Although interruption of the vessels supplying the testis is a common practice in urologic surgery, little attention has been called to its acute effects on the hemodynamics of the testis. The present communication is concerned first with an experimental study of the effects on the dog testis of interruption of the testicular, vasal and cremasteric arteries, and second with that in man as demonstrated by polarographic monitoring of tissue oxygen tension.
The animals used for these experiments comprised forty-one mongrel dogs weighing 10-36kg. Under i. v. thiamylal-Na anesthesia, the testis, vas deferens and spermatic cord were exposed by a median incision in the scrotum. Clamping of the testicular artery was made transperitoneally through an median incision in the lower abdomen.
Testicular tissue oxygen tension, an index of testicular blood flow, was continuously monitored by using the Yagi's polarographic oxygen electrode, an enameled copper wire 300μ in diameter. The electrode was thrust into the substance of the upper pole of the testis in to the depth of 5mm. Oxygen tension measurements were made in these animals after occluding the vasal artery, cremasteric artery, testicular artery and spermatic cord. The effects of occluding blood supply to the testis by rotating the spermatic cord 180-360 degrees on its axis were also studied. Measurements were also made after removal of the occlusion. After starting every experiment, the animals were given pure oxygen to breath for a short period in order to determine the post-occlusion PO₂ response time and increment. The changes in the polarographic amplitude were expressed as percent of the pre-occlusion level (100).
Similar experiments were also performed on 5 patients with prostatic carcinoma. Statistical analysis was made by using the Student T test.
1) On occlusion of the vasal artery the testicular PO₂ was 98.1±13.4 (mean±1S. D.) which did not significantly differ from that of the control. This findings suggest that the vasal artery contributes only a small amount of blood to the testis, or that the other two vessels sufffice in perfusing it.
2) Occlusion of the cremasteric artery produced a significant reduction in the testicular PO₂ (85.3±11.7). However, 4 out of 10 testes were able to restore the ability to increase their PO₂, with the increment of 13. 9±4. 8. This increment could be due to some collateral circulation from the testicular artery.
3) Occlusion of the testicular artery produced a drastic reduction of PO₂ (34.2±17.9). Four out of 10 testes showed only a small restoration of the PO₂ (11.1±5.2), which suggests that the other two vessels are insufficient to compensate for the deficit.
These results suggest that the magnitude of contribution of blood supply to the testis by the vasall artery, cremasteric artery and testicular artery is in the order of 1:8:35.
4) Occlusion of the spermatic cord produced a profound reduction in the testicular PO₂ (41.1±
13.8). Four out of 11 testes were able to increase the PO₂ (14.7±10.6) afterward, the amount of which approximated that of the fall in the PO₂ produced by the cremasteric artery occlusion alone, suggesting that the cremasteric artery is able to compensate for the deficit in the testis in the absence of the testicular and vasal blood flow.
There was no significant difference in the reduction of PO₂ between the occlusion of the testicular artery and the spermatic cord. This suggests that no serious congestion would occur in the testis even when the testicular veins were occluded.
5) In 180 degree-rotation of the spermatic cord the PO₂ was 81.5±14.2, which was significantly lower than the control. The testicular PO₂ showed a good response to the inhalation of pure oxygen, but the PO₂

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Preoperative transcatheter embolization of individual vesical artery had been performed on 7 cases of bladder carcinoma followed by variety of resection that enabled the clinical and histological assessments. An end-hole catheter was transfemorally cannulated into a vesical artery concerned and 1-3ml of gelatine sponge suspension was injected to fill up the arterial tree under fluoroscopic control. Six of the 7 cases had total cystectomy and the remaining one required partial cystectomy 4-15 days after the embolization. The bladder was observed to be edematous and pale over the area nourished by the artery and rather easy to dissect. Estimated blood loss at these total cystectomies was 45% lower than that in our recent 15 similar cystectomies that were not treated with embolization. Microscopically, formation and phases of organization of emboli and tumor infarction along the vascular trees were observed within the tumorous portion in 4 early stage cases including one case showing a similar change in the muscle layer to a moderate degree. These findings were not seen in 2 cases with advanced carcinoma.
Reviewing literature, transcatheter embolization of hypogastric artery and its branches had been applied for intractable hemorrhage of inoperable bladder tumor and other pelvic tumors, pelvic fracture and A-V malformation of bladder so far. However, the embolization for surgically curable bladder carcinomas has not been documented. We intended a reduction of blood loss in surgery, easy dissection of bladder, discouragement of tumor growth and lessened tumor cell contamination. All but the last of the above have been accomplished. Considering the acceptable degree of side effects, this technique shown in this study is applicable to a wider selection of clinical disorders without sacrificing bladder function in benign diseases as well as malignancies.

