The cellular insoluble lipoprotein extract was prepared from a bladder transitional cell carcinoma (TCC). This extract was solubilized by the aid of deoxycholate and the solubilized fraction was chromatographed on Sepharose 4B. With the retained fraction, antisera were produced by the immunization of guinea pig. After suitable absorptions, the immune sera allowed the characterization of an antigen closely associated with TCC by double gel diffusion. Indirect viable cell immunofluorescence studies with the immune sera rendered TCC-specific after absorptions revealed tumor-associated antigens on the plasma membrane of all 5 human TCC cell lines including T24 and RT4, but not of 4 non-TCC cell lines tested. Antibody-induced redistribution experiments showed that the TCC-associated antigen and β2-microglobulin exist as separate molecules on the cell surface.

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It is generally assumed that decreased libido and infertility are common in male patients with terminal renal failure. In our cases, ten of 20 patients (aged 25-45 years) undergoing chronic hemodialysis experienced decreased libido but none of them was impotent. Only one of the patients fathered during regular hemodialysis treatment.
Twenty patients (aged 20-39 years) receiving intermittent hemodialysis were also studied to determine the basal levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), and teotosterone (T).
The mean values of serum FSH and LH in the patients receiving hemodialysis were significantly higher than those of normal adult male (aged 20-49 years) (p<0.05). On the other hand, mean value of serum T in the patients receiving hemodialysis was significantly lower than that of normal adult male (p<0.005).
However, some patients whose T levels were very low did not have elevated LH levels and others whose T levels were high normal have elevated LH levels.
In three patients receiving hemodialysis serum gonadotropin (GnH) levels in response to synthetic LH-RH has been found to have a prolong elevation. These studies suggested that the patients receiving hemodialysis have not only a primary testicular failure but also a hypothalamopituitary dysfunction.
Basal changes of serum GnH and T after renal transplantation have been investigated in 8 recipients (aged 17-34 years). After renal transplantation serum LH decreased markedly within 3 months while serum FSH rose to many times over the pre-transplant level. This FSH surge was seen at the time when the subject was recovering from renal function and receiving prednisolone (25-35mg/day) therapy. Serum T decreased within one month after operation and gradually recovered to normal levels.
On the other hand, serum GnH was measured in two patients of nephritis with normal renal function and normal testicular function treated by large doses of 60mg/day of prednisolone. Prednisolone therapy did affect serum GnH level in these patients.
The explanation of t he FSH surge after renal transplantation was unknown, but we surmised that the FSH elevation would result from recovering of the hypothalamo-pituitary dysfunction and testicular damages of surgical stress and/or prednisolone treatment.

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Incidental carcinoma of the prostate (occult, latent or unsuspected carcinoma, stage A or I carcinoma and TO cancer) is defined as a cancer not clinically diagnosed but discovered by pathological examination of tissue specimens after various prostatic surgeries. Treatment of incidental carcinoma has long been the subject of controversy. Recommended treatment has varied from an aggressive approach of radical prostatectomy, of definite irradiation, more conservative antiandrogen therapy, to the most conservative approach of simple observation.
In the present study, the biological potential of each incidental carcinoma was assessed on the basis of pathological findings, such as the size of cancer lesions, cell differentiation and the condition of the surgical cut end in the surgical specimens. The cancers were then classified as follows considering the heterogeneity of the tumor natures and the treatment was assigned accordingly.
Group 1) Focal (A1) and well differentiated cancers with negative surgical cut end: No treatment.
Group 2) Multifocal or diffuse (A2) and poorly differentiated cancers irrespective of the condition of surgical cut end: Immediate initiation of an antiandrogen treatment.
Group 3) Any other types of tumors including a focal (A1) well differentiated but positive cut end tumor, a focal (A1) but poorly differentiated tumor as well as a multifocal or diffuse (A2) but well differentiated tumor: No treatment but careful follow-up.
Of 19 patients with incidental carcinoma, 10 received no treatment and 9 received antiandrogen treatment. The average follow-up period was 56 months in the former and 43 months in the latter group. The 5 year and 10 year actuarial survival rates were 62.2% and 29.9% in all 19 incidental cancers and were 58.0% and 32.5% in clinically diagnosed 64 cancers (stage B, C, D) treated during the corresponding time periods, respectively. Prognosis of the incidental carcinoma was better in well differentiated tumors (n=11) with the 5 year survival of 81.8% than in poorly differentiated ones (n=8) of 41.7%. The condition of the surgical cut end did not affect the survival significantly, since the 5 year survival rate was 58.2% in positive tumors (n=12) and 66.7% in negative ones (n=7). The 5 year survival rate of no treatment group (n=10) was 100%, while that of antiandrogen treatment group (n=9) was 38.4%, which was worse than that of the clinically diagnosed cancers (58.0%, n=64).
The results clearly indicate the reliability of our therapeutic guideline for the incidental carcinoma of the prostate. We can conclude that at least half of incidental cancer, namely, A1 and well differentiated tumors, do not require further treatment. Antiandrogen treatment, however, could not yield satisfactory therapeutic results in diffuse (A2) and poorly differentiated cancers. Therefore, more aggressive therapy such as definite radiotherapy or radical surgery should be performed in the group 2 fraction (A2 poorly differentiated tumor) of incidental carcinoma.

