Divided renal function studies were performed in experimental unilateral renal hypertension in dogs. Renal ischemia of the left side was produced by coarctation of the aorta between the ramification of renal arteries with a modified Galen's technique.
1. In the condition of a 27 to 68 per cent decrease of systolic blood pressure in the femoral artery by aortic coarctation, significant hypertensive state was induced in 3 to 4 weeks postoperatively and sustained up to 8 weeks.
2. Results of divided renal function studies were as follows. Decreases of GFR, urine volume, Na concentration and TRF-Na were observed, as well as increases of PAH, creatinine and K concentrations, and osmolarity in urine of the ischemic kidney.
3. Ratio of K/Na urinary concentration in the right to left kidney (U-K/Na Index). The value of this index was 0.35±0.14 and a highly significant correlation between this Index and TRFR was found (r=0.892, p<0.001).
4. U-K/Na Index is valuable as a clinical examination in the diagnosis of unilateral renal artery stenosis.

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The present study was performed on a total of 121 children with neurogenic bladdder, consisting of 51 boys and 70 girls, or diagnostically of 45 with uninhibited neurogenic bladder, 6 with automatic neurogenic bladder and 60 with autonomous neurogenic bladder (incluidng 25 with tethered cord syndrome (Table 1). On these 121 children was performed the voiding urodynamic examination (hereafter referred to as VUD) which simultaneously recorded the voiding factors on a 6-channel polygraph: intra-abdominal pressure, urethral pressure, vesical pressure, tone of the anal sphincter, EMG of the anal sphincter and urinary flow rate. Furthermore, the sacral nerve reflex test using the tone of the anal sphincter and EMG of the anal sphincter was performed as necessary. The Lewis' cystometrograph or the Sato's cystometrograph was used for taking the cystometrogram during filling. The determined values were statistically processed as voiding parameters by the student t-test, with the published values for normal children as standards. The results are presented below.
1. Uninhibited neurogenic bladder
A. From the results of statistic processing of the voiding parameters (Table 2-A), (1) because the resting vesical pressure at the maximal desire to void and the terminal voiding pressure were high and also because the rate of occurrence of vesical after-contraction was high, it was presumed that the bladder was in an unstable state; and (2) urethral resistance during voiding was found located chiefly at the site where the external urethral sphincter is present.
B. From the voiding factor curves, (1) contraction insufficiency or relaxation insufficiency of the pelvic floor musculature during voiding was observed in part of the children (Fig. 1-a-iii), while the voiding factor curves were mostly normal in the other childnren (Fig. 1-b-ii)-A); (2) only a small number of children could not or insufficiently could interrupt voiding voluntarily (Figs. 1-a-i)-B, and 1-b-ii)-C); (3) the urethral pressure was unstable in some children before and after voiding and also during total voiding (Fig. 1-a-i)-B); and (4) the sacral nerve reflex test was normal or enhanced (Fig. 1-a-iii).
2. Automatic neurogenic bladder
A. From the results of statistic processing of voiding parameters (Table 2-A), (1) it was presumed that the bladder and the urethra were in an unstable state as in uninhibitied neurogenic bladder; (2) it was presumed that a very large power was required to open the bladder neck; (3) resistance was found in the external urethral sphincter segment, too; and (4) the urinary flow rate was decreased.
B. From the voiding factor curves, (1) contraction insufficiency of the pelvic floor musculature was found during voiding (Fig. 2-a); (2) the urethral pressure curve was normal or lower than normal, compared with a very high vesical pressure curve (Fig. 2-a); and (3) the sacral nerve reflex test was normal or enhanced (Fig. 2-b).
3. Autonomous neurogenic bladder
Out of the children with this disease, many girls were with hypotonic bladder: therefore, only the girls were divided into those with hypertonic or normotonic bladder and those with hypotonic bladder.
1) Hypertonic or normotonic bladder in boys and girls
A. From the results of statistic processing of the voiding parameters (Table 2-A), (1) there were large losses in energy at the bladder neck; (2) there were some energy losses in the external urethral sphincter segment; (3) the urinary flow rate was low; and (4) many children of this group made the micturition in co-operation with abdominal straining.
B. From the voiding factor curves, (1) children with typical hypertonic or normotonic bladder gave the vesical pressure curve intermixed with sharp spikes due to voiding with abdominal contraction (Figs. 3-a and 3-b); (2) the urethral pressure was low, compared with the markedly high vesical pressure (detrusor-vesical neck dyssynergia); (3) the anal sphincter tone cur

