Transurethral ultrasonography has been developed mainly for bladder cancer staging. This sonogram is much better than that obtained by the conventional transrectal scanning or scanning via abdominal wall: for instance, ureteral penetration into the wall was more exactly observed (Fig. 12). Since the bladder is scanned by a probe inside the bladder, this new method is called transurethral intravesical scanning or endoscopic ultrasonography. Our scanning device is suitable for practical use, because it has following advantages 1. High-speed scanning enables a real-time observation of the tomogram. 2. The size of the probe sheath is reduced to 24 F. 3. The scanner can be held by hand. 4. Picture quality was improved by using a 7.5MHz transducer. 5. The vesical area in the dead angle of the scanner is minimized by a probe with head angulating device (Fig. 3) or a transducer faced to retrograde direction (Fig. 2. B).
The vesical structures such as mucosal edema (Fig. 4-6), superficial and deep muscle layer as well as tumor base were clearly determined on the tomogram. Therefore, almost the same criteria as in pathological staging is applied in the ultrasonic staging of bladder cancer. The criteria are as follows; (1) Ta or T₁ tumor: the image of the muscle layer is intact at the tumor base (Fig. 15). (2) T₂ tumor: the image of the muscle layer is superficially indented at the tumor base (Fig. 16). (3) T₃ tumor: the image of the muscle layer is deeply indented or disappeared at the tumor base (Fig. 17).
The tumors often had very characteristic shapes on the tomogram, indicating their stages. Eight patterns of these findings were shown as subsidiary diagnostic finding for cancer staging. (a) An image of tumor base on the mucosal edema is a sign of no muscular infiltration (Fig. 29. a, Fig. 19). (b) An image of clear and undeformed bladder surface beneath the tumor is a sign of no muscular infiltration (Fig. 29. b, Fig. 20) (c) Tumor image with a narrow pedicle is a sign of no muscular infiltration (Fig. 29. c, Fig. 21). Tumor stalk is well observed by pushing the tumor from behind. (d) An image of tumor base with (markedly) irregular border is a sign of (deep) muscular infiltration (Fig. 29. d, Fig. 23, 24). (e) A thickening or split image of the muscle layer at the tumor margin is a sign of deep infiltration (Fig. 29. e, Fig. 25). (f) Tumor image under bladder surface with less deformity is a sign of deep infiltration (Fig. 29. f, Fig. 26). (g) Tumors with smoothly indenting tumor base must be staged carefully by the diagnostic criteria previously shown, however, (deeply) indenting tumor image at the intravesically protruding wall is a sign of (deep) muscular infiltration (Fig. 29. g, Fig. 27. B). (h) Image of tumor spread into the pros tate or other perivesical structure is a sign of stage T₄ (Fig. 29. h, Fig. 28).
67 cases of bladder cancer were examined by our transurethral intravesical scanning system. Scanning was effective except for 3 cases which had main tumors at the bladder neck.
Diagnostic criteria for staging were confirmed in 16 of 17 cases. The correlation between the tumor and the wall observed on the tomogram was proved consistent with the crosssection of the pathological specimen. One misdiagnosis was due to lymphatic invasion in the muscle layer. In these 17 cases, exact comparison between the tomogram and the crosssection of the specimen was possible, because tumors were excized with full thickness of the wall and their shapes were not modified by preoperative treatment.
In total of 58 cases, including transurethrally resected cases and others, ultrasonic findings based on both of diagnostic criteria and subsidiary findings for staging were in accord with the pathological stages except 4 cases.
In other 6 cases, pathological specimen could not be obtained.
It is remarkable that this new system clinically displays minute structures of tumor base as we

