The serum concentration and urinary excretion of uric acid in 205 stone-formers were estimated comparing to those in 145 controls.
The results were as follows:
1) Serum uric acid levels did not show significant difference between both groups, although in stone-formers it tended to increase.
2) Urinary uric acid levels in stone-formers were significantly higher than in controls.
3) Hyperuricosuria was more frequent in stone-formers. The incidence of hyperuricemia, on the other hand, was not different.
4) The characteristics of uric acid disorders in stone-formers described above were observed only in male patients.
These results suggest the possibility that uric acid disorder may play some role in the genesis of nephrolithiasis especially in male patients.

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Based on observation made on 202 cases of renal cell carcinoma during a 14-year-period from 1965 through 1978, a retrospective study was made of the relationships between the stage and grade and the prognosis. The results obtained are the followings:
1) The 5-year relative survival rate was 75% for stage I, 77.5%, for stage II, 53.8% for stage III and 0% for stage IV. These figures clearly indicate that the stage of disease is one of the important determinant factors of the prognosis.
2) The grade-related 5-yeas relative survival rate was 77.5% for grade I, 59.8% for grade II, 37.2%, for grade III and 17.4% for grade IV. It became thus obvious that the prognosis of the disease quite well reflects its grade.
3) Among stage I cases those of lower grade tended to have a higher survival rate. However, grade III cases gave a 5-year relative survival rate of 71% and there were no striking differences among 4 grades in survival rate.
4) Among stage III cases those of low grade (grade I+II) had a 5-year relative survival rate of 75.9%, while the corresponding value for those of high grade (grade III+IV) was 32.3%. A similar trend was observed with stage IV cases. The grade of disease was thus shown to be a major determinant factor for prognosis.
5) Our study has shown that the proportions of lower grade were larger in lower stage carcinoma and higher grade in higher stage, indicating that the grade of the disease is a determinant of its stage. The above mentioned fact points out the necessity of studying the prognosis of renal cell carcinoma in relation to the grade as well as to the stage of the disease.
6) The 10-year crude survival rate, recurrence rate and the incidence of metastasis, which was first seen more than 10 years after operation, for stage I renal cell carcinoma were 30%, 70% and 3/7 (43%), respectively. It was felt important, therefore, not to take the malignancy easy even in such an early stage and to make all-out efforts to treat the cancer and prevent its relapse.

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During the last 15 years (1965.1-1979.12), we have experienced 17 cases of urolithiasis in children under 15 years of age. Childhood urolithiasis was rare and occupied 1.6% of 1047 urolithiasic patients of all ages during the same periods. There were 12 boys and 5 girls. The sex ratio was 2.4 to 1. The youngest case was 8 month-old and the eldest was 15 year-old. Eight cases (47%) were under 5 years-old. Thirteen patients had stones in the upper urinary tract (9 in the kidney and 4 in the ureter), 2 in the lower tract (2 in bladder) and 2 in both upper and lower tracts (1 in the ureter and bladder, 1 in the ureter and urethra), respectively. Signs and symptoms were gross total hematuria in 6 cases, fever in 3, flank pain in 3, vesical irritation in 3, urinary retension in 1 and urinary incontinence in 1. Thirteen operations were performed in 11 patients with stones in the upper urinary tract. The nephrectomy was done in two patients and the kidney was conserved in 9 patients. Ten stones were analysed by infrared spectrography. There were 4 phosphate containing calculi, 3 oxalate containig ones, 2 cystine stones and 1 xanthine stone. Predisposing factors for stone formation were assumed in 9 cases (52.9%): Cystinuria in 2 cases xanthinuria in one case, urinary tract obstructions and/or infections in 3 cases, side effects of drugs administered to underlying, diseases in 2 cases and long-term immobilization in one case. Of 12 cases successfully treated to the stone free conditions, only one patient recurred the stone during the follow-up period of averaging 9.6 years. The recurrence rate was 8.3%, which was significantly lower than those of adult cases. A complete urographic study is necessary for early diagnosis of pediatric urolithiasis. Abdominal CT scan may be of great help in the case of X-ray negative stones. A thorough search for predisposing factors is important in children, since metabolic disorders and urinary tract obstructions are prevalent in pediatric urolithiasis.

