1) Studies on 75 autopsy cases of urogenital malignant tumor were performed, especially as to the distributions of their metastases.
The percent incidences of the metastasis in lung, liver, bone, kidney, spleen and lymph node was 63, 41, 37, 19, 9 and 69, respectively.
In cases having pulmonary metastasis, systemic arterial blood stream metastases were fre quently recognized.
Most metastasis of urogenital malignant tumors was of caval type. But metastasis of another type, that is by the route of paravertebral vein (Batson's route), was also seen in cases of prostatic cancer who had bone metastasis at a high incidence (70 per cent).
2) Most pulmonary metastases from urogenital malignant tumors showed multiple and nodulated growth. Solitary pulmonary metastasis was rare. Even in 29 per cent of cases which were considered free from pulmonary metastases by x ray films, macro- and/or microscopical metastases were found out in the lung by autopsical examination.
Sixty two per cent of 47 cases having pulmonary metastases had no clinical symptoms.
3) The existence of tumor cell emboli in pulmonary vessels was considered as pre-metastatic condition. Their emboli were frequently observed in renal cell carcinoma and prostatic sarcoma, but rarely in bladder cancer.
Calibers of the pulmonary vessels including tumor cell emboli and diameters of the emboli, were mainly from 25μto 100μ.
Tumor cell emboli were frequently found in vessels around the tumor metastatic foci.
Venous emboli were more frequent than arterial emboli.
Tumor cell emboli were observed in 74 per cent of 47 cases with pulmonary metastasis, but nothing was observed in cases without pulmonary metastasis.
With the exception of bone metastases, the tumor cell emboli in pulmonary vessels were observed frequently in the cases having systemic arterial blood stream metastases such as liver, kidney and spleen. The tumor cell emboli in pulmonary vessels were observed frequently in the cases having left supraclavicular and pulmonary hilar lymph nodes metastases.
4) Intimal thickening of pulmonary vessels was found in 39 percent of 75 examined cases. In the cases with such an intimal thickening of pulmonary vessels, the tumor cell emboli were frequently observed.

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1) Roentgogenological analysis of nodular type metastasis in lung, from urogental malignant tumors, was made on 17 untreated cases.
The results were as follows:
i) The growth curves of pulmonary metastases in semilogarithmic chart were almost linear. Therefore, pulmonary metastases were considered as logarithmic growing.
ii) Several pulmonary metastases in one patient were growing at the almost same t ate.
iii) The growth rate of pulmonary metastasis was dependent on the characteristic of the original tumor.
a) Super rapid or rapid growing group: The doubling times of Wilms tumor, testicular tumor and prostatic sarcoma were from several hours to 30 days.
b) The intermediate growing group: The doubling times of renal cell carcinoma, renal pelvic and bladder cancer were from 30 days to 60 days.
c) The slow growing group: The doubling times of 1 case of renal cell carcinoma and 2 cases bladder cancer were from 60 days to 120 days.
d) The very slow growing group: The doubling times of 1 case of bladder cancer was over 120 days.
iv) The establishing time of the pulmonary metastases was calculated from their growth rates. In 12 cases, the pulmonary metastases were established before the manifestation of their first clinical symptoms of primary tumors. And in 3 cases, the metastases originated about the manifestation of their first clinical symptoms but before the surgical procedure. In only 2 cases, the metastases were disseminated after their surgical procedure.
v) In three cases of renal pelvic and bladder cancer, the doubling times were more than 70 days, which meant the necessity of more than 5 years' observation to find the metastasis.
2) The changes of the growth curves of pulmonary metastases caused by treatment (radiation therapy, chemotherapy and hormone therapy) were analyzed on 5 cases of urogenital malignant tumors.
It was revealed that the changes of growth rates of pulmonary metastases were well correlated with the effects of each treatment.
Therefore, it was concluded that the analysis of alternations of growth rate in pulmonary metastases is important for evaluation of their treatment.

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Ileocolic conduit diversion was performed in five patients. Although, the follow-up period is still too short to obtain any conclusive data, satisfactory results were so far observed on the whole.
Encountered post-operative complications were urinary leakage in case I and diarrhea and fever attack by pyelonephritis in Case II. They were however transient.
IVP, retrograde conduitography, blood chemistry and acid-base balance were examined on the patients. The retrograde conduitography showed that the contrast medium was blocked at the ileocecal valve under the retrograde low pressure irrigation, and no reflux was observed in the ileal portion or ureter. Under the high pressure irrigation, however, the contrast medium passed beyond the ileocecal valve and flowed back to the ureter.
Some anatomic and functional advantages of the ileocolic intestinal conduit are discussed.
Because the ileocolic vessels are less in variation and easily mobilized, the isolation procedure of the intestinal segment is simpler and the stoma is also easily constructed without any undue tension.
The stomal stenosis is expected to be fewer in comparison with the ileal conduit case.
This operation is considered to be further examined extensively as one of the conduit type urinary diversions.

