For the better understanding of etiology of nocturnal enuresis, the development of bladder function with children's age should be taken into consideration. Functional bladder capacity (FBC) and average urinary flow rate (AFR) are easy to measure and can be valuable indices for checking the bladder function of normal children. FBC is estimated by the volume of urine passed at the time of urgent desire to void, and AFR is defined as the quotient between voided volume and flow time measured with a stop-watch.
Using this method, FBC and AFR after water loading were measured in 102 nursery and school children, aged from 4 to 14 years. The data obtained were analysed using the techniques of variance analysis. The results are as follows; 1. FBC increases with age from 4 to 14 years. 2. FBC of boys is slightly, but definitely larger than that of girls. 3. AFR is approximately in proportion to square root of voiding volume. 4. AFR increases with age. There is a considerable correlation between AFR and FBC, which increases with age. However, AFR is not related to FBC alone. An age-dependent definite increase of AFR could be shown clearly by covariance analysis of the data. 5. AFR of girls is larger than that of boys.

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Cystometric findings of 105 enuresis nocturna childrén, all cases primary and functional, were analyzed. 69% of the cases showed uninhibited contractions, that is, unstable bladders. In 11% of the cases unstable pattern was provocated by bethanecol injection. The remaining 20% were with stable bladders.
Enuresis of nocturnal-diurnal type showed unstable patterns more frequently than that of nocturnal type. In older children, over 12 years, unstable bladders were less frequent than in younger.
Bladder capacity in enuretic children increased with age, but was estimated to be smaller than in normal children of comparable ages. Bladder capacities were smaller in unstable bladders than in stable ones.
Voiding pressure in boys was higher than that in girls. Voiding pressure in unstable bladders was higher than that in stable bladders.
Based on the above data, we insisted that the cystometry was the important means for investigation of etiology and planning of treatment for nocturnal enuresis.

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The ultrastructural changes of the epithelium and tunical muscularis of the ureter to urinary obstruction were examined in rats by transmission and scanning electron microscopy. Hydroureter was made by complete double ligation of the lowest part of the left ureter. The rats were in series sacrificed from 1 day to 20 weeks after ureteral ligation. The results obtained were as follows:
1) The normal ureter was lined by three to eight-layerd cells which were composed of superficial cells, intermediate cells and basal cells. The superficial cell had a scalloped free surface and many fusiform vesicles in the cytoplasm. The superficial cell was oblong in shape, the intermediate cell spindle and the basal cell cuboidal. The tunica muscularis was composed of closely packed smooth muscle cells which were characterised by abundant myofilaments and many dense bodies. There were scattered collagen fibers in the intercellular space.
2) Within 3 days after ligation, lipid droplets appeared and tonofilaments were accumulated in the epithelial cells. Smooth muscle cells showed cellular edema and had lysosomes. A considerable amount of fibrin was deposited in the intercellular space of the tunica muscularis.
3) From 5 days to 5 weeks after ligation, the epithelium was thickened and lined by three to eight-layered cells. The superficial cells became flat and the intermediate cells were provided with increased fusiform vesicles and slightly developed rough endoplasmic reticulum. The tunica muscularis became hypertrophic and the smooth muscle cells contained an increased number of mitochondria, well developed rough endoplasmic reticulum and Golgi apparatus.
4) More than 8 weeks after ligation, the epithelium bacame thinner down to 2, 3 or 4 layers and the intermediate cells were exposed to ureteral lumen. Myofibroblasts appeared in the tunica muscularis. Smooth muscle cells were extremely elongated and widely separated by the increase of the intercellular matrix. Myofilaments and dense bodies decreased in the cytoplasm of elongated smooth muscle cells and myofibroblasts.
The following suggestions were made from above observation: first; the epithelium accommodated itself to extension of the ureter by thinning and sliding of the overlying cells, second; until 5 weeks after ligation, the tunica muscularis well responded to the increase of intraureteral pressure with hypertrophy of smooth muscle cells, third; the ureteral peristalsis was finally impaired by the decrease of myofilaments and dense bodies in smooth muscle cells and excessive increase of the intercellular matrix among smooth muscle cells.

