Oral calcium tolerance test (OCTT) by modified Pak's method was done in 74 patients (55 males, 19 females) with calcium-nephrolithiasis. Depending on the results of urinary calcium-creatinine ratio (Ca/Cr), these patients were able to be classified into 3 distinct subgroups as follows: In the group 1 (33cases), fasting urinary Ca/Cr was higher than control group (normal men) and these patients were presumed to be hypercalciuric on the basis of such as primary hyperparathyroidism (PHPT) or renal hypercalciuria (RH). In the group 2 (18 cases), fasting urinary Ca/Cr was normal but after oral Ca loading (Ca 1.0g) it was elevated to higher range, and this group was defined as a group with absorptive hypercalciuria (AH). In the group 3 (23 cases), both urinary Ca/Cr were normal and this group was defined as normocaliciuric.
In these patients, level of serum Ca (S-Ca), serum C-terminal parathyroid hormone (S-PTH), and except few cases serum ionized Ca (S-Ca⁺⁺) were examined. As expected, the cases, one or more such blood studies were high level (S-Ca>10.0mg/dl, S-PTH>1.0ng/ml, S-Ca⁺⁺>4.50mg/dl), were the patients of group 1 with OCTT. In the group 2 and 3, these blood studies were almost normal.
However, the results of these blood studies in 33 patients of group 1 were variable but were able to be classified into 3 types with mainly level of S-Ca and S-Ca⁺⁺ as follows: (A) S-Ca high (B) S-Ca normal and S-Ca⁺⁺ high (C) S-Ca, S-Ca⁺⁺ normal. And the cases, high level of S-PTH, were found in the patients with type A or B.
The patient of type A (8 cases) were diagnosed as PHPT, type B (12 cases) suspected as RH and type C (8 cases) as crossover to group 1 of AH (in the other 5 cases of group 1, level of S-Ca were normal but level of S-Ca⁺⁺ not examined).
Type A and B were suspected to be hyperparathyroidism and parathyroid function were normal in the patients of type C. So scintigram for parathyroid was done in 18 cases with group 1 patients (type A-8, type B-8, type C-2) and in 16 cases without 2 cases of type C abnormal concentration at parathyroid gland were found. And operative parathyroid exploration was done in these patients with positive findings.
Except one case of type A, abnormal parathyroid glands were found in 15 cases and diagnosed as adenoma (8 cases) and primary hyperplasia (7 cases) histologically. 5 of 7 patients (PHPT suspected) of type A were having adenoma and 5 of 8 of type B (RH suspected) were hyperplasia.
We could not define whether these patients such as type B (fasting urine Ca/Cr high, S-Ca normal, S-Ca⁺⁺ high) were normocalcemic “primary” hyperparathyroidism or “secondary” hyperparathyroidism caused by primary renal Ca leak.
But ratio of renal Ca reabsorpton (% TR-Ca) was tend to be lower than normal men in normocalcemic group 1 patients.

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131 urinary tract stones composed of calcium oxalate, apatite, a mixture of the two, struvite, uric acid or cystine were analyzed for 18 trace metals by means of inductively coupled plasma-optical emission spectrometry. A large number of trace metals have been found in all the urinary tract stones except those composed of cystine, in which significantly fewer elements are found in less quantity. The trace element assemblages are identical with the oxalates (whewellite & weddellite); apatite and struvite are also generally similar, but with notable exceptions. High concentrations and high relative frequency rates of occurrence of molybdenum, strontium and zinc are found in all those stones.

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Ureteral crossover method, a newly devised anti-reflux operation, has been investigated in 13 female mongrel dogs in order to assess the practicability and usefulness.
The technique was characterized by crossing and overlapping of both ureters submucosally at the middle portion of retrotrigonal area. A ureteral stent was not left post-operatively. The assessement of this technique was performed for 6 months after the operation.
1. The intravenous urogram revealed 19 renal units (73%) normal, 4 (15%) non-functioning, and 3 (12%) dilated. One ureter was found to have the reflux up to the kidney, which was consistent with a dilated renal unit.
2. The value of blood urea nitrogen, creatinine, Na, K, and Cl remained within the normal range in 9 dogs successfully operated on.
3. Percutaneous retrograde pyelography was attempted successfully in one of two dogs through a trocar penetrated the skin and the blader wall suprapubically.
4. The length of submucosal tunnel was examined in 10 dogs in vivo by ureteral pressure profile measurement. The length of ureter with normal upper urinary tract (mean=31.2mm) increased significantly (p<0.005) in comparison with that of 4 control ureters (mean=15.7mm).
5. Histopathological investigation did not demonstrate any sign of compression, necrosis and stenosis in both ureters at overlapping portion in dogs with normal upper urinary tract. However, the dogs unsuccessfully operated on did show either stenotic change in ureterovesical junction or total disapperance of ureter in the submucosal space in association of deterioration of upper urinary tract. These changes seemed to be caused by ischemic change of ureter at the time of dissecting the ureter and by compression of ureteral wall at the time of closing the original hiatus.
6. Based upon these results, in some cases the deterioration of upper urinary tract could be seen which seemed to be responsible for the surgical technique. However, if this problem were solved, the ureteral crossover method could be applicable to the clinical subject.

