Clinical and experimental studies were made on the effect of prostaglandin F_2α (PGF_2α) and prostaglandin E₂ (PGE₂) on the lower urinary tract. PGF_2α and PGE₂ were administered intravenously to female mongrel dogs under general anesthesia using α-chloralose. Both prostaglandins caused slight elevation of bladder pressure and reduction of urethral pressure. In cases of women who had lower motor neuron lesion, oral administration of 16-(3-trifluoromethylphenoxy)-ω-tetranor-trans-Δ²-PGF_2α methyl ester caused elevation of tonus limb on cystometrogram and had no effect on urethral pressure profile and uroflowmetry.

View full abstract

Clinical studies were done on 29 patients who underwent ureterosigmoidostomy or ureterorectostomy with cystectomy because of malignancy. Ten patients died, -six of recurrence and four of unrelated diseases. Nineteen patients are alive, leading active life. Electrolyte imbalances are apparently managed by compelling patients to void frequently by locating anastomosis as caudal as possible, to the rectum or to the sigmoid colon close to the rectum. Hypokalemia was not seen after the disappearance of the transient hydronephrosis on IVP and hyperchloremic acidosis was easily managed by sodium bicarbonate supplement. The incidence of urinary tract infection was minimized by maintaining sufficient urinary volume with adequate amount of fluid. Since patients can return to social life more comfortably without any problem of external collecting device and without any trouble of urinary smell, ureterosigmoidostomy or rectostomy should be considered more frequently as a method of urinary diversion.

View full abstract

Renal arteriography in the diagnosis of carcinoma has become one of the most useful tools to urological surgeons. In the evaluation of renal arteriograms, primary attension is usually directed to the arterial significant information regarding many cancerous processes. We therefore present material from fifty cases in which arteriographic studies with regard to venous features were made. These cases were experienced at the Jikei University Hospital during the 8 year period 1972 through 1979.
The main renal vein was visualized in 21 out of 50 cases (42%). On the other hand, in normal kidney, there was visualized in 25 out of 30 cases (83%). The incidence of arteriographic visualization of the main renal vein of the kidney with renal cell carcinoma was worse than that of normal kidney. In 50 cases, 28 cases were affected on the right side and 22 cases on the left side. In a series of 29 cases which the main renal vein was not visualized, 19 out of 28 cases were affected on the right side (68%), 10 out of 22 cases on the left side (45%). Therefore, the visualization percentage of the left main renal vein was better than that of the right.
The main renal vein in low stage group (stage 1 and stage 2) tended to be visualized more frequently than that in high stage group (stage 3 and stage 4). If the cases of renal vein thrombi were excluded in high stage group, the visualization percentage of high stage group comes near to low stage group.
Although less frequently encountered, radiographic evidence of arteriovenous fistula was visualized in 6 out of 50 cases. In 3 out of 6 cases, renal vein thrombi were demonstrated by nephrectomy. The prognosis of these 6 cases was not so poor as was reviewed before.
Tumor invasion of the renal vein was demonstrated in 13 out of 50 cases by nephrectomy. 10 out of 13 cases were diagnosed by arteriographic striated vascular pattern.
In these 13 cases with tumor extended into the renal vein, 5 of whom demonstrated collateral veins, (38%) and also, collateral veins were demonstrated in 11, 5 of whom demonstrated renal vein thrombi. Therefore, the visualization of collateral vein does not definitely indicate invasion of the main renal vein in the renal cell carcinoma.

View full abstract

The structure of the ureter and ureterovesical junction was investigated serially in 17 fetuses (from 3 to 21 fetal weeks) and in 2 neonates with particular emphasis on their muscular development in reference to renal excretion of urine and development of bladder wall. Urine is believed to be formed at around 8th week since the pelvis starts to expand and the ureter communicates with the bladder at this stage in the presence of developing renal units. Bladder wall is formed by the vesical detrusor muscle which is recognized at around 7th week from the apical dome, continues the differentiation caudally, and to complete the development by the 17th week. Contribution of vesical detrusor to the ureterovesical junction as superficial periureteral sheath was documented at the 12th week. Around the same period muscles of the pelvis and the ureteral wall start to differentiate from the cephalad to caudad direction coursing spirally. In the most caudal end of the ureter, however, the muscular development of the intravesical ureter and the contributing unit from the trigone as a deep periureteral sheath is delayed and the formation of distinct muscle bundles becomes recognizable later some time between 14 to 16th week. Generally there seems to be a parallelism between the development of trigonal muscle and intravesical ureteral muscle, although at times the latter appeared to be preceding the former. Discussion was made on the inference of these orderly development of the bladder, ureter and ureterovesical junction to the disease entities such as congenital vesical diverticulum, primary VUR, ureterocele, ureteral ectopia and megaloureter.