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To elucidate the degree of androgen dependence in prostatic carcinoma, 5α-dihydrotestosterone (DHT) formation from testosterone in various histologic and cytologic features of the cancer tissue was studied.
Testosterone-³H was incubated with 25mg of minces of prostatic needle biopsy specimens in the absence of coenzyme for one hour at 37°C in an atomosphere of 95 per cent of O₂ and 5 per cent of CO₂. Subsequently, the metabolites from testosterone were separated and purified with thin layer chromatography using a benzene acetone solvent system (4:1, v/v). The intracellular conversion rate of testosterone to DHT was employed as a biological marker for androgenic activity in the tissue of prostatic carcinoma.
Histologic findings of the carcinoma were evaluated by the method of Harada, Mostofi, et al. Histologic malignancy was divided into two groups, low and high grade, using various combination of histologic and cytologic analyses. Furthermore, the structural patterns of carcinoma were classified into five groups depending upon these predominant structual features, namely, a) single gland, b) cribriform, c) fused gland and cribriform, d) microgland, column and cord, e) medullarly, column and cord.
The results in the present paper were summarized as follows:
1) Average DHT formation was significantly higher in benign prostatic hypertrophy than in untreated prostatic carcinoma.
2) It should be born in mind that there are some patients who have the reactivation of prostatic carcinoma because of discontinuing hormonal treatment. The plasma testosterone concentrations of the patients were within the normal limit. (592±210ng/dl n=6)
Determination of plasma gonadotropin and testosterone levels can become a diagnostic step to find the false reactivation of prostatic carcinoma.
3) Similar degree of approximately 30per cent of the conversion rates of testosterone to DHT was observed in untreated prostatic carcinoma in the remissive status with hormonal therapy and in the false reactivation.
4) Histologically, low grade carcinoma showed statistically significant high conversion to DHT compared to high grade cancer.
5) The conversion rates to DHT in the groups of cases with single gland; cribriform; fused gland and cribriform; microgland, column and cord; and medullarly, column and cord were 40±8 (M±SD)% (n=4), 33±6 (n=3), 31±5 (n=7), 27±2 (n=3), and 15±4 (n=6), respectively.
Although the group with medullarly, column and cord pattern indicated significant lower conversion rate to DHT than the other histologic groups mentioned above, there existed correlation between the ability of DHT formation and structural patterns in the order highest in group a) and lowest in group e).
6) The findings of structural patterns in reactivated prostatic carcinoma showed the predominance features of medullarly and column & cord. However, there are, in part, single gland, microgland and cribriform. Consequently, reactivation has a wide spectrum of histologic patterns ranging from well to poor differentiation in a single specimen.
7) The reactivated prostatic carcinoma revealed the lowest ability of DHT formation in the tissue.
Getting together, it is suggested likely that histologic high grade of prostatic carcinoma and predominant features of medullarly, column and cord may imply relative androgen independent cancer, and that from the view of 5α-reductase activity, the reactivated prostatic carcinoma must be out of the control system in androgenic action. Furthermore, the assessment of 5α-reductase activity in combination with that of histologic and cytologic features in a biopsy specimen seemed to be a useful diagnostic tool in developing a prognosis and determining a suitable therapeutic program for prostatic carcinoma.

