Twenty four hour urinary excretion of oxalic acid was compared among control group, calcium oxalate stone group, and calcium oxalate and calcium phosphate mixed stone group. Oxalic acid was measured by the Hodgkinson & Williams method (1972) and expressed as anhydrous oxalic acid per 1.73m² body surface area. The value of each control or patient is the mean of three to five assays. The above three groups excreted 30.2±1.5 (S.E.) mg (n=31), 41.4±3.4 (S.E.) mg (n=15), and 37.5±2.2 (S.E.) mg (n=23), respectively. The differences between control group and the latter two groups were statistically significant (P<0.01).

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Concerning the abdominal phlebolith and urolithasis, the following were clarified by our statistical investigations of 2, 027 patients who had undergone roentgenographic checks of abdomen or urinary tract twice or more.
1. The frequencies of abdominal phlebolith and urolithiasis were 19.3% and 13.0% respectively.
2. An “aged phenomenon” which means a higher frequency of occurrence as age advances was noted with abdominal phlebolith, while urolithiasis was noted more often in those patients who were in their 20s and 30s.
3. No difference was seen between the sexes in terms of prevalence of abdominal phlebolith, whereas caluculi of the urinary tract was obviously more frequent in male patients than in female patients.
4. Multiple occurrences were noted more frequently in the cases with abdominal phlebolith, whereas single occurrences were more often with urolithiasis.
5. In 77.4% of the cases with phlebolith the caliculi were as small as from 0.1×0.1-to 0.3×0.3cm and in 75.6% their shapes were round. In contrast, in the cases of urolithiasis, the sizes were as small as above in 45%, of moderate sizes of 0.4×0.4-0.6×0.6cm in 25%, and in 30% they were larger than 0.7cm. Their shapes were round in 36.1%, and in remaining 26.4% and 37.5% they were nearly round ones and ellipse or irregular, respectively, without showing such a trend with the phlebolith which was mostly small and round.
6. The regions of their frequent occurrences (distributions) were schematically illustrated with specific coordinates, in which the decreasing order of density of distribution was noted of phlebolith in pelvic laum, renal and upper ureter calculi, ureter stone in pelvic laum, phlebolith on pelvic bone, upper abdominal phlebolith, and urinary tract calculi on pelvic bone. A trend that phleboliths were distributed on the lateral side of the way of urinary tracts was noted if a comparison was made between the pelvic phlebolith and pelvic urolithiasis.
7. From the results of our investigation on the translocations of abdominal phlebolith and urolithiasis depending on the bodily positions, it was found that the distance of translocation of mesenteric phlebolith was longest, followed by those of renal and upper ureter calculi, calculi of the pelvic laum, and pelvic phlebolith. It was almost impossible to distinguish the phlebolith from urolithiasis by the differences of the distance of the translocation depending on the body positions.
8. An interesting result that the complications with each other were significantly higher than the noncomplications was obtained from the comparison between the rate of occurrences (complication rate) of urolithiasis or abdominal phrebolith with the group of positive cases of abdominal phlebolith or urolithiasis and the rate of occurrences (non-complication rate) of urolithiasis or abdominal phlebolith with the group of negative cases of abdominal phlebolith or urolithiasis.
9. Two intrapelvic phleboliths and one mesenteric phlebolith were showed in terms of their shapes, relation with veins in which these were detected, and the pictures of a pelvic phlebolith and a ureter stone with softex rays.

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A silica stone is common in herbivorous animals such as ovine and cattle, but rare in humans. In humans, the silica stone has been encountered only in patients who had been administered orally magnesium trisilicate for many years in the treatment of gastritis and peptic ulcer.
In our clinic, only 2 silica stones were found among 1579 urinary calculi analized by infrared spectroscopy from February 1972 to September 1977.
Case 1. A 64-year-old female who had been treated for rheumatoid arthritis with betamethasone for a long period took magnesium trisilicate to prevent the peptic ulcer. She suffered from a left ureteral stone which was removed operatively.
Case 2. A 52-year-old male had been treated with magnesium trisilicate for peptic ulcer. He also suffered from urolithiasis, stone being passed out spontaneously.
This paper reported the details of the case 1 and commented briefly on the formation mechanism and the growth process of this paticular stone.

