Urine ferritin, urine cytology, urine fibrin/fibrinogen degradation products (FDP) and urine carcinoembryonic antigen (CEA) were investigated in 6 patients with renal pelvic and ureteral cancer, 36 with bladder cancer, 14 with prostatic cancer and 49 after operation for urologic malignancies.
The results were as follows:
1) Urine ferritin levels in the poorly differentiated and advanced stage group were significantly higher than those in the well differentiated and early stage group.
2) Urine ferritin as a tumor marker was not suitable because of lower diagnostic accuracy compared with urine cytology, urine FDP and urine CEA.
3) No significant correlation between serum ferritin and urine ferritin was noted (r=0.269) in prostatic cancer patients. No significant elevation of serum ferritin was noted by radiation therapy, while significant elevation of urine ferritin was noted in all cases. It was considered that urine ferritin did not reflect increment of serum ferritin and the source of urine ferritin in prostatic cancer was secretion from cancer and destruction of tissue by radiation.
4) Urine ferritin level was increased remarkably in most cases of renal pelvic and ureteral cancer, and this result suggested that destruction of renal tubular cells might play some part in pathogenesis of elevation of urine ferritin.

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In microexplosion cystolithotripsy, it is most important to investigate the degree of damage to the bladder wall and to prevent this damage.
The bladders of 8 dogs excised after sacrifice were used. An originally developed explosive catheter fixed by a special apparatus was used to induce microexplosion at various distances between the explosive chamber at the catheter tip and the bladder wall in air, water or jelly. Macroscopic and histological damage was studied and the amount of lead included in some bladder fragments was measured.
1) The greater the distance from th explosive chamber to the bladder mucosa and the higher the density of the medium, the less was the damage to the bladder wall. It was noted that the bladder fragment remained intact when the distance from the explosive catheter tip to the bladder mucosa was over 1.0cm in water or 0.75cm in jelly.
2) Black deposits observed histologically in the bladder wall contained much lead. The amount of them correlated well with the stage of injury in the bladder.
3) It was thought that the three factors which the determimed the extent of bladder damage from microexplosion were: Shock wave, gas or other reactive products and heat.
(1) The dynamic effect of shock wave from microexplosion might be injurious in air but not in water or jelly.
(2) It was thought that gas and other reactive products were the most imporant factors in bladder damage. However, they were less hazardous in water or jelly than in air, because water or jelly might suppress their movement.
(3) Though burning by heat was not recognized histologically in this experimental study in vitro, heat might be a factor of local damage in air. In water or jelly rapid cooling might prevent the damage.
It is concluded from these results that water or jelly is more suitable than air as the medium for microexplosion cystolithotripsy. Microexplosion will be able to be employed clinically in a water or jelly medium.

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Radioimmunoassay (RIA) for serum prostatic acid phosphatase (PAP) has been developed recently.
I measured PAP levels with four commercial PAP-RIA kits and compared RIA kits with enzymatic assay and counterimmunoelectrophoresis (CIEP) in detecction of prostatic cancer.
Serum samples were collected from 120 patients (624 samples) with prostatic cancer and 234 patients (265 samples) with other diseases.
By CIEP method, sera with prostatic cancer (0/1 of stage A, 0/6 B, 1/16C, 41/85D) and controls (2/11) gave positive results.
By RIA kits, sera with stage B (1/5) and over 80% with pretreated patients (stage D) gave also positive.
Forty-one patients with prostatic cancer were followed for PAP levels and I classified them with stage and pathologic grade (well, moderately and poolrly differentiated adenocarcinoma). In these cases, the means±S. D. of PAP levels of pretreated patients of three types were 28.5±25.3, 66.0±132 and 248±331ng/ml, respectively.
The means±S. E. of the percentage of diminution of PAP levels during treatment on 4 weeks in three types were 90.0±2.68, 82.9±3.60 and 76.6±2.85%.
I might say that high grade adenocarcinoma could be controlled well and PAP levels during treatment on 4 weeks indicate prognosis.

