Ninety cases of urinary bladder cancer treated by radical cystectomy with pelvic nodes dissection were reviewed.
The five year survival rate of the transitional cell carcinoma cases of in low and high stage was 80.6% and 39.7% respectively. Urethral recurrence following cystectomy was observed in 7.4%. Sixty-four cases had no lymph node involvement, and the five years survival rate of these cases was 92.9%. In twenty-six cases, more than one lymph node involvement was disclosed and the five years survival rate of these cases was only 26.8%.
Fifty-eight specimens of the bladder were examined by step section of the entire urothelium. The distribution of carcinoma, carcinoma in situ and atypism was schematically illustrated. According to the analysis of schema and tumor growth pattern, bladder cancer could be divided into the following four types: Type 1 is unifocal papillary cancer without invasion. Slight atypism is observed in the vicinity of the neoplasm. Type 2 is multifocal papillary cancer without invasion. Atypism is observed even in the area far from the overt neoplasm. Type 3 is multifocal invasive carcinoma. Multifocal carcinoma in situ is also observed in the area far from the overt neoplasm. Type 4 is unifocal invasive carcinoma. Any preneoplastic change in other mucous membrane is not observed. This type of carcinoma shows a rapid growth and special malignancy.
According to the retrospective analysis of the clinical course of each type, a plan for reasonable treatment of bladder cancer may be proposed as follows.
The 1: This type may be controlled sufficiently by TUR or partial cystectomy when the tumor is in the low stage. When the stage is beyond B, total cystectomy is recommended.
Type 2: This type may be basically controlled by TUR, but the recurrence is observed frequently. Careful follow up of the patients is mandatory and when the stage appears B, total cystectomy is indicated.
Type 3: This type should be treated by total cystectomy including urethrectomy and lymph nodes dissection.
Type 4: In this case total cystectomy and lymph nodes dissection must be performed immediately.

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The purpose of this investigation was to determine if auto-transplantation of the kidneys produces any adverse effects on the ureteral function. Mongrel dogs weighing 13-34kg were used in this study. Under anesthesia with i. v. Na-thiamylal, the kidneys and ureters were exposed transperitoneally and electrodes for EMG were secured at the central part of the ureter. The kidneys removed for auto-transplatation were immediately perfused with heparinized Ringer solution at a pressure of 150cm H₂O. The renal vessels were then anastomosed to the opposite femoral vessels. In another set of experiments, blood flow of the kidney was interrupted for 30-60min by clamping the renal vessels and then restored by releasing the clamp. The duration of the interruption of renal blood flow was similar to that required for renal auto-transplantation. Changes in the action potentials, discharge frequency and propagation rate before and after diuresis were compared. The diuresis group was further divided into 3 stages: the initial, early and diuresis. In the non-diuresis group, the EMG recordings were obtained at the time intervals of 0-20, 21-40 and 41-60min and compared with those of the diuresis group. The results obtained were as follows: Diuresis occurred in 18 out of 26 auto-transplanted kidneys. In the diuresis group, antiperistaltic discharges that had previously seen disappeared after the onset of diuresis and frequency of the action potentials increased as the amount of urine increased. In 8 ureters of the nondiuresis group, peristaltic discharges decreased after auto-transplantation. Peristaltic waves were regular in 5 ureters and irregular in 3 ureters. Before diuresis, the discharge frequency was lower (5.0±2.4/min) than control, but it became higher (14.0±6/min) than control during diuresis. In contrast, the nondiuresis group showed consistently lower discharge frequency than control. There was no difference in the amplitude and duration time between the diuresis and non-diuresis group. The propagation rate was higher in the diuresis group than the nondiuresis group. The action potentials disappeared in 6 out of 10 ureters during interruption of renal blood flow. Regular peritstalsis was seen in 3 ureters and some antiperistalses were seen in one ureter. Following restoration of the renal blood flow, diuresis occurred in 10 out of 17 ureters. Peristalsis was regular during diuresis, as it was in the auto-transplanted ureters. In the non-diuresis group, action potentials appeared in all but one. Regular peristalsis was seen in 3 ureters. Irregular peristalsis was seen in 6 ureters, 4 of which had some antiperistases. The frequency of the action potentials was 4.8±1.9/min in the prediuresis and 9.9±3.2/min during diuresis. The discharge frequency in the non-diuresis group was 3.8±2.6/min 20min after restoration of renal blood flow, but thereafter it increased to 8.1±3.0/min. There was no difference in the amplitude and duration between the diuresis and non-diuresis groups.
In contrast to the auto-transplanted ureters, the propagation rate of the hemoccluded ureters was lower in the diuresis group than the non-diuresis group. Thus, the ureteral function of the auto-transplanted kidneys did not significantly differ from that of the kidneys with interruprion of renal blood flow before diuresis. During diuresis, however, the difference between the two became evident, i. e., the ureters of the auto-transplanted kidneys were more active than those of the kidneys with the interruption of renal blood flow. However, the amount of urine was greater in the auto-transplanted kikneys than the hemoccluded kidneys. This may account for the difference in the ureteral activity observed between the two group. These results suggest that auto-transplantation of the kidneys if performed within 60min does not produce any adverse effects on the ureteral function.