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Two hundreds and ten patients first treated from 1963 to 1972 were followed through 1975.
One hundred patients with T1 or T2 tumor were treated by TUR (including transurethral coagulation). Of the 100 tumors, 94 were grade 1 or 2, 5 were grade 3 or 4 and 1 was unknown grade. Of the 100 patients, 1 underwent total cystectomy ultimately and 2 underwent open resection of the tumor. Five-year relative survival rate after TUR was 100% (SE: standard error 4%, ESS: effective sample size 86).
Thirty patients underwent open resection (or coagulation) of the tumor. Of the 30 tumors, 25 were T1 or T2, 5 were T3 or T4, 18 were grade 1 or 2, 11 were grade 3 or 4 and 1 was unknown grade. Radon seeds implantation (average 16 mCi) into the wall was combined in 17 patients. Five-year relative survival rate after open resection was 75% (SE 11%, ESS 30). However all patients having high stage tumor died within 2.5 years after open resection. No favorable effect was obtained from radon seeds implantation.
Forty-three patients had partial cystectomy. Of the 43 tumors, 28 were T1 or T2, 15 were T3 or T4, 17 were grade 1 or 2 and 26 were grade 3 or 4. Of the 43 patients, 2 underwent total cystectomy ultimately. Overall 5-year relative survival rate after partial cystectomy was 52% (SE 9%, ESS 39), while that of low stage was 63% (SE 12%, ESS 24), that of high stage was 32% (SE 14%, ESS 15), that of low grade was 70% (SE 15%, ESS 14) and that of high grade was 41% (SE 11%, ESS 26).
Twenty-nine patients underwent total cystectomy. Pelvic node dissection was associated in 7 patients and irradiation in 3 patients. Anti-cancer chemotherapy (mostly systemic administration of Mitomycin C) was employed postoperatively in 11 patients. Of the 29 tumors, 16 were T1 or T2, 13 were T3 or T4, 11 were grade 1 or 2 and 18 were grade 3 or 4. Overall 5-year relative survival rate after total cystectomy was 49% (SE 11%, ESS 26), while that of low stage was 82% (SE 15%, ESS 12), that of high stage was 9% (SE 8%, ESS 13), that of low grade was 88% (SE 17%, ESS 8) and that of high grade was 26% (SE 11%, ESS 18).
Thirteen patients had urinary diversion alone. All patients but 1 died within 2 years and no patients survived 5 years.
Rate of intravesical recurrence after treatment was calculated. The number of deaths in the calculation of actuarial survival rate was replaced by the number of patients with recurrence, and the cumulative proportion of nonrecurrence was subtracted from 1.
Intravesical recurrence rates 1 year after TUR, open resection and partial cystectomy were 26% (SE 4%, ESS 100), 44% (SE 9%, ESS 30) and 52% (SE 8%, ESS 43) respectively, while 5-year intravesical recurrence rates were 50% (SE 5%, ESS 86), 59% (SE 9%, ESS 28) and 60% (SE 8%, ESS 41), respectively. Intravesical recurrence after TUR was less frequent in patients with grade 1 tumor than with grade 2 and significantly more frequent in patients with multiple tumors at first seen.

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Plasma testosterone (T.) was determined by radioimmunoassay for nine normal adult males, nine infertile males which showed azoospermia due to hypospermatogenesis and eleven Klinefelter's syndromes, each after HCG administration on day 0 (once, intramuscular 10, 000 units) and on days 4, 5, 6, 7, and 8, (daily, intramuscular 3, 000 units). On day 0, samples were collected at one hour intervals in 180 minutes, on day 4 before and six hours after HCG administration and on days 5, 6, 7, and 8, each six hours after HCG administration. For another five normal adult males, samples were collected daily for five days after HCG administration (once, intramuscular 10, 000 units). In nine normal adult males, no increases were found except one on day 0, but on day 4 before HCG administration significant responses were obtained in all cases, after day 5 increases were small except three. In another 5 normal adult males with steadily increasing values after HCG administration, maximum values were showed one on day 2, two on day 3 and two on day 4. Significant decreases were not found after maximum. In infertile males, as in normal males, no increases were found except one on day 0, but on day 4 meaningful responses were found in six, after day 5 increases were small except two. In Klinefelter's syndromes, basal values were statistically lower than normal adult males and infertile males. No increases were found except one on day 0 and response on day 4 and increases after day 5 were poor in all.

