Fifty-four cases of renal cell carcinoma, 24 cases of renal pelvic tumor, and 16 cases of ureteral tumor treated from Jan. 1968 to Dec. 1972 were followed through 1975.
Five-year relative survival rates calculated by the actuarial method were 43% (standard error 8%, effective sample size 49) for renal cell carcinoma, 46% (standard error 12%, effective sample size 23) for renal pelvic tumor, and 43% (standard error 16%, effective sample size 15) for ureteral tumor.
Pyrexia, anemia, increased erythrocyte sedimentation rate, positive C-reactive protein, decreased serum albumin, and elevated serum α₂-globulin were demonstrated to be factors of significantly poorer prognosis with regard to renal cell carcinoma. Local extension, the presence of the tumor in renal vein or regional lymph node, and the existance of distant metastasis also significantly affected survival rates. Patients receiving nephrectomy combined with chemotherapy and/or radiotherapy did not show significantly better survival rates than those with nephrectomy alone.
Five-year relative survival rate for well differentiated carcinoma of renal pelvis and ureter was 90% (standard error 12%, effective sample size 15), as compared to 16% (standard error 8%, effective sample size 24) for poorly differentiated carcinoma. The recurrence rate of subsequent bladder tumors following surgery for the renal pelvic and ureteral tumors was 21%.

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Ninety-five patients with prostatic carcinoma first treated from 1963 to 1972 were followed through 1975. Age of the patients ranged from 45 to 85 years old with an average of 68 years old. Histological diagnosis was adenocarcinoma in all patients; 64 patients had well differentiated type and 31 had poorly differentiated type. Five patients were classified in stage T₀N_xM₀, one in stage T_1-2NxMo, 45 in stage T_3-4N_xM₀, and 44 in stae T_0-4N_xM₁. All patients were treated by synthetic estrogen (hexestrol). Castration was done in combination with estrogen therapy in 74 patients.
Patients with non-metastatic prostatic carcinoma showed a little better relative survival rates than patients with metastatic prostatic carcinoma; 5-year relative survival rates were 55% (S. E. 10%) for non-metastatic prostatic carcinoma and 35% (S. E. 10%) for metastatic prostatic carcinoma.
Survival rates of patients with prostatic carcinoma of poorly differentiated type were significantly worse than those of well differentiated type; 5-year relative survival rates were 10% (S. E. 7%) for poorly differentiated type and 65% (S. E. 9%) for well differentiated type.
As for the dosis of synthetic estrogen, 41 patients were maintained on 100mg of hexestrol daily and 54 patients on 30mg daily. There was no significant difference of the relative survival rates between the two groups.
Relative survival rates of patients who had castration in combination with estrogen therapy were not superior to those of patients with estrogen therapy only.
The effect of anti-androgenic therapy on the size of palpable prostatic mass was estimated. The size had been reduced in 25% of patients, unchanged in 36% and increased in 36%. The results were not related to the grade or stage of the carcinoma.
X-ray examination showed that metastasis deteriorated in 70% of patients who had metastasis at first seen and metastasis newly developed in 40% of patients.
Patients who had hydronephrosis due to prostatic carcinoma survived very poorly; 5-year relative survival rate was 8% (S. E. 8%).
Patients with elevated serum alkaline phosphatase revealed a little worse survival rates than those with normal levels.
Elevation of serum acid phosphatase, accelerated erythrocyte sedimentation rates or anemia found at first seen had no significant influences on the relative survival rates.
Side effects of anti-androgenic therapy were as reported by many investigators. Causes of death were mostly due to the carcinoma.