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1) The operation for bladder enlargement devised by Taguchi, making use of the regenerative ability of the bladder, was done on 35 cases of bladder tumor and contracted bladder admitted at Sagamihara National Hospital from 1970 to 1979. 17 cases (30 specimens) in which the capacity increased to above 200ml were biopsied under fixed conditions from 2 months until 6 years postoperatively and were examined histologically. Regenerating processes were also examined by cystoscopy.
2) The regenerated vesical wall which was not covered with mucosa about 2 months postoperatively was a granulation wall chiefly composed of fibroblasts and blood capillaries. Slight fibrous connective tissue and round cell infiltration were also occasionally found.
3) The regenerated vesical wall which was covered with mucosa about 6 months postoperatively revealed none or one layer of immature epithelium and the same connective tissue as seen at about 2 months.
4) Specimens taken during 1 to 3 years postoperatively showed 1 to 3 layers of epithelium and connective tissue composed of fibroblast, fibers and collageneous connective tissue. More than 4 years postoperatively, the epithelium was 3 to 6 layers thick with loose connective tissue.
5) As for the muscular tissue, a few muscle like cells were found after about one to one and a half years. These cells increased in number gradually. After about 2 years the tendency of aggregation of muscle fibers was found. Between 2 to 4 years postoperatively, more aggregations of muscle fibers were found. More than 4 years later almost normal muscle fiber bundles were seen.
6) The growth of epithelium, connective tissue and muscular tissue were parallel with the elapsed time after operation. These findings indicated that there were not only the real regeneration of epithelium and connective tissue but also muscular tissue. However it takes long time more than 4 years, until almost normal muscle fiberr bundles are found.
7) Fibroblasts were also thought to be the source of regeneration of smooth muscular tissue in addition to the edge of the residual bladder wall.
8) Two cases which did not recover sufficient bladder capacity were diagnosed as interstitial cystitis.

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As an additional treatment following radical orchiectomy in patients with non-seminomatous testi cular tumor, stages I and II, the retroperitoneal lymph node dissection has been generally employed in the U. S. A, and satisfactory results have been recently reported. On the contrary, it has been reported in Europe that satisfactory results have been obtained with postoperative radiotherapy alone.
Retroperitoneal lymph node dissection following radical orchiectomy is not yet popular in Japan and concerning its indication, the opinion of Japanese urologists is still diverse.
Clinical observations on cases with non-seminomatous testicular tumors have been done since 1962. In this paper, clinical study on 19 patients with retroperitoneal lymph node dissection following radical orchiectomy is reported.
In 13 out of the 19 cases, dissection was complete. However, in the remaining 6 cases, it was incomplete. In the 13 cases with complete dissection, the number of stage I and II were 7 and 6 cases, respectively. In all of the former cases, lymph node metastasis was not found histologically. However, in 3 out of the latter 6 cases, lymph node metastasis was demonstrated.
The 3 year survival rate in stage I and II with lymph node dissection was 83 and 100 per cent, respectively.
The 3 year survival rate in stage I without lymph node dissection was 90. 5 per cent.
As for the accuracy rate of preoperative lymphangiographic diagnosis, the false positive and negative rates were 43 and 0 per cent, respectively.
From the results above mentioned, it may be conjectured that in cases with stage I non-seminomatous testicular tumor, radical orchiectomy plus retroperitoneal radiation therapy alone may obtain satisfact ory results. However, in cases with questionable lymphangiographic findings, retroperitoneal lymph node dissection should be performed following radical orchiectomy.

