The present assay for oxalate in plasma is a modification of the radioenzymatic isotope-dilution technique developed by D. J. Bennett et al. The oxalate in 5ml of plasma ultrafiltrate is purified by precipitation and ex-traction. The enzyme assay is carried out in a 0.2ml reaction mixture, so that the assay sensitivity is increased up to 0.3μg of anhydrous oxalate. The mean oxalate concentration from 15 apparently healthy subjects who had fasted overnight was 15.9±10.8μmol/l (SD), while that from 15 calcium oxalate stone-formers was 27.6±7.2μmol/l.
It was suspected that the latter value might be too high, possibly due to the conversion of glyoxalate to oxalate, as has been pointed out by T. Ackay et al. Inhibitors of the glyoxalate oxidation were, therefore, added to the freshly taken blood samples. The mean oxalate concentration with the inhibitors from the controls was 14.3±5.1pmol/l (SD), while that with the inhibitors from the stone-formers was 12.1±4.5pmol/l (SD). It is likely that normal blood spontaneously generates oxalate on standing.
It is concluded that there is no significant difference in plasma oxalate concentration between the two groups, nor any sex-dependent differences, as determined by means of a sensitive, specific, and accurate assay, with inhibitors used in order to prevent the enzymatic conversion of glyoxalate to oxalate.

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The effects of fast urinary bladder distention on blood pressure, plasma catecholamines (CA) and plasma renin activity (PRA) were studied in 33 mongrel dogs anesthetized with chloralose. The blood for measurements was obtained from the inferior vena cava and brachial artery. Plasma CA was measured by THI method using Shimazu HLC systems and PRA by radioimmunoassay.
1) Preliminary experiments revealed that blood pressure and plasma CA level were stable during one hour anesthesia, till a 40ml blood loss in total.
2) During rapid bladder distention, blood pressure was significantly increased to 110-120% of the initial level.
3) Accompanying the blood pressure rise, plasma norepinephrine level was also significantly increased to 150% of the initial level.
4) PRA was also increased during bladder distention, but it rose more gradually than plasma CA.
5) The pattern and rate of plasma CA and PRA increase were not characteristic of the evoked blood pressure rise. Therefore, it seemed that plasma CA and PRA might not play the main roles to increase blood pressure.

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Simultaneous measurement of cystometry and external sphincter electromyography were performed on 197 patients with various neurogenic and non-neurogenic bladder disturbances. Detrusor sphincter dyssynergia (DSD) which is defined as a persistent electromyographic activity of external sphincter during and/or intended micturition, was found on 50 patients among them. The incidence of DSD was as follows; Encephalopathy 7/33 cases (21.2%). Myelopathy 18/42 cases (42.9%). Neuropathy 8/31 cases (25.8%). Mixed type 10/35 cases (28.6%). Non-neurogenic 7/56 cases (12.5%). It is worth to note that DSD was also found in non-neurogenic patients and the incidence of DSD in the patients with myelopathy significantly higher than that of encephalopathy. We classified the electromyographic pattern of DSD as follows. Type 1; Increased electromyographic activity during micturition... 12 cases. Type 2; Unchanged electromyographic activity... 12 cases. Type 3; Decreased but persistent electromyographic activity... 19 cases. Type 4; Failure to supress the electromyographic activity voluntarily and the patient was unable to initiate micturition... 5 cases. Clinical as well as pathophysiological importance of above classifications is awaited for further study.