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During the 10-year period from January, 1963 to December, 1972, 1, 820 patients with urinary tract calculi were seen in the Department of Urology, the University of Tokyo Hospital. They consisted of 917 patients with ureteral stones, 655 with renal stones, 110 with bladder stones, 21 with urethral stones and 117 with the combination of the aforementioned diseases. The ratio of males to females was 2. 6 to 1. About one-fourth of patients with upper urinary tract calculi had multiple stones. One-tenth of them had stones bilaterally.
Approximately one-half of spontaneous passage of ureteral calculi occurred within one month after diagnosis. The average size of calculi passed spontaneously within one month was significantly smaller than that passed after one month or later. The overall rate of spontaneous passage of ureteral stones within one year was 53% (269/503) in this series. In all calculi measuring more than 8mm in width, spontaneous passage will not be anticipated by expectant treatment, while one-fourth of stones measuring 7mm and one-third of those measuring 6mm in width will pass spontaneously within one year.
The average lengths of ureteral calculi passed spontaneously, manipulated endoscopically and treated by ureterolithotomy were 6.3mm±2.5 (SD), 7.7±2.6, and 11.7±5.0 respectively, while the average widths of those in these three groups were 4.0mm±1.5 (SD), 4.6±1.4 and 7.1±2.8 respectively. The differences of average lengths and widths among these three groups were statistically significant.
The rate of success in basket catheterization for ureteral calculi was 30% (18/60). The rates of residual stones after partial nephrectomy, nephrolithotomy and pyelolithotomy were 25%, 42% and 12% respectively. Of 117 kidney stones followed conservatively for more than 2 years with average period of 5.2 years, approximately one-third or 36 became enlarged and two-third or 76 remained unchanged in size.
The recurrence rates either ipsilateral or contralateral calculated by means of the actuarial method in the total of 382 patients were 29.5% after 5 years and 47.9% after 10 years. The recurrence rates in 342 patients with upper urinary tract calculi were 28.9% after 5 years and 48.1% after 10 years. The crude recurrence rate was 31.6% (108/342) and the mean duration of follow-up was 5.5 years in this series. Ipsilateral recurrence rates following ureterolithotomy and spontaneous passage of stones were 33.3% and 12.4% after 5 years respectively, the difference being statistically significant. Ipsilateral recurrence rates following nephrolithotomy and partial nephrectomy were significantly higher than those following pyelolithotomy.

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In urine of normal and sick persons, platelets and/or cell components originated from platelets are always observed (The authors have called these bodies “platelet-like bodies”).
This study examined the small bodies in urine of 3 patients with acute myelogenous leukaemia (AML), 2 patients with chronic myelogenous leukaemia (CML) and one patient with acute monocytic leukaemia (AMoL). The appearances of small bodies in urine of these patients were spheroid or ellipsoid with rough and irregular surface, and azurophile granules were not stained with Giemsa stain.
The transmission electron microscopic findings of the small bodies were as following: AML-The limiting membranes and the exterior coats were sometimes reserved and the high electron-dense and fine granules were diffusely distributed in the matrix, but some of the small bodies were edematous. The electron density of the dense bodies was relatively lower and the very dense bodies were rarely observed. In the matrix were relatively many vesicles. Mitochondria and glycogen particles were observed, but dense tubular system (DTS) and microtubules (MT) were unknown. CML—The limiting membranes were sometimes partly reserved, and the matrix had swollen or been destroyed. Most of the dense bodies had swollen and its electron density decreased, and glycogen particles were diffusely scattered in the matrix. The other organelles were unknown. AmoL—Some of the small bodies had swollen and been destroyed, and the swollen dense bodies and glycogen particles were observed in the matrix as with CML. Some of the small bodies had lost its limiting membranes and the matrix was edematous and fine granular, in which glycogen particles were diffusely scattered, and many tubular components and the amorphous masses suggesting the degeneration were prominent.

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During the 10 years from January, 1965 to June 1976, 45 patients (24 males and 21 females) were treated at the Department of Urology, Niigata University Hospital for any urological complications of spina bifida. There were 6 cases of spins bifida occulta and 39 cases of spina bifida cystica (meningocele and myelomeningocele). The ages on the first visiting ranged from 0 years to 24 years, with an average of 6.2 years. Urological examinations revealed following abnormalities: Vesicoureteral reflux in 33% of the cases, hydronephosis (38%), residual urine (62%), urinary tract infection (65%), abnormal cystogram (95%), urine incontinence (98%), abnormal cystometrogram (100%), negative anal tonus (43%) and absence of bulbocavernosus reflex (65%). Relatively conservative treatments were recommended. Credé bladder expression was beneficial both in reducing the amount of residual urine and in treating urinary tract infection. Indwelling urethral catheter drainage was also useful in preventing upper urinary tract deterioration. When these managements were found not enough effective, surgical procedures (cutaneous vesicostomy, ileal conduit, colocystoplasty, or Y-V plasty of the bladder neck) were indicated.