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Twenty-one (21) patients with renal carcinoma were treated with transcatheter embolization of the renal artery (hereafter referred to as embolization). Twelve of them underwent embolization as preoperative treatment for nephrectomy and the remaining 9 patients as conservative treatment because of unsuitability for operation. After clinical research for the merits of embolization, the following results were obtained.
1. Effect of embolization as preoperative treatment in patients expecting nephrectomy
a. Nephrectomy
Embolization facilitated the performance of nephrectomy since it induced ischemia, atrophy and fibrosis of the vein on the surface of the tumor and also an atrophic contraction of the tumor. The mean volume of blood loss during operation was 475ml and the mean operation time was 2hours and 35minutes.
b. Pathological findings
It was difficult to find viable tumorous cells on the tumor macroscopically 24 hours after embolization but it was possible to microscopically detect clusters of tumorous cells here and there on the tumor at that time. In all the patients nephrectomized three days or more after embolization, much lymphocyte infiltration and fibrous capsule formation were observed on the growing point of the tumor.
c. Prognosis
All 7 patients who were without distant metastasis of tumor before embolization survived for 9 to 32months after embolization with a mean of 18.7months without distant metastasis. Of five patients who had had distant metastasis of tumor before embolization, one died 2months after embolization and four survived for 2 to 26months after embolization, with a mean of 13.2 months.
2. Effect of embolization as conservative treatment in patients unsuitable for nephrectomy
Symptomatic relief due to embolization was obtained: hemostasis against hematuria, mitigation or disappearance of pain, reduction of abdominal mass, and mitigation or disappearance of fever and hypertension. In combination with immunotherapy and hormone therapy, the embolization was clinically useful in 7 of the 9 patients. All of them had cancer in the terminal stages with a wide range of distant metastases or obstruction of the vena cava inferior, but 5 of them survived for more than 1 year.
3. Material for embolization
Re-canalization of the renal artery was observed in 3 patients in whom a gelatine sponge was used over a long period as material for the embolization. Therefore, when a gelatine sponge is used for embolization performed as a conservative treatment for renal carcinoma, alternate renal arteriography and embolization every a few months seems to be necessary. It is desirable to use a more permanent obstructive material than gelatine sponge, e. g. 1-isobutyl-2-cyanoacrylate. This material is appropriate for the purpose because an obstructive effect is obtained with a small amount, even thin arterial branches are obstructed without any trouble and there is little tissue reaction on the obstructed site.
4. Local administration of anticancer drugs through embolization
In patients undergoing embolization with a gelatin sponge containing a high concentration of adriamycin, the drug soon disappeared from peripheral blood, but it was retained longer in the tumor tissue.
5. Clinical course after embolization
a. Side effects commonly encountered after embolization are flank pain, fever and hypertension which are transient and readily controllable by symptomatic treatment. When these symptoms continue for a long period, there is a high possibility of imperfect artery obstruction, re-canalization of the renal artery or progress of the primary disease.
b. Blood and blood-chemistry changes after embolization are described as follows.
1) RBC and hemoglobin level decreased significantly from 1week after embolization and anemia continued for 3 to 4months.
2) Platelet counts increased significantly 3weeks to 1month after embolization.
3) WBC increased significantly immediately

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Host immune response after transcatheter embolization and subsequent nephrectomy for renal carcinoma was examined from laboratory findings such as albumin. to globulin ratio (A/G ratio), α₂-globulin, γ-globulin, WBC, neutrophils and lymphocytes in the peripheral blood and in vitro lymphocyte response to phytohemagglutinin mitogen (PHA) and poke weed mitogen (PWM). The following results were obtained.
1) Patients with renal carcinoma had A/G ratio: 1.10±0.28, (mean±standard deviation) globulin: 12.8±2.6%, γ-globulin: 20.0±6.1% and lymphocytes: 2, 128±705/mm³. Their A/G ratio was lower and α₂ globulin was higher than those in healthy volunteers. A/G ratio of patients with distant metastasis was 0.97±0.24, while the value of those without distant metastasis was 1.28±0.24. The former value was significantly lower than the latter.
After embolization, A-G ratio decreased, α₂-globulin and γ-globulin increased and lymphocytes decreased. These were significant changes compared with the values before embolization. These values tended to return gradually to the pre-embolization levels.
In patients nephrectomized within a few weeks after embolization, A/G ratio, α₂-globulin and γ-globulin returned to normal within 3months after operation, with a significant improvement rate.
2) In patients with renal carcinoma, lymphocyte response to PHA and PWM was 17, 790±7, 221 and 14, 972±11, 923cpm respectively. These values were lower than those in healthy volunteers. There were few differences in values between patients with and without distant metastasis of carcinoma.
After embolization, lymphocyte response to both PHA and PWM decreased slightly for a short period but not significantly as compared with the values before embolization. There were no significant differences even after long-term observation.
In patients nephrectomized within a few weeks after embolization, the values rose or tended to rise significantly from 2months after operation as compared with the values before embolization.
3) The inhibitory percent of lymphocyte response to PHA in patients with renal carcinoma was calculated from the difference between the response values at the time of addition of autologous plasma and pooled homologous plasma against host lymphocytes. The value thus obtained was 20.6±19.8%. There was a significant difference in inhibitory rate between patients with distant metastasis (30.1±19.6%) and those without distant metastasis (8.4±13.0%).
After embolization in patients both with and without distant metastasis, the inhibitory percent of lymphocyte response to PHA rose to 43.4±27.4% on the 2nd week and thereafter returned to the preembolization levels. The changes were not significant, as compared with the values before embolization.
In patients nephrectomized after embolization, the inhibitory percent of lymphocyte response to PHA decreased significantly from 2months after operation as compared with the levels before embolization.
4) One patient who underwent embolization was given an immuno-potentiator both locally and systemically and a favourable clinical course was obtained. It was observed that there was a correlation between changes of clinical course and immunological parameters.

