The measurement of urethral pressure profile can be carried out under simultaneous fluoroscopic visualization of posterior urethral changes by means of X-ray television.
This investigation was initially performed on 4 adult males having normal micturition under two different conditions: the measurement of UPP was done before the cystometrogram (in empty bladder) and after the cystometrogram (in full bladder which gives a more than minimal desire for urination).
The profile curves with full bladder showed no marked increase in pressure along the functional urethral length (FUL) when compared to those with empty bladder. The FUL was however shortened.
The tendency to shorten the FUL of the full bladder was more remarkable at the distal portion of posterior urethra than at the proximal portion.
It is believed that the FUL is shortened when the thickness of the bladder wall at the cervical portion diminishes and stretches laterally as the bladder is distended (descending tendency).
A group of pelvic striated muscles, on the other hand, increases their tension following distention of the bladder.
These conditions will make the posterior urethra positioned higher and, consequently, the ascending tendency of the distal portion of posterior urethra becomes greater than that of the descending proximal end.
In clinical applications, 12 patients with spinal cord injury were studied during the spinal shock or initial recovery stage using the same method. Some patients, in spite of their atonic paralysis shown in the cystometrogram, exhibited a remarkable rise in urethral pressure when the bladder was full. In such cases, the fluoroscopic visualization revealed that the FUL was not shortened and the bladder neck remained in a closed state. A few patients, on the cotrary, exhibited a rise in pressure with the bladder neck opened while the bladder was distened.
It is therefore indicated that conditions of the bladder neck should be confirmed as to whether it is closed or open before having the patient with a UPP rise go through TUR incision. Moreover, the UPP measurement using X-ray television is useful to determine whether certain drugs such as adrenolytic agents have exerted effects on the bladder neck.
Finally, it is to be noted that X-ray irradiation time during the course of the UPP curve should be as short as possible from the safety point of view and the catheter drawing should also be done as speedily as possible within a limitation.

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It is well known that acetazolamide induces urolithiasis. But there have been no reliable prophylactic measures up to the present time. This paper presents a successful prophylactic treatment for the iatrogenic urolithiasis.
Comparative studies were made between 19 no stone-forming patients as the control and 19 glaucoma patients administered acetazolamide. In the latter, there were significant rises of serum ionized calcium/total calcium ratio and increase of urinary calcium excretion. It was considered that both phenomena were owing to metabolic acidosis induced by the long-term administration of acetazolamide.
Twenty-six glaucoma patients were given citrate (K₃ citrate; 8-10g/day and Na₃ citrate; 4-6g/day per os.) for the correction of metabolic acidosis.
Before taking citrate, 11 out of 26 patients had 26 stone episodes in 1.5 years, i. e., an average of 1.58 stone episodes per patient per year. Nine patients who had received citrate therapy in 1.5 years had only one stone episodes i. e., an average of 0.07 stone episodes per patient per year. During the follow-up periods, it was elucidated that citrate administration did not affect the intraocular pressure decreaing action of acetazolamide, and as expected, decreased serum ionized calcium/total calcium ratio and urinary calcium excretion.
Prophylactic effects of citrate administration is considered to be due to the improvement of metabolic acidosis and subsequent decrease of serum ionized calcium/total calcium ratio and urinary calcium excretion.

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The response of the lower urinary tract to alpha adrenergic Blocker was studied. The contractile strength of detrusor muscle remained unchanged, while static urethral resistance and stimulated dynamic urethral resistance were decreased in response to intravenous administration of alpha adrenergic blocker, which were demonstrated in male and female dogs in vivo. A series of 37 patients (24 males and 13 females) with varying degrees of neurogenic bladder dysfunction were evaluated by oral administration of phenoxybenzamine hydrochloride, alpha adrenergic blocker. 6 patients were suffering from complete supranuclear lesion, 5 incomplete supranuclear lesion, 7 complete and 19 incomplete nuclear and/or infranuclear lesion.
Effective daily dose of phenoxybenzamine was found between 5 and 15mg a day, which was safe and tolerable for the majority of patients. 19 patients were treated with phenoxybenzamine, one of which had parasympathomimetics also. The rest required the combination therapy of phenoxybenzamine and intermittent self-catheterization. Objective improvement was always preceded by an improvement of subjective complaints, which was observed in 88% of patients and generally appeared in 12 to 48 hours. The significant decrease of residual urine was noted in 52% of patients. 7 patients with indwelling catheter were all liberated from it after the treatment. The maximum urethral pressure in the urethral pressure profilometry significantly decreased in 8 out of 11 cases (73%), and 60% of patients showed an improved uroflowmetrogram. 43% of the cases complained of side effects such as dizziness, nasal obstruction and orthostatic hypotension.
The overall result is as follows; excellent 6 (16%), effective 22 (60%) and non-effective 3 (8%). Other 6 patients (16%) could not be evaluated, since the cessation of therapy was required by the side effect during the early course of treatment. Alpha adrenergic blocker is quite of promise to facilitate the bladder emptying in patients with neurogenic bladder dysfunction with or without the assistance by the intermittent self-catheterization. Mode of micturition has been promptly improved due to the decreased urethral resistance. No severe side effects can be expected unless the daily dose exceeds 15mg a day. It should be stressed that the conventional treatment to establish the satisfactory voiding by increasing the bladder tonicity with parasympathomimetics should now be replaced by the new method of decreasing the urethral resistance.