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The right kidney was removed from each dog; the ureter was obstructed on the left to elevate the intrapelvic pressure; and the alterations that then occurred in the thoracic duct lymph flow and the renal venous blood flow were followed up. At the same time, various isotopes were injected into the renal pelvis; and the ureter was obstructed, to follow up the behaviors of the isotopes in the thoracic duct lymph and the renal venous blood; and the followings were found:
I. Alterations in the Thoracic Duct Lymph Flow
1. The obstruction of the ureter was followed by a gradually increased thoracic duct lymph flow; the flow came to a plateau at about its maximum, and then tended to gradually decrease.
2. In the dogs with the urine flow of not less than 0.17ml/5min/kg before the obstruction, there was a correlation between the urine flow and the rate of increase in the thoracic duct lymph flow after the obstruction of the ureter (Table I).
3. The obstruction of the ureter was first followed by an increased intrapelvic pressure, and then by an increased thoracic duct lymph flow; the pressure and the lymph flow then showed a similar pattern of increase to each other; the lymph flow came to a plateau in 79% of the experimental animals with the intrapelvic pressure of not less than 50mmHg, and then tended to gradually decrease.
From the findings presented in 1, 2 and 3 above, it may be presumed that the thoracic duct lymph flow after the obstruction of the ureter is affected by the urine flow before the obstruction and the intrapelvic pressure after the obstruction.
4. Transfer into the thoracic duct lymph of various isotopes injected into the renal pelvis: The isotopes used consisted of ¹³¹I-hippuran as a soluble isotope, and ¹³¹I-PVP and ¹³¹I-HSA as microparticulate ones.
1) The soluble isotope tended to appear in the lymph earlier and in a larger amount after the obstruction of the ureter than the microparticulate isotopes.
2) The hippuran level in the lymph was the higest of the 3 isotopes, followed by PVP and HSA in a decreasing sequence of significance (Fig. 6).
3) Of the three isotopes, it was the soluble isotope that appeared in the lymph first, with a lag of about 5 minutes between the soluble isotope and the microparticulate ones. It was also with the soluble isotope that the maximum level in the lymph was attained earliest, with the maximum levels with the microparticulate isotopes, PVP and RISA, similarly lagging.
From the findings presented in 1), 2) and 3) above, it may be presumed that the smaller the molecular weight of isotope, the more rapidly it is transferred into the lymphatic ducts.
4) When the time required for the thoracic duct lymph flow to begin to increase after the obstruction of the ureter was compared with the times required for the radioactivities of the isotopes to appear in the lymph, the former took place 5-10 minutes earlier than the latter. The times required for the isotopes to reach their maxima tended to be longer.
From the findings presented in 4) above, it may be presumed that the portion of lymph that increases between the start of increase in the thoracic duct lymph flow after the obstruction of the ureter and the appearance of radioactivity of an isotope is not derived directly from the renal pelvis, but from that portion of lymph that has increased iu the renal parenchyma and that portion of lymph that has been retained in the renal parenchyma aud the thoracic duct up to its terminal and has been pressed out by the former.
5) Relationship between intrapelvic pressure and the thoracic duct lymph isotopes: (1) The intrapelvic pressure at the stage when the radioactivities in the 5-minute thoracic duct lymph flow came to a plateau was in the range of from 40-70mmHg in 86% of the experimental dogs. (2) The isotope concentrations increased as the intrapelvic pressure was increased as a whole, with the isotope concentrations reac