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To investigate the role of sphincter activity in the voiding dysfunction of spinal cord injury, 103 paraplegics were studied by electromyography of both urethral and anal sphincter. Electromyographical activity was recorded with single core needle electrodes. The external urethral sphincter was identified at the apex of the prostate by the intrarectal digital palpation under visual or audio control; the external anal sphincter was found without difficulty in subcutaneous position. (1) Average of urethral and anal EMG activity was 0.45±0.55mV and 0.37±0.48mV, respectively. (2) The activity of these two sphincters was identical in 60 percent, while it was dissociated completely in 25 percent and partially in 15 percent. (3) Correlation between voiding dysfunction and either residual urine or micturition time was statisticaly analyzed to see if these parameters reflect voiding dysfunction. They were formed to be clinically usable (n=89, r=0.619, t=7.36>t_.01=2.66). (4) Correlation between urethral MEG-activity and residual urine was n=89, r=0.539, f=5.97>t_.01=2.66. Correlation between urethral EMG activity and micturition time was n=89, r%0.429, t=4.44>t_.01=2.66. These data suggested that urethral EMG activity correlated very well with dysfunction as evidenced by residual urine or voiding time. (5) Similar statisticaly analysis of the anal EMG activity revealed no significant correlation either to residual urine or micturition time. Anal sphincter seems to be unreliable in predicting voiding dysfunction. (6) Activity of the two sphincters was compared in the group with and without voiding dysfunction. Urethral EMG activity was found to be statistically more significant in the latter than in the former group. Anal EMG activity was variable without any statistical significance between the two groups. (7) There was a statistically significant trend of increasing urethral EMG activity as the level of spinal injury assends -0.67±0.64mV, 0.51±0.57mV, and 0.20±0.33mV in the cervical, thoracic, and lumbar spinal injury, respectively.

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In order to achieve more effective prevention of recurrent stone disease, we are asked to know much more about the natural history of nephrolithiasis. We summed up here a ten years' retrospective analysis of 1770 patients with urolithiasis seen at Keio University Hospital from 1971 to 1980.
1) The incidence of urolithiasis was 4.3±0.6%.
2) Most of the stones (96.7%) were in the upper urinary tract.
3) In males the peak incidence was seen in the twentieth to fourtieth age groups, while in females it was seen only in the twentieth age group. Male to female ratios were: 1:1 in staghorn calculus, 1.5:1 in pelvic stone, 2:1 in calyceal stone, 2.8:1 in ureteral stone and 2.3:1 on the average.
4) 19.4% were the patients with recurrent stone. Those with more than three events represented 21.2% of the recurrent group.
5) Bilateral stones were found in 11.8% of the patients with a first episode, and in 28.1% of those with a recurrent episode.
6) The rate of spontaneous stone passage was significantly higher in males (27.6%) than in females (20.6%, p<0.005).
The above mentioned observations that the natural history of nephrolithiasis of the male differs in many aspects from that of the female and that the recurrence rate increases in middle age group require further systematic investigations of endocrinological and metabolic aspects of the disease.

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The development of muscular structure of the male posterior urethra was histologically investigated serially in 5 fetuses (from 7th to 17th fetal week). The muscle structure of the male posterior urethra can be arbitrarily devided into three parts, (1) muscles of trigone and bladder neck (2) stroma of the prostate and (3) muscles in the region of the external urethral sphincter (i. e. striated urethral muscle and inframontane circular smooth muscle). Striated muscle of the urethra, which differs distinctly from other somatic striated muscles in its morphological and functional aspects, is recognizable at 8th week. They start to develop in the anterior wall of the urethra as a dense cellular accumulation, which eventually extend caudolaterally to form a horse shoe shape appearance. Striation of this muscle, however, is not noticeable until 12th week. Inframontane smooth muscle starts its differentiation between 9th and 11th week, running circularly inside of the striated urethral muscle. There is no distinct fascial plane between these two muscles which are clearly distinguishable by individual morphological difference, and instead they are intermingling each other in this area. Prostatic bud arises at 14th week and grows into prostatic mesenchyme. Following interaction between the buds and mesenchyme, prostatic smooth muscle is recognizable at 17th week around which time trigonal muscle starts its differentiation. From these observations we surmised that primitive vesical function such as emptying and holding its load must be obtained at around 8th week or 12th week at latest. Muscular development of the upper and lower urinary tract is outlined at each embryologic stage. Disturbance of this orderly process is inferred to breed various congenital urological diseases by disturbing urine transport and micturition which are deemed to be one of the essential stimulus for the development.