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We evaluated concentration of cyclic nucleotides (cyclic AMP and cyclic GMP) in 24-h urine and plasma of patients with urogenital cancers, and cyclic AMP concentration in bladder tumor tissue. The values of cyclic nucleotides were measured by YAMASA cyclic AMP Assay kit and YAMASA cyclic GMP Assay kit.
1. Urinary and plasma cyclic AMP levels of control individuals were 3.99±2.14μmoles/g. cr. (mean±S. D.) and 27.9±8.9p moles/ml, respectively. The correlation between age and cyclic AMP levels in urine and plasma demonstrated no significant difference from twenty to seventy years old. But urinary cyclic AMP levels in over seventy years old was slightly lower than that in under seventy. Conversely, plasma cyclic AMP level in over seventy years old was somewhat higher than that in under seventy.
2. Urogenital cancer patients were classified into bladder tumor patients, whose stage and grade were clearly estimeted, and other urogenital cancer patients. But there was no difference in urinary and plasma cyclic nucleotides levels among control indivisuals, bladder tumor patients and other urogenital cancer patients.
3. Bladder tumor patients were classified by stage into high stage patients and low stage patients, and by grade into high grade patients and low grade patients. Urinary cyclic AMP and cyclic GMP levels in high stage patients were significantly lower than those in low stage patients [cyclic AMP: 1.68±1.67μmoles/g. cr. and 4.89±3.39μmoles/g. cr. (p<0.001), respectively, and cyclic GMP; 0.27±0.20μmoles/g. cr. and 0.47±0.25μmoles/g. cr. (p<0.05), respectively]. plasma cyclic AMP and cyclic GMP levels were not statistically differant between the two stages. Furthermore, urinary and plasma cyclic nucleotides levels were not essentially different between the two grades.
4. The post-treatment urinary cyclic AMP and cyclic GMP levels were significatly higher than the pre-treatment levels [cyclic AMP: 6.73±3.61μmoles/g. cr. and 3.85±3.45μmoles/g. cr. (p<0.05), respectively, and cyclic GMP; 0.94±0.55μmoles/g. cr. and 0.44±0.23μmoles/g. cr. (p<0.001), respectively]. This result indicates that determination of urinary cyclic nucleotides levels seems to be a clinically useful marker in urogenital cancers.
5. Cyclic AMP concentrations in control bladder mucosa from BPH patients, bladder tumor tissue and normal bladder mucosa of tumor-bearing bladder were 7.50±3.85n moles/g. wet tissue, 3.58 ±1.55n moles/g. wet tissue and 4.93±2.98n moses/g. wet tissue, respectively. Cyclic AMP concentration in bladder tumor tissue was significantly lower than that of control bladder mucosa (p<0.001). Cyclic AMP concentration in normal bladder mucosa of tumor-bearing bladder was also slightly lower than that of control bladder mucosa.

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The retrospective analyses of renal function were made in 177 patients with primary VUR. Of these patients (121 children and 56 adults), 111 patients had antireflux operations. Renal function was assessed with IVP and renal radioisotope examinations (¹³¹I-Hippuran renogram, ^99mTc-DTPA dynamic study). The results are as follows:
1) ^99mTc-DTPA renogram showed a slight reduction of renal function in 8 of 31 grade IIA reflux kidneys whose IVP indicated normal renal functions. All of these kidneys were treated conservatively or had conservative treatments before antireflux operations. The conservative treatment might have induced only a progress of renal failure in some cases even if they were with low grade refluxes.
2) The kidneys, whose preoperative T 1/2 in ¹³¹I-hippuran renogram were more than 18 minutes, could not recover in their functions. Antireflux operation should be carried out before reflux kidney is damaged irreversibly.
3) Thus, renal radioisotope examinations (¹³¹I-Hippuran renogram, ^99mTc-DTPA dynamic study) are very useful to detect the reflux nephropathy and decide the antireflux operation.

