Our experience with ureteral tapering at the time of ureteroneocystostomy in 9 megaureters is presented. 7 ureters were improved while 2 were failures with postoperative reflux. Ureters more than 1cm in diameter usually require tapering in children. Our surgical technique for ureteral tapering is as follows:
1. Lower one third to half of the ureter is dissected and kinks straightened and excess length excised.
2. A longitudinal strip of ureteral wall (5-8cm long) is excised and its size is reduced to 4-8mm in diameter.
3. Ureteral edge is reapproximated with a running 4-0 chromic catgut stitch.
4. The ureter is reimplanted into the bladder through a long (3-5cm) submucosal tunnel.
5. A 5 Fr. or 8 Fr. splint catheter is placed in the ureter for 10 to 14 days postoperatively.
6. Tapering is usually limited to the lower ureter and upper ureteral repair is rarely indicated.

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Between Jul., 1973, when HYOGO Medical College was established, and Sep., 1975, 136 enuretic children (87 boys 49, girls) were referred to our department. The peak in age distribution of the enuretic was 5 to 6 years old, and the children older over 10 years old were less than 10 per cent. Through the urological and urodynamic examinations, the following results were obtained.
1) Pyuria was found in 41 per cent of the enuretic.
2) Although the incidence of abnormal IVP, such as inflammatory changes and/or dilatation of the collecting system, was low in this series, spina bifida occulta was observed at a rate of 53 per cent, Hutch's diverticula, 27 per cent and V-shaped break at bladder base, 22 per cent.
3) Of the 136, 94 were underwent micturating cystourethrography with/without bougie a boule caliblation, and 57 of them (61 per cent) demonstrated to have urethral stenosis, mainly Lyon's ring.
4) Only 66 children received simple filling cystometry, because of difficulty to obtain co-operation, and 43 of them (65 per cent) were proved to have hypertonicity with ‘uninhibited contraction’.
5) In conjunction with cystometry, sphincter electromyogram was recorded simultaneously. The electrical activities of the 43 enuretics showed normal patterns in 25, detrusor-sphincter dyssynergia in 7, and pathologicaly low or silent electrical activities in 11.
6) In the cases of organic urethral stenosis, the external urethral sphincter was proved to contract during urination and easily excitable to urethral or bulbacavexnous stimulation in more than half of them.
Although enuretic children tend to decrease in numbers with age, probably because of ‘maturation of bladder control’, the presence of latent organic urethral stenosis and/or subclinical neurogenic bladde dysfunction should be considered in relation to pathogenesis of enuresis.

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The origin and character of the stimulus that initiates compensatory renal hypertrophy and hyperplasia has not been clearly established. The present study was undertaken to measure serum of uninephrectomized rats for activity of a humoral factor(s) which has been postulated to initiate compensatory renal hypertrophy. Serum taken from rats 24, 48 and 72 hours ofter unilateral nephrectomy, when compared to serum taken from sham operated animals, stimulated adenine-8-¹⁴C incorporation into DNA and RNA of rat kidney (in vivo) and kidney slices (in vitro) but not into those of liver (in vivo) and liver slices (in vitro).
These results suggested that a circulating renal growth factor (s) was produced in response to a decrease in renal mass.
It has been suggested that the renotrophically active principles were identical with growth hormone. Therefore, it was investigated how renotrophin (s) was connected with growth hormone, if there were a nexus. Bovine growth hormone stimulated adenine-8-¹⁴C incorporation into DNA and RNA of rat kidney and liver (in vivo), and kidney and liver slices (in vitro). The findings suggested that effects of growth hormone were not organ-specific.
The critical experiment would be to administer serum from hypophysectomized, unilaterally nephrectomized rats (supposedly containing the renotrophic factor(s) of extrahypophyseal origin) to hypopeysectomized rats. The results were obtained that serum from hypophysectomized unilaterally nephrectomized rats stimulated the incorporation of adenine-8-¹⁴C into DNA and RNA of rat kidney slices from hypophysectomized rats, but not into those of liver slices. Based on these findings, the existence of a renotrophic factor(s) which is of a non-hypophyseal origin is postulated.