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In 5 cases, consisting of 4 cases of renovascular hypertension and one of renal staghorn calculi, autotransplantation with or without ex vivo renal operation was undertaken.
In 3 of the 4 cases of renovascular hypertension, autotransplantation was carried out since it was considered difficult to perform vascular reconstruction because of the site of lesion. On the other hand, in the remaining one case in which the lesion extended from the main renal artery to the primary branches, autotransplantation was carried out after ex vivo reconstruction of the renal artery. Postoperatively, blood pressure recovered to normal and transplanted kidney functioned well in all of these 4 cases.
In one case of renal staghorn calculi the stones were large in size and recurrent, associated with a great number of small stones, and in addition complication with intractable infection was found. Therefore, ex vivo nephrolithotomy and partial nephrectomy preceded the autotransplantation. After operation, infection was cured with complete removal of calculi, although some renal dysfuction remained.
Clinical courses, operative technique, preservation of kidney and performance of radiography during ex vivo surgery, and postoperative courses in these 5 cases were discussed.
In order to determine the possibility of preserving the kidney during ex vivo surgery, one of the most important problem involved in this surgery, experiments were carried out using adult mongrel dogs. The solution used for renal preservation was prepared as follows: 5% low molecular weight dextran in 500ml of lactated Ringer's solution was added with 200mg of procaine hydrochloride, 2500U of heparin sodium, 4mg of dexamethasone, 8mEq/l of magnesium sulfate and 500mg of ampicillin, and then with 5 to 7g of glucose and 40u of insulin so as to make the osmolarity 315 to 340mOsm/l. The pH value of the solution prepared was adjusted to 7.3 to 7.5.
Following hypothermic pulsatile perfusion using the perfusing solution prepared as described above by ‘MOX’ 100 Renal Preservation System, it appeared possible to maintain the kidney for 72 hours by hypothermic pulsatile perfusion by use of our perfusing solution, judging from the properties of the kidney, findings of the perfusate, histological changes and microangiogram.
In one of the 2 cases who underwent ex vivo surgery, since perfusion could not be applied on account of the need of repairing vascular ostiums, the kidney was preserved by immersion in the above described solution. In the other one case, ex vivo surgery could be performed successfully under hypothermic continuous perfusion by use of the same solution at pressure of 100cmH²O. The duration of ischemia time lasted 2 hours and 25 min to 3 hours and 9 min. Based on the histological findings and arteriogram taken after completion of ex vivo surgery, the kidney was estimated to be preserved well.
It may be justified to apply renal autotransplantation and ex vivo surgery actively for selected indications, because they have various advantages.