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Ureteral crossover method, a newly developed anti-reflux procedure, has beed applied to 9 boys and 9 girls between 3 and 15 years of age (mean of 7.7 years). The primary reflux was found in 13 patients and the secondary in 5 who suffered from spina bifida. Bilateral reanastomosis was made in the 18 children with various degrees of vesicoureteral reflux which was present in 33 out of the 36 ureters. 31 ureters were evaluated grade IIb or more. Urodynamically 5 patients were diagnosed as having stable bladder, 5 unstable bladder and 5 detrusor areflexia. Postoperative followup study was performed 3 to 8 months thereafter.
1. Satisfactory results were obtained in 35 ureters (97%), while one ureter demonstrated the reflux of grade I. An intravenous urogram revealed that the deterioration of renal function took place in none of the cases.
2. The urinary tract infection disappeared postoperatively in 12 patients (67%). The value of blood urea nitrogen, creatinine, Na, K, and Cl remained within the normal limit in all patients. The urodynamic study showed that in one patient unstable bladder changed into stable bladder.
3. A ureteral stent was utilized in 18 ureters (50%) for periods of 9 to 24 days. Operating time averaged 140min and blood loss 115g.
4. The advantage of this surgical procedure lies in (I) a long submucosal tunnel being easily obtainable, (II) the operative procedure relatively simple, and (III) a high success rate with few postoperative complications.
It is believed that the ureteral crossover method is effective and useful for bilateral correction of both primary and secondary reflux.

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In order to investigate the renal function in adult type polycystic kidney disease (PCK), the following renal function tests were performed: 1) Glomerular filtration rate (GFR) and renal plasma flow (RPF) calculated from inulin and para-aminohippuric acid clearance. 2) Urine concentration tests. 3) Chloride reabsorptive capacity in the diluting segment under the maximal water diuresis. 4) Acute acid loading tests. 5) Influence of prolonged dehydration on urinary osmolarity and urinary prostaglandin E₂ (PGE₂) excretion.
A total of 17 patients with PCK, 6 patients with chronic glomerulonephritis (CGN) and 6 normal volunteers were studied.
The following results were obtained:
1) Both GFR and RPF were decreased in PCK patients. Creatinine clearance (Ccr.) should be examined periodically in the outpatients, since Ccr. is a more precise indicator of GFR than serum creatinine level and serum creatinine remains within a normal range despite of the 50% reduction in GFR.
2) Urine concentrating ability was impaired. The decline in urine concentrating ability was significantly correlated with a decrease in GFR. However, a urine concentrating defect was observed in the PCK patients, even in those with normal GFR.
3) Solute delivery to the diluting segments was increased in PCK patients. That was caused by the reduction of solute reabsorption along the proximal tubules resulting from extracellular volume expansion.
4) Urine acidification ability was impaired in PCK patients even in those with normal GFR. This impairment presumably results from anatomical and mechanical deterioration of the collecting ducts. The fact that urine acidificaion is impaired in the PCK patients with normal GFR indicates that PCK in its early stages is one of the disorders which produces renal tubular acidosis of the distal type. Titratable acid excretion per nephron was decreased in the early stages in PCK patients. NH₄⁺ excretion ability was maintained better in PCK patients than in CGN patients.
5) Renal PGE₂ production in PCK was reduced. Prolonged dehydration increased urinary PGE₂ excretion and decreased urine osmolarity in normal subjects. In contrast, this dehydration did not increase urinary PGE₂ excretion, but it did increase urine osmolarity further in PCK patients. The vasopressin-PGE₂ negative feed-back system seems to have deteriorated in the patients with PCK.
This study is the first to evaluate the renal function of PCK patients in large numbers with appropriate control groups. Furthermore, it is first to report the deterioration of the vasopressin-PGE₂ negative feed-back system in PCK patients.