View full abstract

We designed an original questionnaire for the epidemiology of prostatic diseases 5 years ago, consisting of 111 questions covering education, occupation, income, religion, marriage, sexual activity, past and family history, physical condition and diet.
A case control study by matched pair analysis was conducted on 100 prostatic cancer patients and 100 controls matched for age within a year and for residence in the same prefecture. The patients and controls were interviewed by well-trained urologists.
The statistically significant characteristics of the prostatic cancer patients were as follows: 1) Not engaged in administrative jobs (relative risk (RR)=3.24), 2) Not having experienced military life (RR=2.23), 3) Having married at less than 24 years of age (RR=2.50), 4) Having experienced first sexual intercourse at less than 19 years of age (RR=3.37), 5) Having ceased sexual intercourse relatively early (RR=3.57), 6) Having had sexual intercourse more than once per month between 15 and 20 years of age (RR=2.19), 7) Having had sexual intercourse less than once per month between 61 and 70 years of age (RR=2.17), 8) Not being bald (RR=2.05), 9) Having white pubic hair (RR=3.15), 10) Having a previous history of benign prostatic hypertrophy (RR=12.57), 11) Not having undergone previous surgical procedure (RR=1.85), 12) Having a taste for peppers (RR=1.78) and salty things (RR=1.94), 13) Smoking less than 29 cigarettes per day (RR=3.47) and 14) Having eaten no or only occasional sea foods (RR=1.97).
Although less significant statistically (0.05<P<0.10), the following characteristics were also identified: 1) Having contact with dyes at the place of work (RR=11.00), 2) Earning less than 1, 200, 000 yen a year (RR=1.70), 3) Having been married for more than 40 years (RR=1.57), 4) Having experienced first ejaculation over 15 years of age (RR=2.38), 5) Having had sexual intercourse more than once a week between 41 and 50 years of age (RR=1.92), 6) Having a past history of rheumatic disease (RR=3.59), 7) Having taken alcohol rarely or not at all (RR=1.73), and 8) Having eaten green and yellow vegetables only occasionally (RR=1.97).
Based on these results, the high risk group for prostatic cancer was outlined.

View full abstract

In order to clarify the effect of vasectomy on the autonomic innervation of the vas deferens and epididymis, an animal experiment has been performed using histochemical and pharmacological techniques.
A group of 68 rats was subjected to a unilateral vasectomy study and their contralateral vasa deferentia were served as controls. In an additional group of 38 rats, the animals received a unilateral ligation of the vas deferens. Each subgroup of 5 to 9 rats in both groups was sacrified 1, 2, 3 and 4 weeks and 2, 3 and 6 months after vasectomy or ligation. The distribution of adrenergic fibers and acetylcholinesterase positive fibers in these epididymides and vasa deferentia were investigated by Falck-Hillarp method and Karnovsky method modified by El-Badawi and Schenk, respectively. The sensitivity of these removed vasa deferentia to noradrenaline, adrenaline and acetylcholine was determined using an isometric in vitro technique.
The results obtained are as follows:
1) The denervation of the vas deferens and cauda epididymidis proximal to the site of vasectomy or ligation was observed one week after vasectomy or ligation.
2) In case of ligation, the autonomic reinnervation of the proximal portion of the vas deferens and cauda epididymidis occurred 2 weeks after operation, and the rate of regeneration of the autonomic fibers was approximately one cm a month. While, in case of vasectomy, there was a considerable delay of the autonomic reinnervation in most rats and no reinnervation in some rats.
3) The histological distribution of autonomic fibers regenerating in the muscular layer of the vas deferens was similar to that in the controls. On the other hand, the distribution of acetylcholinesterase positive fibers regenerating in the submucosal layer was considerably rare as compared with the controls.
From these results, possible clinical significance of these effects is discussed.

View full abstract

Light and electron microscopic observations were made on the interstitial tissue of human orthospermatogenic testes from 9 patients (11-77 years of age) and hypo- or aspermatogenic testes from 6 patients (25-33 years of age), with particular reference to the interrelationship between lymphatic capillary and Leydig cells, as well as to the changes in the boundary tissue of seminiferous tubules with age. Thin walled lymphatic capillaries (50-200μm in luminal diameter) were frequently observed in the intertubular area of testis with the Leydig cells closely approximal to the wall of lymphatic capillaries. The endothelial cells of lymphatic capillaries were entirely devoid of fenestration, possessed a patchy and discontinuous basal lamina, and showed generally a loose intercellular junction forming what should be called “open junction”. These findings suggest that the interstitial lymphatics would provide an important route for circulation and/or distribution of androgen in the human testis. The boundary tissue of seminiferous tubules was composed of three main components; (1) the basal lamina of seminiferous tubule, (2) the fibrous component consisting of collagen fibrils (59-78nm thick), microfibrils (16-20nm thick tubular structures without transverse striation) and fine filaments (3-4nm thick), (3) the cellular component consisting of myoid cells and fibroblasts. The thickness of the boundary tissue in toto, and the first of its components as well, increased with advance of the age in general. However, in all the 6 cases of hypo- or aspermatogenesis, the thickness of the boundary tissue was comparable with that of the elderly normal subjects. The collagen fibrils, which tended to become thinner in elderly subjects, showed abnormal fine structural appearances, such as a floral pattern (100-200nm in diameter) in cross sections and a wireropelike pattern in longitudinal sections, more frequently in younger subjects with abnormal spermatogenesis and elderly normal subjects than in the younger orthospermatogenic testes. It was concluded that an appearance of abnormal collagen fibrils in addition to the thickening of boundary tissue must be a characteristic of the testicular interstitium in aged human beings and that the changes similar to those of elderly subjects would have already occurred in comparatively younger generations from 20 to 30 years of age with hypospermatogenesis.

