The lymphocytes in the peripheral blood were analyzed in patients with urogenital cancer by electrophoresis using a fully automated cell electrophoretic apparatus.
Peripheral blood was collected from patients with urogenital cancer and the controls (total of 65 cases).
The electrophoretic pattern of the controls was first defined. Then, the results obtained from the patients with cancer were analyzed on this basis.
High mobility cells (HMC) (Mob.≥0.95μm/sec/v/cm) were T cells and low mobility cells (LMC) (Mob.<0.95) were B cells in the controls. In patients with cancer, LMC tended to increase, which suggested the appearance of T cells with low electrophoretic mobility (LMT). The LMT/HMT rate tended to increase as the immunoactivity decreased. Also, it became higher in proportion as the stage of cancer advanced.
In the post-operative cancer patients with maintenance therapy, the LMT/HMT rate of non-curative patients was significantly higher than that of curative ones.
On the basis of these results, it is considered the LMT/HMT rate is and effective parameter in grasping the immunological system, in evaluating the effects of the treatment and in following-up patients with cancer.

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52 specimens from the human genital tract were studied in vitro about the pharmacological reactions by various autonomic drugs. Then the effects of 41 specimens to norepinephrine were evaluated in every part of the genital tract, and the following results were obtained.
1) Tail of epididymis
The spontaneous contractions of the tail of epididymis were observed more frequently and more powerfully than other parts of the human genital tract. But the maximum rhythmic contractions caused by norepinephrine were weaker than those of the vas deferens. Otherwise, the tail of epididymis appeared most sensitive to norepinephrine in the human genital tract, and were able to respond to low concentration of norepinephrine.
2) Vas deferens
The maximum contractions of the distal vas deferens caused by norepinephrine were stronger than those of the proximal vas deferens, and the maximum contractions of the pelvic vas deferens were strongest in the human genital tract. But the sensitivities of the distal vas deferens to norepinephrine were statistically weaker than those of the proximal vas deferens.
3) Vas ampulla
The responses of the vas ampulla to norepinephrine were similar to those of the distal vas deferens.
4) Seminal vesicle
The spontaneous contractions of the seminal vesicle were observed very often with the highest frequency in the human genital tract. While the maximum contractions caused by norepinephrine were weakest in the human genital tract, the sensitivities to norepinephrine were similar to those of the distal vas def erens.
5) From our studies in vitro about the pharmacological reactions of the human genital tract, the following supposition on the sperm transport in the human genital tract was obtained at the time of excitement, emission and ejaculation.
At rest, human spermatozoa are always voided from the testis according to the spermatogenetic cycle, and maturing spermatozoa which reach the tail of epididymis are continuously propelled to the distal genital tract by active spontaneous contractions. At the initial state of the sexual excitement, the tail of epididymis begins to contract forcefully and the sperm transport increases gradually in the human genital tract. At the excitement, the powerful contractions of the proximal vas deferens occur and then the distal vas deferens successively contract powerfully to prevent the regurgitation of the vasal contents. At this time, the internal pressure of the ampulla increases gradually. At emission, the contents of the vas ampulla are discharged quickly into the posterior urethra and the spasm of the distal vas deferens simultaneously prevent the backflow of the contents.
The transport of spermatozoa in the human genital tract may be sustained by the effective contractions of the human genital tract, which are dependent upon reasonable amount of norepinephrine from sympathetic nerve endings.

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Polyamine levels (putrescine, spermidine, spermine) were determined in 6 normal bladder tissues and 33 transitional cell carcinomas obtained at operations. The concentrations of putrescine, spermidine and spermine in bladder cancers were significantly higher than those of normal tissues. In view of the relationship between Polyamine levels and histopathological grades, all of three polyamine levels of grade 1 tumors were significantly higher than those of normal tissues and, in addition, those of grade 3 tumors were significantly higher than those of grade 1 tumors. The ratio of putrescine to spermidine in grade 3 tumors was significantly higher than that in grade 1 tumors, while no difference in the ratio of spermidine to spermine was found among each provided groups according to malignancy grade. As far as the relationship between polyamine levels and histopathological stages, all of polyamine levels in low stage (≤p T1) tumors were significantly higher than those in normal tissues, and polyamine levels in high stage (>p T1) tumors were higher than those in low stage (≤p T1) tumors.
However, there is no remarkable difference on polyamine ratios among the normal tissues and all stage tumors.
In conclusion, polyamine levels of low grade and low stage bladder cancers were significantly higher than those of normal tissues and the increase of polyamine levels was parallel to the histopathological factors, especially to malignancy grade. Preliminarily, the relationship between the metastasis or intravesical recurrence of bladder cancers and polyamine levels was examined. In 5 cases of bladder cancers with metastasis and a case of intravesical recurrence, the ratio of spermidine to spermine was higher in 3 cases. Therefore, polyamine levels migh be one of the useful indicators for the prognosis of bladder cancers.

