Percutaneous translumbar approach on flank position has been attempted in order to determine renal blood flow by Doppler flow meter.
Doppler flow pattern detected by this approach was proved by direct measurement at operation to be a renal blood flow pattern.
Doppler flow determination by this method was carried out in three donors, 6 kidneys for renal transplantation, three patients, 3 kidneys with contralateral renal vessel anomaly and three volunteers, 6 kidneys. Appearance time, acceleration time and d/S which were characteristic in every case were investigated. Therefore, comparison of these calculations is significant to classify blood flow patterns. Changes in renal hemodynamics can be easily detected by serial measurement in each case.
This method is a safe, simple and non-invasive technique that produces no discomfort to the patient. For these reasons, percutaneous translumbar approach of Doppler flowmetry is applicable as a new diagnostic procedure for renal blood flow investigation.

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The present investigation was undertaken in order to clarify the mechanism of the transport of urine by the pelvi-ureteral system in dogs. Twenty-eight preparations of exteriorized renal pelvis and ureter from 18 dogs were used. Dogs were operated under thiopental anesthesia. The pelvis and ureter were exposed transperitoneally, and electrodes were implanted at the pelvis and ureter. Simultaneous recordings of pelvic and ureteral myograms were obtained.
A vein needle connected to a pressure transducer was placed in the pelvis and pressure within the pelvis was recorded. For mesurement of intraureteral pressure, a No. 18 gauge scalp vein needle was inserted into the ureter below the site of implanted electrode.
These measurements were made simultaneously with myogram recordings. The changes in pelvic and ureteral peristalsis were recorded, together with the corresponding myogram and pressure recordings after rapid diuresis induced by an intravenous infusion of Furosemide (10-20mg). Results:
1) The average frequency of contraction before induced diuresis was 24. 6 times per min. in the pelvis and 8.7 times per min. in the ureter. Namely, the peristaltic frequency of the pelvis before diuresis was greater than that of the ureter by a ratio of 3: 1.
2) During diuresis, the average frequency of contraction was 24.1 times per min. in the pelvis and 22.7 times per min. in the ureter, indicating that the peristaltic activity of the ureter increased as the urine volume increased.
3) The frequency ratio of 1: 1 seen during diuresis remained unchanged for 7 min. and 25 seconds. Subsequently it returned to the pre-infusion level.
4) Pressure within the pelvis showed low and continuous contraction waves corresponding to the amplitudes of pelvic contraction before and after the Furosemide-induced diuresis. In the ureter, however, the high contraction waves corresponding to the amplitude of ureteral contraction were seen. During diuresis, both the standing and contraction pressures within the pelvis and ureter were equally elevated.
The results of the present investigation suggest that the intact pelvis continues a rhythmical contraction, despite the absence of urine, and no peristaltic activity is accelerated in the ureter unless urine in the pelvis passes through the pelvi-ureteral junction to reach the ureter. During marked diuresis, distension of the pelvi-ureteral junction occurs as the intrapelvic pressure increases. Subsequently, the frequency of ureteral peristaltic contractions increases as the ureter at the pelvi-ureteral junction is dilated by urine pressure. At this diuretic stage, the capacity of the ureter to adjust itself to changes in urine volume is limited by its inability to dilate beyond a certain point. Therefore, the increased frequency of ureteral peristaltic contraction expels a larger volume of urine to minimize outflow resistance, thereby reducing back pressure toward the kidney.
The data presented would be prerequisite for the better understanding of the pelvi-ureteral function in man.