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From January, 1969 to January, 1977, 9 patients including 7 females between 19 and 44 years of age were found to have renovascular hypertension due to unilateral fibromuscular dysplasia of the main renal artery. All patients were subjected to renal autotransplantation either as a primary or secondary surgical procedure in addition to ex vivo reconstructive surgery in 4 patients.
In two of the nine patients autotransplantation was performed secondarily after initial bypass procedure with Teflon graft had failed, however it was a procedure of choice in the remaining seven patients. Anatomical success was confirmed by postoperative renal angiography in all but one, who had an intrarenal calcified aneurysm as well as a stricture of the main renal artery. Their location made it extremely difficult to excise the aneurysm even in ex vivo procedure, and resulted in a failure due to thrombosis. Subsequently the autotransplanted kidney was removed two weeks after the initial surgery.
Normalization of blood pressure was observed in all 9 patients within 10 to 48 days after surgery (mean, 21.6 days), and 8 patients could meet the criteria for cure used by Kaufman & Mexwell (1964) in judging the effect of the operative procedure on the blood pressure, namely blood pressure of 140/90mmHg or less, one year postoperatively.
Screening the patients with renovascular disease was initiated with safe and inexpensive diagnostic modalities including rapid sequence urogram (RSIP) and radioisotope renogram. Those patients with positive result after the screening were hospitalized for further investigation. Although arteriography is quite useful to visually demonstrate suspicious renal arterial lesion, functional significance of the lesion and/or operative prognosis were determined utilizing split renal function test (SRF), renal vein renin ratio (RVRR) and Angiotensin II (Ang II) analogue test. Plasma renin activity was determined by means of Skinner's bioassay instead of the radioimmunoassay. Ang II analogue test was conducted by infusion of 300ng/kg/min. of 1 Sarcosin 8 Isoleucin Ang II for 30 minutes and blood pressure was determined pre and post infusion. The predictive accuracy of operative prognosis of the SRF, RVRR and Ang II analogue test were 100%, 66% and 80%, respectively. Based on this study it is our conclusion that the autotransplantation should be more frequently utilized as an excellent therapeutic modality for renovascular hypertension. Emphasis is placed that a decision should be made for, or against, operative treatment based on multifacet analysis of SRF, RVRR and Ang II analogue test.

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Two hundred eleven patients with urogenital tuberculosis first treated from 1963 to 1972 were followed through 1975.
Of the 211 patients, 198 had active tuberculosis. They were treated for 2 years by triple drug regimen. Most patients had SM 1 g twice a week, INH 0.3g per day and PAS 10 g per day. When the side effects occurred or the bacilli were resistant to the drug, the drug was replaced with another one. Of 165 patients with active renal tuberculosis, 96 had nephrectomy and 11 had nephro-or uretero-cutaneostomy. Of 49 patients with male genital tuberculosis, 37 had epididymectomy.
As for the long-term results of treatment for active urinary tuberculosis, only 2 patients in whom the diseased kidney was not removed showed recurrence of tuberculosis bacilluria after the completion of 2 years chemotherapy. Persistent microscopic pyuria was found in 2 patients (2%) when the diseased kidney was removed, while it was found in 6 patients (9%) when the diseased kidney was conserved excluding the patients with urinary diversion. Ureteral stricture occurred as sequelae of the chemotherapy in 6 patients out of 70 in whom the diseased kidney was conserved. Pyelocalyceal morphology on IVP was improved in 34 kidneys, unchanged in 56 and aggravated in 6. Minor calyceal changes tended to heal, while advanced changes were mostly unchanged.
Long-term results of the treatment of male genital tuberculosis were satisfactory. However, obstructive azoospermia was found in 12 patients.
No serious side effect was noted during the chemotherapy. The eighth nerve impairment including slight one was recognized in 27 out of 148 patients who had SM or KM.
Thirteen patients underwent nephro-or uretero-cutaneostomy because of obstructive renal failure. Of 13 patients, 7 had colocystoplasty after the completion of chemotherapy and 6 have been unable to abandon the urinary diversion. The patients with urinary diversion have become progressively azotemic. One patient with chronic renal failure due to sequela of renal tuberculosis underwent renal transplantation and died of chronic rejection 2 years and 7 months after the operation. Ureteroplasty in the period of chemotherapy was performed in 2 patients and was followed by formation of urinary fistula or recurrence of ureteral stricture. Ureteroplasty in 6 patients and colocystoplasty in 12 patients performed after the completion of chemotherapy showed satisfactory results.