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In recording of the detrusor electrical activity, mechanical artefacts caused by the relative movements between the bladder and electrodes must be eliminated. In recent years, recordings of high frequency electromyogram of the urinary bladder have been made to exclude the mechanical artefacts that exist in low frequency band. The activity of the high frequency EMG, however, is very low and is interfered with external noise and the mechanical artefacts.
In the present study in order to obtain stable recording of the high frequency EMG, active filters were utilized in a preamplifier which included the circuits based on shield drive method.
Thirty-eight dogs of either sex were used for recordings of electromyogram of the detrusor muscle under anesthesia with pentobarbital at 25mg per kg. The bladder was exposed by a lower midline abdominal incision. Two bipolar platinum electrodes were fixed to the trigone and anterior wall of the urinary bladder. Activation of the bladder muscle was induced at the pressure level of 20.4±7.4cm H₂O and a rapid rise of intravesical pressure and biphasic spike potentials were recorded as 14.7±6.9μVp-p at the trigone and 10.7±4.5μVp-p at the anterior wall. Besides these reflex voidings, some electromyograms were recorded under additional conditions and three of four types of the mechanical artefacts that interfered with the electromyogram could be neglected, since the activation of electromyograms occurred before a rapid rise in the pressure in some cases and spike potentials could be recorded even in the urethral ligature and then spike potentials disappeared in localized heat degeneration.
This basic study has solved some of the basic problems in recording real electromyogram.

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A new technique was employed for visual observation of the contraction of the urinary bladder and urethra. This technique enabled us to observe directly the urinary bladder, prostate and urethra after resecting pubic bone concealing the urinary bladder neck, prostate and proximal urethra of the male dog.
Using this preparation, we understood that the urethral contraction was closely connected with the contraction of the rectum and anus. In addition, we observed two different contraction of the urethral striated muscle. One was the circular contracion of so-called external urethral sphincter positioned below the prostate. The other was the longitudinal contraction of the periurethral striated muscle. And the latter was stronger than the former. It was likely that the bladder contraction was started and then the bladder neck was tracted to the upper oblique direction mechanically when the pelvic nerve was electrically stimulated. As the result of the bladder contraction, we thought that the bladder neck opened not nervously but mechanically. We observed that the bladder neck was fastened when the hypogastric nerve was stimulated electrically. Although the contraction of the urethra was not observed then.
Our technique served the purpose of examining electrophysiologically the lower urinary system, observing its dynamic contraction simultaneously.

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It has been reported that in healthy people and in patients with various diseases, platelets and/or cell elements originating from platelets are always discharged in the urine: these small bodies were termed “platelet-like bodies in the urine” (U-PLB). The authors have assessed a platelet-specific protein β-thromboglobulin (β-T. G.) in urine, and have investigated their relationship to the U-PLB, the urinary components and the renal functions.
The average values of β-T. G. in the urinary supernatant and the non-sonicated and the sonicated sediment of healthy adult control were 0.577ng/ml, 0.410ng/ml and 0.70ng/ml, respectively. In 2 cases suffering from so-called idiopathic renal bleeding (I. R. B.) and one case with acute glomerulonephritis, the supernatant β-T. G. contents were 2.77ng/ml, 4.35ng/ml, and 2.08ng/ml, respectively. The sediment β-T. G. contents in each of these 3 cases exceeded 11ng/ml. In 3 cases with chronic glomerulonephritis (C. G. N.), the values of the sediment β-T. G. content were higher than those of the supernatant β-T. G. content, and in 2 cases out of these 3 cases, the sonicated sediment β-T. G. was higher than that in non-sonicated materials. In other cases with C. G. N., the sediment β-T. G. revealed a lower value than the supernatant β-T. G.. It has also been reported that β-T. G. is contained in the α-granules of platelets. From electron micrographic findings, many U-PLB in I. R. B. can be concluded to present platelets. However, the U-PLB in glomerulonephritis vary from platelet-like bodies to cell elements originating from platelets, and those in healthy individuals resemble cell elements originating from platelets. Moreover, the U-PLB in I. R. B. react with various reagents.
In 4 cases with hypertension and one case with idiopathic edema, the values of the supernatant β-T. G. content were higher than those of the sediment β-T. G. content.
The β-T. G. is always discharged in urine. The relationship of the urinary supernatant β-T. G. content and the sediment β-T. G. content to the osmolarity, creatinine, urea nitrogen, natrium, potassium and calcium in the urine and the creatinine-clearance was different. From these results, it is also suggested that the U-PLB is involved in urine. The β-T. G. in urine is mainly secreted as the β-T. G. itself and sometimes excreted as the β-T. G. non-released in the U-PLB. And, it is suggested that the β-T. G. excretion into urine is related with the renal functions and the renal pathologic changes.