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FDP of serum and urine specimens from 64 patients with urologic malignancies (bladder carcinoma, 33 cases; renal cell carcinoma, 12 cases; carcinoma of the renal pelvis, 3 cases; ureteral carcinoma, 1 case; prostatic carcinoma, 9 cases; prostatic sarcoma, 1 case; testicular embryonal carcinoma, 3 cases; penile carcinoma, 2 cases) have been assayed using a tanned-red cell haemagglutination inhibition technique. In addition, urinary FDP have been studied by immunoelectrophoresis.
The results obtained are as follows:
1. High levels of serum FDP were observed in 14 of the 64 patients (21.9%). Elevated serum FDP values were seen in 4 of 8 patients (50%) with distant metastasis and 8 of 52 patients (15.4%) without distant metastasis.
2. Urinary FDP level increased in 35 of the 64 patients (54.7%), and a highly significant increase of this level was observed in a group of patients with primary or secondary bladder carcinomas as compared with the control group. Urinary FDP level in patients with bladder carcinomas of high stages (Stages B₂ and C) was considerably higher than that in patients with bladder carcinomas of low stages (Stages O, A and B₁).
3. There was no significant relationship between serum and urinary FDP levels in the 64 patients.
4. Urinary FDP levels remarkably decreased after surgical intervention for tumors in 32 patients, while their serum FDP levels showed no significant change.
5. Using the immunoelectrophoretic assay system for identification of FDP fragments, all fragments X, Y and E except fragment D were consistently detected in each of urine specimens of 25 patients.
6. It may be postulated that a part of the urinary fragment E originates from fragment E in the circulating blood and the appearance of early FDP, fragments X and Y, in urine indicates the occurrence of local fibrinolysis in and around the cancerous tissues.
The clinical usefulness of FDP determinations, especially urinary one, for the diagnosis and follow-up study of urologic malignancies is stressed.

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Spironolactone, an aldosterone antagonist has an antiandrogenic effect by potentially inhibiting some enzymatic steps in androgen synthesis in testes and adrenals. In order to clarify the site and mode of the antiandrogenic action of spironolactone in vivo, spironolactone-induced alterations in the hormonal patterns were studied in normal mature male dogs and men with prostatic carcinoma. Decrease in the level of plasma testosterone and increase in the level of plasma progesterone were noted by the administration of spironolactone for a period of 20 days in the animal study as well as in the clinical study. No significant changes were noted in the plasma level of cortisol and 17 β-estradiol as well as LH and FSH. The plasma level of LH, however, increased significantly in one patient whose duration of the drug was extended up to 30 days. Spironolactone did not inhibit the secretion of gonadotropins, however, it was considered that increased level of plasma progesterone would counteract the stimuli of gonadotropin release caused by the low level of testosterone. From these observations, it would be concluded that spironolactone acts directly on the enzyme system contributing to the conversion of progesterone to testosterone, and this agent would be used as antiandrogenic drug for the treatment of patients with cancer of the prostate.

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Spironolactone-induced changes of the prostate gland were studied by conventional light microscopy as well as by electron microscopy in male adult dogs and men with prostatic carcinoma. In order to evaluate those morphological informations quantitatively, volume densities of cell compartments of prostate gland were examined by using morphometrical procedure.
After the administration of spironolactone for 20 days, significant decrease in the volume densities of prostatic acinar parenchyma, rough endoplasmic reticulum and secretory granules were observed in the animal study. The volume density of acinar parenchyma also decreased by 50% in the men with prostatic carcinoma. On the contrary, the volume density of the interacinar tissue increased significantly after the administration of spironolactone in both animal and clinical study.
From these observations it would be concluded that spironolactone has an antiandrogenic effect on the acinar parenchymal tissue of canine prostate gland as well as of human prostatic carcinoma. However, this material also has some proliferative effect on the interacinar tissue of the prostate gland, probably by elevating plasma progesterone level or by its direct action on the tissue.