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The effects of synthetic luteinizing hormone-releasing hormone (LH-RH) on plasma pituitary gonadotropins (LH and FSH) and human chorionic gonadotropin (HCG) on plasma testosterone (T.) were studied in fourteen boys with delayed puberty including one Prader-Willi syndrome. T. was measured at one hour intervals in 180 minutes after HCG administration (intramuscular 10, 000 units) on day 0 and on day 4 before and six hours after HCG administration (intramuscular 3, 000 units) and on days 5, 6, 7, and 8 six hours after HCG administration (daily, intramuscular 3, 000 units). Short term responses were poor except one case, but good responses were found before HCG administration on day 4 and increases were steady after daily HCG administration in the same eleven cases. In other three cases including Prader-Willi syndrome responses were poor to HCG administrations. LH to LH-RH (intraveneously 100μg) was meaningful in cases with good responses of T. to HCG and not meaningful in cases with poor responses of T. to HCG except one case. For FSH to LH-RH, no correlation was found between T. to HCG.

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The effects of synthetic luteinizing hormone-releasing hormone (LH-RH) on plasma pituitary gonadotropin (LH and FSH) and human chorionic gonadotropin (HCG) on plasma testosterone (T.) were studied in eleven adult males with hypogonadism including three cases of Kallmann's syndrome, each one case with history of hypophysectomy at fifteen years of age, bacterial meningitis at eight years of age and bilateral hernia repair at eighteen years of age. All cases had normal karyotype. T. was measured at one hour interval in 180 minutes after HCG administration (intramuscular 10, 000 units) on day 0 and on day 4 before and six hours after HCG administration (intramuscular 3, 000 units) and on days 5, 6, 7, and 8 after HCG administration (daily intramuscular 3, 000 units). Basal T. exhibited prepubertal values in all cases. Short term responses were poor in all cases and on day 4 only three cases had responses, but after day 5, three cases (with history of hypophysectomy, meningitis and Kallmann's syndrome) showed steady increases to normal adult basal values. Basal LH and FSH were low except one (with history of hernia repair) and LH to LH-RH (intravenonsly 100μg) were small but meaningful in five cases and FSH in three cases. A case with history of hernia repair showed high basal LH and FSH and poor response of T. to HCG. Cases with history of hypophysectomy and meningitis, in spite of no responses of LH and FSH to LH-RH, showed steady increases on daily HCG administration. Three cases of Kallmann's syndrome showed different responses as to LH and FSH to LH-RH and as to T. to HCG from one another.

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Gonadal function was studied for forty-three cases with history of surgery to cryptorchidism and five normal pubertal boys. Methods of surgery for cryptorchidism were: bilateral orchiopexy (13 cases), unilateral orchiopexy (25 cases) and unilateral orchiectomy for unilateral cryptorchidism (5 cases). Ages were from prebubertal to postpubertal. Pubertal maturations for external genitalia (G1-G5) and pubic hair (PH1-PH5) by Tanner were correlated with chronological and bone ages. Plasma LH and FSH and responses to LH-RH (intraveneonsly 100μg) and plasma testosterone (T.) and responses to HCG (4th day after HCG, intramuscular 10, 000units) were increased in most cases with chronological age and pubertal maturations. In bilateral orchiopexy, plasma LH and FSH and LH response to LH-RH were higher than unilateral orchiopexy(P<0.02, P<0.05, P<0.05). Plasma T. and response to HCG were not different according to methods of surgery and retained positions. One after bilateral orchiopexy showed low response of plasma LH and plasma T, in spite of pubertal age. All cases of bilateral orchiopexy (n=4) were azoospermia and two of unilateral orchiopexy (n=6) were oligospermia.

