Four prepubertal boys with Prader-Willi syndrome are herein reported. They were 7-6/12 (Case 1), 5 (Case 2), 3-4/12 (Case 3) and 5-8/12 years old (Case 4) respectively. All of them had typical symptoms, such as hypotonia, hypomentia and hypogonadism (cryptorchidism, small penis and hypoplastic scrotum) and three of them had obesity. Patients of case 2 and 4 had retarded bone age on X-ray examination and that of case 1 had abnormal glucose tolerance.
Endocrinological studies showed normal adrenal and thyroid function in all cases. Plasma growth hormone and thyroid stimulating hormone were also normal before and after administration of insulin and thyrotropin releasing hormone (TRH) respectively. As for plasma prolactin three of them were normal before and after TRH administration, while case 1 showed high basal levels at various ages. As for plasma luteinizing hormone and follicle stimulating hormone, three of them showed normal response to luteinizing hormone releasing hormone, while the patient of case 1 showed a low basal level and response at the age of 7 years old, but showed almost normal response at 10 years old Human chorionic gonadotropin administration caused a variable increase in plasma testosterone (T) and estradiol. However, there was no relationship between plasma T and hypogonadism. Therefore, it was suggested that hypothalamic-pituitary-gonadal function of male patients with Prader-Willi syndrome was variable at prepubertal stage.
This paper contains statistical studies on 61 cases of male patients with Prader-Willi syndrome reported in Japanese literature including our 4 cases.

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The clinical effect of chlormadinone acetate (CMA) on 52 patients with carcinoma of the prostate was investigated. CMA was administered orally 100 mg daily.
45 patients primarily treated consisted of 4 stage A, 4 stage B, 18 stage C and 19 stage D patients. In the early stage patients, the 5 years actual survival rate was 86%. In stage C patients, the mean duration of response was 33 months and after CMA treatment, most of the patients received estrogen therapy. The 5 years actual survival rate was 84%. In stage D patients, the mean duration of response was only 11 months and most of this group was followed by estrogen therapy and/or castration. The 5 years actual survival rate was 11%.
All of the 7 patients reactivated did not show any response to CMA.
The clinical effect of CMA on carcinoma of the prostate seems to be weaker than that of estrogens, but no serious side effects were observed. In conclusion, CMA is valuable in the primary treatment of carcinoma of the prostate.

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Intratesticular allo-implantation of testis tissue of either rats or nude mice was carried out with various combination of ages between donors and recipients. Some of the recipients were administered either immunosuppressants or hCG after the implantation. The viability and spermatogenic function of the grafted tissue were evaluated independently according to the criteria defined on the basis of findings pbtained in the present experiments.
The order of the viable rate of implanted tissues was as follows; between nude mice, between immature rats, and then from immature to mature rats. In the last group, the younger the donor, the better the viable rate. In contrast, no grafted tissues were viable when they were implanted from the mature to another mature rat. The viable rate of tissues grafted from immature to mature rats was improved by administration of immunosuppressants (azathioprine and/or prednisolone) except for the group administered azathioprine alone. No marked changes were observed in the viable rate of grafted tissues between mature rats after administration of hCG to the recipient, which should increase intratesticular concentration of testosterone.
Inhibition and delayed induction of spermatogenesis were observed in the grafts implanted into nude mouse testes. The younger donor resulted in the better induction of spermatogenesis in the grafted tissues of rats. The induced spermatogenesis, however, was impaired in the grafts survived for 182 dyas when compared with those which survived for either 70 or 77 days. Grafted immature testis tissues in immature rat recipients showed promoted induction of spermatogenesis in comparison with that of intact testes at the equivalent age. Administration of immunosuppressants revealed an inhibition of spermatogenesis of testis grafts.
The above results indicate that ageing of grafted tissues including decreased viability against ischernia and manifestation of antigenicity with maturation of germ cells is an important factor affecting their acceptance and spermatogenesis. Endocrine milieu in testes of the recipient was also found to influence the spermatogenic induction in the accepted grafts.

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Patients with bladder cancer and those to be followed up, urine cytological findings and urinary FDP, bladder tissue fibrin deposition and tumor tissue plasminogen activator activity were examined.
The following results were obtained:
1. The combination use of urinary cytology and urinary FDP were useful to those with urinary abnormalities (i. e, redblood cells, leucocytes and albuminuria) and without abnormality as well.
2. The combination use of urinary cytology and urinary FDP estimations were useful for recurrence surpervision and following up patients after partial cystectomy or transurathral resection.
3. The appearance of urinary FDP is closely related to the deposition of fibrin around tumor tissue and the tumor tissue plasminogen activator activity.
It is confirmed that the combination use of urinary cytology and urinary FDP estimation were useful for diagnosis of bladder tumor, recurrence surpervision of tumor, prediction of prognosis and choice of treatment.

