1) Disintegration of urinary calculi was intened by the use of laser beam.
2) As the first step, perforation of extracted urinary stones was attempted using CO₂ gas laser beam (continuous wave) and ruby laser beam (pulse). Stones were perforated rather easily by either laser beam.
3) We are planning to continue the fundamental studies for future development of a method of disintegration of urinary calculi, including influence of laser beam on the wall of the urinary tract.

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Excretion levels and pattern of amino acids in urine were studied on 79 cases (52 males and 27 females) with calculus in the upper urinay tract, and compared with that obtained on 30 males and 17 females in the non-calculus group, respectively. The results were as follows:
1) No difference was observed on the sorts of free amino acids excreted in urine between both groups.
2) In the 24-hour excretion levels, the total amino acid amounts were not so different in the male subjects of both groups; as to individual amino acids, significant reduction of α-amino adipic acid and a reducing tendency of glycine were observed in the calculus group. In the females, the calculus group showed a significant reduction of the total amino acid amounts as well as of individual amino acid amounts of threonine, asparagine, glycine, cystine, lysine and histidine.
3) As to the excretion pattern, the ratios of phsophoserine, taurine and lysine increased and the ratio of glycine tended to reduce in the males, though the changes were not significant; in the females, the ratios of phosphoserine, taurine, alanine, isoleucine and arginine increased and the ratios of asparagine and glycine tended to reduce: particularly, phosphoserine, alanine, isoleucine and asparagine showed a significant difference statistically.
4) When compared based on the values corrected by the endogenous creatinine clearance over 24h. per 1.48m² value, the males did not show any difference, but the females in the calculus group exhibited a significant reduction of asparagine and a reduction tendency of glycine.
According to the results described above, particularly the reduction tendency of glycine, an abnormal metabolism of glycine may be assumed in the calculus group.

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The effect of urokinase on thio-TEPA toxicity has been studied in monolayer cultures of KK-47 cell line, which was established from a human bladder carinoma in our department in 1977.
The results obtained are as follows:
1. The cell growth curve consisted of a 2-day lag phase and a 5-day logarithmic phase followed by a stationary phase. The average doubling time for the cells on Ham's F12 medium supplemented with 20 per cent calf serum was approximately 36 hours.
2. Thio-TEPA in Ham's F12 medium supplemented with 20 per cent calf serum was stable for 72 hours on incubation at 37°C. Urokinase and thio-TEPA showed no deteriorating effect on each other under some mixing conditions.
3. Remarkable toxicities of thio-TEPA were observed with each exposure of 2 and 24 hours at concentrations of the agent between 10-1 and 102μg/ml. Value of IC 50 at the 2-hour exposure was approximately 10μg/ml. A potent inhibitory effect of urokinase against the propagation of the cells in vitro was observed at a concentration of 100CTAu./ml, although there was no significant change in cell growth at concentrations ranging from 10^-4 to 10 CTA u./ml.
4. Using methods, of assessing cell growth and ³H-thymidine uptake, a combined use of urokinase (10 CTA u./ml) and thio-TEPA (10μg/ml) resulted in a significant increase of the thio-TEPA toxicity with both the exposure times.
5. A peak in ³²P-thio-TEPA uptake in the cells was observed 2 hours after administration of the agent (0.1μCi/10μg/ml), and about 2-time increase in the peak was obtained by adding urokinase (10 CTA u./ml).
From the results, it is quite possible to say that the increased cytotoxicity may be related with a gross change in cell permeability to thio-TEPA through plasminogen activation by urokinase.
Because of the substantial effect of urokinase obtained in vitro, a possible usefulness of urokinase as an adjunct to the topical use of thio-TEPA in the treatment of bladder carcinoma is discussed.

