A follow-up study of alkaline phosphatase activity in the ureters after the induction of obstruction and vecico-ureteral reflux in mongrel dogs has been made for 4 weeks. In addition, the urinary osmotic and static pressures in the obstructed ureters have been determined.
1. In the obstructed ureters, alkaline phosphatase activity in basal cells of the epithelium tended to decrease temporarily after the induction and then to return to its normal activity toward the end of the 2nd week. In the contralateral ureters, a temporary decrease of the activity was prone to retain until the 2nd week and then gradually recovered from the decrease. In the refluxing ureters, the activity had a tendency to decrease in the first week, while there was no change of the activity in the contralateral ureters.
2. In the obstructed ureters, the number of capillary vessels showing alkaline phosphatase-positive reaction in cross section units of the ureteral muscular layer decreased remarkably in the first week, and the number in the contralateral ureters decreased significantly. In the refluxing ureters and contralateral ureters, a mild decrease of the number was observed in the 4th week.
3. The osmotic pressure of urine in the obstructed ureters was approximately equal to that of plasma on the 3rd day and it was preserved until the end of experiment. The static pressure in the obstructed ureters showed a significant high value in the 4th week as compared with that in the first week.
From the results obtained, it is assumed that changes of alkaline phosphatase activity in the basal cells and capillary vessels may be responsible for changes of the epithelial and capillary functions which resulted from an increased intraureteral pressure and the functions can not participate in water reabsorption.

View full abstract

One hundred and thirty-seven out of 198 cases of prostatic carcinoma admitted in our clinic were treated with trans-pubic total prostateccomy (modified Shishito's method) combined with bilateral orchiectomy and pelvic lymphoadenectomy during the past 12 years since 1968. A follow up study was made in those patients by mailed questionaires in September 1979.
The 5-year actual survival rate was 57.5% and the 5-year relative survival rate was 71.7% through the cases. The 5-year relative survival rate in T0-1-2 and T3-4 cases was 71.7% and 62.7% respectively. Lymph node dissection was deemed nessesary through this study, because lymphatic node metastasis was found in 10% of T0-1-2 cases. Impotency and urinary incontinence occurred in most patients after the radical operation.
The former has lasted until the time of the questionaire. On the contrary, the latter was improved within a year in most cases. Although the main cause of post operative death was the cancer itself, but some cases died from renal insufficiency. Prevention of post-operative renal insufficiency is important.

View full abstract

Human prostatic acid phosphatase (PAP) was highly purified from prostatic tissue, obtained during operation for prostatic hypertrophy. With the antiserum raised in rabbit against the PAP, a double-antibody radioimmunoassay (RIA) for human prostatic acid phosphatase was developed.
Serum samples from 24 male and female controls, 113 patients with prostatic cancer (23 untreated and 90 treated), 201 with benign prostatic hyperplasia, 18 with prostatitis, 69 with other cancels and 107 with other diseases were studied by the RIA. In 180 samples of them we compared the RIA with the standard enzyme assay for quantitation of PAP in serum.
The normal upper limit of the serum PAP levels in the assay was set at 3.0ng/ml, since the control value of mean±2SD was 1.6±0.8ng/ml in males and 1.0±0.8ng/ml in females.
An elevated serum PAP was found in 82.6% of untreated prostatic cancer patients, but only in 14.4% of treated patients. Sera from untreated patients with prostatic cancer gave positive results in 3/6 of stage A, 2/2 of stage B, 6/7 of stage C and 8/8 of stage D. The highest value of them was 4260ng/ml in a case of stage D, and all cases with serum PAP level over 100ng/inl were with stage D prostatic cancers. The diagnostic sensitivity of the RIA was most decreased in stage A patients as expected. While in 201 patients with benign prostatic hyperplasia, 26 cases (12.9%) had elevated serum PAP levels and the highest value of them was 5.4ng/ml. It will be of great interest to follow these positive cases.
In contrast to the enzyme assay, the RIA technique was more efficient and distinguished for the detection of prostatic cancer.
The level of serum PAP measured by RIA was correlated with the clinical symptomatic response to estrogen therapy for prostatic cancer. We believe this specific test, RIA, is a clinical reliable parameter in diagnosing, staging and following-up prostatic cancer.