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A study was made of the effect of total ureteral occlusion on renal function in 27 mongrel dogs weighing 5-12.5kg (Fig. 1).
Total unilateral ureteral occlusion was performed in 23 dogs, and the intrapelvic pressure was measured. Intravenous infusion of normal saline with 1.6-9.0ml/h/kg body weight caused the intrapelvic pressure to rise and reach a constant level in 61.3±12.0 (S. D.) minutes. The intrapelvic pressure at this stage was 61.8±14.7 (S. D.) mmHg (Fig. 2).
At the time when the elevated intrapelvic pressure became mostly stable, the glomerular filtration and tubular PAH secretion were investigated. At the stage when the elevated intrapelvic pressure became mostly stable, 18 dogs were injected intravenously with 150mg of Inulin per kg of body weight and 4mg of PAH per kg of body weight, and sacrificed 1 hour later. Inulin and PAH were demonstrated in the pelvic urine on the occluded side of all the 18 dogs. The Inulin and PAH amounts found in the pelvic urine on the occluded side were 29.3±14.0 (S. D.) % and 35.5±16.3 (S. D.) % of the counterparts in the contralateral normal kidney (Table 1 and 2).
The bilateral renal blood flows were simultaneously measured in 11 dogs. The renal blood flow on the occluded side increased as the intrapelvic pressure rose after occlusion of the ureter (Fig. 3). The renal blood flow increased by 22.5% on the average over the control flow 30 minutes after occlusion of the ureter, and by 34.6% on the average at the stage when the elevated intrapelvic pressure became stable.
Three kinds of parameters were used to observe the effect of total ureteral occlusion on the contralateral renal function: renal blood flow, glomerular filtration rate and urine volume.
The contralateral renal blood flow increased by 4.1% on the average over the control flow 30 minutes after occlusion of the left ureter, and by 10.8% on the average at the stage when the elevated intrapelvic pressure became mostly stable.
The endogenous creatinine clearance was measured in 21 dogs as an index to the glomerular filtration rate. The contralateral renal glomerular filtration rate was decreased to 81.8% of the control rate on the average during the stage when the elevated intrapelvic pressure remained stable (Table 3).
In 18 dogs were measured the control urine volume of both side, the urine volume from right kidney during the first 30 minutes following left ureteral occlusion, the urine volume from right kidney during the period when the left intrapelvic pressure was elevated and became stable, the urine volume from right kidney during the first 30 minutes after injection of Inulin and PAH, and the urine volume during the second 30 minutes after injection of Inulin and PAH. The urine volume tended to increase slightly after occlusion of the ureter (Fig. 4). The percentages of the urine volume during the above-mentioned periods to control urine volume averaged 115.4%, 107.7%, 123.1% and 123.1%, respectively.
The mean aortic blood pressure was continuously measured during the experiment, as shown in figure 5. The pressure in no way altered in any of the animals.
From the above-presented results of experiment, it was demonstrated that even during the stage when the intrapelvic pressure was elevated due to total ureteral occlusion, and remained mostly stable the glomerular filtration and tubular PAH secretion proceeded in the kidney on the occluded side. Considering pyelovenous and pyelolymphatic backflows, it may be presumed that the glomerular filtration and tubular PAH secretion are carried out actively in the kidney on this side.
There was no significant difference between values of the 3 parameters measured during the control stage and that after occlusion of the ureter. Thus, the effect of total ureteral occlusion on the kidney on the contralateral side was not clear.

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The effects of various anti-cancer drugs on nucleic acid metabolism of human bladder tumor were investigated in vitro. After incubating the slices of human bladder tumor with 5-fluorouracil (5-FU), mitomycin C (MMC) or cyclophosphamide, combination of either two drugs or three drugs, the slices were homogenized and fractionized. Nuclear, mitochondrial and microsomal fractions were obtained. 5-FU, MMC or cyclophosphamide inhibited the incorporation rate of adenine-8-C¹⁴ into deoxyribonucleic acid (DNA) and ribonucleic acid (RNA) of the nuclear fraction of human bladder cancer. 5-FU, MMC and cyclophosphamide had no additi ve inhibitory effects on the incorporation rate of adenine-8-C¹⁴ into DNA and RNA of the nuclear fraction, when either two drugs were given together or three drugs were given to the incubation medium. The incorporation rate of adenine-8-C¹⁴ into DNA of the mitochondrial fraction of human bladder cancer was inhibited by 5-FU, cyclophosphamide or MMC. When either two drugs or combination of these three drugs were given to the incubation medium, these drugs had no additive inhibitory effects on the incorporation rate of adenine-8-C¹⁴ into DNA of the mitochondrial fraction of human bladder cancer. Sinilar result was obtained with the microsomal fraction. These in vitro experiments would provide us with a screening system of anticancer drugs and help to bridge a gap between the results of animal experiments and those of clinical application of the anti-cancer drugs.