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On ten cases of renal cancer, transcatheter embolization was performed by using gelfoam preparations labeled with a hemoclip which we devised. This method is effective in preventing the emboli from scattering outside the renal artery. The scattering is the most serious complication that occurs in transcatheter embolization. This method we employed offers the following advantages:
1) By fluoroscopic monitoring, the location of labeled gelfoam can be confirmed easily without a contrast medium.
2) At embolization with this technique, it is possible to observe the migration speed of the emboli, the renal blood flow, and the result of renal embolization.
3) Since a metal clip is attached as a weight to light gelfoam, gelfoam preparations can be handled with ease.
4) The regression of the kidney after embolization can be observed objectively without difficulty.

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Our experiences with transurethral incision and resection of urethral strictures under direct vision are presented.
During the past one year and 5 months, 12 patients with severe strictures have been treated with Dettmar's optical urethrotome and resectoscope. These patients have been followed up for a period of over 5 months. Internal urethrotomy by this urethrotome was safer and more reliable than that by Otis's or Maisonneuve's urethrotome, because all manipulations were conducted under direct vision.
Seven strictures were traumatic, 4 were iatrogenic and the last one was of a questionable etiology. The strictures were in the prostatic urethra in 2 cases, in the bulbous or membraneous urethra in 9 cases, and in the pendulous urethra in one case.
The result was judged “good” when F24-F26 sounds could be passed readily without obstruction, interval dilatations were not required and the patient was free from symptoms. Good results were obtained in all cases except one which had complete urethral obstruction with suprapubic fistula and showed unsatisfactory results.
A ureteral catheter inserted into a blade was passed through the stricture and followed by the blade under direct vision (Figs. 1 & 2). The cutting took only a few minutes and bleeding was usually stopped without difficulty. The incision was made at the 12 o'clock position in 6 cases and 1 or 2 incisions at the 3 or 9 o'clock position were added in 5 other cases. In 6 cases, strictures were still present and resection by resectoscope was performed until the obstructive scar was relieved. A F22 or F24 Foley catheter was inserted during the healing phase and left in place for approximately 2 weeks.
The tissue resected at the stricture showed severe fibrosis or squamous metaplasia histopathologically. It suggested that transurethral resection of a severe scar after cutting by a urethrotome was necessary to relieve recurrent strictures in severe urethral stenosis.
Our results led to the conclusion that in transurethral incision and resection under direct vision of the urethral stricture, the surgical procedure is simple and short for the urologist and is well tolerated by the patient.

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We wish to report a case of renal cell carcinoma which metastasized to the vagina, and studied the metastatic route of renal cell carcinoma to the vagina.
A 22-year-old woman was admitted to our hospital on August 12, 1976 with chief complaints of epigastric pain, nausea and vomiting. She also complained of pain in the lumbar area. On examination, a palpable mass in the left flank was observed but microscopic pictures showed no hematuria. On the basis of excretion urography and renal angiography, she was diagnosed as having left renal cell carcinoma. Renal venography revealed a tumor embolism from the renal vein to the inferior vena cava, and X-ray film examination of the chest indicated a metastasis of tumors to the bilateral hilus lymph nodes.
In spite of radiationtherapy and chemotherapy, tumors were not reduced in size. Five months later, in January 1977, vaginal bleeding occurred. A tumor more than the size of the tip of the thumb was found at the positions of 2 and 10 o'clock near the vaginal introitus, and also found a small egg-sized tumor at the left vaginal wall adjacent to the uterine neck.
Histological examination of the vaginal lesions showed a clear cell adenocarcinoma abundant in the capillaries, and she was diagnosed as having a metatasis from renal cell carcinoma. The patient died on June 11, 1977. Autopsy was refused.
We studied, in adult mongrel dogs, collateral circulation when the renal vein was ligated, by means of venography and autopsy, and blood flow of the ovarian vein before and after the left renal vein was ligated.
The main collateral veins after ligation of the left renal vein were the ovarian vein and the ureteral vein, both of which passed on the route. On the other hand, in the right kidney, it was observed that the renal capsular veins passed to the ovarian vein after being anastomosed to the ureteral vein.
The blood circulation of the left ovarian vein before the left renal vein was ligated was at a rate of 36ml/min from the ovary toward the renal vein, but the blood circulation began to flow, in the opposite direction, toward the ovary concurrently with the ligation of the renal vein, and 1 minute later, the flow rate came to 78ml/min.
From the above result, the metastatic routes of renal cell carcinoma to the vagina are thought to be as follows. In left renal cell carcinoma, the tumor cells flow from the renal vein, directly or through the ureteral vein, to the left ovarian vein, the ovarian plexus, the uterovaginal plexus and the vagina, and in right renal cell carcinoma, the tumor cells flow from the renal capsular veins or the ureteral vein to the vagina through the right ovarian vein.