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1. Twenty-nine human urogenital tumors were transplanted into athymic nude mice with the genetic background of BALB/c which were kept under the specific pathogen free condition. The results were as follows (Table 1):
1) The tumor take was confirmed in 12 of the neoplasms, which consisted of 2 (66%) of
3 renal cell carcinomas, 1 (50%) of 2 ureteral carcinomas, 8 (80%) of carcinomas of the urinary bladder and 1 (11%) of 9 testicular tumors.
2) Of these neoplasms, 7 serially transplantable tumors were established, including 2 (100%) of the renal cell carcinomas and 5 (62.5%) of the carcinomas of the urinary bladder.
3) At present, the longest maintenance is in the 6th passage and the shortest in the 2nd passage, both being of the carcinomas of the urinary bladder.
4) No metastatic lesions were revealed in any of the nude mice transplanted with tumors.
2. Of the 7 maintained tumors, 2 renal cell carcinomas and 2 carcinomas of the urinary bladder were examined in detail by light microscopy, and it was proved that the 1st and 2nd passage retained the original morphological characteristics well (Fig. 2-10).
3. A human prostatic carcinoma which was in the 14 passage in nude mice at the examination was treated as described below.
1) ⁶⁰Co irradiation was performed once over the whole body. Since all nude mice, both of 1000 rad and 2000 rad groups, died early, the statistical evaluation could not be made on their growth curves (Fig. 11). Histological damages to the tumor used were revealed in light and electron microscopic findings, so that irradiation appeared to become more effective if performed by an improved method (Fig. 19-21, 31).
2) Administration of adriamycin in the intraperitoneal doses of 1, 2 and 4mg/kg was shown to be ineffective against the tumor used either by the growth curve or by light microscopic examination (Fig. 12, 22). Electron microscopy, however, proved the drug to have been more or less effective in treating the tumor (Fig. 32).
3) Administration of estramustine phosphate did not elicit retardation in tumor growth (Fig. 13). By electron microscopy, however, the activity of this drug on tumor tissue was more distinct than by microscopy (Fig. 23, 33).
4) Platinum complex preparation were administered twice (day 1 and 5 after transplatation) to nude mice intraperitoneally. In CPDD (cis platinum (II) dichlorodiamine) 5mg/kg and FOCD (platinum oxalate cis dach) 20mg/kg groups, significant inhibitory effects on tumor growth were revealed in terms of growth curves and by histological examination by light and electron microscopies (Fig. 14, 15, 25-29, 35).

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Percutaneous puncture technique using ultrasonic real-time scanner is described. A special puncture attachment was newly developed for this purpose, which is fastened to a handy mechanical real-time sector scanner (ALOKA ASU-25-7C). A puncture needle is introduced into the scanning plane by the attachment. The real-time image of both the target lesion and the needle are produced on an oscilloscope. By this technique, accurate puncture not only to cystic structure but also to solid mass can be made easily and safely. The technique has been successfully used for renal cyst puncture, percutaneous pyelography, percutaneous nephrostomy, percutaneous renal biopsy and perineal prostatic biopsy. No complications occurred.

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A classification for the degree of varicocele is determined in general practice by inspection and palpation alone. This, however, did not seem to be a most useful indicator. A new diagnostic technique is necessary for accurate and reliable interpretation of varicocle.
Fifteen patients with grades II or III varicoceles were studied by the method of ^99mTC scrotal scan.
Information from scrotal radionuclide image was correlated well with the clinical course and the venographic findings. The feature of varicocele was showed in perfusion phase rather than tissue phase. This technique reflect the vascular flow from the testis, but the scrotal image should be reviewed along with the clinical as well as the other routine data.
We emphasize that scrotal scan is a useful method for the detection of varicocele and may give excellent support in the dagnosis of subclinical varicocele.

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As one of the fundamental researches for the development of microexploxion lithotripsy, we measured the water absorption rate and the weight decrease rate in dryness on 8 urinary calculi. And on other 8 urinary calculi, we also measured the compressive strength and the modulus of elasticity in both dry and wet conditions. The results were as follows:
1) The water absorption rate was from 1.3 to 21.0%.
2) The weight decrease rate in dryness was from 3.4 to 19.2%.
3) The compressive strength was, from 11 to 61kg/cm² in dry condition, from 6.6 to 36kg/cm² in wet condition. The ratio wet to dry condition was from 0.32 to 1.04 (mean 0.67±0.26).
4) The modulus of elasticity was, from 11.5×10⁸ dyne/cm² to 47.8×10⁸ dyne/cm² in dry condition, from 3.8×10⁸ dyne/cm² to 23.6×10⁸ dyne/cm² in wet condition. The ratio wet to dry condition was from 0.26 to 1.10 (mean 0.66±.030).
5) When a calculus model for destruction test is prepared, ti may not be necessary to take the layer formation of calculus into consideration. The strength of the model in the wet condition should be similar to, or slightly lower than the value estimated in the former report.