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In order to elucidate the cause of unexplained hematuria, we made radiological studies by angiography in 133 cases with so-called “essential hematuria”. Aortography and renal arteriography were carried out in all of them, and pharmaco-assisted retrograde renal venography was performed in 95 of those 121 cases in whom arteriography had proved negative for anything abnormal. Arteriography revealed abnormal findings in only 12 (9%) of the 133 cases, whereas retrograde renal venography revealed abnormalities in as many as 49 (52%) cases. Abnormal x-ray findings in those 49 cases were classified into the following six types:
Type 1: Collaterals formation of the renal vein (14 cases)
Type 2: Stenosis of the renal vein (7 cases)
Type 3: Pyeloureteric varices (15 cases)
Type 4: Renal vein thrombosis (2 cases)
Type 5: Congenital anomalies of the renal venous system (5 cases)
Type 6: Others (6 cases)
Such a radiologic classification has never been reported. Any of the abnormal findings we experienced in the renal venography could be classified into one of these types.
What is the most noteworthy is that the abnormal findings under Type 1 to Type 4 are all suggesting the presence of congestion in the venous system of the upper urinary tract and their incidence was as high as 78% (38 of 49 cases). These results suggest us that congestion in the venous system of the upper urinary tract plays an important role in formation of hematuria, and that renal venography may be very useful for clinical investigation of that congestion.
In order to support the above derived from the clinical studies, then the authors carried out experimental studies with dogs. The renal veins of dogs were ligated either completely or incompletely to elucidate the relationship between congestion in the venous system of the upper urinary tract and hematuria. All of the dogs with complete obstruction of the renal vein showed development of hematuria immediately after obstruction in association with a sharp rise in the pressure of the renal vein. The dog with incomplete obstruction of the renal vein of which the pressure increased above the level of 30mmHg showed the development of hematuria. The RBC counts in urine were well proportioned to the increase in pressure of the renal vein following ligation and the decrease in the pressure was found associated with a retreat of hematuria. Renal venography following ligation demonstrated development of collateral veins, while aortography demonstrated reduction in the diameter of the renal artery. These two changes could be pointed out as the causal factors for the fall in the pressure of the renal vein.
The above experimental results indicate that congestion in the venous system of the upper urinary tract can be a cause of hematuria, and that it is developed if the pressure of the renal vein increases above the level of 30mmHg. These results may be said to support the clinical observation that congestion in the venous system of the upper urinary tract is closely related with the cause of bleeding at the upper urinary tract. Although all of clinical cases with essential hematuria may not be explained on the basis of the congestion in the venous system of the upper urinary tract, it probably has a close connection with hematuria. Besides, usefulness of renal venography for clinical examination of the disorder could also be confirmed.

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Endocrine studies were performed on two hundred and nineteen cases of male infertility. Forty normal adult men and thirty-three cases of Klinefelter's syndrome were also studied for comparison. Serum levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), testoterone, prolactin (PRL), thyroid-stimulating hormone (TSH), thyroxine (T₄) and triiodotllyronine (T₃) were determined and correlations between these hormone levels and sperm concentrations as well as histological indexes on testicular biopsy specimens investigated. Stimulation tests for these hormones using LH-RH, TRH, or hCG were also added in some cases.
Serum gonadotropin levels (particularly FSH levels) were found to be increased in patients with azoospermia and severe oligozoospermia (sperm concentrations lower than 10×10⁶/ml), the mean values for LH and FSH being significantly elevated from those in normal men (p<0.05). Serum levels of PRL, TSH, T₄ and T₃ and their responses to TRH stinnulatiotn were within normal ranges for men. Pituitary reserve function for secreting gonadotropins in response to synthetic LH-RH has been found to be almost normal in the majority of cases of male infertility showing adequate increases of LH and FSH. On the other hand, some alterations or hypofunctiori of the Leydig cell reserve capacity to secrete testosterone in response to hCG have been suggested to exist in certain cases of disordered spermatogenesis.
Analyses of correlations between testicular biopsy score count and endocrine parameters suggested the possibility that cases of spermatogenetic failure with given biopsy scores are mixed up with those with different etiologic factors, i. e., at least one with primary testicular failure and another with secondary testicular failure due to hypothalamo-pituitary dysfunction to secrete gonadotropins appropriately. These endocrine pictures are discussed in analogy to those in certain types of eunuchoidism, and spermatogenetic failure may reasonably be considered as milder forms of male hypogonadism.

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The electromyograms of canine external urethral sphincter were recorded, using our new preparation and observing the external urethral sphincter directly.
Its electromyographic responces to the α-blocker (phentolamine) and β-blocker (propranolol) were not observed in this study. Although the discharges of the external sphincter disappeared on administration of suxamethonium and pancuronium.
The opinions that the α-adrenergic system acts dominantly on the external urethral sphincter can not be supported by our data.

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Anterior subcostal incision; a surgical approach to the kidney, adrenal and retroperitoneal space is reported.
The surgical method is described in detail.
One hundred and twenty-one cases including renal cell carcinoma involving the vena cava, malignant paraganglioma invading the vena cava, huge adrenal tumor, renovascular disorders and neuroblastoma cases were operated on by this approach.
Comparative analysis on renal cell carcinoma according to surgical approaches namely anterior subcostal incision and the other incisions showed an improved 5 year survival rate in the anterior subcostal incision group.
This incision can provides us with a superior operative field, direct approach to the renal pedicle, excellent wound healing, easy and safe patient control during surgery and choice of tiansperitoneal or extraperitoneal approaches.
The anterior subcostal incision as a surgical approach to retroperitoneal disorders is recommended especially in cases of renal cell carcinoma, adrenal tumor and renovascular disorder.