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Congenital anomalies of the urinary tract are often found in multiple rather than single similar to congenital anomalies in the other systems. Among them it has been reported by many authors that the maldeveloped kidney are frequently associated with the congenital ureteral anomaly which causes obstruction. However, the etiology causing the maldeveloped kidney is still obscure and the morphological classification of this makes us confuse although the terms of hypoplasia, dysplasia, dysgenesis, aplasia and agenesis have been used. Except for hypoplasia and agenesis, these terms are used by different authors to mean different states.
From this point of view we reviewed and reevaluated the histological examinations of the kidneys to define the classification of the maldeveloped kidney: vesicoureteral reflux 4, ureteral stenosis 2, ureterovesical junction obstruction 1, ectopic ureter 13 and pyeloureteral junction obstruction 15. These renal specimens were obtained by biopsy or nephrectomy in the Urology Department of the Osaka University Hospital during the past 18 years.
The results were as follow. These 35 specimens were classified into 4 groups from the composition of glomeruli and tubules which were mature, primitive or absent.
Type I: Glomeruli and tubules are all of matured types although some hydronephrotic or inflammatory changes are observed. (12 cases)
Type II: Glomeruli and tubules are all of matured types with slight hydronephrosis or inflammation. However the kidney is definitely small. (4 cases)
Type III: Mixture of matured and primitive glomeruli and tubuli with moderately increased connective tissue. (16 cases)
Type IV: Only primitive tubules in severely increased connective tissue are observed without any glomerular component. (3 cases)
Therefore, the maldeveloped kidney should be classified into hypoplasia (type II), dysplasia (type III), dysgenesis (type IV) and agenesis.
Back pressure to the intrauterine kidney by disturbance of the urinary flow has been reported as one of the causes of the maldeveloped kidney. Also the time of onset of this is important. Relation of the classified types of the maldeveloped kidney to the time of onset of the congenital ureteral anomalies was discussed.

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In 1959 Wrong and Davies reported on three patients with an inability to lower urine pH in response to ammonium chloride loading test in the absence of systemic acidosis. This is the first description of incomplete renal tubular acidosis. Twenty-seven cases of this condition have been reported in the literature since the presentation by Wrong and Davies. Though Miyake et al. (1964) and Hirooka et al. (1965) observed a similar tubular acidification defect, the following case is the first to be reported as incomplete renal tubular acidosis in Japan.
A 41-year-old man was admitted to the hospital on March 2, 1974 with recurrent urinary calculi. He passed numerous stones repeatedly since 1952. X-ray films showed bilateral nephrocalcinosis and upper urinary calculi with no evidence of excretion from the right kidney and with left pyeloureterectasis. Laboratory examinations revealed slightly infected urine with pH 6.5 or over but no systemic acidosis was indicated. The ammonium chloride loading test showed an acidification defect leading to diagnosis of incomplete renal tubular acidosis. A left ureteral stone was extracted on July 7 and right pyeloureterolithotomy was performed on August 9, 1974. The patient has had no recurrent calculus since he started alkali therapy.
Light microscopic examination from the biopsy specimen revealed evidence of chronic pyelonephritis i. e. atrophy and degeneration of tubules with thickened basement membrane, increase of fibrous elements in interstitium and occasional accumulation of lymphocytes, pericapsular fibrosis of glomeruli which remained with minimal changes.
Fine granular deposits are occasionally observed in subepithelial spaces in capillary loops and rare dense amorphous deposits in subendothelial spaces by electron microscopic observation.

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Papillary adenocarcinoma of the prostate was first described by Melicow and Pachter, who thought that it was derived from the median Müllerian remnant. Subsequently, Dube et al. reported papillary adenocarcinoma which was derived from the prostatic duct. It is not easy to identify the origin of papillary variety of prostatic adenocarcinoma but it is important, since this lesion may have a natural history and biological behavior different from that of usual prostatic carcinoma.
Our case is a 77-year-old merchant who sought relief for acute urinary retention. The prostate was enlarged, firm and partly indurated. Serum acid phosphatase level was normal and needle biopsy of the indurated lobe revealed only benign prostatic hyperplasia. A suprapubic prostatectomy was performed without difficulty. The gland was enucleatced easily.
The specimen submitted for histological examination consisted in 16 gm, prostatic tissue which was grossly normal with usual nodular hyperplasia. Histologically it was mostly nodular hyperplasia but focally there existed areas of papillary adenocarcinoma of moderate cellular atypism. A pattern of the carcinoma was strikingly different from that of usual carcinoma of the prostate. It was consisted of large columnar type of cells with hyperchromatism which were arranged in bands with infolding and papillary formations. Nuclei were relatively large and seen at the bottoms of cells. They had one or two distinct nucleoli.
The patient's postoperative course was uneventful.
One and half years postoperatively obstruction appeared again and under diagnosis of a recurrence of prostatic carcinoma TURP and castration were performed. At that time there was no evidence of metastasis and serum acid phosphatase was normal.
Stilbestrol has been prescribed for these 5 years after the second operation. The patient is well and free of metastasis. In this case antiandrogenic therapy was not thought to be harmful.

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