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Four primary hyperparathyroid patients with 1 or more calcium-containing stones, as evidenced by surgical removal of a solitary parathyroid adenoma in every case, were examined pre- and post-operatively for serial changes in serum and urinary calcium (Ca), magnesium (Mg) and phosphorus (P) level. Immunoreactive parathyroid hormone (i-PTH) and nephrogenous adenosine 3', 5'-monophosphate (N-CAMP) level in serum were also examined. One (Y. K.) of the patients had subperiosteal resorption and markedly high serum alkaline phosphatase (Al-P) level (1180U/l). The others showed no skeletal abnormality and slightly high serum Al-P concentration. Blood samples were drawn at 9:00 A. M. in the fasting state and 24hr urine samples were collected from 6:00 A. M. to 6:00 A. M. of the next day with a glass bottle containing several ml of 6N HCl. The pre-operative data (Table 1) are the average values of 3 days during 1-3 months before operation. The post-operative day 1 signifies the 24hr period begining at 6:00 A. M. of the day immediately following the operation. The patients were administered intravenously 20-100ml/day of 2% CaCl₂ when they felt numbness. They took 0.25-1μg/day of 1α-hydroxyvitamin D₃ and 5-15g/day of calcium lactate from the post-operative day 3 or 4 to the end of 3 months after parathyroidectomy. Plasma i-PTH and plasma and urinary c-AMP were measured by radioimmunoassay. The i-PTH assay is specific for the carboxy terminal of the PTH molecule. Mg was measured by Xylidyl Blue method. Ca, P, creatinine and Al-P were measured by an autoanalyzer.
As shown in Table 1, Fig. 1 and 2, serum Ca, urinary P, plasma i-PTH and N-CAMP decreased significantly on the post-operative day 1. Serum and urinary Mg were slightly lowered on the post-operative day 3. Urinary Ca and serum P showed no significant change during 2 weeks after parathyroidectomy. There are 2 peculiar changes in N-CAMP. The first patient (M. Y.) showed a paradoxical increase of N-CAMP after the surgery. The others demonstrated abrupt decrease to minus values after the surgery. These two problems should be further investigated in the future.
In conclusion, after the end of the post-operative day 3 almost all of the laboratory values appear to approach the normal levels and to be within the normal limits in 2 weeks.

