prognosis of bladder tumors are not only stage and grade but macroscopic growth pattern, histopathological mode of spread of the forefront, and intramural lymphatic and venous invasion. We propose the following pathological classification of the latter four items, in view of their roles in determining the prognosis.
a. Macroscopic growth pattern: Pe, Se₁, Se₂, Se₃
b. Histopathological mode of spread: α, β, γ from the viewpoint of INF (type of infiltration)
c. Intramural lymphatic invasion: ly₀, ly₁, ly₂, ly₃
d. Intramural venous invasion v(-) v(+)
As far as b. Histopathological mode of spread and c. Intramural lymphatic invasion are concerned, significant difference in the 5-year survival rate was detected between a and β plus γ, and ly_0-1 and ly_2-3.
Of the four items from a to d, the magnitude of b. Histopathological mode of spread in terms of INF is detectable to a certain extent even with the conventional TUR. Accordingly, the INF must serve as a useful guide to the early judgment of whether superficial carcinomas in question are progressive or to remain dormant, and undoubtedly lead to the establishment of policy in the management of superficial bladder carcinomas.

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In order to evaluate the feasibility of utilizing small amount of testicular tissue for the studies of androgens biosynthesis in vitro, various amounts of testicular tissue from patients with carcinoma of prostate and with undescended testis were studied.
The testicular tissues (0-100mg) were incubated with progesterone-7α-⁸H and determinations of converted radioactive androgens were made.
Between 0mg and 50mg of the testicular tissues, the conversion rate of progesterone to testosterone was proved to be propotional to the weight of the sample tissues.
In conclusion, a 30mg sample of each testis was analysed to compare their ability of testosterone formation and interstitial cell function of various testicular tissues was estimated.
The results indicated that studies of androgens biosynthesis of testis could be performed even with a small amount of testicular biopsy speciemen which was easily obtained without disturbing testicular function.

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In the first report the author stated that androgens biosynthesis of various testicular tissues could be compared each other by using 30mg testicular biopsy speciemen.
This article is based on the result of androgens biosynthesis on human cryptorchidism.
Summaries are as follows:
1. The ability of undescended testes to convert progesterone-7α-⁸H to 17α-hydroxyprogesterone, ⁴Δ-androstenedione and testosterone was compared with that of contralateral intrascrotal testes.
It was noted that the testosterone conversion rate of cryptorchid testes in under 4, 5-10, 11-13 and adult age group were 0.66±0.48% (N=4), 1.15±1.20% (N=8), 6.44±3.18% (N=3) and 7.9±2.2% (N=3), respectively. On the other hand, the conversion rate of the contralateral intrascrotal testes in the above mentioned age groups were 0.43±0.02% (N=2), 5.05±3.73% (N=5), 17.00±0.00% (N=1) and 19.30±0.00% (N=1), respectively.
It was clearly demonstrated that the great difference of conversion rate began at the age of 5.
2. During the prepubertal ages, it was strongly suggested that the normal subjects was higher than that of contralateral intrascrotal testes of cryptorchid patients.
3. From the results mentioned above it was proved that testicular interstitial function at prepubertal stage was not silent, but actually active.
4. Nowadays, it is generally supported that spermatogenesis depends upon androgen concentration in testicular tissue and FSH does not play a main role in spermatogenesis.
It was suggested that the decrease of testosterone formation in testicular tissue could be a main cause of infertility of the patients with undescended testes.

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This report describes the effect of human chorionic gonadtropin (HCG) on biosynthesis of testosterone, plasma testosterone concentration and histological findings of testes in cases with human unilateral cryptorchidism.
The results are summarized as follows:
1. By administration of 4, 000 IU of HCG for 3 days to cases with unilateral cryptorchidism it was noted that the conversion rate of progesterone to testosterone on undescended testes was proved to increase from 0.99±1.04% (N=12) to 9.13±3.88% (N=5) in 0-10 age group and from 7.9±2.20% (N=3) to 21.5±0.9% (N=2) in adult age group.
2. On the other hand, the conversion rate of contralateral testes increased from 3.73±3.78% (N=7) to 12.7±4.4% (N=4) in 0-10 age group, but decreased from 17.00±0.0% (N=1) to 5.77±0.0% (N=1) in 11-13 age group and from 19.3±0.0% (N=1) to 3.08±0.92% (N=2) in adult group.
3. Plasma testosterone concentration, including response following 3 days injections of 4, 000 IU of HCG, was studied on 54 cases with cryptorchidism aged 1-35 years, and also examined on 30 healthy boys aged 1-17 years and 10 healthy girls aged 3-13 years as the controls.
It was noted that under 10 years of age no difference of plasma testosterone concentration between cryptorchid boys (15.92±9.08ng/dl) and normal boys (11.00±6.90ng/dl).
A significantly higher testosterone response (214.4±123.4ng/dl) to HCG was demonstrated in prepubertal cryptorchid patients.
4. Electron-microscopically a lot of collagen fibers and few smoothsurfaced endoplasmic reticulum and mitochondria were demonstrated in the interstitial cells of undescended testis of a 10 years old boy. Number of collagen fibers remained unchanged before and after HCG stimulation. However, smooth-surfaced endoplasmic reticulum and mitochondria appeared to increase to some extent after stimulation.
5. From electronmicroscopic aspects, a lot of smoothsurfaced endoplasmic reticulum and mitochondria were demonstrated in the interstitial cell of contralateral scrotal testis before HCG stimulation. But normal smoothsurfaced endoplasmic reticulum and mitochondria were replaced by vacuoles in the interstitial cell after HCG stimulation.
6. It was pointed out that HCG administration on cryptorchid patients might give some degree of destructive effect on better functional contralateral scrotal testes.