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Boys with complaints of micro-penis or delay of pubertal signs were followed for over two years' period. Pubertal signs were discussed on criteria of Tanner (G1-G5, PH1-PH5). Boys were divided into two groups, one showing good response of plasma testosterone on HCG test and plasma LH on LH-RH test, the other with poor response on HCG test and on LH-RH test. The former (n=9) had good pubertal signs for the period of follow-up without medications except one which had long HCG administration for the social reason. The latter (n=4) had no pubertal sign in spite of long HCG administration. Therefore both HCG test and LH-RH test were thought to be good methods for diagnosis of constitutional delayed puberty and hypogonadism with organic failures.

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PHO/CON TM Multi-plane Imager System (PHO/CON) produced 12 pictures from one scan and each picture was sharply focused on a different plane in the subject.
The PHO/CON had two detectors, upper and lower. Six anterior and 6 posterior tomographic planes, equally spaced, were obtained at one scanning. The distance between two adjacent tomographic planes was dependent on the collimator and on the setting of the tomographic separation switch.
The PHO/CON was used for various urogenital diseases and its clinical value was evaluated. Renal tomoscintigraphs with ^99mTc-DMS (dimercaptosuccinate) and skeletal tomoscintigraphs with ^99mTc-pyrophosphate or-diphosphonate were studied in 60 patients and in 52 patients, respectively. And tomoscintigraphy with ⁶⁷Ga-citrate were performed in several cases.
Tomoscintigraphs of a variety of diseases were presented. The lesion of renal parenchyma was visualized more clearly by PHO/CON than by a conventional scinticamera. Especially in peripheral parenchyma the tomoscintigraph gave accurate information for diagnosis. When compared to the conventional scinticamera, the PHO/CON provided additional useful information in 18 of 37 (48.6%) cases with urological renal diseases, but did not provide additional information in the remaining 23 cases with microscopic hematuria or proteinuria.
In skeletal and other scanning, the PHO/CON did not fail to detect any lesion visualized with other instruments, and provided additional information and superior resolution without overlap of activity.

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There is a group of cases who show the clinical features of obstructive uropathy but neither anatomical obstruction nor neurological disorder. After introduction of urodynamic examinations to the lower urinary tract, this subclinical or occult neurogenic bladder dysfunction is frequently detected not only in the patients with severe obstructive lesions, but also in the patients with recurrent urinary tract infection and/or slight urination disorders.
1. Consideration for possible neurological lesions:
The age distribution chart of subclinical neurogenic bladder cases is very similar to that of neurogenically evident bladder dysfunction cases. The cases of neurogenic bladder clearly show the peculiar variety and incidence in each generation. Therefore, when the diagnosis of subclinical neurogenic bladder is made, it should be asked first of all whether the thorough neurological examinations have been made to find the causal diseases.
2. Subdivision of vesico-urethral dysfunctions and the possible site of neurological lesions:
Even in the same group of patients with the same neurological disease, such as meningomyelocele or cerebrovascular lesion, the urodynamic features are variable, and the nature of their vesico-urethral dysfunctions could be subdivided based on detrusor and sphincter reflex activities, detrusor-sphincter coordination, and voiding cystourethrographic pattern. However, these proceedings of classification do not necessarily simplify the complicated problem, “the decision of the site of neurological lesions”.
3. Uninhibited bladder:
The age distribution chart of all the cases with uninhibited bladder contraction shows the characteristic curve of parabola, in which the overwhelming majority of the cases are distributed in young children. Contrary to the high incidence of mechanical obstruction or organic disease in old patients, most of these children can not be proven to have any neurological defect, though organic urethral stenosis, including Lyon's Ring, is detectd in less than half of them.
Even after excluding these mechanical obstruction or evident neurogenic bladder dysfunction, functional bladder neck obstruction or external sphincter spasm can be demonstrated in some of these uninhibited bladder cases, and all of them have positive urinary tract infection.
4. The causal background of enuresis:
Uninhibited bladder contraction can be detected in most of the enuretic children, but its incidence decreases rapidly after 10 years of age, and is replaced by other types of bladder dysfunction such as reflex bladder in elder children and adults.
Anticholinergic drugs and/or Imipramine are used routinely in its treatment, but these drugs are not effective in the cases whose internal sphincter mechanism is weak. In these cases, combination of Imipramine or anticholinergic drugs with GOMT-inhibitor that elevates endogenous norepinephrine activities, thus increasing alpha-adrenergic response, are successful.
5. Hypotonic or large bladder:
If one excludes patients with obvious outflow obstruction, the detection rate of hypotonic or large bladder is high in patients with recurrent or persistent cystitis in females and chronic prostatitis in males.
Although neurological lesions can not be detected by the usual neurological examination, spinal deformities on X-ray such as spina bifida occulta and spondylosis deformans are frequently visible both in children and adults. In middle aged people, the characteristic clinical histories, such as delivery in female, lumbar or ischiatric neuralgia, and perineal discomfort in both sexes are heard very often. In addition, disturbed detrusor and sphincter reflex activities, and abnormal decrease of UPP to alpha-blocker are constantly detected in these patients. These results are suggestive of the incomplete lesions of peripheral nerves concerned with micturition, probably at the level of the roots of the lumbar spinal nerves, cauda e