View full abstract

As a result of examination of the anatomical structure of ureterovesical junction in sixteen normal bladder specimens by microdissection and histological method, the following views were obtained:
1) Intravesical ureter is formed to be oppressed by longitudinal muscle fibers of the posterior side of the bladder.
2) The ureter from 1-2cm upper side than ureteral hiatus to intramural segment is almost surrounded by the periureteral sheath running parallel to the strike. This periureteral sheath consists mainly of the longitudinal muscle fibers of the bladder and partly of the circular muscle fibers and collagen fibers. Accordingly, it is considered that the periureteral sheath has developed from the bladder.
3) On the roof and fundus of the Intravesical ureter, there exist thick circular and longitudinal muscle fibers running at right angles to the ureters, by which the ureter is oppressed upon extending and contracting of the bladder.
4) Although the ureteral muscle fibers are not stratified but reticulated at the extravesical portion, these fibers clearly run at the intravesical portion longitudinally. After the ureteral muscle fibers expand like a fan at the portion passing the ureteral orifice and from each side partly cross to form the superficial trigonal layer, almost all parts of these fibers reach the verumontanum but partially terminate under mucosa of the trigone.
5) Most of the superficial trigonal layer is consisted of the ureteral muscle fibers partially including the vesical detrusor muscle fibers.
6) There exist the vesical circular muscle fibers under the superficial trigonal layer. These vesical circular muscle fibers partly cross to the longitudinal muscle fibers of the deeper layer and reticulate. Some fibers run into the periureteral sheath.
7) The longitudinal muscle and circular muscle of the bladder are not separate and cannot be distinguished as outer and middle layers, but a continuity between them is witnessed.
According to these views, as to the role of UVJ for VUR prevention, I have reached the conclusion that VUR shall be prevented by wringing and oppression of the intravesical ureter by the tension and contraction of the vesical detrusor muscle, enlargement of the intravesical ureter and the reduction of cavity by the tension and contraction of the trigone, and the reduction of the ureteral cavity by the periureteral sheath.

View full abstract

Preoperative assessement of invasiveness of the renal cell carcinoma is important to select the treatment. Preoperative angiographic staging were compared with the operative or pathologic findings of fifty patients who underwent nephrectomy for renal cell carcinoma.
Angiographic extent of renal cell carcinoma was assessed using the staging system originally proposed by Lang. His system was used after modified as follows (except for Stage 4B which denotes distant metastases and requires other radiological methods to diagnose): Stage I; a tumor receiving all its vascular supply from the main renal artery, Stage 2; cannibalization of the capsular arteries and/or parasitic arteries, Stage 3A; designaton of a striated vascular pattern at the renal vein level, Stage 3B; designation of a tumor brush in regional lymph nodes, similar in apperance to the primary lesion, Stage 3C; designation of both Stage 3A and Stage 3B appearance, Stage 4A; designation of tumor neovascularity in adjacent organs other than the adrenals. And also, pathologic extent of renal cell carcinoma was assessed using the staging system proposed by Robson.
The accuracy of angiography in assessing the clinical extent of the renal cell carcinoma was as follows: Stage I; 9 cases out of II (82%) were correctly diagnosed, Stage 2; 18 cases out of 27 (67%) were correctly diagnosed, Stage 3A; 8 cases out of 10 (80%) were correctly diagnosed, Stage 3; 1 case out of 3 (33%) was corectly diagnosed, Stage 3C; 1 case out of 3 (33%) was correctly diagnosed, Stage 4A; no case was correctly diagnosed. The over-all accuracy of angiographic staging in this series was 74% (37 cases out of 50 cases).
The problems of the comparative angiographic and pathologic findings were as follows; the renal artery, contributing blood flow to tumors in which renal capsule appeared histologically invasive, was found out about 20% of these tumors, and capsular arteries and/or parasitic arteris, contributing blood flow to tumors with intact renal capsules, were found out about 20% of these tumors. Agiographic diagnosis of lymphatic metastases disclosed inaccurate in these series. The pattern of the collateral drainage was found out in 50% only in the series of renal vein invasion from tumors. The presence of striated vascular pattern was a more reliable indication of Stage 3A than the presence of collateral drainage in our series.