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The patients with symptoms simulating chronic bacterial prostatitis are very common in clinical urology, whose urine is sterile and prostatic fluid culture is negative. The pathophysiology of these conditions named as “prostatosis” has not been clearly defined yet. Because of its unknown etiology, efficacy of treatment is very difficult to evaluate. The incidence of “prostatosis” was 5.5 percent of all the outpatients attending Urological Department of Keio University Hospital. On the other hand, the percentage of “prostatosis” among the patients with the diagnosis of chronic prostatitis was 85.8%. In order to evaluate the incidence and importance of psychosomatic factors in prostatosis a systematic study of 44 patients with prostatosis has been carried out. The following investigations were performed on each patient; 1) complete urological examination, 2) psychiatric interviews completed by multidimensional psychometric evaluation. To rule out bacterial prostatitis, urological examination included review of history, physical examination, bacterial examination of urine and prostatic fluid, and urological X-ray studies. Psychiatric evaluation included interviews by a psychiatrist and psychological tests such as Cornell medical index (CMI), manifest anxiety scale (MAS), Yatabe-Gilford test (YG) and sentence completion test (SCT). The average age of the 44 patients was 37.5 year old with the range of 20 to 76 year-old. The number of subjects in each age group was as follows; age 20 to 29, 15, age 30 to 39, 16, age 40 to 49, 3, age 50 to 59, 6, age over 60, 4. The time required from the subjects first visit to the commencement of psychosomatic diagnosis and the number of patients involved were as follows; less than 6 months, 7, more than 6 months and less than 1 year, 11, more than 1 and less than 2 years, 12, more than 2 and less than 3 years, 2, more than 3 years, 12. From psychosomatic analysis, these patients were classified into the following four groups; 1) Neurotic group: subjects with neurotic conflicts, 19 (43.2%), 2) Psychosomatic disease (PSD) group: subjects with psychosomatic symptoms in a narrow sense, 19 (43.2%), 3) Senile group: subjects whose psychological factors are typical of the old age, 4 (9.0%), 4) Normal group: subjects in whom no particular psychological problem was observed, 2 (4.5%). The symptoms of the patients who were classified as the neurotic group were various and should be considered to be the symptom of neurosis itself. Therefore those patients in this group should be treated by a psychiatrist. The conditions of many patients in PSD group were improved by the brief psychotherapy. Meanwhile prolongation and fixation of the symptoms in this group often related to the previous treatment. Therefore a urologist who can establish good physician-patient relation should treat these patient by psychosomatic approach.

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It has been disclosed in the previous study that the majority of the patients with prostatosis have psychosomatic factors. From urological and psychiatric analysis these patients were classified into four groups-namely, neurotic group, psychosomatic disease (PSD) group, senile group and normal group. In this study, the patients classified as PSD, group were treated by a urologist from the viewpoint of psychosomatic medicine. The conditions of 37 out of 40 patients (92.5%) were improved by the psychosomatic therapy. The therapy in this study differed from the conventional treatments by urologists or the psychotherapy by psychiatrists. It was considered that this great success in the treatment of prostatosis owed to early establishment of good physician-patient relationship. Furthermore, it was found from the psychosomatic analysis in these patients that the conditions could be exaggerated and fixed by the conventional treatment without psychosomatic consideration. From the results of this study, it was concluded that the psychosomatic approach was very important and necessary for the treatment of patients with prostatosis.

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A 32-year-old patient with extensive local recurrences of penile carcinoma was successfully treated by a wide local resection and coverage of the tissue defect with bilateral tensor fascia lata myocutaneous flaps. He was previously treated by partial penectomy with bilateral groin dissections. Moreover, he received multiple chemotherapy including bleomycin and supervoltage irradiation to the groin and pelvis. Fifteen months after the first operation, he had extensive local recurrences in the remaining penis, scrotum, groin and perineum. The skin of the groin and lower abdomen showed a slight radiation damage. No definite distant metastasis was observed. An en bloc resection including the penis, scrotum, scrotal contents, skin of the groin, hypogastrium and perineum with bilateral groin and pelvic lymph nodes dissections was performed. Local tissue defect was as large as 26×25cm. Bilateral tensor fascia lata myocutaneous flaps were anteriorly rotated and placed on the tissue defect, leaving a minimal donor defect. Perineal urethrostomy was constructed in the center of the bilateral flaps. Postoperative course was uneventful and he is now working as farmer 3 months after the last operation.
It appears important for urologists to cooperate with plastic surgeons in treating the broad tissue defect or tissue damage due to extensive ablation in cancer surgery, trauma and radiotherapy.