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Three continuous cell lines were established in 62 urologic carcinomas. They were derived from clear cell carcinomas of the kidney of a 70-year-old man (KH-39) and 30-year-old woman (KN-41), and from a transitional cell carcinoma of the bladder of a 44-year-old man (KW-103). They have showed a vivid growth of epithelium-like cells in successive cultivations, and have been maintained for over 34 months and over 140 transfer generations. Transmission electron microscopic studies revealed that all these cells had abundant microvilli, and that KH-39 cells and KN-41 cells had the polarity in arrangement of cellular organelles. Heterotransplantations of these cells into the back of nude mice produced well-demarcated solid tumors that were histologically similar to their original cancerous tissues; renal cell carcinoma and bladder carcinoma. Chromosomal analysis of the cells transferred to the 44 to 48th generations revealed hyperdiploid number with 2 marker chromosomes, the modal number was 58 to 59 in KH-39 and KN-41, 57 in KW-103, and the centromere indexes were 15.1 and 22.4 in KH-39, 15.2 and 22.7 in KN-41 and 16.2 and 24.1 in KW-103. Using a replicate culture method, the doubling times of the cells of KH-39, KN-41 and KW-103 were 16.0, 20.9 and 16.0 hours, respectively.

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Measurements of HLA Antigens (A Locus 17, B Locus 28 and C Locus 4) in 87 cases with tumors of urogenital system were carried out to elucidate the influence of HLA Antigens upon sensitivity and resistance of the human tissue to malignant tumors.
Our results are summarized as follows.
1) Appearance of B8 and CW2 was significantly frequent in epithelial tumors of urogenital system.
2) Epithelial tumors of urogenital system were devided into the following two groups; (A) non-papillary (invasive) tumor and papillary tumor, and (B) patients who died of tumors and patients who did not die of tumors.
The appearance of B7 was significantly frequent in the non-papillary (invasive) group and also in patients who died of tumors. These findings suggest that persons carrying B7 have relatively weaker resistance to the development and growth of malignant tumors.
It is considered that the number of cases might be insuffcient to apply the results of these findings directly into clinical purposes. It is, however, suggested that identification of HLA Antigens in patients with malignant tumors at least in the urogenital system is clinically useful for establishment of early diagnosis and decision of therapeutic methods, when the number of cases of our study have increased and the same tendencies of the findings on HLA Antigens in patients with malignant tumors are confirmed.

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The uroflowmetry is a valuable method for diagnosis and postoperative evaluation of obstructive uropathy.
We obtained 256 flow curves from 174 patients, who had symptoms of urinary obstruction, through mictiomater (DISA 14F-41).
We classifiedd flow curves into 5 patterns (I-normal pattern, II-left peak pattern, III-right peak pattern, IV-wave like pattern, V-flat pattern).
Each of the 5 patterns was analysed by six micturition parameters and was studied as to the relation to obstructive diseases.
1) Average voided volume was over 200ml in patterns I, II and III, but below 200ml in patterns IV and V. But the volume of residual urine was larger in patterns IV and V than in patterns I, II and III.
2) Maximum flow rate and average flow rate were within the normal limit in pattern I, but were below it in other four patterns.
3) There was no significant difference in voided volume, maximum flow rate and flow time between pattern II and pattern III but the volume of residual urine and the time to maximum flow were significantly greater in pattern III than in pattern II (p<0.05).
4) 60 urinary flow curves were obtained from patients of preoperative benign prostatic hypertrophy. 35 (58.3%) of them showed pattern II, and 12 (20%) pattern V, 9 (15%) pattern III, 3 (5%) pattern I and 1 (1.7%) pattern IV.
5) Pattern II had the largest distribution of urinary flow curve after operation (suprapubic prostatectomy or TUR-p).
6) 5 urinary flow curves, which were obtained from patients with prostatic cancer, all showed pattern II.
7) 41 urinary flow curves were obtained from neurogenic bladder. 14 (34%) of them showed pattern IV. Patients of detrusor-external sphincter dyssynergia showed mostly pattern IV.