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To evaluate cell-mediated immunocompetence of patients with bladder cancer, skin reactivity to 2, 4 dinitrochlorobenzene (DNCB) and tuberculin (PPD) as delayed cutaneous hypersensitivity were examined in 42 controls (without cancer) and 62 patients with bladder cancer.
1) A significant difference in DNCB responsiveness was present between patients with bladder tumor and normal controls. 45 per cent (25/55) of the patients with bladder cancer were DNCB-positive compared to 87 per cent (26/30) of the control group. DNCB reactivity was depressed especially in patients with recurrent or metastatic cancer.
2) The rate of positive reaction to DNCB was higher among the patients who underwent conservative therapy than the patients who underwent radical operative procedure. Fathermore, inoperable cases were all DNCB-negative.
3) There was no difference in DNCB responsiveness among grade I, II and III, but DNCB responsiveness of grade IV was significantly depressed compared to grade I, II and III.
4) Only 7 per cent (1/15) of the patients with high stage cancer were DNCB-positive compared to 63 per cent (19/30) of the patients with low stage, which indicated a difference in immunologic responsiveness correlated with the tumor stages as measured by DNCB skin reactivity.
5) DNCB responsiveness of the patients with tumor over 2cm in diameter or multiple tumor were significantly depressed. It was suggested that there was definite correlation among immunologic defficiency, tumor growth and multiplicity.
6) Although only 9 per cent (1/11) of the patients who showed positive reaction to DNCB died in the follow up period, 38 per cent (8/21) of the patients who showed negative reaction died of widespread metastasis or cachexia and 75 per cent (6/8) of the deceased died within 6 months.
7) There was no significant difference in immunologic responsiveness among tumor grades and tumor stages as measured by PPD skin reactivity.
These results indicated that skin reaction to DNCB was one of the important parameters to evaluate cell-mediated immunocompetence of the patients with bladder cancer.

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Experimental bladder tumors were induced in rats by oral administration of 0.025% BBN and investigations were performed concerning histopathological changes in the bladder with respect to tumorigenesis and changes with time in the mitogen response of lymphocytes of rats treated with carcinogen.
There were no significant differences in body weight changes between the experimental and control groups. There was a remarkable increase in bladder weight in the experimental group, while the thymus weight showed a significant drop (p<0.01).
From about 12 weeks after BBN administration, hyperplasia started in the bladder mucous epithelium, there was a gradual growth in a papillary form and after 24 weeks, transitional cell carcinomas were found in all rats.
The SI values of the lymphocytes from cervical and mesentric lymph nodes began to decrease significantly (p<0.05) from the time hematuria was observed macroscopically (about 21 weeks after BBN treatment) but there were no significant differences between additions of PHA and Con A.
The SI values of the lymphocytes from the thymus showed significant decreases (p<0.01) from the time hyperplasia was found in the bladder mucous membrane (about 15 weeks) before the significant reduction of mitogen responses of lymph node lymphocytes appeared. This decrease was much greater in the case of Con A stimulation than in the case of PHA.

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A case of renal amyloidosis caused by a perirenal plasma cell granuloma is reported. A 27-year-old man had been with an elevated E. S. R. since 1972. The patient with epigastragia and weight loss had been treated without remission in the Internal Medicine of our hospital under a diagnosis of duodenal ulcer since Jaunary 1974. He had been rehospitalized with fever, general fatigability, weight loss and albuminuria in July 1976. Laboratory findings during the admission revealed gross albuminuria, markedly elevated E. S. R. and polyclonal hyper-γ-globuminemia. Radiographical examination suggested a left renal tumor. A mass, which was at the upper ventral portion of the left resected kidney, was localized closely outside of its fibrous capsule. The mass revealed plasma cell granuloma histologically. The following histological examination revealed amyloidosis of the bilateral kidneys. His chief complaints have been diminished except for slight albuminuria by the conservative treatment in the Internal Medicine.
In last 10 years, 1967-1976, about 409 cases of amyloidosis have been reviewed in Japanese literature, which have include 78 cases of secondary amyloidosis. No case of renal amyloidosis caused by plasma cell granuloma in renal region has been reviewed previously.

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Herein we described an improved technique of coagulum pyelolithotomy using autologous plasma and bovine thrombin.
Prior to the clinical practice, laboratory works showed that the best coagula were formed at the rate of 40U thrombin and 1ml plasma and were soluble in urine within twelve hours at 37°C surroundings.
12 patients have been operated on by our coagulum pyelolithotomy using their autologous plasma with successful results.
It is worthy of notice that additional stones beyond roentgenographic expection were extracted in 4 patients, thus suggesting the possibility of preventing the pseudo-recurrence of renal calculus following surgical removal.