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Removal of kidney or ureter stone via percutaneous nephrostomy was successfully performed in 17 out of 18 patients. There were no untoward effects.
Initially, a percutaneous needle nephrostomy was done with ultrasound guidance and subsequently nephrostomy channel was dilated in one-stage up to a size enough to pass a fiberscope (24F). Then, a flexible fiberscope was introduced into the renal pelvis and the ureter.
The stone was trapped and extracted using the basket catheter or the grasping forceps, which was directed to the stone through forceps channel of the fiberscope, under endoscopic or fluoroscopic control.
This relatively atraumatic procedure for urinary stones has many advantages. Further improvement of stone manipulation via nephrostomy is expected when instruments designed especially for this purpose are available.

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A 66 year-old-man with the chief complaint of weak urinary stream was admitted to our hospital on July 26, 1982, for evaluation of the lower urinary tract function.
Accurate diagnosis of bladder neck contracture was confirmed by combined ultrasonotomographic and urodynamic monitoring. TUR-bladder neck was performed on August 26, 1982, and the histological examination showed a marked fibrosis. After operation he had no symptoms related to micturition. Postoperative combined ultrasonotomographic and urodynamic monitoring also revealed no bladder outlet obstruction.
We feel that our method-combined ultrasonotomographic and urodynamic monitoring-is extreamly reliable for the evaluation of bladder neck function.

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The hydrodynamic character of the newly designed catheter with only one eye around the circumference of the tip was examined, in comparison with the catheter with four eyes and the microtip transducer by Millar. The pressure error of catheters with one eye or four eyes was not less than 1.7cmH₂O when water is perfused, although the error became larger to about 5.0cmH₂O when 60% urografin was perfused.
The pressure recorded using the tip transducer was found to be easily affected by the diameter of the urethra, although the urethral pressure was stabilized independent of the urethral diameter, when the catheter with only eye was used to measure, perfusing saline at a rate of 2.0ml/min.

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22 patients with high grade invasive bladder cancer were treated with preoperative radiation therapy (910 rad by fast neutron or 3000 rad by X ray during 2 weeks) followed by radical cystectomy and urinary diversion. 62.5% of patients showed reduction in tumor size more than 50% evaluated by cystogram. Stage down was observed in 38% of patients compared between clinical and pathological stage. Histopathological effect of GII or GIII, according to the criteria described by Ohboshi, was noticed in 79% of the patients. Better effect seemed to be obtained in fast neutron treated group than in X ray group.
19 patients received curative operation, and 18 patients are alive without recurrence for 10 months (mean observed term). One has died from lung metastasis 4.5 months after operation. 50% of the patients complained of side effects of irradiation although they were tolerable, and 32% of the patients had major complications of operation.

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Renal autotransplantation is technically well accepted nowadays. It has some advantages in reconstructive surgery for various ureteral diseases over the conventional techniques.
We chose renal autotransplantation for 15 patients who had extensively damaged ureters. The causative diseases of ureteral damage were postoperative scar (6 patients), retroperitoneal fibrosis (5 patients), tuberculosis (2 patients), primary amyloidosis (1 patient) and injury (1 patient).
Renal autotransplantation was performed without technical difficulties. Thirteen removed kidneys were implanted in the ipsilateral iliac fossa and two in the contralateral iliac fossa. Urinary reconstruction was performed by pyeloureterostomy in 5 patients, by ureteroureterosomy in 2 and by ureteroneocystostomy in 8.
Fourteen patients have been followed up for 13 to 58 months except 1 patient, who had lost the implanted kidney in the early postoperative period. Fourteen kidneys were salvaged with good functions. These 14 patients have no postoperative difficulties such as urinary tract infection. However one kidney was lost on the 14th day after surgery because of rupture of an arterial anastomosis.
These results indicate that renal autotransplantation might be a useful technique in reconstructive surgery for extensively damaged ureters. It should be indicated for more patients with obstructive ureteral disease.