View full abstract

Thirty-six adults with malignant diseases have undergone cutaneous synadelpho ureterostomy as a urinary diversion. Seven patients had slightly dilated ureters, and the remaining 29 patients had normal ureters. The follow up period ranged from 1 to 24 months, median 10.8 months. Transureteroureterostomy was done with interrupted sutures in 9 patients, and with a continuous suture in 27 patients. In the latter group 2 ureteral stents were left indwelling for 12 days postoperatively. Uretero cutaneostomy was done according to Toyoda's method.
Urinary leakage from the anastomotic site occurred in 20 patients, but ceased spontaneously within 90 days in 16 of them.
Stomal stricture developed and necessitated dilatation, revision, intubation or nephrostomy in 14 patients (39%). Postoperative IVP showed progressive hydronephrosis in 11 patients, and in 7 of them azotemia also developed.
Sixteen patients (44%) were completely free from stomal trouble, hydronephrosis or urinary tract infection and were considered to be successful. No correlation could be found between the history of irradiation or size of the ureter and the result of the operation.

View full abstract

Preservative effect of in situ cooling of cadaveric kidney was examined in experimental allotransplantation in dogs. Double balloon catheter devised by Inagake was employed throughout the experiments in flushing the kidney. The results obtained were: 1) In five mongrel dogs in which the catheter had been indwelled in the aorta prior to sacrifice, temperature of renal cortex fell to 9.18±1.50°C within sixty minutes after starting perfusion with cold (1 to 2°C) solution at a rate of 20ml/kg body weight/minute. 2) Five kidneys removed from the above mentioned dogs were transplanted to other five dogs in which renal function had been abolished by bilateral ureteral ligation. In four of the five kidneys transplanted dye excretion was noticed by excretory urography on the fourth post-operative days. The average survival time of the transplanted dogs was 12.0±3.46 days which exceeded that of control dogs which were treated similarly except kidney transplantation.
In situ cooling was applied in three clinical cases of cadaveric kidney removal. Perfusion rate, however, averaged to ca. 2ml/kg body weight/minute since drip infusion was employed instead of the forced perfusion with pumping device in the experimental cases. In six kidneys removed, one was discarded because of multiple artery and five kidneys were transplanted to recipients. In three cases urine secretion was noticed on the 12th, the 16th, and the 17th postoperative days respectively and the recipients were free from the dialysis thereafter. However, in two cases no secretion of urine was observed until the grafts were removed because of rejection reaction.
Effectiveness of cooling by forced perfusion employing the double balloon catheter in preservation of renal function was ascertained in experimental transplantation of cadaveric kidney. However, in clinical cases, the result was less effective since the perfusion velocity was much smaller than that in experimental transplantation. Therefore, the device to force fluid with larger perfusion rate through the catheter is necessary to obtain better preservative effect in clinical application.

View full abstract

During the period from 1973 to 1980, 5 cases of bilateral testicular tumors were found at our department and the related hospitals. Two of them (their ages were 32 and 33 years), showing different histology between the left and right testis, represent the 16th and 17th cases reported in the literature in Japan, and both cases were found to be suffering from bilateral germ cell tumors. One of them (32 years) was the second case of bilateral testicular tumor with different histology between the left and right testis in which the tumors were detected simultaneously for both sides. The remaining three cases with similar histology between the left and right testis included one case of lymphsarcoma (7 years) and 2 cases of seminoma (54 years and 57 years). The case of lymphsarcoma was a simultaneous tumor and the cases of seminoma were successive tumors, while in one case (54 years) of the latter the tumors developed on the remaining side 22 years after the development on the other side, with the second longest interval between the first and the second tumor recorded in Japan.
Including our cases, we collected a total of 118 cases of bilateral testicular tumors in Japanese literature, consisting of 17 cases with different and 101 cases with similar histology between the left and right testis, and discussed on their incidence, age distribution, location of testes, time of onset and etiology, histological classification and prognosis by dividing them into germ cell tumors and non-germ cell tumors.

View full abstract