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We studied 114 patients with benign prostatic hyperplasia who underwent surgical treatment during the past 5 years starting from October 1976 to September 1981.
The ages of the 144 patients in the study ranged from 47 to 88 years with the most frequent age distribution in 70's and 60's in order of decreasing number.
Various surgeries were done in the 144 patients: suprapubic prostatectomy (SPP) in 88 patients, perineal prostatectomy in 1, cryosurgery in 5 and TUR in 50.
The average operation times were 107.3 and 94.5 minutes in SPP and TUR, respectively. The average blood loss during SPP was 457.7ml.
Acute epididymitis was the most frequent postoperative complication followed by intractable &/or febrile urinary tract infection. There was no postoperative death.
The average postoperative admission periods were 20.6, 35.8 and 15.1 days in SPP, cryosurgery and TUR, respectively.
The average weight of the resected adenoma was 40.6 and 6.8gm in SPP and TUR, respectively. The heaviest one weighing 535gm was excluded in this study. This is also the heaviest ever reported in Japan. There were 5 patients with the resected adenoma weighing more than 100gm. There was a tendency that the older the patient, the heavier the resected adenoma.
There was only one incidental carcinoma found in the resected adenoma in routine pathological examination (0.7%).
Four groups of operators consisting of Jr. Resident, Sr. Resident, Chief & Jr. Staff and Sr. Staff were compared regarding operation time, amount of blood loss, weight of the enucleated adenoma and amount of blood transfusion at open surgery. It was concluded that SPP could be properly done by the rotating Jr. Resident if assisted by the teaching staff during the surgery.

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We have tried to record the action potential of the proximal end of the renal pelvis on living canine Kidney and compared the data to those obtained our previous in vitro experiment.
Both action potentials at the pelvi-calyceal border in in vivo and in vitro experiment had a slow rising positive wave form, very similar to each other. The potentials recorded in in vivo experiment had constant intervals of about 5 seconds and an approximately 20μV amplitude. The potentials recorded at PUJ and the ureter in vivo showed sharp peaked waves with an initial negative deviation.
The discharge interval at the lower pelvis and the ureter was also a multiple of the discharge interval of the pelvic proximal end in in vivo study.
The speed of propagation of the peristalsis was found to be slower in the upper pelvis than in the lower pelvis and the ureter in in vitro experiment.

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The aim of this investigation is to clarify the pattern and mechanism of pure urethral response to nerve stimulation in connection with the urethral function. The bladder and the whole urethra of anesthetized female dogs were exposed for visual observation through a midline laparotomy and removal of the symphysis pubis. The extraluminal strain gauge transducers were fabricated in my laboratory. They were implanted at three points in the proximal, middle and distal urethra to measure separately and simultaneously both longitudinal and transverse movements. The intraluminal urethral pressure, intravesical pressure and rectal pressure were monitored at the same time. To locate and characterize the urethral response, electrical efferent nerve stimulation was performed under three sets of conditions; control, urethrovesical separation and amputation of the rectum.
Stimulation of bilateral pelvic nerves resulted in a rise in urethral pressure, prolongation of the longitudinal axis and shortening of the transverse axis of the proximal and middle urethra. The response was reduced but was not abolished after urethrovesical separation and/or amputation of the rectum. Stimulation of the hypogastric nerve brought about a rise in pressure, prolongation of longitudinal axis and shortening of transverse axis in the proximal urethra. The prolongation along the longitudinal axis disappeared after urethrovesical separation. Stimulation of the pudendal nerve produced a rise in pressure, shortening of transverse axis and variable responses along the longitudinal axis in the distal and middle urethra. Amputation of the rectum weakened the response.
These results indicate that the pelvic nerve can produce appropriate urethral tension for voiding urine efficiently, the hypogastric nerve plays an important role to support urinary continence and the pudendal nerve can stop voiding voluntarily.