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Mitogenic effects on human lymphocytes of ALG against human splenic, peripheral lymphocytes and cultured human lymphoblast were investigated in vitro.
Lot 007 (ALG against splenic lymphocytes) and LOT 013 (ALG against peripheral blood lymphocytes) were subsequently proved to have an intensive mitogenicity, however Lot 017 and Lot 020 (ALG against human cultured lymphoblast) showed only a slight effect.
Mitogenicities of these ALG did not always correlate with their antibody titers (lymphocyte cytotoxiclty titer, Rosette forming Inhibition titer, hemagglutinin titer, Antiplatelet titer).
In the presence of a complement, the mitogenic activities of ALG Lot 013, 017 and 020 were depressed, but they were not evident in ALG Lot 007.
In the absence of complements, ALG Lot 013 indicated the most intensive mitogenicity in a low concentration (0.5mg/ml), but only a slight reaction in a high concentration (5.0mg/ml).

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The electrical potential difference and iodide ion permeability of rat seminal vesicles were investigated in in vitro experiment. Iodide ion permeability was measured using radio isotope (Na¹³¹I).
1) The electrical potential difference was approximately -1.4mV with the mucosa electrically negative and faded on 1mM 2, 4-dinitrophenol (DNP) administration.
2) The transfer of iodide ion from the serosal side to the mucosal side was always predominant over that from the mucosal side to the serosal side. This result means that iodide ions were transported against the electrical potential. Therefore it was considered an uphill transport.
3) The appearance rate of iodide ion in both direction increased on DNP administration. The result suggests that the permeability of iodide ion depends on not only the electrical potential but also the metabolic energy.
4) The appearance rate of iodide ion of the seminal vesicles which were obtained from the castrated rats and non castrated rats showed the same tendency.
In conclusion, the iodide ion transport of rat seminal vesicles showed an uphill transport and the transport depends on metabolic energy. Therefore it was considered that the transport was performed actively, on which androgen showed no significant effect.

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The effects of autonomic drugs (norepinephrine, isoproterenol, acetylcholine) and prostaglandin F_2α on the release of ¹⁴C-fructose from the seminal vesicles were studied in vitro.
Norepinephrine 1×10^-5g/ml and prostaglandin F_2α 1×10^-4g/ml increased the release of fructose but isoproterenol 1×10-⁵g/ml and acetylcholine 1×10^-5g/ml showed no response.
The effect of the norepinephrine 1×10^-5g/ml was also observed in the specimen from which the muscle layer had been removed.
The effect of norepinephrine 1×10^-6g/ml was blocked by phenoxybenzamine 1×10^-5g/ml.
The results indicated that the release of fructose was increased by α-adrenergic agents, which suggested further that the fructose secreting might be influenced by the sympathetic nervous system.

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A high percentage of recurrent rate is observed in patients with idiopathic calcium urolithiasis. We selected 86 calcium stone formers with normal serum calcium level and normal urinary tracts. They live in the outer area of Tokyo, are commuters and live on standard foodstuffs. In those patients we tried to find out the frequency of hypercalciuria and its type by performing an oral calcium load test. In addition, we studied the effects of hypercalciuria on recurrence of calcium stone diseases.
Hypercalciuria in which 24-hour urinary calcium excretion surpassed 250mg was observed in 35 of the 86 subjects or 40.7%. In the other 51 non-hypercalciuric stone formers, daily calcium excretion averaged 154.1±55.0mg. Recurrent and/or multiple stones developed in 10 of the 35 hypercalciuric (29%) and 16 of the 51 normocalciuric patients (31%). The oral calcium load test suggested the etiology of hypercalciuria. Recurrent and/or multiple stones were more frequently formed in possible renal or absorptive hypercalciuric subjects than in those with idiopathic hypercalciuria (3.5:1).

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Of scrotal contents removed from 15 patients with prostatic cancer, methylmetacrylic resin was injected into the epididymis in the reversed direction from the ductus deferens in order to make a cast of the ductus epididymidis. The casts were examined under the epidiascopic microscope, and the following results were obtained.
1) The resin injection was possible as far as to the tail of epididymis. The lumen of the ductus epididymidis was gradually tapered, but there was no evidence of sudden narrowing.
2) The course of the ductus epididymidis was relatively regular, taking a double zigsag way in a folded manner. Holstein's theory that the epididymis is formed by the initial and secondary winding of Wolffian duct was proved to be correct by this study.
3) 1cm length of the tail of the epididymis was constructed with about 65-70cm length of the ductus epididymidis. Consequently, the actual length of the ductus epididymidis in humans is estimated as about 3-4 meters, although in conventional textbooks it is described as 4-6 meters.

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Benign multiple ureteral polyps in childhood occurred in a 12-year-old boy admitted to our hospital with a chief complaint of pyuria. X-ray examinations showed left hydronephrosis and hydroureter with intrinsic filling defects which were extensive in the upper and lower ureter. Surgical exploration revealed a total of 33 multiple polyps in the lower ureter as well as the upper ureter. The histological findings showed a fibrous polyp with inflammation. We gave up conservative surgery because the normal ureter was too short, and nephroureterectomy was performed. We discussed on 26 cases of ureteral polyps in childhood in the Japanese and English literature. We believe our case is the first ureteral polyp in childhood which was found in the lower ureter.

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