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Pepstatin (200μg/kg), clonidine (200μg/kg), phenoxybenzamine (POB) (1mg/kg or 3.5mg/kg) or propranolol (3mg/kg) was subcutaneously injected twice daily to male young Wistar Kyoto rats (WKY), spontaneously hypertensive rats (SHR) and stroke-prone spontaneously hypertensive rats (SHRSP) for consecutaive 14 days. It was found 1) that pepstatin failed to reduce the blood pressure in SHR and SHRSP, and PRA in these genetically hypertensive strains were similar to that of the saline-treated control animals. However, a slight decrease of blood pressure (6.2%, p<0.05) concomitant with an increase of PRA (81.5%), p<0.05) was observed in the pepstatin-treated WKY. 2) that there was a significantly lower blood pressure in clonidine-treated WKY (16.2%, p<0.001), SHR (22.6%, p<0.01) and SHRSP (37.7%, p<0.001) as compared to that of saline-treated räts; that PRA of WKY, but not that of SHR, or SHRSP, was decreased by treatment of clonidine (79.3%, p<0.01). 3) that lower dose of POB significantly (p<0.001) decreased blood pressure in WKY (11.5%), SHR (12.8%) and SHRSP (25.1%); that higher dosage of it caused significant (p<0.001) reduction of blood pressure and an increase of heart rate in each strain concomitant with remarkable increase (p<0.001) of PRA in WKY (328.5%), SHR (336.2%) and SHRSP (249.7%). 4) that blood pressure and heart rate of propranolol-treated WKY was similar to those of control rats, however PRA was lower than that of the control rats. Propranolol administration to SHR or SHRSP did not lower PRA, but caused bradycardia with a paradoxical rise in blood pressure in SHR at the age of 7 weeks (7.0%, p<0.001) or 8 weeks (7.3%, p<0.01) as well as 8-week-old SHRSP (5.8%, p<0.001).
These results indicate three important variables. First, renin-angiotensin system in young genetically hypertensive rats did not play an important role in the pathogenesis of genetic hypertension. Second, adrenergic receptor of WKY appeared to be more sensitive than that of SHR or SHRSP except the response of heart rates of SHR or SHRSP treated with propranolol. Third, pepstatin showed no hypotensive effect on SHR or SHRSP.

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According to the “Statistics of mortalities of malignant neoplasm” by the Japanese Welfare Mimistry, malignant tumors of the upper urinary tract are increasing in number. One hunderd and four cases of renal cell carcinoma, 48 cases of renal pelvic tumor, and 34 cases of ureteral tumor treated in our department from 1955 to 1977 were followed through 1979.
The actual 5-year survival rate was 49% for renal pelvic tumor, 40% for renal cell carcinoma and 34% for ureteral tumor.
The actual survival rate for high stage (P3+P4) renal cell carcinomas was 24%, as compared to 66% for low stage (P1+P2) renal cell carcinomas. The prognosis of high stage group of renal cell carcinomas treated with adjuvant therapy (mainly radiation therapy) was better than that without it.
The actual survival rate for high grade (G3+G4) renal pelvic tumor was 36%, as compared to 77% for low grade (G1+G2) renal pelvic tumor. Concerning the high grade group, the prognosis of the group treated with operation alone was the best.
The prognosis of the ureteral tumors was poor, and 5 of 6 patients who lived more than 5 years were treated with operation alone.
On analysis of these results, we noted that ESR, RBC counts and α₂-globulin are parameters to be considered in developing a prognosis.

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The DNA content of exfoliative single cells from bladder washings in patients with bladder cancer has been analysed by means of flow cytometry. Materials were obtained by bladder irrigation and preparation was made by the cell isolation with trypsin and the DNA staining with propidium iodide.
The DNA histograms in 37 cases from 39 cases with bladder cancer revealed double or more peaks consisted of 2c (diploid) fraction and hyperploid fractions, meanwhile histograms in all 11 cases with benign diseases revealed only single peak of 2c fraction. The hyperploid peaks on DNA histograms disappeared in 9 cases from 10 cases with inactive bladder cancer after TUR-Bt. Agreement of these results with histological findings were superior to that of cytological findings with histological findings in the same materials.
We classified the DNA histograms into four grades by the original criteria. There appeared to be a correlation of DNA histogram grading with histological grading and staging. It is suggested that automation of cytological examination might be possible by application of flow cytometry.

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Pyelolithotomy was performed in 42 cases, coagulum pyelolithotomy in 22 cases, nephrolithotomy in 8 cases, and nephrolithotomy using coagulum (coagulum nephrolithotomy) in 10 cases. The rate of residual stone was zero when the stone was single. In the case of multiple stones or staghorn calculi, the rate of the failure to remove all the stones were 45% in pyelolithotomy (20 cases), 21% in coagulum pyelolithotomy (14 cases), 67% in nephrolithotomy (3 cases), and 20% in coagulum nephrolithotomy (10 cases). Thus, the use of coagulum increased the rate of success to remove all the stones.
Frequently sand-like stones or small stones that cannot be recognized by X-ray were removed with coagulum.
Although there is no indication for coagulum pyelolithotomy when the extrarenal pelvis is small or the infundibulum of the calyx is narrow, the coagulum nephrolithotomy can be done effectively in such situations. Furthermore, it is easier to remove the coagulum intact in coagulum nephrolithotomy than in coagulum pyelolithotomy. Therefore, the advantage of using coagulum is greater in nephrolithotomy than in pyelolithotomy.