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This study was done to determine whether there had been any fundamental improvement in the survival of patients treated for transitional cell carcinomas primarily by surgical methods.
Three groups of patients with transitional cell carcinomas were studied to obtain comparative survival data. The first group (old series) consisted of 41 cases seen from 1964 to 1969. The second group (mid series) consisted of 51 cases seen from 1970 to 1974. The third group (recent series) con-sisted of 72 cases seen from 1975 to 1979.
Survival data were analyzed by 1) histological grading, 2) growth pattern, 3) infiltrative growth pattern, 4) staging 5) lympho-vascular invasion and 6) operation method.
Patients with superficial carcinomas have enjoyed improvement in 5-year survival rate of mid and recent series as compared with old series, which was at least in part the result of improvement of postoperative care and choise of adequate method of operation. The survival rate of patients with invasive cancers was essentially unchanged.

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In 45 cases of renal cell carcinoma undergone radical nephrectomy at the Jikei University Hospital during the 5 year period from 1975 to 1979, the effect of renal arterial embolic occlusion on prognosis was assessed by dividing these cases into 2 groups: groups undergone (22 cases) or not undergone (23 cases) renal arterial embolic measure. In cases without metastatic lesion at the time of operation, a tendency was observed that the incidence of postoperative metastasis was lower with more favourable survival for the group undergone the embolic occulsion than that without it. From these findings it was considered that this technique could reduce the risk of spreading of tumor cells at the time of operation.
On the other hand, among cases with metastatic lesion at the time of operation there were more cases which survived for a longer period in the group undergone renal arterial embolic occlusion.
This technique may be useful to improve immunological competence of patients with renal cell carcinoma. For decisive evaluation it is required to observe more patients for a longer period. However, it may be said that this is a valuable therapeutic measure as a preoperative treatment for patients with renal cell carcinoma.

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At our Department endoscopic operations were performed in 201 pediatric patients during the past 9 years (1974-1982): posterior urethral valve 32 cases, anterior urethral valve 4 cases, congenital bulbar urethral stenosis 135 cases, acquired urethral stenosis 16 cases, bladder neck contracture 8 cases and ureterocele 6 cases. Miniature pediatric resectoscope of 10 or 13 Charriere were used. The results of transurethral valve resection for the posterior or anterior urethral valve were quite satisfactory. Good results were obtained by optic internal urethrotomy for the congenital bulbar urethral stenosis, regarding vesicoureteral reflux, enuresis nocturna or recurring urinary tract infections.
In cases of acquired urethral stenosis consisting of hard scar tissue, optic internal urethrotomy must be done several times and the results were mostly satisfactory.
Transurethral resections against bladder neck contracture were ineffective in our hands, probably because of the secondary nature of the bladder neck contracture in children. Indications of transurethral surgery in ureterocale are also described.

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The typical testicular injury was produced by using one shot subcutaneous administration of 0.04mM per kg body weight of cadmium chloride in adult male rats (Sprague-Dawley strain) weighing 40-250g following Parizek's method which was reported in 1956. Zinc acetate at a dose 100 times of cadmium chloride in molecular weight was administrated following Parizek's method with the aim of studying its protective effect on the testicular damage by cadmium. 2, 6, 12 and 48 weeks after the injection of CdCl₂, the testis and accessory sexual organs (epididymis, prostate and seminal vesicles) were weighed and the testicular blood flow was measured by the radioactive microspere method. The testicular blood flow change was compared with the change of plasma testosterone concentration and the histological changes in testes.
The result was as follows:
1. The weight of the testis and accessory sexual organs of the rat injected with CdCl₂ decreased from one half to one fourth in comparison with the control rat 2 weeks after the injection of CdCl₂.
2. The testicular blood flow of the rat injected with CdCl₂ decreased below a half of that in the control rat 2 weeks after the injection of CdCl₂. Although it increased slightly after 6 weeks, it was still significantly (p<0.05) smaller than that of the control rat after 48 weeks.
3. The plasma testosterone concentration of the rat treated with CdCl₂ decreased after 2 weeks, and then it increased gradually, and it was not significantly different from the level in the control rat 12 weeks after the injection of CdCl₂. This increase of the plasma testosterone concentration was parallel to the regeneration of Leydig cells which was recognized in light microscopic study.
4. The testicular damage by cadmium was perfectly protected with 100 times dose of zinc acetate.