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The renal growth in children with primary reflux, congenital hydronephrosis, non-refluxing megaloureter, neurogenic bladder, renovascular hypertension, solitary kidney and glomerulonephritis was investigated.
Renal ratio (renal length/length of L2 plus its disc), Parenchymal ratio (renal Parenchymal section area/renal section area) and Parenchym-Vertebral ratio (renal Parenchymal section area/the distance from the top of L1 to the bottom of L4 vertebral bodies×width of L2) in children with these diseases were compared with those in normal children.
1) Primary reflux: Renal ratio and Parenchymal ratio were useful to make prognosis and to follow up the primary reflux.
In 64% of grade 3 reflux, Parenchymal ratio of initial IVP was below -2 S. D. Before the 5 years of age the Parenchymal ratio was below -2 S. D. in only 17% while after the 6 years of age it was below -2 S. D. in 83% of the patients.
Disturbance of renal growth seems to appear after the 5 years of age, thus indicating antireflux surgery to be done before then in grade 3 reflux.
In grade 1 and 2 reflux, there is no indication for an immediate operation since there remains a possibility of spontaneous cessation of reflus providing Renal ratio and Parenchymal ratio were in the normal range.
2) Congenital hydronephrosis: Prenchymal ratio was the most useful index to determine the result of plastic surgery. In the follow up of renal growth after the operation, Parenchym-Vertebral ratio and Renal ratio were useful when compared with normal growth chart.
3) Non-refluxing megaloureter: By serial determination of Parenchymal ratio after the operation, we can perceive the improvement of the kidny, and if reflux occurred in the operated unit, we can predict it fairly accurately.
4) Congenital neurogenic bladder: The parenchyma) ratio and Renal ratio were under -2 S. D. in the initial IVP only in the refluxing kidney. The Renal ratio and Parenchymal ratio were useful in determining the choise of treatment for the neurogenic bladder.
5) In the children with suspected glomerulonephritis: Renal ratio and Parenchymal ratio were all in the normal range.
6) Congenital or acquired solitary kidney: In all solitary kidneys, Parenchymal ratio was normal. Renal ratio and Parenchym-Vertebral ratio were useful to estimate the rate of hypertrophy. Hypertrophy of residual kidney after unilateral nephrectomy was seen already in a month postoperatively and continued for another six months.
In two cases of Wilms tumor who demonstrated severe side effect from chemotherapy, hypertrophy was less significant than in another 3 cases without adverse reaction to it.

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A clinical analysis of selective adrenal venography on 17 cases of primary aldosteronism, 5 cases of
Cushing's syndrome, 3 cases of pheochromocytoma, 1 case of adreno-cortical carcinoma, 1 case of adreno-genital syndrome and 1 case of unilateral adrenal hematoma revealed the following findings.
As for complications, one patient having aldosteronoma exhibited transient mild tetany-like seizure during the examination and two patients experienced a moderate pain after rupture of their adrenal veins. The pheochromocytoma cases did not show any blood pressure change during the procedure. Adrenal venography can be performed without grave untoward effects if proper cares are paid to the procedure.
16 cases out of 17 aldosteronomas were diagnosed accurately by the venography and their chief findings were circular vein around oval avascular or blushed area, shift or obstruction of the central vein, and radiating veins.
In contrast to the similar venographic findings of Cushing's syndrome producing adenoma to that of aldosteronoma, 3 cases of nodular hyperplasia showed mesh-like patterns.
From the above findings, venographic patterns of adrenocortical tumors were divided into “egg in egg-cup”, “basket”, “balloon catheter-tip”, “spoke of a wheel”, and “mesh”.
Selective adrenal venography could viscualize the tumor size and the venous vascularity in addition to the laterality of the masses in 3 cases of pheochromocytoma which were not demonstrated well by the other locality diagnosing techniques.
The adreno-cortical carcinoma case showed “cut off” of the large central vein associated with marked weaving vein.
In conclusion, adrenal venography in combination with selective venous sampling method can furnish us with valuable informations regarding adrenal mass lesions if performed under meticulous care and skill.

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The role of the kidney in the post-DCA hypertension of rats was studied by the renal transplantation, utilizing the microsurgical technique of Lee. DCA hypertension was made by subcutaneous injection of desoxycorticosterone acetate (DCA) on weekly basis and administration of 1% saline as drinking water.
The increase in body weight of the experimental group received DCA and 1% saline was smaller than that of the control. But, after cessation of this treatment, the gain of the weight was equal in both groups. The daily fluid intake and the urine output were increased during the the treatment and they returned to the control level about 7 days after cessation of the treatment. The significant elevation of blood pressure was seen after one week of DCA treatment and remained high for 3 months in spite of discontinuance of the treatment.
This type of hypertension (post-DCA ehypertension) was obtained in about 60-70% of the rats thus treated.
Histologically, post-DCA hypertensive kidney showed the degeneration of the glomeruli and tubuli, and arteriolar sclerosis.
As the blood pressure of the normotensive rats transplanted with post-DCA hypertensive kidney elevated markedly, the kidney may play the major role in post-DCA hypertension.
Possible explanation of the role of the kidney in the development of post-DCA hypertension was discussed.