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30mg of Adriamycin (ADM) was administered to eleven patients with bladder tumor by intravesical instillation combined with hydrostatic pressure technique.
The results of the treatment evaluated from cystoscopic findings as well as clinical course were markedly effective in 4 cases, effective in 6 cases and noneffective in 1 case.
Urinary recovery of ADM of the patients treated by intravesical instillation combined with hydrostatic pressure technique (16.6-60.9%) was markedly decreased in comparison with the patients by intravesical instillation alone (63.4-102.4%), although serum concentrations of ADM made no difference between them.
More ADM seemed to be taken in the bladder wall by enhancement with hydrostatic pressure, which was further confirmed by estimating ADM content of several bladder tissue of dogs both with instillation of ADM combined with hydrostatic pressure and instillation of ADM alone.
The new treatment of intravesical instillation of ADM enhanced with adjuvant hydrostatic pressure technique would be advisable for the treatment of the patients with high stage bladder tumor also.

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Urodynamic examinations (cystometry with simultaneous recording of anal sphincter electromyography, urethral pressure profile and uroflowmetry) were performed in 46 patients with benign prostatic hypertrophy.
The preoperative cystometry showed detrusor hyperreflexia in 25% of total cases and it was thought that detrusor hyperreflexia was a cause of pollakisuria which was one of the chief complaints of patients with benign prostatic hypertrophy.
The urethral pressure profile of these patients had significantly elongated functional profile length and prostatic profile length.
Postoperatively, these lengths were significantly shortened.
These lengths showed a tendency to correlate with the size of adenoma and its clinical diagnostic value was discussed.
In uroflowmetry, maximum flow rates and average flow rates were decreased preoperatively, but increased postoperatively.
The correlation between voided volume and these two parameters was increased postoperatively.
Significant difference could not be showed in uroflowmetry between the small sized adenoma group and the large sized adenoma group.
Objectively, its results showed that the difficulty of micturition was never correlated with the size of adenoma.
We tried objective analysis of micturition disturbance by uroflowmetry and emphasised that the difficulty of micturition was caused by organic mechanical obstruction in patients with benign prostatic hypertrophy.

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A case of primary hyperoxaluria with calcium oxalate nephrolithiasis was presented.
The patient, 24 years old male, was quite well until the age of 15 when he was diagnosed as having left renal stones with symptoms of colic pain and hematuria. At the age of 19, he was operated for pyelolithotomy under the diagnosis of right renal stones. Following this operation he passed multiple stones during 5 years. Finally he came to our clinic and was diagnosed as having left multiple renal stones and right nephrocalcinosis.
The removed staghorn calculi from the left kidney by nephrolithotomy in March, 18th. 1977 was analysed as pure calcium oxalate monohydrate by infrared spectrophotomater. The histological examination of the biopsy specimen demonstrated multiple deposits of crystalline material in the renal tubules under the polarizing microscope.
From these results the abnormal oxalate metabolism was suspected, so that the urinary excretion of oxalic acid was measured. His urinary excretion of oxalic acid was markedly elevated to 140mg/24hrs (167.5mg/gr creatinine), but the excretion was within normal range in his parents and relatives.
According to these findings he was prescribed pyridoxal phosphate 180mg/day under the diagnosis of primary hyperoxaluria. However the treatment was not effective. At present he is on hemodialysis because of postoperative progressive renal deterioration.

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A transcatheter embolization (TcE) procedure was performed in six patients with renal cell carcinoma, using Gelfoam^® (artificial fibrin foam) containing an anticancer agent. Of these patients, five also underwent nephrectomy 2-19 days after this embolization procedure. During the surgical operation, the tumor was observed to be edematous, and the magnitude of vascular dilation was mild. The impression was that in these five cases, the operation was easy to perform. In the remaining one, where an operation was judged to be impossible to carry out, the TcE was given three times, and as a result, the tumor regressed. Gelfoam was present in the capillary vessels in the glomeruli in the histological samples collected two days after the TcE, and disappeared in the samples taken 19 days after. Adverse reactions observed included pain, fever and meteorism tympanites.
The manipulation of this method is simple and can easily be repeated. If surgical operation is impossible, this method is worth trying.

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A 9-year-old girl who had urethro-vaginal fistula due to a traffic accident underwent bilateral ureterosigmoidostomy on December 29, 1952. For a few years after operation, she had suffered from pyelonephritis once a year. In December, 1969, at the age of 26, she married. At the age of 28, she became pregnant and had frequent episodes of pyelonephritis during the last 4 months of pregnancy. In January, 1972, she was delivered of a normal girl at full term through vagina. After the delivery, she has been asymptomatic. In March, 1978, IVP revealed normal excretory systems. However, slight anemia and hyperchloremic acidosis were noted. Literatures concerning the pregnancy in the presence of ureterosigmoidostomy were reviewed.

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