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The function of the lower urinary tract has been evaluated by the urodynamic examination together with synchronous radiographic cystourethrography. The disadvantage to the synchronous urodynamic and radiographic cystourethrographic examination is that X-ray dosage is not boosted. Therefore we have used the ultrasonic method-voiding echography-as the imaging modalities instead of the radiographic method.
Transrectal longitudinal ultrasonotomography of the bladder and urethra by electronic linear scanning in real time is performed on sonolayer (Toshiba, SAL-30A). Urodynamic examination is performed on the polygraph system (Nikon-Kohden, RM-6000 and DISA, 2100 urosystem type). Ultrasonotomographic images and urodynamic data are projected through the display controller (Nihon-Kohden, VY-600G) to the colour display monitor (Nihon-Kohden, VD-610G). Urodynamic study together with simultaneous ultrasonotomography of the bladder and urethra can be seen on the colour display monitor.
It seems that our technique is indispensable for the evaluation of the lower urinary tract function.

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A 38 year-old physician complaining difficulty of urination was found to have enlarged verumontanum at the proximal part of membranous urethra by using voiding cystourethrogram, retrograde urethrogram and endoscopic examinations.
Transurethral verumontanum resection improved his obstructive symptoms as well as urinary flow rate.
We are unable to find any report of malpositioned verumontanum located at the membranous urethra causing obstructive symptoms, although there are several papers which describe verumontanum causing bladder-neck obstruction.

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A case of metastatic adrenal cancer was presented. The patient was a 55 year-old man who had had a right upper lobectomy for squamous cell carcinoma of the lung before 18 months. He was admitted to our department with a complaint of low grade fever and anemia, and for the examination of his large mass in the left suprarenal region which was pointed out by computed tomography. Ultrasonography and angiography revealed a left adrenal tumor which was successfully operated on for left nephro-adrenalectomy. The adrenal tumor was confirmed as a metastasis from the lung cancer by histopathological examination.
Although metastatic adrenal tumor is apt to be overlooked clinically, the high incidence of adrenal involvement seen in patients with malignant disease at autopsy has been reported. A statistical analysis of the metastatic adrenal cancer in 125, 581 autopsy cases based on Annuals of the Pathological Autopsy Cases in Japan from 1974 to 1978 was described with special reference to its primary lesions.
It should be emphasized that various imaging techniques such as angiography, ultrasonography and computed tomography were useful in the diagnosis of metastatic adrenal cancer.

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Invasion of renal cell carcinoma to the spleen is extremely rare, and it is difficult to detect it preoperatively. This is a case report of renal cell carcinoma with direct invasion to the spleen diagnosed by computed tomography.
A 68-year-old woman was admitted to the hospital because of recurrent fever and gross hematuria. Physical examination disclosed a man's fist sized tumor with tenderness at the left upper quadrant. The urinary sediment showed two to five red cells and many white cells in each high-power field. The hematocrit was 31.1%; the white blood cell count was 9, 200. The erythrocyte sedimentation rate was 114mm per an hour; CRP 3+. The serum electrolytes, urea nitrogen, creatinine, and serum enzymes were within normal limits. The serum protein was 7.6g per 100ml with hypoalbuminemia (46.9%) and elevated α₂-globlin (18.0%). Excretory urography revealed a deformity and filling defect in the left renal pelvis and the upper calyces. An increased vascularity in the superior pole of the left kidney and dilatation of the upper and middle capsular arteries were identified on selective left renal arteriogram. Celiac arteriogram disclosed that a branch of the splenic artery was feeding the left renal tumor, but invasion to the spleen was unclear. However the direct invasion of the left renal tumor to the spleen was found on computed tomogram. No distant metastasis was discovered by clinical and laboratory examinations.
Under the diagnosis of left renal carcinoma with invasion to the spleen, stage 4A, thoracoabdominal nephrosplenectomy was performed. The tumor invaded from the left kidney to the spleen directly. The histopathological diagnosis was clear cell type renal cell carcinoma containing partly an anaplastic pattern. Postoperative chemotherapy was given and she is in good clinical course after discharge.
To the best of our knowledge, only two cases of renal tumors diagnosed angiographically as direct invasion to the spleen have been reported, but, in Japan, this is the first case correctly diagnosed by computed tomography before surgery.

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