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1) Twenty-three cases of complete duplication of the urinary tract experienced at our institution from 1970 to 1976 were reviewed.
2) They were subdivided depending on whether the major lesion of urinary obstruction was at the ureterovesical junction or in the kidney. Twenty-two cases belong to the former and were grouped into the following three groups: Group I of 9 cases with ectopic ureterocele, Group II of 9 cases with ureteral reflux (reflux to lower ureter in 7 and to upper ureter in 2) and Group III of 4 cases with ectopic ureter with marked hydroureter without ectopic ureterocele, ureteral reflux or stricture of the ureteric orifice. One special case was designated as Group IV because it was a case of intrarenal obstruction of upper pelvioureteric junction by vascular commpression.
3) Retrospective observation was made from the operative and clinical findings regarding the type of vesical junction of the twin ureters. The twin ureters which shared the common hiatus of the vesical wall were arbitrarily designated as Type C (common). This type was comprised of in total 16 cases (each 7 from Groups I and II and each one from Group III and IV.). The twin ureters which independently had a completely separate hiatus were designated as Type S (separate). Here the orthotopic ureter was anchored to the lateral cornu of the trigone through the cranial vesical hiatus, while the twin mate ectopic ureter, being separated from the orthotopic ureter, took a completely independent extravesical course and was anchored at the bladder neck and urethra through the different hiatus. This type was found in 4 cases (each 2 from Groups I and II.). The twin ureters which simulate Type S, but differ from this in that the twin mate ectopic ureter, after separating from the orthotopic ureter, coursed in the tunnel between the two layers (outer detrusor longitudinal and inner deep trigonal) of bladder base before being finally anchored at the bladder neck through the separate hiatus, were designated as Type I (intermediate). Three cases of the Group III belonged to this type. To take a scrutinizing look at the type of hiatal condition in the duplex ureters appears to provide a better clue in understanding various pathophysiological conditions including the kidney, ureter and ureteral end. Because of not an infrequent instance of submucosal ureteral extension from the hiatus in ectopic ureters, hiatal position and size, rather than the position of the ureteral orifice per se as postulated by Mackie and Stephens (1975), appears to be correlated better with renal dysgenesis.
4) Full utilization of batteries of diagnostic modalities from nephrotomography, voiding cystourethrography and endoscopy along with a shrewd suspect of the duplex system was of utmost importance in the diagnosis. These are also helpful in conceiving preoperatively about the type of the hiatus, the knowledge of which is valuable in the management of the ureteral end at the time of operation.
5) Twenty-one of 23 cases required some forms of operative treatment to be relieved of various disabilities from the duplex anomalies. This implies that the complete duplex of the urinary tract is no longer the same clinical entity, hitherto conceived as common but clinically insignificant one. Regarding the operative management the significance of not leaving excess ureteral stump was discussed, and our method of excising the ectopic ureteral stump was also described in detail.
6) In refecance to the embryogenesis of ectopic ureterocele, ureteral reflux and ectopic ureter o the duplex system, it was proposed to conceive them as developmental phenomenon involving the terminal end of the ureters where ureteral buds, dually layered precursors of bladder base and primitive vesicourethral canal interact to form the ureteral end in a true sence from the hiatus through submucosal ureter to the ureteral orifice. In understanding the abnormalities of the ureterovesical junction this e

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Fifty-seven patients with germinal tumor of the testis treated from 1963 to 1972 were followedthrough 1975.
Twenty-eight patients with pure seminoma were treated by high inguinal orchiectomy and para-aortic lymph node irradiation of an average of 3, 500r. Of the 28 patients two had retroperitoneal lymph node dissection.
Twenty-two patients with non-seminomatous malignant tumor of the testis had high inguinal orchiectomy. As an additional treatment, of the 22 patients seven received irradiation to the para-aortic lymph nodes and six underwent retroperitoneal lymph node dissection, five of which were followed by irradiation. For non-seminomatous malignancy, an average of 4, 400r was given. Seven patients with adult teratoma had orchiectomy or resection of the tumor, and no other treatment was performed.
Five-year relative survival rates calculated by actuarial method were 94% (standard error 5%, effective sample size 28) for pure seminoma and 50% (standard error 11%, effective sample size 22) for non-seminomatous malignant group. The difference of survival rates between the two groups was statistically significant. Patients with adult teratoma showed 100% survival.
Crude survival rate of patients with metastasis manifested by physical or X-ray examination before treatment was significantly lower than that of patients with negative findings. Patients with seminoma invading periorchium or patients with non-seminomatous malignancy complaining of testicular pain had a tendency to show lower crude survivals.