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Two hundred forty-two chidren with urethral ring stenosis were investigated by the urological and urodynamic examinations. Althouth the diameter of the urethral ring itself was confirmed to be the less contributing factor to the symptomatology, voiding cystourethrographies and simultaneous recordings of intravesical pressure and electromyographies of striated external sphincter demonstrated some characteristic figures. But diagnosis of minor urethral ring stenosis and decision of surgical treatment are still under discussion.

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Of 15 patients with renovascular hypertension having stenotic lesions of both renal arteries, the effects of surgical treatment on blood pressure were analyzed in relation to renal function studies performed preoperatively.
Rapid sequence intravenous pyelography showed abnormalities in 14 of 15 patients. The results of split renal function studies successfully performed showed the finding consistent with the positive criteria for unilateral renal ischemia in 5 of 7 patients. Bilateral renal venous and peripheral venous renin assays were performed in 10 patients. Five of them had a similar pattern of the PRA ratio to that noted in a group of patients with hypertension caused by unilateral renal artery stenosis; the renal venous renin level from the more severely affected side was higher than that from the less severely affected side, which was the same as the peripheral venous renin level.
Four of 5 patients with positive split renal function studies and 3 of 5 patients with positive renal venous renin assays underwent unilateral operation on the positive side. All of them were cured or improved.
Therefore, it is reasonable to expect that unilateral renal vascular repair or unilateral nephrectomy based on the physiological information provided by the ratio of three different vein renins and split renal function studies as above mentioned is sufficient of correct renovascular hypertension associated with bilateral renal artery stenosis.

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The value of the diagnostic criteria of plasma renin activity (PRA) for unilateral renal ischemia was investigated in hypertensive rabbits with bilateral renal artery stenosis.
Hypertension was produced by staged constriction of right renal artery with one of three different clips followed by left renal artery constriction with a clip of the smallest diameter. Eighteen of 21 rabbits thus operated developed sustained hypertension.
In all 21 rabbits, PRA was determined in three different blood veins, L: left renal vein renin, R: right renal vein renin and IVC: distal vena cava renin. Three PRA patterns, L>RIVC (A type), L, R>IVC (B type) and R>LIVC (C type), were observed.
A significant reduction in blood pressure after unilateral removal of the more severely affected kidney was obtained in those with A type PRA pattern. Two of 4 rabbits with B type PRA pattern showed some decrease in blood pressure after unilateral nephrectomy in those with renin ratio of 1. 4 between the venous blood samples obtained from unoperated kidney and distal vena cava.
The observation was in accord with the clinical experience, that patients with A type PRA pattern were surgically curable in renovascular hypertension.