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In 1971 we reported papers entitled, ‘Some Clinical Evaluation on Cystoplasty Utilizing “Nobectane” Sprayed Gelatin Sponge.’ Subsequently through the original research work of Taguchi, we further reported ‘A Study on Cystoplasty by Regeneration of Contracted Bladder Using Novectane (Liquid Synthetic Resin)-Sprayed Thin Paper (1), (2), and (3).’ These papers dealt with the classification of various cases of tuberculous contracted bladder into three types and with the regeneration of the contracted bladder using a synthetic resin which has thin Japanese paper as a padding, for a prescribed period of time, thus enabling enlargement of the bladder and spontaneous urination. Furthermore, the application of this regeneration showed a new system of treatment by cystoplasty.
Taguchi also applied such experience to the treatment of tumor of bladder. The purpose of this cystoplasty is to let the bladder regenerate and to make spontaneous urination possible by the same method as in the contracted bladder.
The operative procedure for tumor of bladder consists of, in principle, the two types as given in Fig. 1 and 2.
The type I (Fig. 1) is the procedure in which the bladder is excised, leaving the trigone and the neck inclusive of both uretheral meatuses or leaving a part of them. Consequently, any procedure that leaves a part of the bladder, however small, belongs to type I. The artificial material used is a conical membrane of synthetic resin having a thin Japanese paper padding. This has been employed since 1970 as already reported. In 3 to 4 weeks after the operation the artificial material is removed transurethrally.
Case 1 is a 40 year-old male. This is the case reported in “A Study on Cystoplasty by Regeneration in a Case of Tumor of Bladder Using Novectane (Liquid Synthetic Resin)—Sprayed Thin Paper (1) ”. He was suffering from the 3rd degree transitional epithelial tumor and was operated on by the procedure, type I. Four years have passed since then, and at present the capacity of his bladder is 300 to 400cc with normal urine and renal function.
Case 2 is a 60 year-old male who was subjected to the type I operation. He was suffering from the 3rd degree transitional epithelial tumor. The capacity of his bladder reached 300cc in 3 months after the operation. The cystogram taken one year later indicated a normal state as shown in Fig. 4. In 2 years his single urination reached 300 to 400cc and the urine analysis indicated a normal state.
The type II (Fig. 2) is a whole excision of the bladder except a part of the posterior urethra. The inner glands of the prostate are also excised in the case of male.
Case 3 is a 58 year-old male who was subjected to the type II operation The cystogram indicated filling defects all over the bladder as shown in Fig. 5. Fig. 6 shows a state when the whole bladder and prostate inner glands together with a part of peritoneum were excised. The excised bladder indicated the spread of tumor almost all over the bladder wall except the bladder neck, proving to be 2nd to 3rd degree transitional epithelial cancer. Spontaneous urination at one time was 100 to 120cc, 4 months after cystoplasty. In Fig. 8 is shown a cystogram taken 2 years 6 months after cystoplasty. The remakable vesicoureteral reflux was noticed similarly to the observation made 5 months after cystoplasty. When compared with excretory pyelogram taken prior to the operation, conspicuous enlargement of the pelvis of the kidney and of the ureter were observed. Little difference, however, was found in the renal functions before the operation, 5 months and 2 years 6 months after operation. Fig. 9A is a cystogram taken one year after cystoplasty and Fig. 9B is the one taken 3 years later, revealing distinct formation of granular tissue.
Case 4 is a 46 year-old male who was subjected to the type II operatio

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Analysis on the technical problems of 65 split renal function studies (mainly on the renovascular hypertensives) performed by the author revealed the following findings: minor complications such as cystitis symptoms after the examinations took place in 35% of all the cases. However, those patients who were catheterized Fr. 5 or 6 polyethylene catheters through the Fr. 21 cystoscope showed less frequent complication, in 20%. 60% of the patients studied by the large bore (more than Fr. 7) woven catheters developed bladder leakage whereas those studied by the small bore (Fr. 5 or 6) polyethylene catheters developed bladder leakage in 23% of the cases. Thin walled Fr. 5 or 6 polyethylene catheter with multiple side holes (10 holes in 10cm from the tip) was recommended as the catheter of choice for split renal function studies. Observation by the objective micrometer revealed that the commercially available catheters had poor industrial uniformity. Flow capacity studies of the catheters showed the polyethylene catheters had a flow rate three times faster than that of the woven catheters with the same caliber.

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Activities of serum lactate dehydrogenase, leucine aminopeptidase, aldolase and alkaline phosphatase were estimated at the follow-up of 54 cases of genitourinary tract malignancy (renal cell carcinoma 15, renal pelvic and ureteral carcinoma 10, bladder cancer 23. testicular malignancy 6).
The following conclusions have been obtained.
1. In renal cell carcinoma, the measurement of leucine aminopeptidase was useful at the preoperative diagnosis and the follow-up. Elevated activity of leucine aminopeptidase was noted in the cases of advanced stage.
2. The combined evaluation of both leucine aminopeptidase and lactate dehydrogenase might be of some value in terms of the diagnosis and prognosis of renal pelvic and ureteral carcinoma.
3. The estimation of lactate dehydrogenase along with alkaline phosphatase and leucine aminopeptidase activities was of some help in the preoperative diagnosis and follow up of bladder cancer.
4. At the time of liver metastasis, the value of leucine aminopeptidase was elevated along with alkaline phosphase activity in renal cell carcinoma, while the elevated activity of lactate dehydrogenase was observed in bladder cancer.