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The present study was undertaken to clarify whether or not and if affirmative how the renotrophic factor(s) which is postulated to initiated compensatory renal hypertrophy demonstrates influence on protein synthesis at the polysomal fraction. Serum taken from rats 48 hours after unilateral nephrectomy, when compared to serum from sham operated animals, stimulated the incorporation of 1-leucine-¹⁴C into the free polysomal fraction from rat kidneys. The increment of the incorporation was dose-dependent of the serum administered to the subcellular protein synthesis system. The increase of the incorporation of 1-leucine-¹⁴C was not noticed at the bound polysomal fraction of rat kidneys.
Growth hormone (bovine), which is postulated to be identical with renotrophin(s), did not demonstrate any influence on the incorporation of 1-leucine-¹⁴C into both free and bound polysomal fractions of rat kidneys. Addition of cyclic AMP with bovine growth hormone did not stimulate the incorporation of 1-leucine-¹⁴C into both polysomal fractions of rat kidneys. It is inferred that renotrophin(s) has a stimulatory effect on the process of protein synthesis.

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A 42-year-old man fell down from the roof of house on Oct. 11, 1973 and got a complete spinal cord injury at C-6. He underwent the implantation of bladder pacemaker, which we developed and tested in a series of canine experiments. External transmitter contains rechargeable nickel-cadmium batteries, and transmits power through skin at 200KHz to the receiver. The maximum power of 18 volts in Type-I and 29 volts in Type-II can be generated when the transmitter-receiver distance is 0. Electric current of 33Hz, 4msec duration of biphasic square wave is produced by the electric circuit inside the receiver. Six disk-type electroldes are connected with the receive. The electrodes and leads are made of stainless steel. The electrodes were fixed on the bladder serosa in two circles between the ureterovesical junction and bladder apex.
Following sphincterotomy and subarachnoid phenolization, which lowered the urethral resistance from 105 to 26mmHg, a bladder stimulator Type-I was implanted on May 29, 1975. Sixty-nine mmHg of isometric intravesical pressure was obtained on the operation table. Three weeks later the isometric pressure fell down to 39mmHg in response to stimulation. An interrupted and weak urinary stream was observed after the end of electrostimulation. Insufficient power of pacemaker and elevation of tissue impedance were thought to be the cause of failure. The receiver was removed to be replaced with a more powerful one on July 3, 1975. The pacemaker Type-II was re-implanted and connected with the previously fixed electrodes on Oct. 31, 1975, yielding 70mmHg of isometric bladder pressure. A powerful micturition was accomplished without spasm of lower extremities by applying the stimulaiton of 20 to 30sec duration at 30sec intervals. Two hundred to 300ml of urine was evacuated by the repetition of this on-and-off maneuver without residual urine for the first 6 weeks. Later the residue gradually increased in volume in accord with the change of voiding mode; micturition took place after the cessation of stimulation. Electrostimulation elevated the bladder pressure without urinary stream because of concomitant spasm of the external sphincter and pelvic floor muscles. The detrusor-sphincter dyssynergia is apparently responsible for this change in voiding mode. Several episodes of pyelonephritis, fistular formation and residue of up to 130ml forced us to remove the whole receiver-electrode unit on Apr. 17, 1976.
On the electrode surface a thin layer of tissue debris dark brown in color was found. This was later identified to be an accumulation of degenerated protein by heat in laboratory experiment. This proteindebris-layer prevents the smooth flow of electric current due to the increased impedance. Furthermore the fibrillation by heat at the detrusor is well anticipated based upon the histological evidence found in dog bladder. The impairment of this terminal connection leads to a weak bladder contraction, which is overcome by the spasm of external urethral sphincer with ease. This phenomenon apparently deteriorated the micturition efficiency.
Presently the bladder capacity has increased to 400to 600ml and residual volume is averaged 33ml by Credé maneuver, a third to a fourth of that observed pre-operatively. It is hypothesized that the intermittent electrostimulation has activated and facilitated the function of the peripheral micturition reflex center, which lies at the detrusor and submucosa of the bladder. The denervation supersensitivity effect is not the case, since none of parasympathomimetics has been prescribed after the pacemaker was removed. Electrode material is to be altered to platinum and further clinical trial is now under consideration.