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Two cases of urethral leukoplakia, in males aged 41 and 37, were reported and 41 cases of urethral leukoplakia collected from the European, American and Japanese literature were reviewed.
The age distribution of the cases ranged from 7 to 67 years old (mean: 40 years old) and sex distinction was male 36 versus female 3 and unknown 2. Among the clinical symptoms, urinary obstructive ones such as difficulty of urination or small stream of urine and symptoms of urethral irritation such as pollakisuria or micturitional pain were frequent.
Intraurethral originating sites of leukoplakia were as follows: 19 cases in the anterior urethra, 6 cases in the posterior urethra and 1 case throughout the urethra. Especially pars pendula to pars bulbosa in the anterior urethra was found too be the most frequent site of the disease. Chronic factors of urethral irritation such as stones or traumatic strictures were found in about a half of the collected cases and gonorrhea or non-gonorrhoic urethritis was complicated in 37% of the total cases. These factors seem to have an important relationship to the pathogenesis of urethral leukoplakia. Several cases had leukoplakia of all the urinary system or other parts of the urinary organs except the urethra and one of the cases we examined had vitiligo vulgaris with familial occurrence. These are interesting phenomena suggesting that there may be some predisposition or genetic background for the disease.
Histological findings in our two actual cases were of the first type with complete cornification by Kusunoki (1940), but overall study on the histology of the collected cases was not possible because of the lack of description in detail. There was one case with squamous cell carcinoma of the penis, but no malignant cases of urethral leukoplakia. This, however, could not be made light of since the rate of malignant changes was considerably high in leukoplakia of all the urinary system.
For the treatment of urethral leukoplakia surgical procedures such as urethral incision or resection of leukoplakia were carried out on 17 cases and conservative therapies including 13 cases of urethral dilatation, intraurethral instillation of various drugs or irradiation on 25 cases. One case with local administration of β-ray was reported to have shown excellent results and this way of treatment should be given much attention in future.

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A 36-year-old tripara woman in the fifteenth week of pregnancy was admitted to our hospital, because of gross hematuria. No vaginal bleeding was noticed. There were active fetal movements, and the fetal heart tones were strong. Routine blood chemistry studies were within normal limit. A severe hypochromic, microcytic anemia was present. Cytology of the urine showed the class IV. Cystoscopy revealed a huge tumor on the left side of the bladder wall. The biopsy specimen of the bladder tumor was grade I, transitional cell carcinoma.
The pregnancy was stopped by artificial abortion. The cystography demonstrated a large shadow defect on the left half of the bladder. The pelvic angiography revealed a rich-vasculized tumor. Preoperatively, arterial chemoembolization was done twice with microenccapsulated mitomycin C 10mg and 30mg. Gross hematuria diminished. Substantial tumor reduction of greater than 50 per cent was found cystographically. Total cystectomy with ileal conduit formation was performed. A hen's egg sized tumor and a red bean-sized tumor were found in the bladder. Histological examination revealed grade I, stage A, transitional cell carcinomas but did not demonstrated the remarkable effect of chemoembolization. The patient did well postoperatively and has been followed for 6 months without any evidence of metastasis or recurrence.
Primary non-bilharzial bladder carcinoma during pregnancy is extremely rare in the world literature. We add another ease, bringing the total number of reported cases to 8. The authours' case seemed to be the 1st in Japan. Our experience in the present case suggests that hematuria during pregnancy requires a through urologic diagnostic study as usual and that hysterectomy with total cystectomy should not necessarily be indicated in any bladder carcinoma in pregnancy.

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