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The effects of psychotropic drugs both on ejaculation, which was induced by manual stimulation fo the penis in dogs, and on the brain contents of catecholamines (CA) and serotonin (5HT) in dogs and rats were investigated.
The results obtained are as follows:
I) Effects on ejaculation in dogs.
1) Although erection was maintained after administration of 0.063mg/Kg of reserpine i. p., ejaculation was almost suppressed by the drug. When 50mg/Kg of L-dopa was administered i. p., ejaculation was recovered to the extent before the administration of reserpine. As the doses of reserpine increased to 0.125 and 0.5mg/Kg, the rate of dogs which maintained erection decreased, and ejaculation was suppressed completely. Administration of L-dopa, 50mg/Kg, i. p., also recovered ejaculation in these dogs.
2) After administration of tetrabenzaine, 100mg/Kg, i. p., erection was maintained in all dogs, but ejaculation was suppressed. Administration of L-dopa, 50mg/Kg i. p. recovered ejaculation.
3) When 50 and 25mg/Kg of L-5-hydroxytryptophan (L-5HTP) administered i. p. to 4 dogs, erection was suprressed in 3 of 4 dogs examined, and ejaculation was suppressed in all dogs. Administration of 12.5mg of 5-HTP suppressed ejaculation, although erection was maintained.
4) Administration of p-chlorophenylalanine (pCPA), 100mg/Kg once a day for 3 days did not change ejaculation. When L-5HTP 12.5mg/Kg i. p. was administered to the dogs, ejaculation was suppressed, although erection was maintained.
5) When haloperidol, 3-4mg/Kg, was administered i. v., erection was maintained but ejaculation was suppressed. In dogs, to which 5mg/Kg of haloperidol was administered, both erection and ejaculation were suppressed.
II) Effects on brain monoamine contents in rats.
1) When 50mg/Kg of tetrabenazine was administered i. p., the level of dopamine (DA) decreased in the cerebellum, pons-medulla-oblongata, hypothalamus, striatum, midbrain, hippocampus and cortex. The level of noradrenaline (NA) decreased in the cerebellum, pons-medulla-oblongata, hypothalamus, striatum, midbrain, hippocampus, and cortex. The level of 5-HT decreased in the pons-medulla-oblongata, hypothalamus, striatum, midbrain, hippocampus, and cortex.
2) When 300mg/Kg of L-dopa was administered i. p. after administration of tetrabenazine, the level of DA increased in all sites measured, compared with the rats in which tetrabenazine was administered alone. The level of NA increased significantly in the cerebellum, striatum and midbrain. The level of 5-HT did not change significantly, compared with that in the rats in which tetrabenazine was administered alone.
3) When 200mg/Kg of pCPA was administered once a day for two days, the level of DA increased in the hypothalamus and decreased in the cortex, compared with that of the controls. The level of NA increased only in the cerebellum. The level of 5-HT decreased significantly in all sites, compared with the controls.
III) Changes of brain monoamines in dogs.
Twenty-four hours after administration of reserpine, 0.063mg/Kg, the DA level was markedly decreased in the anterior hypothalamus, hippocampus and caudate. The NA level did not change in any site except for the hippocampus and caudate. The level of 5-HT decreased in the anterior hypothalamus but no change was observed in the other sites.
When L-dopa was administered to these dogs, the DA level markedly increased in the anterior and posterior hypothalamus. The DA level of the hippocampus was restored only to the control level. However, the NA and 5-HT levels did not change in any site, compared with those of the dogs in which reserpine was administered alone.
These results show that ejaculation is controlled by the dopaminergic and serotonergic systems in the brain, and that ejaculation is activated by the dopaminergic system, particularly by that in the anterior hypothalamus, and inhibited by the serotonergic system.

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