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To test the cellular immunocompetence in patients with prostatic (P. C.) and bladder carcinoma (B. C.), rosette-forming cells % (RFC %) of peripheral lymphocytes were investigated, and the results were compared with RFC % in the control group of healthy adults and benign prostatic hyperplasia (BPH) cases.
1. RFC % in 14 healthy adults was 65.5±1.4%.
2. RFC % in BPH group (17) was 63.5±4.8%. RFC % was not related to the ages of subjects.
3. RFC % in 13 P. C. patients before therapy was 56.8±9.3% and RFC % in 18 B. C. patients before therapy was 54.2±6.0%, which were significantly lower than in control groups.
4. RFC % in 12 P. C. patients after therapy was 67.4±8.7% and RFC % in 22 B. C. patients after therapy was 64.2±7.5%, which were significantly higher than before therapy in P. C. and B. C.
5. RFC % before and after therapy in each patient were compared. RFC % after therapy in 7 P. C. patients were all higher and those 14 B. C. patients were the same except in 1 case when compared with the percentages before therapy.
6. RFC % in recurred cases of 4 P. C. and 5 B. C. were respectively 54.0±3.9% and 55.0±7.9%, which were significantly lower than in control groups.
7. No influence of gestagen therapy on RFC % was found in BPH and P. C. patients.
As mentioned above it is to be estimated that cellular immunocompetence in P. C. and B. C. patients is first lowered and then recovered after therapy, and thereafter goes down again in recurrence. In addition, the investigative technique and results were discussed.

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Hypertension of renovascular origin is potentially a surgically correctable condition. In children, the results of primary repair of the affected renal artery or bypass graft have been far less satisfying, Most attempts at revascularization have ended in thrombosis of the repaired vessel and subsequent nephrectomy. The high rate of failure of revascularization in children has been attributed to technical problems due to the small size of the involved vessels and the growth of the child. Autotransplantation is a safe and reasonable procedure in the management of childhood renovascular hypertension. We reported herein a twelve-year-old girl with stenosis of the left renal artery caused by aortitis syndrome who underwent such a procedure.

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From January, 1964 to December, 1975, we have experienced 294 cases with bladder tumors in the Department of Urology, Kyoto Perfectural University of Medicine. Clinical evaluation was performed on 67 cases out of them who were treated by partial cystectomy.
The results obtained were as follows:
1) The 3 years survival rates of the patients in stages O, A, B₁, B₂ and C or D were 78%, 80%, 83%, 67% and 75%, respectively. The 5 years survival rates of the patients in stages O, A, B₁, B₂ and C or D were 78%, 80%, 62%, 55% and 38%, respectively.
2) The recurrence rate of bladder tumors was 25% in stage O, 38% in stage A, 44% in stage B₁, 40% in stage B₂ and 100% in stage C or D.
3) The death rates of the patients who died of the tumors in stage O, A, B₁, B₂ and C or D were 0%, 14%, 24%, 32% and 75%, respectively.
4) There were 20 cases which had lived or have been living more than 5 years after the surgery.
Two cases in them which belonged to the low stage group have been living more than 12 years. One case in stage D had lived for an exceptionally long period, about 7 years.

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The purpose of the present paper is to investigate the psychiatric and psychological states of patients undergoing chronic hemodialysis. The answers from 228 patients 144 males and 82 females in 23 hospital, to whom the inquiries about these problems, were made, were investigated and particularly analysed by Taylor's manifest anxiety scale (MAS). Furthermore, Rorschach test was carried out in 19 patients. The following results were obtained.
1) At the beginning of chronic hemodialysis, 77.6% of the patients had vague anxiety over hemodialysis. At the present time, 40.4% of them had anxiety, regarding the side effects or physical complications such as shunt troubles. The thing that troubled the patients most was the fact that a relatively long time is required in hemodialysis. Renal transplantation was expected by 57.9% of the patients.
2) The MAS-score of the hemodialysed patients was higher than those of both inpatients of our urological ward and normal students by Taylor. In hemodialysed patients, the group of the forties and sixties, females, inpatients, unrehabilitated patients and patients with anxiety or unsatisfaction showed higher scores than the cortrol groups, but no distinct difference was observed between the group of socalled unstability phase and that of stability phase.
3) Rorschach test disclosed that 17 out of 19 patients were in Level III and remaining 2 in Level II.
4) The results suggest that patients undergoing chronic hemodialysis never have a stability phase psychologically, and early psychological and psychiatric treatments are necessary in most cases. It is also important to prevent the side effects and complications during hemodialysis to achieve the psychological stability.

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