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When Diet 13 B, containing oxalic acid in a ratio of 2%, was orally administered to dd-strain male mice for 50 days, progress of oxalate stone development in the kidneys of these mice was traced by means of scanning electron microscope. The following results were obtained.
1. In the lumen of the proximal tubules, not only deposit of non-crystalline and irregular structures mainly composed of degenerated epithelial cells but granular or globular structures of various sizes could be recognized. Some pictures indicated that a portion of these structures was being taken into the tissue through the spaces between the microvilli of the brush border. In those pictures, the brush border was generally disarranged and partially destructed or fallen. In addition, the cytoplasm of these tubular epithelial cells became thinner and flat, and it was characterized by vesicles, increased vacuoles, distinct nucleus and evident mitochondria. At this experimental stage, deposit of irregular octahedral crystals was already found out on the luminal surface of the proximal tubules. The pictures to suggest the developmental process from non-crystalline structure to crystalline one with various sizes proved that crystal deposition resulted in fall of the brush border, destruction of epithelial cell structure, and cellular flattening.
2. The experimental results observed in the thinner portion of Henle's loop could be summarized as follows; non-crystalline multiform structural material of which central portion had already crystallized first appeared, and its central crystallized portion then cumulatively grew up in a fashion of lamellae or wavelets, some of the crystals being columnar, needle-like or polygonal plates. On the free surface of the epithelial cells, there were of course microvilli and single cilium. The nuclei of these cells became flat. In the cytoplasmic matrix, vacuoles were evidently observed.
3. Artificial deposit observed in the lumen of the distal tubules was composed of crystals which were radial, petal-like or partially needle-like in shape. The original crystals gradually and radially developed to petal-, rod- or needle-like crystals which could occupy the whole tubular lumen. Actual morphological progress could be characterized by central formation of fine granular crystals and peripheral annual-ring-like layer formation. Sometimes the picture indicated that oxalate deposition took place following deep invasion of needle- or rod-like crystals into the cytoplasmic matrix of the epithelial cells. In these micrographs too, cytoplasmic destruction resulting from crystal deposition, cellular flattening or vacuolation was markedly recognized.
It was concluded from the experimental results that oxalate stones usually appeared in the lumen of the proximal tubules, and the matrix of these stones was mainly constituted by fallen degenerated epithelial cells. In addition, the stones which were probably protein in nature were granular or globular in shape. These intratubular structures, observed in the experiments, were characterized by complete crystallization. During the course of tubular crystal development, the structures formed first in the proximal tubules became multiform crystals especially within the thinner portion of Henle's loop and also became complete calculous crystals within the lumen of the distal tubules. The lumen was gradually occupied by the experimental stone with increasing size. In parallel with the increase in stone size, it was possible to cause not only destruction of the epithelial cytoplasmic pattern but partial invasion of the formed stone into the cytoplasm of the tubular epithelial cells.

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We have reported bladder cancers of BALB/c mice after oral administration of N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN). The present study describes chronological changes observed by electron microscope in the process of bladder carcinogenesis of mice after BBN treatment.
The following findings became evident with the development of neoplasia: increase of nucleocytoplasmic ratio, enlargement of nucleoli, increase in number of free ribosomes, polysomes and fasciculated tonofilaments, mitochondria showing enlargement or vacuolation and appearance of mitochondria with inclusions.
The distinct asymmetric unit membrane (AUM) of the vesicles and luminal surface of the mucosal cells of normal untreated mice was decreased in hyperplastic mucosal cells and was not recognized in overt cancer cells. Angularity of the surface membranes of normal cells became less apparent in hyperplastic mucosal cells and microvilli-like structures appeared in the neoplastic cells.