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The main purpose of endocrine treatment of prostatic carcinoma is to reduce the level of androgen via either inhibition of the secretion of luteinizing hormone (LH) or a direct suppression of testosterone formation in the testis. However, the principal mechanism of estrogenic or antiandrogenic compounds, particularly the action on testicular steroidogenesis activities, has been a controversial subject for many years. On the other hand, the determination of the minimal dosis of estrogen has been widely required, since the Veterans Administration Cooperative Urological Research Group (VACURG) emphasized the cardiovascular risks from estrogen.
In the present paper, the effects of estrogen and gestagen on hypothalamo-pituitary-testis axis was studied to elucidate more suitable endocrine therapy.
Radioimmunoassay was used for measurement of LH, testosterone, chlormadinane acetate (CMA) and ethinylestradiol (EE₂) concentration in plasma. Microsomal fraction obtained from testicular tissue was incubated with radioactive substrates for evaluation of in vitro activities of the enzymes concerning testosterone formation from pregnenolone. The compounds used in this experiment were hexestrol, diethylstilbestrol (DES), diethylstilbestrol-diposphate (DES-DP), EE₂, 17β-estradiol and CMA.
The results were shown as follows:
1) Marked reduction of plasma testosterone concentration without sufficient gonadotropin suppression was observed in CMA administration, while both LH and testosterone levels were significantly reduced by administration of synthetic estrogen.
2) The maximal concentration of EE₂ in plasma after oral administration of 5mg EE₂ was approximately 2.0×10^-8M. Similarly, 50mg of CMA showed the maximal plasma concentration as 3.4×10^-7M.
3) Testicular 3β-hydroxysteroid dehydrogenase plus Δ₅-Δ₄ isomerase (3β-HSD) and 17α-hydroxylase in microsomal fraction were markedly affected within two months of treatment at the dosages of 30mg hexestrol and 300mg DES-DP. Furthermore, 3β-HSD, 17α-hydroxylase and C17-20 lyase were definitely impaired by 2mg EE₂ daily for one month. However, no inhibitory effect on testosterone formation from pregnenolonc was demonstrated by administration of 100mg CMA daily for two months.
4) 3β-HSD seemed to be a rate limiting enzyme influenced by synthetic estrogen treatment.
5) 17β-Estradiol and EE₂ added in the order of 10^-5M inhibited the activities of 3β-HSD and 17α-hydroxylase. Hexestrol in the concentration up to 1.2×10^-4M showed no decrease in steroidogenesis activities in vitro. In contrast, addition of CMA at 8.2×10^-7M. could limit the activities of 3β-HSD and 17α-hydroxylase.
6) 3β-HSD, 17α-hydroxylase and C17-20 lyase, impaired by synthetic estrogen, could restore following discontinuance of the treatment.
7) Based on the degree of reduction in testosterone production, the suitable daily dosis of synthetic estrogen for endocrine therapy was determined as follows; 30mg hexestrol, 200mg DES-DP, less than 3mg DES and less than 2mg EE₂.
It is noteworthy that endocrine therapy of prostatic carcinoma should be continued for the maintenance of low androgen milileu, and that castration should be performed for the patient who can not preserve the therapeutic program. Furthermore, as the effect of gestagen on testicular enzymes and the prostate obviously differs from that of synthetic estrogen, a combination of the agents may become more effective hormonal treatment for prostatic carcinoma.

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Plasma testosterone and estradiol were determined by the RIA method, and the following results were obtained:
1) The estradiol concentration in the venous blood of the spermatic cord was 38.1 times higher than that in the peripheral blood. Compared with the concentration gradient of 95.1 times in blood testosterone, the rate of secretion of estradiol was calculated to be 40% of its production rate.
2) The blood testosterone value in males at high age was noted to have been decreased, while the blood estradiol value was found to be distributed in the range of 9.9pg/ml to 69.0pg/ml, with wide individual differences, and no fixed tendency was observed.
3) In patients with Klinefelter's syndrome, a reduction in blood testosterone was observed, but no significant change in blood estradiol was observed.
When the E₂/T ratio was studied, an elevation of the E₂/T ratio in correlation with the reduction in the blood testosterone value was noted.
4) Following administration of HCG (10, 000IU), both the blood testosterone and estradiol values were elevated, and in 96 hours blood testosterone reached a value 2.5 times higher and blood estradiol, 2.0 times higher.
Chronological observation revealed that blood testosterone was increasing gradually, whereas blood estradiol reached the peak in 24 hours, and thereafter was decreasing gradually, indicating dissociation in the reaction of testosterone and estradiol.
5) HCG test in aged male cases revealed that both the basic and reacted values of blood testosterone were low.
As regards blood estradiol, the basic value was within the normal range, while the reacted value remained low. The rate of reactivity proved to be 2.35 times, as compared with 3.74 times in young adult males.
6) In patients with Klinefelter's syndrome, the reaction after the administration of HCG was lowered. Even in the case where blood estradiol was taken as the index, the reduction in the Leydig cell preparatory capacity was clear.

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The anti-reflux operation which is the Politano-Leadbetter's operation with extra-vesical approach technique was carried out in 57 patients during the period from June 1977 to August 1980.
Great care was payed in the extra-vesical approach not to damage the nerves and vessels around the bladder and ureter.
The age of these patients ranged from 1 to 65 years old. They consisted of 19 males and 38 females. Fortyfive cases had primary vesico-ureteral reflux (VUR) and 12 cases had secondary VUR.
After operation, follow up was performed from 3 to 42 months.
Voiding cystourethrogram was taken post-operatively in each patient to evaluate the presence of neurogenic bladder dysfunction by the extra-vesical approach technique.
In this period, VUR had dissppeared in 55 cases (97%), while it persisted in 2 cases (3%) for 6 months after operation.
Only 2 cases had, 3 months after operation, an increased residual urine and incomplete contraction of the bladder, which are well known complications of extra-vesical approach technique. But such complications had disappeared after 6 months.
Consequently, we consider that the combined method performed in this study should be recommended in anti-reflux operation.