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The various causes of intrarenal arteriovenous fistulas are considered. The major clinical manifestations are circulatory disorders, such as diastolic hypertension or cardiac decompensation, and urological signs, such as hematuria. Recent advances in angiography contribute to the increased frequency of detection of these lesions.
The purpose of this paper is presentation and discussion of 5 cases with different causes, which are cirsoid aneurysm, trauma, inflammation (tuberculosis) and 2 tumors.
Hypertension was seen in 3 patients and gross hematuria in 4. Two cases of renal cell carcinoma were nephrectomized. Of 3 instances with benign lesions nephrectomy was performed in 2 and partial nephrectomy in the third case associated with tuberculosis.
A-V fistula associated with the renal tuberculosis (case 5; Fig. 10, 11, 12) is rarely encountered. As far as we know no such case has been previously reported.

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The purpose of the study is to clarify whether serum proteins such as immunoglobullns and others and CRP as well as ESR may be usefull as diagnostic and therapeutic parameters in urinary tract infections. The investigated serum proteins other than IgM, IgG and C₃ are prealbumin (Pre), ceruloplasmin (Cp), α₂HS glycoprotein (α₂HS), transferrin (Tf), C₃-activator (C₃-A), β₂glycoprotein I (β₂I) and CRP.
The levels of these serum proteins and ESR were measured in 140 cases with urinary tract infection (UTI) and 25 healthy adult controls.
The results obtained in this study were as follows:
1. ESR is presumably useful for differential diagnosis between upper and lower UTI except upper UTI with negative CRP. ESR and CRP may reflect the therapeutic effectiveness of upper UTI. Serum IgG level increased in patients with chronic UTI, but the range seems to vary in individuals. On the other hand, the increase of serum IgM level was predominant in the patients with acute UTI, and it was thought to be useful as a diagnostic parameter in acute UTI.
2. A tedency of rising of Cp, C₃ and C₃-A levels was noted in patients with every group of UTI and the degree of elevation of the level was remarkable in febrile patients with upper UTI.
3. The levels of Pre and α₂HS were inclined to decrease in the patients with UTI, and there existed a significant difference between normal controls and febrile patients with upper UTI. Clinical usefulness of Tf was not recognized. The level of β₂I increased only in patients with exacerbation of chronic pyelonephritis (PN), so that the rising of β₂I level is thought to be useful in differential diagnosis between exacerbation of chronic PN and acute simple PN.
4. The level of Pre and α₂HS in patients with chronic PN with positive CRP approximate to those in patients with exacerbation of chronic PN, while the levels of these proteins in patients with chronic PN with negative CRP showed no significant difference from normal controls. Moreover, in patients with chronic PN with negative CRP the mean of Cp, C₃ and C₃-A levels revealed statistically lower than those in patients with chronic PN with positive CRP and with exacerbation of chronic PN. These results indicate that patients with chronic PN with positive CRP was in the latent phase of an exacerbation of chronic PN.
5. As the patients recover from acute simple PN, the level of CRP returns to normal rapidly, and then Pre, α₂HS, C₃ and C₃-A follow in this order. The time point when Cp and ESR return to normal range is presumably later than the other serum proteins. In order to determine clinical healing of acute PN, it is thought that CRP reacts too rapidly and ESR does too late. Accordingly, Pre, α₂HS, C₃ and C₃-A are thought to be clinically valuable as therapeutic parameters of UTI, but more investigation may be necessary to clarify the meaning of them in UTI.
On the other hand, in patients with exacerbation of chronic PN, normalization of these serum protein levels seems to be delayed as compared with that in patients with acute PN. These data suggest that patients with exacerbation of chronic PN have to be treated for a longer period than those with acute PN.
6. The fact that these serum proteins are not specific and necessarily correlate to UTI and react to associated inflammation and infection in other organs is well known. However, the results of the study strongly indicate that these serum proteins closely correlate to clinical course of UTI and may be good parameters in the diagnosis and treatment of UTI.