View full abstract

Hydronephrosis was produced in rats by complete ligation of the left ureter at the middle portion and the renal papilla was examined with light and electron microscopes. Special attention was paid on changes of the interstitial cells containing prostaglandin precursors. Rats were sacrificed at the interval of 2 days to 5 weeks after the ureteral ligation. The number of osmiophilic granules of the interstitial cells was counted to evaluate the biological significance of these granules in hydronephrosis.
In the early stage of the development of hydronephrosis (i. e. before 2 weeks after the ureteral ligation), there were interstitial edema and an increased number of osmiophilic granules in the interstitial cells. The number of granules per interstitial cell reached a peak on the 2nd day after the ureteral ligation and thereafter decreased. From the 2nd day to the first week the granules were significantly increased, and after 2 weeks they turned to be decreasing as compared with control (p<0.01).
As the number of the granules diminished, the interstitial cells displayed well developed rough endoplasmic reticulum and Golgi apparatus, suggestive of transformation of fibroblast-like cells. Concomitantly, interstitial edema subsided and collagen fibers were laid down, frequently associated with basal lamina-like materials. The basal lamina of collecting tubules and blood capillaries became thick and tortuous.
From these findings it seems possible that interstitial edema and increased prostaglandin synthesis in the early stage, and repair process of the interstitium in the late stage of hydronephrosis partially account for the impairment of the concentrating ability of urine in hydronephrosis.

View full abstract

Forty-six patients underwent renal allotransplantation at Kanazawa Medical University Hospital from March 1975 to December 1980. All patients received the kidneys from living related donors. Only one patient underwent bilateral nephrectomy before the transplantation. Sequential changes in renal function were described in a series of 19 transplanted patients by using standard renal function measurements. The nineteen patients were treated for 33 acute rejection episodes.
The changes in several parameters on blood and urine, especially on free water clearance in 33 acute rejection episodes after renal allotransplantation have been analyzed. The following results were obtained as common functional changes of the transplanted kidneys during the development of acute rejection.
The significant changes of free water clearance are proposed as criteria for the earliest diagnosis of acute rejection: these changes were found to have occurred from 48 to 72 hours before the onset of serum creatinine elevations (p<0.05).
The changes of osmolar clearance were also important to diagnose the acute rejection.
There were no significant changes of the mean excretion fraction of filtered sodium (EFNa) at the time of acute rejection. The mean excretion fraction of filtered potassium (EFk) was increased, and the mean concentration index of creatinine (U/P creatinine) was decreased, but both changes were statistically not significant in this study.
The patients, who showed high values of negative free water clearance at the time when acute rejection was diagnosed, demonstrated an earlier recovery of graft function (p<0.05). There was a similar relationship between osmolar clearance and recovery of graft function (p<0.05).
There was a tendency to lower values of negative free water clearance in kidneys with HLA-matching grade C than in those with HLA-matching grade A during early postoperative periods when no acute rejection episode was observed.
About a half of 19 patients showed positive free water clearance immediately after the transplantation, but all of transplanted patients showed negative free water clearance on the fourth postoperative day. And this state continued until the diagnosis of acute rejection in all cases.
Thus, it may be concluded that the most significant change is reduction of negative free water clearance: it is the earliest and reliable evidence of acute rejection and important for evaluation of recovery from acute rejection.

View full abstract

A case of transitional cell carcinoma in a pyelocalyceal diverticulum is presented. A 42-year-old man, NHH 1008757, was hospitalized with asymptomatic hematuria. Cystoscopically, a left renal bleeding was noticed. The routine laboratory data, the chest X-ray and repeated urine cytology were normal or negative. Radiographically an excretory urogram (IVP) revealed a compression of the calyces and pelvis of the left kidney. A renal angiogram revealed the avascular mass measuring ca. 8 by 8cm. Although retrograde pyelography could not reveal any communication with the calyx immediately, computed axial tomography done thereafter demonstrated contrast medium staying in the cavity of the cystic lesion. However, puncture of the cavity was attempted under the CT scanning without success. The inner aspect of the wall showed irregularity.
On exploration of the kidney, the inner aspect of the cystic cavity was warty. Radical nephroureterectomy was performed, since the biopsy of the wall demonstrated transitional cell carcinoma on the frozen section.
Grossly a large cyst, measuring 8 by 8cm, occupied the middle portion of the left kidney but no apparent connection between the calyceal system and the cyst was identified.
Microscopically, the wall of the cavity was covered with mixture of nearly normal transitional cell epithelium and transitional cell carcinoma of grade II and grade III. Therefore, we concluded that the clinicopathological diagnosis is a case of transitional cell carcinoma developed in the calyceal diverticulum of the left kidney.
To our knowledge, this is the first case of transitional cell carcinoma in pyelocalyceal diverticulum in Japan.

View full abstract