The effect of adrenergic drugs upon renal pelvic pacemaker controlling ureteral peristalsis was measured. By using an in vivo experimental model recording renal pelvic pressure and electromyogram with blood pressure, we found that noradrenaline stimulated the rate of ureteral contraction up to the rate of pacemaker rhythm, While isoproterenol depressed the renal pelvic pressure and ureteral contraction, Although, using an vitro method which enabled us to record the electromyograms on the proximal end of the renal pelvis and other part of the pelvis and ureter with renal pelvic pressure changes, we found that isoproterenol decreased the renal pelvic pressure and suppressed the propagation of the pacemaker discharge toward the renal pelvis and ureter, while pacemaker activity was not affected by the isoproterenol administration. As a result, we found that the pelvic pressure did not reflect the pacemaker activity of the proximal end of the pelvis under administration of isoproterenol.

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The prolactin levels following castration and exogenous estrogen and androgen administration were studied in patients with prostatic cancer and Klinefelter's syndrome. Serum prolactin levels were measured by double antibody radioimmunoassay.
In patients with prostatic cancer, serum prolactin levels and response to TRH in about 2 weeks after castration were not different from those before castration. Therefore, it was considered that the castration might not affect on the release of prolactin from the pituitary gland in patients with prostatic cancer whose age were high.
Serum prolactin levels and response to TRH were significantly increased following acute and chronic estrogen administration in patients with prostatic cancer. Increased serum prolactin levels following chronic estrogen administration were easily suppressed by L-DOPA and CB-154 administration.
Serum prolactin levels and response to TRH were relatively increased following testosterone administration in Klinefelter's syndrome, but the increase of serum prolactin levels were low and delayed as compared with estrogen administration.
Serum prolactin levels were not changed following administration of dihydrotestosterone that was not converted to estrogen.

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A 2-site immunoradiometric assay for urine ferritin was investigated in 285 patients with urogenital diseases.
The results were as follows:
1) The recovery rate of this method obtained 7 urine samples was 97.9±5.05% (mean±S. D.). The intraassay coefficient of variation (C. V.) and interassay C. V. were 9.3 and 11.4% respectively.
2) The highest levels of urine ferritin appeared near 10:00hr., but no clear diurnal rhythm was observed. Quantitative 24hr. urine ferritin collections in 9 subjects did not significantly reduce the variability in urine ferritin levels as compared with random samples and this suggested that random samples were enough for clinical assay. No significant change was observed in urine ferritin levels between bloody or infected urine and clear urine.
3) Serum iron, total iron-binding capacity, serum ferritin had no significant influence on urine ferritin, since no significant relationships were observed between urine ferritin and these serum factors.
4) Urine ferritin levels were less than 30ng/ml in most cases of benign diseases, while they increased remarkably in cases of glomerulonephritis, pyelonephritis, and tumors of the upper urinary tract.
These data suggested that the injured renal tubular cells might be the source of urine ferritin.

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It has been generally accepted that self-catheterization is a useful treatment for chronic neurogenic bladder dysfunction in these ten years but there is still some uncertainty if it causes infections in undefiled, fresh neurogenic bladder. We have developed new catheter sets fitted for a safe and handy self-catheterization and applied it for 25 old and 24 fresh patients with spinal cord injury. In 25 old injuries of the spinal cord 6 of 8 cases with hydronephrosis, one of 8 cases with vesicoureteral reflux and 15 of 17 cases with urinary incontinence improved these pathological conditions during 63 weeks of follow up period.
Most patients with complete spinal cord lesion used to be incontinent when spasticity of the bladder returns since they have no urinary sensation to control urination. We treated 24 patients with complete cord lesion in spinal shock period by intermittent catheterization, nontouch technic to cause overdistension of their bladder (Program II). Patients were put in free fluid intake and were catheterized three times a day to distend their bladder over than 500ml in each catheterization. Our urinary management, Program II has been applied for all patients with complete spinal cord lesion except for male tetraplegics.
They could start self-catheterization in 12 weeks after injury. Eleven cases remained ice water test negative and thirteen cases recovered their bladder function in 12.8±7.6 weeks after injury. Their bladder contraction revealed very weak, namely upper motor neuron bladder, hypoactive in urodynamic survey. All these cases were free from urinary incontinence with self-catheterization though some case required anticholinergic agent.
The rate of urinary infection was 15.0±15.2 per cent in aseptic intermittent catheterization period of 12weeks duration while it was 18.4±13.0 per cent in self-catheterization period of 23 weeks duration. There was no statistical difference between these two groups. Self-catheterization using our new sets was revealed to be very safe and valuable for paraplegic patient saving them from bothersome urinary incontinence.

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30 pure calcium oxalate caluculi were selected by means of X-ray diffraction from among upper urinary tract calculi which had been passed spontaneously, and further studied by infrared spectroscopy with the aid of thermal analysis. This showed that a small amount of apatite was contained in so-called “pure calcium oxalate calculi”.
The 30 calculi were divided into two groups, group I (22 calculi) and group II (8 calculi), on the basis of the apatite content. The mean apatite content of group I was 2.2% and that of group II was 9.9%. In addition group I-calculi were composed mainly of calcium oxalate monohydrate and group II-calculi mainly of calcium oxalate dihydrate.
The organic matrix content was larger in group I than in group II and tended to increase in proportion to the apatite content in group I.