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A 76-year-old woman was admitted with complaints of general fatigue and consciousness disturbance. Clinical examinations showed that she was in a uremic state. Ureteral catheterization revealed an obstruction of the right ureter end. Right nephrostomy was performed, improving her general conditions. Further investigations indicated left renal pelvic carcinoma and right ureter carcinoma extending into the bladder. Left nephroureterectomy and right ureterectomy with total cystectomy were carried out. By pathological examination, the right ureter tumor was an invasive urothelial carcinoma extending into the bladder, and the left renal pelvic tumor was an invasive urothelial carcinoma invading almost of all the renal parenchyma, which has made the renal function extinct. She died of multiple liver metastases 9 months postopetatively. Reported cases of bilateral tumor of the upper urinary tract were reviewed and the causes of non-functioning kidney by renal pelvic tumor were discussed.

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A 59-year-old man was seen because of intermittent gross hematuria of 4 months duration. Cystoscopy disclosed papillary tumor with broad base about the right ureteral orifice. Excretory urography revealed large right nephrogram with non-visualization of the excretory system. The preoperative diagnosis was bladder tumor and right non-functioning hydronephrotic kidney due to ureteral obstruction by tumor. Right nephroureterectomy and radical cystectomy with left ureterosigmoidostomy were carried out. At surgery a small opening was accidentally made on the huge hydronephrotic kidney, spilling a large amount of mucinous and bloody fluid.
By histological examination, the renal pelvic wall was entirely replaced by poorly differentiated adenocarcinoma with mucus in the intercellular space. Papillary transitional cell carcinoma was recognized in the lower end of the right ureter and bladder. Adenocarcinoma was found in the enlarged prostate, which was clearly different from the carcinoma of the renal pelvis.
On the 40th day after the operation, the adenocarcinoma of the renal pelvis recurred in the right flank at the site of the previous incision. He died on the 70th postoperative day.
These three carcinomas confirm to the criteria of multiple cancer defined by Warren and Gates. Only 3 cases of urologic triple cancer could be found in the literature. Including our case, 39 cases of adenocarcinoma of the renal pelvis could be accumulated.
Adenocarcinoma should be included in the differential diagnosis in the cases with abnormal pyelogram, especially non-visualization of the collecting system, with or without nephrolithiasis. If adenocarcinoma is suspected, special care must be taken not to open the kidney, because recurrence in the incised site occurred in 8 cases and in 7 of which the kidney was opened at surgery.

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An 8-year old girl had suffered from recurrent urinary infection. X-ray examination revealed incomplete sagital septum of the bladder, left vesicoureteral reflux and left non-functioning hypoplastic kidney.
She was successfully treated by partial cystectomy including the septum and left nephroureterectomy.
Review of the literature showed that this was the twenty-sixth case of reduplication of the bladder in Japan.

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