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Adriamycin was given to rats for the purpose of establishing an effective dosing method of chemotherapeutic agents for malignant renal carcinoma. The rats were divided into three groups, 1) intravenous injection group given a single dose of 5mg/kg into the caudal vein, 2) arterial injection group given a single dose of 1mg/kg into the renal artery and 3) embolization group undergoing transcatheter embolization of the renal artery with a gelatine sponge containing 1/mg/kg. Pharmacokinetics of adriamycin in these groups were investigated and the following results were obtained.
1. The serum concentration of adriamycin 1 hour after dosing was 0.74±0.05μg/ml (mean±standard error) in the intravenous injection group, 0.22±0.04μg/ml in the arterial injection group and 0.21±0.06μg/ml in the embolization group. Serum concentration thereafter was maintained at low levels in the descending order of intravenous injection, arterial injection and embolization. The drug became undetectable 6 hours after dosing in the arterial injection group, and 48 hours after dosing in both intravenous injection and embolization groups.
The half life of adriamycin in the blood was 6.5 hours by intravenous injection, 1.4hours by embolization and 1.2 hours by arterial injection.
2. The peak concentration of adriamycin in the kidneys was 45.39±8.90μg/g 2 hours after dosing in the intravenous injection group, 48.57±7.65μgg 1 hour after dosing in the arterial injection group and 170.45±37.39/μg 1 hour after dosing in the embolization group. The renal concentration of the drug thereafter changed similarly in both intravenous injection and arterial injection groups, wheras it was approximately 3 to 6 times higher in the embolization group than in the two other groups.
The half life of adriamycin in the kikneys was 63 hours by intravenous injection, 58 hours by embolization and 46 hours by arterial injection.
3. The concentrations of adriamycin in organs other than the kidneys were as follows:
a. The peak concentration in the liver was 47.32±4.88μg/g 2 hours after dosing in the intravenous injection group, 9.23±1.31μg/g 2 hours after dosing in the arterial injection group and 13.76±0.53μg/g 1 hour after dosing in the embolization group. The drug concentrations thereafter changed similarly in the arterial injection and embolization groups, and were approximately 1/3 to 1/6 of those of the intravenous injection group.
b. The peak concentration of adriamycin in the prostate was 6.07±0.22μg/g 2 hours after dosing in the intravenous injection group, 1.47±0.60μg/g 3 hours after dosing in the arterial injection group and 0.97±0.17μg/g 2 hours after dosing in the embolization group. The drug concentrations therafter changed similarly in the arterial injection and embolization groups and was approximately 1/5 to 1/17 of those of the intravenous injection group.
c. The peak concentration of adriamycin in the bladder was 7.19±1.03μg/g 2 hours after dosing in the intravenous injection group, 3.46±0.74μg/g 1 hour after dosing in the arterial injection group and 1.46±0.15μg/g 3 hours after dosing in the embolization group. The drug concentrations thereafter changed similarly in the arterial injection and embolization groups and were approximately 1/2 to 1/8 of those of the intravenous injection group.
d. The peak concentration of adriamycin in the lymph nodes was 19.23μg/g 2 hours after dosing in the intravenous injection groups, 7.71μg/g 1 hour after dosing in the arterial injection group and 5.65μg/g 1 hour after dosing in the embolization group. The drug concentrations thereafter changed similarly in the arterial injection and embolization groups and were approximately 1/4 to 1/20 of those of the intravenous injection group.
e. The half life of adriamycin in the intravenous injectio