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A rapid and simple cytologic screening technique for fresh urine specimens stained with toluidine blue was described. As for the validity and description of cell structures, the accuracy of urine cytology with this procedure is very simillar to that of Papanicolaou technique. Utilizing this simple technique, a hospital population was screened for urinary tract cancer from specimens sent for soutine urinalysis. In this study of 16062 fresh urine sediments selected at random from non-urologic patients, a total of three histologically proven bladder cancer were detected. The detection rate of one bladder cancer in 5000 individuals makes this simple technique worthwhile in mass screening. On the other hand, another study of 730 urine sediments from all of urological patients, five were proved to have malignancy in genitourinary tract including three bladder cancer, one urethral cancer and one prostate cancer. Two of them were proved to be carcinoma in site by the histological examination and they were all, unsuspected in routine examination.
The results emphasize the usefulness of this simple screening technique in combination with clinical urinalysis and cytology for early detection of urinary malignancy.

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This study represents a statistical analysis of 79 patients with staghorn calculi treated at our hospital in the years 1972 to 1978 inclusive. Staghorn calculi were defined as stones filling the renal pelvis and at least 2 major calyceal branches. The following yields were gained.
(1) Staghorn calculi accounted for 23.7% of all renal stone admissions in the same period.
(2) Ages ranged from 11 to 83 years old and it was most common between the ages of 30 to 60 years old.
(3) Of the 79 patients, 27 were males and 52 were females with a ratio of 1:1.9.
(4) The involvement of the kidney was diagnosed as bilateral in 9 cases, right side in 28 and left side in 42, which demonstrated the more frequent involvement of the left kidney.
(5) Of the 79 patients, 69 presented associated renal infection (70.4% in males and 96.2% in females).
(6) The most common organism was Proteus, which was isolated from 23 patients (46%). Other organism such as E. coli in 11 and Klebsiella in 3 cases accounted for 22% and 6% of the all organisms, respectively.
(7) Of 37 patients, 3 had residual urine and 3 had vesicoureteral reflux.
(8) Each kidney was considered as one renal unit and the operation was performed on 60 units in 56 patients. Preservative procedure was used in 48 units of 44 patients through which nephrolithotomy was more frequent.
(9) Of calculi associated with infection, 42 composed of calcium-phosphate, Mg-phosphate-ammonium with carbonate and this was the most common type. Composition of carbonate radical appeared to be important in predicting the infection as a predisposing factor of stone formation.
(10) Serum and urine analysis showed no differece compared with the normal controls.
(11) In cases with preoperative infection and postoperative residual stone, the infection tended to continue for a long time.

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We studied the ureteral dilatation in cases of renal staghorn calculus.
(1) Diameters of 60 ureters in 55 cases with renal staghorn calculi were 0.73±0.32cm and statistically exceeded (p<0.01) in comparison with those of 42 normal examples that showed diameters of 0.53±0.17cm.
(2) In the cases of staghorn calculus with infection, ureteral diameters were 0.72±0.32cm and significantly expanded (p<0.01) compared with the normal values. Cases without infection showed ureteral diameters of 0.77±0.31cm and a difference in diameters was recognized between these with staghorn calculus and those with normal values (p<0.01). No statistical difference was observed between infected and non-infected cases.
(3) In the cases of infected staghorn calculi, no difference in diameters of ureters was found, correlating with various bacterial species such as proteus, E. coli and Staphylococci.
(4) Diameters of 35 ureters in 31 cases with pre-operative infection were 0.52±0.22cm postoperatively with no infection and significantly decreased compared with the pre-operative value of 0.73±0.30cm (p<0.01). However, in contrast to the distinct diminution of ureteral diameter in cases with no infection after operation (p<0.01), no significant difference was found in those with continued infection before and after operation. (p>0.05).
(5) Diameters of 4 ureters in patients with no infection before and after operation showed a distinct decrease post-operatively, (viz. 0.83±0.38cm before, and 0.54±0.22cm after operation).
(6) By comparison of the ureteral diameters before and after operation in cases of incomplete removal with pre-operative infection, the tendency of decrease in ureteral diameters was observed in 8 cases with no infection post-operatively, [viz. 0.84±0.43cm before and 0.48±0.19cm after operation (p<0.05)], whereas there was no significant difference if infection continued post-operatively.
(7) In cases with single renal stone, no changes in the ureteral diameter was found through infected, non-infected and normal groups.
(8) Our results suggest that the expansion of the ureters in staghorn calculi are firstly affected by infection and secondly by the disturbance of pace maker due to infection and lithiasis.