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In vitro sensitivity of the established cell line from human urinary bladder cancer, T24 and 253J, to various sex steroid hormones was examined by colony formation method. They were treated with six kinds of sex steroid hormones and cortisol as control at various concentrations from 5μg per milliliter to 160μg per milliliter for 24 hours and 48 hours.
Of the seven kinds of steroid hormones tested, estradiol-17β (E₂) was intensively cytotoxic, progesterone (P) and estriol (E₃) were moderately cytotoxic, while estrone (E₁), testosterone (T), dehydroepiandro-sterone sulfate (DHEA-S) and cortisol (F) were less cytotoxic. No significant difference in sensitivity to sex steroid hormones and cortisol was noted between T24 cells and 253J cells. The reduction rate of both cell colonies was dose and time dependent.

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The transitional epithelium of the normal renal pelvis and the response of the renal pelvis to urinary obstruction were examined in rats using scanning and transmission electron microscope. Urinary obstruction was made by complete ligation of the ureter. The rats were sacrified 1, 2, 3, 4, 5 and 6 weeks after ligation and were examined for an electron microscopic study.
The following results were obtained:
1) Scanning electron microscopy of the normal renal pelvis showed that the papillary tip had several slits and its free surface had small and microvillous depressions. Calyceal surface was covered with polygonal and flattened cells with a smooth, microvillous or concave surface.
2) Transmission electron microscopy of the normal renal pelvis showed that the papilla was overlain by one or two-layered cuboidal cells with a microvillous surface. The renal calyx was lined with one to three-layered flattened cells with a scalloped surface.
3) By scanning electron microscopy, microvilli and microplicae of the calyceal surface increased in number one week after ligation, partly aggregating in a starfish or flowering arrangement. Further more, microvilli and microplicae decreased and ciliae were observed. The slits of the papillary tip opened in size and small openings were found in the calyx with advance of hydronephrosis.
4) By transmission electron microscopy, severe changes were not observed in the cytoplasm of the renal calyx till three weeks after ligation, but the intercellular spaces were found to be open from one to three weeks after ligation. The transitional epithelium of the renal calyx then thinned to one layer and subepithelial fibrosis increased with advance of hydronephrosis.
These observations suggested that the transitional epithelium accommodated itself to the extension of the renal pelvis by an increase in microvilli and microplicae and thinning and sliding of overlying cells, and decreased the rise of intrapelvic pressure by an increase in pyelorenal backflow through the slits of the papillary tip, the small openings of the calyx and the intercellular spaces.

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The activity of 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMG-CoA reductase, EC, 1. 1. 1. 34) was measured in rat ventral prostate and liver, in order to compare the regulation in both tissues. Hepatic microsomal HMG-CoA reductase activity in rat showed a diurnal variation and its peak was observed in mid dark period, as already reported by others. Prostatic microsomal HMG-CoA reductase activity had also a diurnal variation, but its peak point was at the transitional period from dark to light.
In castrated state and testosterone administration, HMG-CoA reductase activity showed respective different changes in both tissues. In rat liver, HMG-CoA reductase activity was elevated at 7 days after castration, but in the prostate, its activity showed no change. Subsequently, testosterone was administered in 7 days, the hepatic HMG-CoA reductase activity showed a slight supression, but the Prostatic HMG-CoA reductase activity was elevated. After castration, testosterone enanthate was administered for 3 weeks. The prostate weight was increased, but the peak of HMG-CoA reductase activity was observed after 7 days and after 21 days its activity showed the same level as the control.