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The concentrations of hCG in human tissues were measured. One hundred and nine tissue samples were obtained by surgery and autopsy. They were composed of genitourinary tumor tissues, normal tissues and tissues of benign diseases-testicular tumors, normal testes, renal adenocarcinomas, normal kidneys, benign prostatic hyperplasias (BPHs), bladder tumors and so on. HCG concentrations in peripheral and testicular venous blood were also measured in almost the same patients (peripheral venous blood in 59 samples, testicular venous blood in 36 samples).
The concentrations of hCG in tissue extracts and serum were measured by radioimmunoassay with anti hCG-β antiserum.
The following results were obtained.
1) In all of normal testes, seminomas and non-seminomatous germ cell tumors (NSGTs), tissue concentrations of hCG were positive. The average of them were 66.6, 439.7 and 3355ng/g·tissue.
2) HCG concentrations in the testes of prostatic cancer patients under diethylstilbesterol diphosphate administration were positive in 68.8% of them and the average of them was 19.2ng/g·tissue.
3) Positive tissue concentration of hCG in the normal kidney was seen in 66.7% and 41.7% in renal adenocarcinomas.
4) HCG was detectable in 85.7% of bladder tumor tissues composed of transitional cell carcinoma, 60% of normal epididymis and 33.3% of BPH.
5) HCG concentration of testicular venous blood was positive in 91.7% of seminoma and 50% of NSGTs, but was detectable in none of testes under anti-androgen therapy and normal condition.
6) Positive rate of hCG in peripheral venous blood was 58.8% in seminomas and 60% in NSGTs.
7) In three of four patients with testicular tumors, hCG concentrations of tissue, testicular and peripheral venous blood were related with gradient, the highest in the former, and so hCG secretion from tumors was suggested.
8) Dilution curves of testicular tumor extracts and standard curve of CR119 hCG were parallel on the semi-logarithmic section paper in such a way that the existence of hCG-like substance was justified.

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For prevention of metastasis after total or partial cystectomy applied to bladder cancer patients, chemotherapy was conducted by one-shot preoprative arterial injection and postoperative systemic intravenous injection.
Preoperative one-shot arteial injection was conducted in such manner that 12mg of Mitomycin C, 300mg of Endoxan, 18mg of Thiotepa, 500mg of 5FU were simultaneoulsly injected in one shot into the internal iliac artery.
Postoperative chemotherapy was conducted by co-administering 4000-8000mg of FT207, 200mg of Cylocide, 20mg of Toyomycin or 20000units of Necoarzinostatin to replace Toyomycin by intravenous injection for five weeks.
As a result, 11 out of 31 (35.5%) cases developed metastasis postoperatively and vascular invasion was observed in 15 out of 31 cases (48.4%) while in 10 out of the said 15 (66.7%), metastasis was observed.
When the relation between chemotherapy and metastasis was investigated in 15 patients with vascular invasion, in 12 cases out of 15 which received chemotherapy, 7 (53.8%) cases developed metastasis while in 3 cases, for whom no chemotherapy was conducted, metastasis was observed in all.
In cases who received one-shot arterial injection preoperatively, the rate of advent of postoperative metastasis was 50 percent. The above results indicate that for prevention of postoperative metastasis of 350 bladder cancer chemotherapy comprising one-shot preoperative arterial injection and postoperative systemic intrevenous injection is effective.

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A series of 108 stones (108 patients) which were passed spontaneously from the upper urinary tract during the last five years were analysed by X-ray powder diffraction method and were divided according to their composition into pure calcium oxalate (65 stones), calcium oxalate+calcium phosphate (31 stones), calcium phosphate (6 stones) and other stones (6 stones).
As compare with the sex and age of 601 patients and the composition of 632 stones which were removed surgically or passed from the upper urinary tract (Takasaki, 1975), there were more males and more people over 30 years, more pure calcium oxalate stones and less stones of magnesium ammonium phosphate and calcium oxalate+calcium phosphate in our series.
Pure calcium oxalate stones are likely to be small and to be expelled spontaneously because of their slow growth.