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This paper contains results of our experienced 30 cases of the penile cancer and description of our own abstraction for the treatment.
We have treated 30 cases of a carcinoma of the penis in the last 17 years between 1954 to 1970 and been able to trace all of them up for prognosis over 5 years.
Sixty-six per cent of patients were in their fifties and sixties and the interval of onset to clinic visit varied from a half month at the shortest to 12 years at the longest case, averaging one year and eleven months. Twenty-three patients were phimotic (76%) and the inguinal lymphnode metastasis was proved in 9 cases (30%) at the time of initial visit.
All 30 cases were classified by Jackson's staging as follows; Stage I: 6 cases, Stage II: 8 cases, Stage III: 10 cases and Stage IV: 6 cases.
The number of patients who survived over 5 years in each stage was all 6 in stage I, 6 in stage II, 4 in stage III and 0 in stage IV, and over-all survival rate was 53.3%.
The treatment consisted of surgery, irradiation and the Bleomycin chemotherapy.
The Bleomycin chemotherapy preceded in recent 11 cases because it gives maximum effect in cases who have not been treated before. One of the eleven cases has been living six years and a half, being treated with Bleomycin alone without evidence of cancer either clinically or histologically. Six patients have been observed to be with tumor shrunk but cancer cells remained histologically. They required additional treatment of surgery or irradiation. The remaining 4 cases did not respond to the Bleomycin chemotherapy at all.
The era of surgical amputation as a initial treatment of the penile cancer is over. In the consideration to preserve both function and shape of the penis, we believe the treatment should be as described here; the biopsy of the lesion when suspected and circumcision if needed at the same time. The patient who has pulmonary disease or dysfunction, or older than 70 years of age should be treated by radiotherapy first. The cases out of the above category should be treated with Bleomycin first. When the patient does not respond to Bleomycin beyound the fifth injection, that is after a total of 75mg, the radiation therapy is then added because most effective cases will show obvious improvement by that time. This combination therapy gives a better result with minimal dose of radiation. Therefore, use of Bleomycin may be considered any time even when the radiotherapy starts first. The surgery comes last, only when these treatment fails.

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As urodynamic investigations for the lower urinary tract, simultaneous recordings of intravesical and urethral pressure, and electromyographies of bulbo- and ischiocavernosus muscles have been performed through the bladder resting-filling and voiding phases, revealing the high incidence of outlet disorders in children with pyuria, microhematuria or vesical symptoms.
Normally urethral pressure is stable during the bladder resting-filling phase, but in cases of hypertonic bladder with uninhibited detrusor contraction, urethral pressure is unstable and showes sharp waves, and in accordance with normalization of cystometrogram, urethral pressure is stablized. However, in half of the cases of hypotonic or flaccid bladder, urethral pressure becomes unstable and fluctuates in irregular waves, which differs apparently from those of hypertonic bladder.
Peak pressure is usually recorded at the external sphincteric urethra, and sharply decreases immediately before detrusor contraction in normal cases. But this dynamic change during prevoiding phase is easily altered, when outlet disorders are present. The urethral pressure curves during prevoiding phase could be divided simply into three patterns: normal decrease, no change, and increase. When recorded as normal decrease, the external sphincter may be expected to be electrically silent. When recorded as abnormal increase, the external sphincter shows electrically pathological discharges, which means external sphincter spasm; or oppositely very low electrical activities. Although the external sphincter spasmus is not proved electrically in these cases, unstable urethral pressure during the bladder resting-filling phase is recorded, and defective opening of the bladder neck is observed on micturating cystourethrogram. When recorded as no change, organic urethral stenosis, mainly Lyon's Ring, could be proved in more than half of the cases.
To simplify the various roentgenographic shapes of bladder outlet disorders, micturating cystourethrograms are divided into five patterns based on diameter of the posterior urethra and the relative degree of bladder neck opening, and matched to the simultaneous recordings of pressure and electromyographies. The results are partly mentioned above, and each pattern is corresponded well to the urodynamic data, especially to the urethral pressure.
Although the bladder outlet disorders are well analyzed in general, but we still need more new clinical methodes for the full understanding of the bladder neck dysfunction.

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Complete stopping of bleeding during and after operation is considerably difficult in prostatectomy. Benign prostatic hyperplasia is not infrequent among older males. More careful attention is needed during operation and rehabilitation than with young patients because of the poor risk. It is very important, therefore, that to control the bleeding during and after operation.
The prostate has a special organ in the physiology of fibrinolytic system. It is well known that the surgical capsule of the prostate has a greater contents of tissue plasminogen activator, and severe, prolonged, profuse bleeding or oozing are chiefly caused by increase of fibrinolytic activity in blood at the manipulation of the surgical capsule of the prostate during prostatectomy.
In the present paper, studies on prostatectomy and three kinds of anesthetic methods are reported. Between 1970 and 1972, 53 consecutive prostatectomies were performed by Millin's method (30 cases) and vesico-capsular technique (23 cases) under general anesthesia (nitrous oxide-fluothane), spinal block or epidural block. The comparative evaluations in three anesthetic methods were in number of case, age, volume of blood loss during operation, operating time and postoperative stay.
The age of patients ranged from 45 to 87 years and 41 cases (80%) were from 61 to 80 years of age. The least blood loss on the average was 339.6g of spinal cases. There was no significant difference in postoperative stays.
The pathogenesis of the profuse bleeding or oozing during and/or after prostatectomy is discussed by reviewing the literatures together with our experiment.
In conclusion, by our studies it was proved that the suitable method of anesthesia for prostatectomy was spinal block because of the least blood loss during operation and the shortest operating time.

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