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Prostatic size and weight were measured in 346 normal subjects by means of transrectal ultrasonotomography. The weight of the prostate ranged 16.0±2.8-18.0±2.6g between 16-55 years old (y. o.), 14.5±2.4-14.7+2.6g between 56-65 y. o. and 10.4±1.7-11.9±3.6g between 66-90 y. o. Our data indicate that the prostatic weight is maximum in adolescence and begins to decrease from 56 y. o.

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The surface morphology of normal and neoplastic human bladder epithelium has been examined by scanning electron microscopy (SEM) and the blood group ABH isoantigens (IA) have been studied by scanning immunoelectron microscopy using bacteriophage T₄ (T₄) as a marker.
Microridges, short microvilli and microplicae were present on the surface of normal epithelium. The trigone epithelial cells were dominated by microplicae and distinguished from the cells of other anatomical regions. IA were distributed uniformly on the luminal surface of the normal bladder epithelium, showing some differences of labeling intensity in different anatomical regions.
Inflammatory condition did not induce essential changes in the distribution of IA, although considerable changes in the surface morphology occurred.
Neoplastic transformation induced drastic alterations both in the surface morphology and in the distribution of IA. The existence of pleomorphic microvilli, as observed in most of neoplastic bladder epithelium, was a most distinctive feature of malignant tumors and provided a surface marker of irreversible neoplastic transformation. Based on the altered surface appearence, pleomorphism of microvilli and the degree of attachment to the surrounding cells, tumor cells were classified into 5 main SEM cell types; Type 1: Cells with short microvilli and microridges. Type 2: Cells with uniformly distributed least pleomorphic microvilli. Type 3: Cells covered evenly with moderately pleomorphic microvilli and smooth surface cells. Type 4: Cells with highly pleomorphic microvilli gathering or fusing each other. Some of these cells had blebs and membrane ruffles. Type 5: Round small cells with poor cell-to-cell contact. Most of these cells had highly pleomorphic microvilli and blebs and some of them had smooth surface.
There was a high degree correlation between these cell types and histological grade; grade I consisted of types 1, 2, and 3, grade II of types 2, 3, and 4 and grade III of types 3, 4, and 5. The degree of the deletion of IA expression was correlated with histological grade. In the grade I lesions 23% were negative for IA, in the grade II 71% were negative, and in the grade III IA could not be detected. With regard to the relation between SEM cell type and IA expression, IA were preserved in all cases of type 1, while IA were deleted in all cases of type 2 and type 5. In types 3 and 4, the rate of deletion of IA was 50% and 73%, respectively.
The deletion of IA might represent changes in the cell surface glycolipid and glycoprotein and express a kind of functional dedifferentiations of the bladder tumors. Therefore, the morphological analysis using scanning immunoelectron microscopy might be valuable for the analysis of the variety and the growth pattern of human bladder tumors.

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We have been studying the introduction of flow cytometry into automated cytology using obtained DNA histogram of exfoliative cells in bladder cancer. But in the patient of bladder cancer, inflammatory cells constitute an appreciable part of saline bladder washings, obscuring the polyploid or aneuploid peak in DNA histogram. To obtain more precise flow cytometry data, we investigated the method of removing leukocytes from bladder washing specimen. After Triton X-100 pretreatment, which destroys only leukocyte cell membrane, suspension of specimen was layered on top of Ficoll-Paque and centrifuged for 10 minutes at 100g. Leukocyte nuclei gathered at interface and sediment mainly consisted of epithelial cells. Morphological examination revealed satisfactory separation of leukocyte from epithelial cells. DNA histogram obtained by flow cytometry showed decreased cellular population from diploid (2c) peak, making polyploid peak more prominent. With this procedure we can get more precise DNA histogram which resembles to tumor cell population and accurate cytological examination by flow cytometry may be possible. And flow cytometry is considered to apply in wider range of clinical practice.
Fixation of specimen with 50% ethanol for two weeks is shown to have no infiuence on DNA histogram with the use of fluorescent dyes of propidium iodide or acridine orange.

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The patient was a 62-year-old male who was examined initially for the major complaint of hematuria and pain in the right lumbar region on May 8, 1980. The patient was admitted to hospital on the same day.
The diagnosis was renal cell carcinoma according to excretion pyelography, C-T scanning, urine cytodiagnosis, etc. Metastasis in the lung was detected by stethendoscope. The results of the test performed on hospitalization revealed that leucocytes numbered 51, 000/mm³, which gradually increased to a maximum of 111, 000/mm³.
Serum Ca also gradually increased. Due to the aggravation of general symptoms, the patient suffered from dyspnea due to cachexia and the increase of pneumonic metastasis which led to his death at post-hospitalization 24 days, without having the chance to be treated by cancer chemotherapy.
Since no pathological anatomical examination was performed, necropsy was rendered necessary which revealed clear cell carcinoma.
Due to the fact that neither infection nor bone metastasis causing leukocytosis was detected, the possibility of a CSF-producing tumor was strongly suspected, and CSF measurement was tried, but was not successful.
In Japan, 5 cases of CSF-producing tumor have been reported, i. e., 3 cases of lung cancer, 1 case of thyma and 1 case of mandibular carcinoma, but no case of urological malignant tumor has been reported yet.

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