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To evaluate the relationship between cell surface glycoprotein and embryonic development and to find out possible tumor markers, Specific Red Cell Adherence test (SRCA) was applied to 20 patients with testicular tumors. SRCA was developed by Davidsohn and can detect cell surface ABH blood group substances, which are glycoproteins or glycolipids, on formalin-fixed paraffin-embedded tissues. Blood group 0 patients were not included and the tumors examined were; 14 seminomas, 5 embryonal carcinomas, 1 yolk sac tumor, 2 choriocarcinomas, 2 teratomas and 1 rhabdomyosarcoma, when each component of a mixed tumor was counted separately.
All seminomas, typical or anaplastic, choriocarcinomas and a rhabdomyosarcoma showed negative SRCA results. In embryonal carcinomas and a yolk sac tumor erythrocytes of the blood group identical to the patient adhered to the tumors, but they were found only around and not on the tumor cells. Therefore, the presence of blood group substances in these tumors seemed doubtful. In teratomas, skin, hair and glandular tissues gave positive while cartilage and connective tissues gave negative SRCA results thus simulating fetal tissues

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The production of benzidine and β-naphthylamine in Wakayama was started in the early 1920's and continued until Sep. 1972 when the synthesis and handling of these materials were prohibited by law. According to the records of the Wakayama Labor Standard Office, at least 1, 085 workers were exposed mainly to benzidine during this period. Of the 1, 085 workers, 56(5.2%) have been confirmed to have had the urinary tract tumor by this time.
The average age when the tumor of the urinary tract was first disclosed was 53.2±11.3 yrs. (Mean± S.D.) for this occupational group and 64.0±11.5 yrs. for the patients (340pts.) with spontaneous urinary tract tumor. The difference was significant (p<0.001).
The latent period was estimated as 19.9±9.7 yrs. in total, but the older the age of workers at the start of exposure, the shorter their latent period. Especially, the patients who had begun the exposure over 50 revealed a significant reduction of the latent period (9.2±3.1 yrs.)
There was no significant difference in the survival rate between the occupational group and the spontaneous group. The proportions of renal pelvic, ureteral and bladder tumor to each group were also shown to be insignificant.

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Endoscopic management with the modified urethrotome from American Cystoscope Makers, Inc. was performed on 4 cases of disrupted posterior urethra and 2 cases of severe membraneous urethral stenosis.
Techniques are as follows;
1) A central-holed bougie from the bladder into the proximal urethra and a holed-tipped metal catheter from the meatus into the distal urethra were inserted.
2) An edged-wire was bridged between the above instruments.
3) A urethrotome was led via edged-wire by incising the stenotic urethra.
The short-time results were very satisfactorily good in 4 cases and the judgement was suspended in 2 cases. The new method may point out a new direction of surgical treatment of posterior urethral disruption.

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The benign renal tumor of the newborn has received increasing attention in recent years. In the past, it was generally confused with nephroblastoma. The degree of differentiation and the obvious lack of malignant features of this tumor distinguish it from the usual malignant nephroblastoma. Recently, the term “Congenital Mesoblastic Nephroma” has been adopted to describe this tumor. In this paper, two cases of congenital mesoblastic nephromas were studied.
Case 1: A 4-day-old female was admitted for investigation of a left flank mass. There were no urinary symptoms. The child, born 6 weeks prematurely, weighed 2240g at birth. The mother had polyhydramnios for several weeks prior to delivery. The left kidney was resected on August 11, 1976. The specimen measured 6.5×5.5×3.7cm and weighed 69g. The cut surface of the tumor had a yellowish-gray color and watered-silk appearance. There was no hemorrhage or necrosis. Microscopically, tumor was composed of compact interlacing bundles of elongated spindle cells. There was immature cartilage and clustering of vascular channels in tumor. No radiation or chemotherapy was given.
Case 2: A 2800g girl was referred at 2 days of age when a right-sided abdominal tumor was found. The mother had polyhydramnios during the pregnancy but delivery was normal. Right nephrectomy was performed on February 7, 1978. The kidney and renal tumor together measured 10×15×10cm and weighed 170g. The surface of it was smooth and on cut section the mass had a white-yellow color. The histologic and cytologic features were similar to those in case 1. No other therapy was given.
Two patients were well and had no sign of reccurrence of tumor.

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