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The phagocytic function of urinary leukocytes of patients with urinary tract infection (UTI) was studied.
Urinary leukocytes were alive irrespective of the type of UTI, urine osmolarity or pH. The mean rate of the viability was observed to be 82%. The rate of phagocytosis, the percentage of leukocyte phagocytizing bacteria in all urinary leukocytes, was high under the urine condition of low osmolarity (≤600mOsm/L) and nearly neutral pH. The mean rates of phagocytosis of patients with acute cystitis, acute pyelonephritis, chronic cystitis, and chronic pyelonephritis were 3.0%, 2.1%, 13.2%, and 18.3%, respectively. The rate of phagocytosis of acute UTI was kept very low regardless of urine bacterial count; however, in chronic UTI, this rate increased in accordance with urine bacterial count.
The rate of phagocytosis of patients with indwelling catheters was higher than that of patients without catheters.
All chronic cystitis patients with indwelling catheters and 58% of chronic cystitis patients without catheters showed to have positive tests for antibody-coated bacteria (ACB). The opsonic effect of ACB could not be confirmed.
The phagocytic function of urinary leukocytes was also studied in vitro. By the Lab-Tek chamber method, the rate of phagocytosis was 20 to 30% in normal and infected urine regardless of urine osmolarity. By the tube method, the phagocytosis was almost none in urine with osmotic pressure higher than 600mOsm/L, and even in urine with osmotic pressure lower than 600mOsm/L the rate of phagocytosis was lower than 5% in many cases.
However, the rate of phagocytosis apparently increased in urine with osmotic pressure lower than 600mOsm/L by centrifuging the tubes, which means acceralated contact of leukocytes and yeasts. No difference in the rate of phagocytosis was observed between normal urine and infected urine.
The following three experiments were counducted by the transmission electron microscope; morphological study of urinary leukocytes of patients with various types of UTI, observation of phagocytosis in infected urine added with latex particles, and that of phagocytosis in aseptic pyuria added with bacteria.
The above results suggest that leukocytes in urine are not mere passive spillover as long considered but taking a part of defense function against ascending UTI.

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From follow up studies of eleven patients with Shy-Drager syndrome, we could make the following points.
1. There were residual urine and urge incontinence through the course of illness even in the early stage. The amount of residual urine gradually increased during the course of illness with frequent risk of complete urinary retention.
2. The responsible sites of lesion of detrusor dysfunction changed from supranuclear to infranuclear, and the detrusor sphincter dyssynergia appeared as the disease progressed.
3. The functions of the upper extremities were fairly well preserved whereas those of the lower extremities deteriorated steadily during the follow-up periods.
From the high amount of residual urine and the risk of urinary retention with preserved function of the upper extremities, we conclude that intermittent selfcatheterization is the basic management for vesicourethral dysfunction in Shy-Drager syndrome.

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From urological follow-up studies of eleven patients with Shy-Drager syndrome, we found that the adequate micturitional management was essential for the proper care of the patients because of steadily deterioraton of their voiding function. Since there is always the risk of urinary retention, every patient should be trained for intermittent selfcatheterisation.
Alpha-blockers were effective in reducing the residual urine but bethanechol chloride was ineffective.
Propantheline and diazepam were fairly effective for urge incontinence. However, overall drug therapy was useful only in the early stage of the disease.
Transurethral resection of the bladder neck was done in the patients and was found to be effective even in the advanced stage of the disease.
Our conclusion for the management of urinary diturbance in Shy-Drager syndrome is initial training of intermittent selfcatheterisation, to be followed by drug therapy and transurethral resection of the bladder neck.

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