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A ten-year-old boy was seen on November 4, 1975 complaining of urinary incontinence and enuresis nocturna. His mother said that since birth his urinary stream had always been poor and he had never been dry both day and night, and he had often high fever attacks and terminal micturitional pain. On physical examination there was no remarkable finding except slight strabism. At micturition he strained to pass urine as a poor stream and he had terminal dribbling. Laboratory examinations were not remarkable but pyuria. On X-ray examinations spina bifida occulta was seen on plain films (KUB). Excretory urography revealed a large irregular bladder with diverticula but no change in the upper urinary tracts (Fig. 1). Residual urine was seen after voiding. A retrograde urethrogram showed a linear filling defect on ventral wall of peno-scrotal functional urethra (Fig. 2). The ventral wall below the filling defect was rough and slightly dilated. Under general anesthesia 14 F metal catheter was inserted smoothly into the urinary bladder. Cystoscopic examination revealed marked trabeculation and diverticula with normal mucosa. A normal curve was taken on cystometric examination. We suspected a lower urinary tract obstruction due to anterior urethral diverticulum.
On September 9, 1976 external urethrotomy was done but no diverticulum could be found. The wound was closed leaving an indwelling Foley 12 catheter. Four days after the operation the catheter was removed and then a urethrocutaneous fistula was made spontaneously. On October 5, 1976 retrograde urethrography was performed again (Fig. 3). The same filling defect was seen in the anterior urethra and urethrocutaneous fistula was observed proximal to the filling defect. For the first time we came to consider an anterior urethral valve. On October 18, 1976 external urethrotomy was done again. Bulbous urethra was cut longitudinally at about 1cm proximal to the filling defect. A small malleable probe was modified by bending the tip sharply against itself to create a small hook. The hooked probe which was inserted from the external urethral orifice was moved from the wound to the external orifice. It was apparent that stroking the ventral wall of the penile urethra revealed a snagging effect. A valve in the peno-scrotal junction was identified as a fold of normal mucosa, 5mm in length, 7-8mm in width, 1mm in thickness. The valve arose symmetrically from the lateral urethral walls at 4° and 8°, extending from proximal to distal. Beyond the point of fusion the valves formed a thin transverse membrane that is fused distally to the urethral floor forming an end-pouch in the urethra (Fig. 4). It was thought that the obstructing action is produced as in a flutter valve by the ballooning of the valve into the urethral lumen during micturition. The valve was completely excised by electric fulgulation and the urethra was closed by 0000 atraumatic dexon in layers. Indwelling urethral catheter drainage was instituted for 78 days because a urethrocutaneous fistula was made in the wound. The fistula was closed spontaneously 15 days after the urethral catheter had been removed. Following removal of the catheter the child urinates with forceful stream and has no urinary incontinence and no enuresis nocturna. Fig. 5, Fig. 6 are postoperative voiding and retrograde cystourethrography respectively.
Anterior valve in the male urethra is a rare congenital disease which produces lower urinary tract obstruction. Twenty-eight cases in Europe and USA, twenty-three cases in Japan have been reported in the literature. Our case is the 52nd reported case of the diagnosis and treatment of a valve of the anterior urethra.
In our case enuresis nocturna was one of the chief complaints. We emphasized that the importance of the voiding cystourethrography in diagnosis and of transurethral resection of the valve in treatment.

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Despite the fact that the number of reported cases of ureteral tumors has increased considerably during the last two decades throughout the world, cases of bilateral ureteral tumor remain to be rare.
A case of bilateral asynchronous ureteral tumor in 64 years old male was reported together with the discussion on 34 previously reported cases of bilateral ureteral tumor (17 synchronisms, 11 asynchronisms and 6 unknowns).

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