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The present study was undertaken to determine if internal iliac artery ligation causes changes in the bladder wall circulation sufficient to control hemorrhage by shutting off the blood flow in urologic surgery. Such study is prerequisite for a better understanding of the internal iliac artery ligation widely used as a means of hemostasis in urologic surgery.
Twenty-two dogs weighing 7 to 31 kg were used in the present study. Dogs were anesthetized with thiamylal-Na and the aorta, the internal iliac artery and the bladder were exposed transperitoneally. One male patient with bladder carcinoma was anesthetized epidurally and his bladder was exposed by a median incision at the lower abdomen.
The bladder wall PO₂, an index of blood flow, was continuously measured by the Yagi's polarographic O₂ electrode of an enameled copper wire 300μ in diameter implanted in the muscular layers of bilateral and posterior bladder walls, respectively.
In the patient with bladder carcinoma the electrode was implanted in the posterior bladder wall.
In four dogs, the electrode was also placed in the abdominal aorta to measure arterical PO₂. Changes in the polarographic amplitudes after artery ligation were expressed as percent of the level obtained before ligation.
In the experiments with ligations of internal iliac artery and abdominal aorta ligation, both arterial and bladder wall PO₂ were monitored during 100% O₂ breathing and the increment of the bladder wall PO₂ and the response time to O₂ breathing were measured.
The following results were obtained:
1) Before ligation, the bladder wall PO₂ increased up to 141-174 during O₂ breathing.
2) After internal iliac artery ligation, the bladder wall PO₂ decreased to 76-79% and the PO₂ increments (28-45) were significantly lower than the control values (41-74) (P<0.01). The response time to O₂ breathing was significantly greater in the ligation (20-25sec) than the control (8-10sec). After ligation PO₂ decreased initially but it showed an increase in 14 out of 46 areas of the bladder later, the mean increment was 11% and it occurred 204 seconds after the ligation on the average.
3) The bladder wall PO₂ during ligation of the aorta was 59-70% which was lower than that of internal iliac artery ligation and that of 11 areas did not respond at all to O₂ breathing. The increment of PO₂ during O₂ breathing was 12-20 which was lower than that seen in the internal iliac artery ligation (p<0.05). The response time to O₂ breathing was significantly prolonged (40-51sec). These results indicate that the ligation of the aorta causes a profound decrease in the bladder wall blood flow.
4) In the patient with bladder carcinoma the bladder wall PO₂ increased markedly (193). After internal iliac artery ligation, it decreased to 79% but again increased to 114 by O₂ breathing. The response time to O₂ breathing before internal iliac atery ligation was 6sec and 12sec after ligation. This finding suggests that like in the dog the internal iliac artery ligation does not reduce bladder wall blood flow sufficiently to produce ischemia in humans.
In conclusion, a significant fraction of the bladder wall circulation (71-76%) can be maintained agter internal iliac artery ligation and collateral circulation can also occur in about 200 seconds. The results of these studies indicate that clinically effective hemostasis can not be expected by iliac artery ligation alone.

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Seventeen cases of varicocele with disturbance of spermatogenesis were studied for volume of bilateral testes, sperm count, histology of bilateral testes, plasma testosterone on HCG (10, 000i.u./M², i.m.), and plasma LH and FSH on LH-RH (100μg/M², i.m.). Volume of left testis in all cases and right testis in nine cases were lower than that of normal Japanese males. Spermatograms were oligospermia (n=6) and azoospermia (n=11). Histology of bilateral in all cases were from 5 to 9 on Johnsen's score count. In comparison of score count between left and right, left disturbances were more remarkable in seven cases, but inverted pictures were exsisted in two cases. There was a significant linear correlation between volume of left testis and score count of left testis (r=0.70, p<0.01). Plasma testosterone and response on HCG were not lower in statistics between normal adult males, but increases on HCG were smaller in cases with low score count than cases with high score count. Plasma LH and FSH, both basal and on LH-RH were not higher in statistics than normal adult males. FSH seemed significant inversed linear correlation with score count from left testis (r=-0.57, p<0.02).

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