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The effects of bilateral nephrectomy at the time of renal transplantation, which were performed at the Kinki University Hospital, the Osaka University Hospital and the Nishinomia Prefectural Hospital, were evaluated. The following results were obtained.
1) In cases of nephrectomized patients, their blood pressure depends mainly on graft function. For example, when a patient had creatinine level of below 2.5mg/dl three months after grafting, his blood pressure remained within almost normal range but a patient was hypertensive if creatinine level over 2.5mg/dl.
2) The anephric patient who has lost graft function and returned to hemodialysis program showed remarkable hypotension, furthermore when graft was removed erythrocytes counts decreased.
3) The patient who had high blood pressure in spite of successful renal transplantation the PRA value elevated constantly and the patient whose graft function had been lost had almost normal PRA value, but the PRA level decreased remarkably, when the graft was removed.
4) Serum erythropoietin value was correlated inversely with the graft function (r=-0.65), and correlated with the number of erythrocytes (r=0.75). These results suggest that the bilateral nephrectomy in renal allotransplantation should be performed on limited patients with indication.

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Four representative cases of severe irradiation injury in urinary tract have been reported.
In one patient who had received an intraoperative regional irradiation for bladder cancer, a Bricker's operation was successful because the damage was limited.
On the contrary, external radiation can cause extensive damage in the pelvic organs. In such 3 patients, Bricker's ileal diversion, Boari's operation and ureteroneocystostomy resulted in failure because of fistula formation at the anastomotic sites. These fistulas were followed by fatal peritonitis in 2 patients.
Irradiation injury may be subclinical. It can progress rapidly after surgical interventions. Preand intraoperative diagnosis of the injury and careful selection of surgical procedure are important in prevention of possible complications following surgery.

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A case of tuberculosis, with calculi and adenocarcinoma in the same kidney and treated by partial nephrectomy, was reported. The case was a 69-year-old man who visited our clinic with the chief complaint of gross hematuria. Urographic examination revealed small renal calculi and a moth-eaten appearance of the left lower calyx which was compatible with tuberculosis. The left selective renal arteriogram showed the angiographic pattern of chronic pyelonephritis without neovascularity.
Left partial nephrectomy on lower third was performed. Postoperative course was uneventful but histologic examination of the specimen revealed tuberculous changes and small adenocarcinoma. The tumor showed tubular and papillary proliferation of atypical clear cells with no tumor in the margin.
Left secondary nephrectomy was not performed and chemotherapy for tuberculosis was continued for one year. The patient is alive and well with no evidence of recurrent tumor two years later.
In discussion, we reviewed the problems of associated renal tuberculosis and malignancy, avascular renal tumor and conservative surgery in certain renal tumors.

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A 66-year-old housewife came to the hospital complaining of fever and pain in the left flank. IP, RP, PRP, renal angiography and reno-scanning were performed. A left renal tumor was diagnosed because pooling and avascularity were found in the renal angiography and a cold spot in the left renal lower polor by reno-scanning. A left nephrectomy was then carried out.
The specimen was 270g in weight and measured 15cm×7cm×5cm. Differentiated liposarcoma was seen in pathological findings. In an electron microscope study, fat droplet and inclusion body of microtubuli (said to be characteristic of liposarcoma in other organs) were observed.
Renal liposarcoma is an extremely rare tumor growing from mesenchymal tissue of the kidney. To date, 119 cases (including this one) with renal sarcoma have been reported bibliographically; of these only 17 cases were renal liposcarcoma.
Renal liposarcomaa was found mostly in people in their four and five decades. It occurred in women 3 times more often than in men, and was found more frequently in the left side. Both tumors and pain were common symptoms and hematuria was rare. Though in many cases there have been complications with tuberous sclerosis, that was not so in this case.

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