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In children, cystometry is often difficult for the poor cooperation of patient.
Cystometry under anesthesia or by administration of analgesia. may be suggested in such cases.
However, anesthesia or analgesia itself may modify the cystometric findings.
To elucidate this point, the effect of Fluothane, Nitrous Oxide, Diazepam and Pentazocine on children's cystometrogram was examined.
Cystometry was performed in 17 children (4 to 12 years old) with and without anesthesia (Fluothane, Nitrous Oxide), in 24 children (5 to 10 years old) before and after administration of Diazepam or Pentazocine.
The results were as follows.
1) Fluothane anesthesia abolished UIC and increased bladder capacity.
2) Nitrous Oxide anesthesia suppressed UIC and increased bladder capacity.
3) Diazepam did not suppress UIC in seven of eight unstable bladders and suppressed in one.
4) Pentazocine had no effect on UIC.

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Idiopathic hypercalciuria is a syndrome which is characterized by normocalcemia, but unexplained by any established cause such as sarcoidosis, renal tubular acidosis, or hyperparathyroidism. This syndrome is the most common form of hypercalciuria in patients who are calcium stone formers.
Many studies of idiopathic hypercalciuria have been reported recently: however, the diagnostic criteria of this syndrome are quite variable. We defined hypercalciuria as a urinary calcium excretion of over 250mg. in a male and over 200mg. in a female. On this basis, we found 45 (24 male and 21 female) patients with idiopathic hypercalciuria out of 195 (123 male and 72 female) calcium stone formers. These patients with idiopathic hypercalciuria, as well as a control group of calcium stone formers within the normal range of urinary calcium excretion, were examined for serum Ca, P and uric acid and for urinary Ca, P, uric acid and Mg excretion on a normal diet (600-800mg. Ca/day, 1200-1400mg. P/day) and on controlled low Ca diet (130mg. Ca/day, 1000mg. P/day). Some patients from each group were given a calcium provocation test (15mg. Ca/kg).
Serum uric acid in the idiopathic hypercalciuria group was significantly lower than in the control group on a normal diet. However, serum uric acid in the idiopathic hypercalciuria group was significantly increased on a controlled low calcium diet. Not only urinary calcium excretion but also urinary magnesium excretion in the idiopathic hypercalciuria group was significantly higher than in the control group on a normal diet. In both groups urinary calcium excretion was significantly reduced on a controlled low calcium diet. The calcium provocation test showed no significant difference between the groups.
Eighteen patients with idiopathic hypercalciuria were treated with trichlormethiazide, and in all of these cases the value of urinary calcium was significantly reduced. Sixteen patients out of these 18 were treated for at least one year, and 3 patients (18.8%) showed new stone formation under treatment. On the other hand, new stone formation was seen in 15 cases (68.2%) out of the 22 patients with idiopathic hypercalciuria who were not treated.
There were no significant side effects from the thiazide therapy, except that only one patient developed general fatigue and vertigo after 2 years of treatment.
It is suggested that long term thiazide therapy can be a safe and effective one for prevention of recurrent calcium stone.

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Recongnition of the innate aggressiveness of a bladder cancer early in the course of the disease would greatly facilitate management, and potentially idenitify those tumors which are likely to recur and invade.
Recently, several investigators have reported on the significance of the detection of blood-group ABO(H) antigens on the surface of bladder tumor of the Specific Red Cell Adherence (SRCA) test, This test, in many cases, proved to be a valuable tool for predicting the behaviour of non-invasive tumors.
However, the SRCA test has limitation. First, the procedure does not reliably detect the O(H) antigen. Furthermore, it is very difficult to locate the antigen in tissue by the SRCA test because the absorbed red blood cells covered morphological details of the specimen.
In this study, the Peroxidase-antioperoxidase (PAP) method was employed to detect the antigens in 23 cases of human bladder cancer. The PAP method is more sensitive and easier to perform than the SRCA technique, and displays the PAP reaction and histopathology of the tissue on the same slide. And the PAP staining could show the exact location of the antigen in reference to well preserved tissue structures.
The PAP method was estimated to be more suitable than the SRCA test for detection of ABO(H) antigens in human bladder tumors.