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A case control study by matched pair analysis was conducted between 100 patients with benign prostatic hypertrophy (BPH) and 100 controls matched for the age within one year and with residence in the same districts.
The BPH patients and the matched controls were interviewed by well trained urologists using an original questionaire.
As the results, the characteristics of BPH patients which were statistically significant as compared to the controls were as follows: 1) Having educational backgrounds higher than the secondary school, 2) Not engaging in agriculture forestry or fishery, 3) Being exposed to no enviromental pollution in work, 4) With present income over 2, 400, 000 yen a year, 5) With past income over 2, 400, 000 yen a year, 6) Living in the best grade housing, 7) Having more than two children 8) Having experienced a first wet dream before 20 years of age, 9) Having spent more than 10 minutes for one time sexual intercourse, 10) Having no experience of sexual impotence for more than one month, 11) Not having past history of gastric ulcer, 12) Not having family history of mammary cancer, 13) Drinking milk, 14) Not having eaten green- yellow vegetables every day, 15) Not having eaten any Japanese pickles for every meal.
Although less significant statistically (0.05<p<0.10), the following characteristics should he noted: 1) Having past history of gonorrhea, urethritis or prostatitis and syphilis, 2) Having eaten meat every day.
From these results, we could summerise the following important factors commonly observed in patients with BPH. As regards the socio-economical status, they have higher educational backgrounds, belong to the higher society, earn much income a year, work in clean and non-polluted places. As regards the sexual life, they are very active generally. We thought that their sexual activity had not been restricted but more vigorous. As regards the foods, they take meat and milk every day and don't take greenyellow vegetables and Japanese pickles.

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Parathyroid function was assessed by radioimmunoassay of plasma parathyroid hormone (PTH) in 63 recipients of renal transplant. In 22 of the 63 patients, with good renal function, plasma PTH level was determined both preoperatively and postoperatively. Plasma PTH level was high in 21 of the 22 patients before transplantation. Determination of plasma PTH level was done within 3 months after transplantation in 17 of the 21 patients, and demonstrated normal level of plasma PTH in 14 of the 17 patients. In 4 patients plasma PTH level was proved to be normal 6 months after transplantation (2 patients) or 1-3 years after transplantation (2 patients).
In 3 patients with high plasma PTH level in spite of good renal function after transplantation, persistent hypercalcemia or aseptic bone necrosis and/or pathological bone fracture was noted. Parathyroidectomy (2 or 3 glands) was performed in these patients, and histological examination revealed hyperplastic state of the parathyroid glands (chief cell hyperplasia).
Significance of parathyroidectomy in patients with high plasma PTH level was discussed. It seems possible to defend a positive attitude towards the performance of parathyroidectomy in recipients of renal transplant or hemodialysis patients accepted into a transplantation programme.

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A 63-year-old man was admitted to our hospital on October 20, 1978 with chief complaints of total macrohematuria and left flank pain.
The patient was submitted to left retrograde pyelography in 1948 because of complaints suggesting urolithiasis.
Plain film of the left kidney showed linear opacities on the pelvio-calyceal system and lymphvessels at the renal hilus, and the middle and lower caylces were not visualized on excretory pyelogram. Urinary cytology was Class IV. Thorotrast-induced renal pelvic cancer was diagnosed, and its latent period was 31 years. On January 9, 1979, transabdominal nephrectomy was performed. The lower extremity of the kidney was nearly completely replaced by solid yellow-white connective tissue. Mictoscopy showed transitional cell carcinoma originating from epithelium of the renal pelvis and brown granular depositions. By autoradiography, gamma-ray spectrum and x-ray microanalysis, the brown granular depositions were confirmed as thorium, and the content of thorium of the specimen was 0.175mg/g tissue.
The patient died of the cancer 11 months after the operation.
In Japanese literature, two cases of thorotrast-induced renal pelvic cancer had been reported and, therefore, our case was the third in Japan. When a patient is diagnosed as thorotrast kidney, prophylactic nephrectomy ought to be performed becaused of a causal correlation between the presence of thorotrast beneath the renal pelvic mucosa and the malignant transformation of this epithelium, as indicated in the world literature.

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