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A statistical study was performed on spontaneous passage of ureteral stones which we treated during the two-year period from 1974 to 1975. Stones spontaneously discharged were 100 (from 97 patiens) out of 288 stones (from 281 patients).
The 100 ureteral stones were divided into four groups on the basis of their size on X-ray films; Group-1: Stones of 6mm or less in both minor and major axes. Group-2: Stones of 6mm or less in minor axis and 7 to 10mm in major axis. Group-3: Stones of 6mm or less in minor axis and 11mm or more in major axis. Group-4: Stones of 7 to 10m in both minor and major axes. X-ray examination was carried out to know whether stones were in the pelvic cavity or in the pelvic bone and/or lumbar region.
Of 70 stones in the plvic cavity, 40 (57.1%) were spontaneously discharged within 30 days, 21 (30.0%) in 31 to 90 days and 6 (8.6%) in 91 to 180 days. Of 30 stones in the pelvic bone and/or lumbar region, 5 (16.7%) were spontaneously discharged within 30 days, 11 (36.9%) in 31 to 90 days and 6 (20.0%) in 91 to 180 days.
There were 49 stones that were in the pelvic cavity and were classified into Group-1 (stones of 6mm or less in both minor and major axes). Among them, 29 stones (59.2%) were spontaneously discharged within 30 days, 14 (28.6%) in 31 to 90 days and 4 (8.2%) in 91 to 180 days. Of 17 Group-2 stones (as defined above) in the pelvic cavity, 9 (52.9%) were spontaneously discharged within 30 days, 5 (29.1%) in 31 to 90 days and 2 (11.8%) in 91 to 180 days. Of 3 Group-3 stones (as defined above) in the pelvic cavity, 2 (66.7%) were spontaneously discharged within 30 days and one (33.3%) in 31 to 90 days. A stone in the pelvic cavity of Group 4 (as defined above) was spontaneously discharged in 31 to 90 days (100%).
Stones that were in the pelvic bone and/or lumbar region and belonged to Group-1 (as defined above) were 16, of which 4 (25.0%) were spontaneously discharged within 30 days, 8 (50.0%) in 31 to 90 days and 4 (25.0%) in 91 to 180 days. Of 8 Group-2 stones (as defined above) in the pelvic bone and/or lumbar region, one (12.5%) was spontaneously discharged within 30 days, 2 (25.0%) in 31 to 90 days and one (12.5%) in 91 to 180 days. Of 3 group-3 stones (as defined above) in the pelvic bone and/or lumbar region, one (33.3%) was spontaneously discharged in 31 to 90 days. For the remaining two stones, spontaneous passage occurred in 181 days or more. Three stones in the pelvic bone and/or lumbar region of Group-4 (as defined above) were all discharged spontaneously in 181 days or more (100%).
The rate of stones spontaneously discharged from the pelvic cavity was similar among four groups that were defined in accordance with stone size (no statistically significant difference among groups). As to stones in the pelvic bone and/or lumbar region, those assigned to Croup 1 had the highest rate of spontaneous passage (with a statistically significant difference). An X-ray film showing site and size of ureteral stones may permit us to tell the time of their spontaneous passage in advance.
Seventy-one patients with ureteral stones who had been treated in our department during the period from 1974 to 1975 were followed up for recurrence. Ureteral stones recurred in 26 of 71 patients (36.6%). The incidence was independent of sex, 36.7% in men and 36.4% in women. The incidenc of recurrence according to primary treatment was 31.8% after ureterolithotomy, 50 after removal by basket catheter method and 38.7% after spontaneous passage. Of 26 recurring cases, 15 (57.7%) had recurrence once, 6 (23.1%) twice, 2 (7.7%) three times and 3 (11.5%) four times or more. Thus, the average frequency of recurrence was 1.96. Of these 26 patients, 4 (15.4%) had a recurrence within a year after primary treatment, 10 (38.5%) within 2 years and 13 (50.0%) within 3 years. The interval between primary treatment and recurrence was 5 years and 5 months on the average.

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