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We studied the continence mechanism of internal urethral sphincter of female mongrel dogs by resecting external smooth muscle and striated muscle around the urethra and preserving certain length of intact proximal urethra. Urinary continece was maintained during ordinal activities even the functional urethral lenght was zero. Under chloralose anesthesia, fluoroscopical examination revealed that the urinary continence was maintained as long as the functional urethra was 0.5cm length.
No incotinence occured after phentolamin administration to the bladder with volume less than the volume of micturition reflexe Extirpation of bladder with functional urethra revealed that the bladder with intact proximal urethra of 2.5cm length could maintain continence whereas the length of 0.5cm become incontinence. From the results non-neurogenic passive mechanism could play an important role in maintaining urinary continence.

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Encouraged by our previous studies that intraarterial use of microencapsulated mitomycin C(MMC-m. c.) could be an intensive topical chemotherapy with minimum systemic side effects, 8 cases of advanced prostate cancer were treated with selective arterial infusion of MMC-m. c. into the internal iliac arteries. Seven patients had failed prior treatments, and one was primarily treated with MMC-m. c. because of chronic heart failure. Eight primary tumor lesions and two metastatic lesions involving the femoral bone and intrapelvic lymph nodes were employed as the targets. The infusion was single in two patients, two times in three patients and three times in three patients, repeated at an interval of 3 to 4 weeks. The total MMC dose ranged 20 to 75mg (mean; 44mg).
By means of echography, CT scanning and ureterovesicography, marked tumor reduction over 50% was observed in 50% of the cases and moderate reduction (over 30%) in 25%. Improvement of symptoms and signs was commonly found at an early stage after the treatment; dysuria was relived in 63% of patients, miction pain improved in 86% of patients and macrohematuria subsided in 66% of patients. Antitumor effect on metastatic lesion was also shown by improvement of regional symptomes and signs such as edema and pain.
Hematological toxicity was observed in one of the eight cases. Skin necrosis at gluteal and perineal region occurred in 5 of the 8 cases, but it was partly prevented by ligation of the gluteal arteries. All patients well tolerated the treatment in spite of their advanced stage of the disease.
These results indicate that intra-arterial infusion of MMC-m. c. may prove to be effective local measures in the treatment of advanced prostate cancer.

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Clinically unsuspected carcinoma of the prostate is sometimes found in subcapsular prostatectomy specimens.
We selected 25 patients who were diagnosed as benign prostatic hypertrophy clinically and had subcapsular prostatectomy. In these 25 patients, enucleated surgical specimen was examined histologically by means of the step-section technique. Five of the 25 patients were found to have prostatic adenocarcinoma. The serum acid phosphatase was not elevated preoperatively in these five patients. Three patients had well differentiated adenocarcinoma, one patient had moderately differentiated adencocarcinoma and one patient had poorly differentiated adenocarcinoma.
Age of the patients with prostatic carcinoma ranged from 72 to 87 years old with an average of 78.6 years old, and age of the patients without prostatic carcinoma ranged from 53 to 85 years old with an average of 69.7 years old.
Two of the patients with prostatic latent carcinoma had small lesions. Other three patients had large lesions.
Three patients with latent carcinoma had no treatment, one patient estrogens and castration, and the other patient had estrogens, castration and irradiation.

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Twenty-six patients with prostatic cancer were treated by fast neutron therapy and clinical effect was observed. Twenty three patients did not receive any previous treatment for prostatic cancer (stage A2, B3, C14, D4) and the other three patients were refratory to the endocine therapy.
1. Early effect (within 6 months after fast neutron therapy; 1 local control, 24/26 (92%), 2 improvement of dysuria, 8/8 (100%), 3 reduction of elevated serum acid phospatase, 7/8 (88%).
2. Late effect; 7 patients died within 3 years. Relatively ineffectiveness on these 7 cases might be due to rather limited field of radiation (6/7, 86%), lower time dose and fractionation (TDF100, 6/7, 86%) and poorly differentiated adenocarcinoma (6/7, 86%). Actual 3-year survival rate was 77.2% for stage C, 53.9% for D.
This result showed that it was necessary to extend radiation field, increase TDF and combine endocrine or chemotherapy for poorly diff. type.