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Forty-four cases of nonobstructive vesicoureteral reflux (VUR) operated at the Department of Urology of Ehime University School of Medicine between 1976 and 1979 were examined and their results are reported.
Of the 44 cases, 14 cases, ranging in age from 5 to 50 years, were males and the remaining 30 cases, ranging in age from 4 to 57 years, were females and the incidence distributed about equally in all age groups in both male and female.
Of the 44 cases, 41 cases (91%) showed VUR greater than grade IIB and there was a significant correlation between the grade of the configuration of the ureteral orifice and that of VUR (p<0.05).
The incidence of previous upper urinary tract infection was 83% (38/44), whereas in 5 cases proteinuria was the only complaint and in one other case with undescended testicle, VUR was found incidentally.
Of the 44 cases, antireflux surgery was performed on 42 cases and nephroureterectomy on 2 cases, whose kidneys were markedly hypoplastic. As for antireflux surgery, Politano-Leadbetter procedure was performed on 26 cases (46 ureters), combined Politano-Leadbetter procedure on 4 cases (5 ureters), modified Paquin procedure on 12 cases (16 ureters). These cases were followed for periods ranging from 4 to 38 months. VUR recurred in only one case who underwent Politano-Leadbetter procedure and the occurrence of VUR in contralateral ureter after unilateral operation was noted in one case who underwent combined Politano-Leadbetter procedure. There was no radiological evidence of VUR or progressive deteriolation and no episode of pyelonephritic attack in the remaining cases.
We think that the majority of ureteral reimplantation for VUR can be done satisfactorily using a transvesical procedure (Politano-Leadbetter procedure) except when an extravesical approach is necessary or indicated for some reason.
Discussion was also made about operative techniques of transvesical procedure and postoperative management.

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The protective effect of chlorpromazine (CP) to damage by warm ischemia was investigated in rabbit kidneys. One week after right nephrectomy, the left renal artery, vein and ureter were temporarily clamped for 90, 120 and 180min. At 30min, before clamp, CP was injected i. m. Doses of CP were 1, 2, 7 and 14mg/kg. After the clamp was released, recovery time of renal colour was measured. Changes of serum level of creatinine, urea nitrogen and potassium were investigated after warm ischemia. On the 7th day after operation, the left kidney was removed and histopathological examination was studied. The pattern of renal vessels was observed by microangiography at the time of clamp off.
1) The kidney function of CP pretreatment group was better than that of non-treated group, especially CP 2mg/kg i. m, showed best protective effect in warm ischemia.
2) No function of the kidney was detected in spite of the use of CP after 180min, of warm ischemia.
3) The microangiographic observation of the renal artery revealed more evident juxta-medullary shunt of blood flow as the WIT became longer, but little shunt flow was found in CP pretreated kidneys.
4) It is a useful method to use CP 2mg/kg i. m, for protection from damage by warm ischemia of the kidney up to 120min, in situ.

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A retrospective study was made on TURP in patients with impaired renal function. In our study, the definition of azotemia was made with the preoperative serum creatinine level of 1.6mg/dl or greater. The results were as following:
1) Between August, 1971 and July, 1978 (a 7-year period), a total of 451 patients underwent TURP for benign prostatic hypertrophy at the Kitasato University Hospital. Twenty (4.4%) of the 451 cases were azotemic preoperatively, with serum creatinine levels ranging between 1.6 and 5.6mg/dl.
2) Of the 20 azotemic patients, 19 had mild to moderate renal impairment with the serum creatinine level between 1.6 and 3.0mg/dl. The serum creatinine value of the remaining one patient was 5.6mg/dl. The mean age of the azotemic patients was 72.0 (range 62 to 87) years.
3) The most frequent preoperative complication was abnormal cardiac conditions such as left ventricular hypertrophy or premature ventricular contraction, which were observed in 16 cases (80%).
4) The mean resection time was 74.5 (range 35 to 140) minutes with a mean resected tissue weight of 42.8 (range 7 to 130) grams. In six cases (30%), blood transfusion was required during the operative procedure with an average of 362.5 (range 300 to 2600) ml.
5) Although the incidence of the intra-and postoperative complications appeared higher in the azotemic patients when compared with that of the patients with normal renal function, there was no mortality or serious complications such as acute renal failure or electrolyte imbalance.
6) Satisfactory results in voiding pattern were obtained in all patients postoperatively. It is concluded that TURP would be the treatment of choice in patients with mild to moderate renal impairment. Furthermore, it could be safely performed in patients with the preoperative serum creatinine value as high as 5.6mg/dl.

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