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Tiopronin (α-mercaptopropionylglycine) not only prevents the stone formation, but also dissolves stones in cystinurics by initiating mixed thiol-disulfide exchange reactions. The treatment, however, requires permanent drug administration. The dosage of tiopronin should be kept as small as possible. For that purpose the protocol for the prophylaxis should be separated from that for the litholysis.
Twenty-two cystinuric stone formers were treated with the following protocol since 1973. The dosage of tiopronin was adjusted to maintain the 24 hour urinary cystine level at less than 250mg/l for the prevention of the recurrent stone formation, and at less than 100mg/l for dissolution of stones. Patients were also advised to drink liquids to keep the daily urinary output over 2 liters for adults and as much as possible for children. On the other hand, adult patients whose urinary cystine excretion were below 400mg/day were treated by hydration only without tiopronin. Patients received this treatment with the protocol (17 patients treated with tiopronin and 5 with hydration only) for 19 to 72 months (50 months on the average). The results are as follows:
1) Out of 17 recurrent stone formers treated with tiopronin, calculi were completely or partially dissolved in 6 patients, recurrent stone formation was prevented in 5, and the treatment failed in 7 (stone recurred after once dissolved in one patient).
2) Among those 7 failures, 5 patients did not take tiopronin regularly and the dosage of tiopronin was too small in one patient. In the last patient, her cystine stone was covered with a shell of calcium phosphate, which was probably formed by alkaline urine and hyperuricosuria.
3) Pure cystine stones were dissolved by maintaining urinary cystine level at 150mg/l, when urinary output was kept 2 liters or more. All of stones which were only partially dissolved, however, were mixed cystine calculi.
4) Of 5 patients treated with hydration only for 3 to 6 years, none had recurrent stone formation except one case with only one colicky attack.
5) The analysis of the stones obtained from these 20 patients revealed that 65% (13 cases) were pure cystine stone, 25% (5 cases) were mixed cystine with calcium phosphate or struvite, and 10% (2 cases) were non cystine stone. The result indicates that urinary pH should be kept below 7, although alkaline therapy is useful in the treatment of pure cystine calculi.
These results showed that our protocol is satisfactorily effective for treating cystinuric stone formers. It is strongly suggested that the stone probably consists of matter other than cystine, when this protocol is not satisfactory.

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A rare case of papillary adenocarcinoma of the rete testis with a papillo-tublar adenocarcinoma of the urethra is reported.
A 67-year-old male was admitted to the Urologic Clinic, the Aoto Hospital, an affiliated hospital with the Jikei-University, on September 8 in 1977, because of a swelling of his right scrotal contents and urination disturbance. The results of laboratory examinations including serum alphafetoprotein and urinary HCG were all within normal limits.
Excretory urography showed a normal upper urinary tract and a slight elevation of bladder floor. Retrograde urethrography showed a filling defect on the prostatic urethra. Endoscopic examination revealed a normal bladder interior and a bean sized nodular tumor on the prostatic urethra.
Right high inguinal orchidectomy and trans-urethral resection of the urethral tumor were performed on September 20 in 1977 under the diagnosis of right testicular tumor and tumor of the urethra. Grosslo multiple papillary growth from 3 to 10mm in diameter were noted in the dilated rote testis. They were confined in the rete testis showing no involvement in the adjacent testicular or epididymal tissues. Micro-scopically, multiple branching papillary growth composed of tall columnar cells and central vascular core were found within the cystic spaces showing a transition to the normal epithelial lining cells of the rete tesis. Electron microscopic investigation showed the resemblances of the testicular tumor cells to the epithelial cells of the normal rete testis.
The significance of characteristic concentric circular structures which consisted of a continuation of tiny round bodies was not known. However, they may be derived from rough surfaced endoplasmic reticulum. The urethral nodular tumor revealed admixture of tublar and papillary structures, although papillaly branching was not prominent. The tumor had pale cytoplams with many PAS positive secretion vacuoles and was associated with chronic glandular urethritis. The patient was doing well as of March 23 in 1980 without any evidence of recurrence.
Papillary adenocarcinoma of the rete testis is extremery rare, and only 21 Gases were found in the literatures. The authers' case seemed to be the 22nd in the world and the 1st in Japan. Choice of treatment and degree of malignancy are briefly discussed.

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