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Owing to the effective radiation-and chemotherapy, the prognosis of patients with seminoma has become fairly good. As far as the therapy is concerned, the unsolved problems have become scarce. However, patients with bad prognosis or recurrences are still occasionally encountered. In an attempt to obtain complete cure of all patients with seminoma, the authors studies and analysed the patients with bad prognosis.
A clinical analysis was made on 89 patients witn seminoma experienced at the Department of Urology, Yokohama City University and Department of Urology, Yokosuka National Hospital during the 17 years from 1963 through 1980. and the following results were obtained.
1. The five-year survival rate was 92.7% in all the cases with seminoma, showing 94.3% in stage I and 85.2% in stage II. The prognosis of anaplastic seminoma was bad and the five-year survival rate was 57.8%.
2. Deaths took place in 3 cases in stage I. Two of them died of anaplastic seminoma and the remaining one died of other disease.
3. Among the cases in stage II, one of 6 N₁ patients developed lung metastasis, resulting in death. One of 6 N₃ patients died of cancer and another is now living with recurrence.
Making reference to literature on the above results, the following was mentioned.
1. Anaplastic seminoma showed a bad prognosis, and the use of concurrent chemotherapy is necessary beside radiotherapy.
2. There are often caused failures in determining the stage, also determining the irradiation field, and in selecting the irradiation method, and accordingly a discreet precaution is needed.
3. To treat the bulky tumor of retroperitoneal lymphnode metastasis, the concurrent use of chemotherapy besides radiotherapy is essential.

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A woman aged 64 complaining of remittent fever, right flank pain, general malaise of 2 weeks duration and transient gross hematuria was admitted to our hospital on Nov. 28, 1980.
Neither peripheral edema, engorgement of superficial abdominal veinnor swelling of superficial lymphnodes was recognized, while all of ESR, CRP, hemoglobin and alpha-2 globulin were of pathognomonic value. PPD reaction, absolute number of T-cell T-cell ratio and stimulation index of lymphocyte blastoid transformation by stimulation of PHA, indicated low non-specific cell immunity. Selective renal angiography, inferior venacavography, computed tomography and ultrasonography revealed a right renal tumor with tumor thrombus extending into the inferior vena cava. Furthermore, echogram suggested that tumor thrombus in vena cava extended to 3cm below the diaphragm.
Upper abdominal median incision with right upper abdominal transversal incision enabled us to carry out transperitoneal right nephrectomy and segmental resection of the inferior vena cava. Pathological examination of the excized specimen showed clear cell dominant renal cell carcinoma.
Post-operatively, abnormal findings such as fever, ESR, CRP, hemoglobin and alpha-2 globulin an lowered non-specific cellular immunitl were markedly improved. Convalescence was uneventful and the patient was free of disease for 14 months after the operation.
This case with an extended right renal tumor showed well developed collateral circulation of the left renal vein and no evidence of distant meatastases. Therefore, the curability was expected by the complete resection of the right kidney and tumor thrombus in the inferior vena cava. And for the diagnosis of the tumor thrombus, computed tomography an ultrasonography were found to be useful as well as inferior venacavography.

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A renal oncocytoma is a rare tumor which is composed of oncocytes, with a large acidophilic cytoplasm containing abundant mitochondria. Renal oncocytes are believed to originate from proximal tubular cells. This case report will become the third case ever reported in Japanses literature. A 41 year-old man was referred because of hypertension and proteinuria. Radiological examinations revealed a tumor in the right kidney and nephrectomy was subsequently performed. The resected tumor measured 8.5×5.0cm was well-circumscribed and uniformly tan-brown in color without any necrosis or hemorrhage. Light and electron microscopy confirmed the diagnosis of renal oncocytoma. Light and dark stained cells were observed, and their presence was confirmed by an epoxy resin section stained with toluidine blue. The electronmicroscopic characteristics of the light cells were compatible with those of “classical” oncocytes. As the dark cells had pyknotic nuclei and also more abundant mitochondria, they were considered to be a kind of degenerative cell which had most likely originated from the light cells.
Clinical findings on renal oncocytomas based on the 61 cases reported in available literature are also reviewed and discussed in detail.

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