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There are many virulence factors on bacterial side in urinary tract infection (UTI). However, pili, surface appendages of bacterium, appear to play an important role in UTI when bacteria adhere to urinary mucosal surface. To prove this assumption, the following in vitro and in vivo experiments were carried out:
1) E. coli O6 bacteria were isolated from UTI, and their pili-rich and poor subgroups were separated by different culture condition, which determine the density of type 1 pili. The pili-rich E. coli O6 (E. coli O6-P^rich) was obtained by serial culture in broth, and the pili-poor E. coli O6 (E. coli O6-P^poor) was by serial culture on agar. The number of E. coli O6-P^rich that adhered to the uroepithelial cells of healthy females was greater than that of E. coli O6-P^poor.
2) Cystitis was experimentally induced in mice by transurethral instillation of E. coli O6. E. coli O6-P^rich invaded into mouse bladder wall more quickly than E. coli O6-P^poor did, probably because of a greater adhesive ability of E. coli O6-P^rich than E. coli O6-P^poor due to the presence of pili.
3) The bacteria in fresh urine of the patients with UTI was examined by negative staining of electron microscopy. Piliated bacteria were seen in 73% of patients with acute cystitis and in 20% of patients with chronic cystitis. No patients with asymptomatic bacteriuria revealed piliated bacteria.
These results indicate that (1) bacterial pili are responsible for adhesion of bacteria on the urinary mucosa and (2) they are one of the most important virulence factors in UTI, thus relating to the severity of subjective symptoms in patients with UTI.

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It is possible that the developent and growth of the prostate is caused by changes of sex hormone levels or metabolism of these hormones with advancing age. Therefore, it seemed desirable to investigate a possible relatinship between hormone state and androgen receptors in patients whose prostate had to be removed.
In the present study, the peripheral serum levels of testosterone (T) and dihydrotestosterone (DHT) were determined in 52 patients with benign prostatic hyperplasia (BPH) aged 54-87 years, in 9 patients with no prostatic disease (total cystourethrectomy was performed for bladder carcinoma) aged 58-65 years and in 9 patients with prostatic adenocarcinoma (PCA) aged 58-81 years. There were no significant differences in the levies of the T and DHT. However, the ratio of T/DHT was lower in the BPH group.
The prostatic cytoplasmic levels of T and DHT were determined in BHP patients and 9 patients with no prostatic disease (total cystourethrectomy was performed for bladder carcinoma). The level of T and DHT was higher in the BHP group, and it is suggested that these two androgens may have a functional role in the BPH.
The potent synthetic androgen methyitrienolone (R1881), which does not bind to serum proteins, was utilized to characterize the binding to receptors in human prostate. Cytosol extracts prepared from hyperplastic prostates were utilized as the source of receptors for the initial studies. The (³H) R1881 receptor-complex had a sedimentation coefficient of approximately 8S by 5-20% sucrose density gradient method.
High affinity binding was detected in the cytosol of 45 of 52 samples of BPH (average number of binding sites, 40.9±33.2 fmol/mg cytosol protein), of 6 of 9 samples of normal prostate (26.0±8.6 fmol/mg cytosol protein) and of 6 of 9 samples of PCA (29.6±21.8 fmol/mg cytosol protein). There was no significant difference among these 3 groups.
However, all samples of PCA from transurethral electro-resection might be degenerated by heat. Therefore, it is necessary to evaluate the effect of electro-resection on receptor protein.

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Antiandrogenic therapy is the dominating form of treatment of prostatic carcinoma. The majority of cases are well controlled for varying periods with this regimen. However, there have been no adequate methods to predict in which cases antiandrogenic therapy is of less benefit.
In this study, transurethral cold punch biopsies from 14 primary prostatic cancer patients were taken before antiandrogenic therapy was given, and the specimens were analyzed with regard to content of methyltrienolone (R1881) binding sites. Maximum binding capacity (Bmax) and dissociation constant (Kd) were calculated from Scatchard plots.
To gain the change by which initial treatment of antiandrogenic therapy (diethylstilbestrol diphosphate 500 mg/day, total 10g administered following bilateral orchiectomy) influences the regression of human prostatic adenocarcinoma, 9 in 14 patients were biopsied before and after treatment.
All 14 cases contained measurable amounts of R1881 receptor (range 4.8-134.7 fmol/mg cytosolic protein). The mean value for maximum binding capacity (Bmax) was 38. 6 fmol/mg cytosolic protein. There was a good correlation (13/14, 92.8%) between the cytoplasmic contents of R1881 receptor and short term response to antiandrogenic therapy.
No difference was observed between the R1881 receptor content of the prostate before treatment and that of the prostate after antiandrogenic therapy (49.3 vs. 34.2 foml/mg cytosolic protein). However, except 1 case, the administration of diethylstilbestrol diphosphate to 8 castrated men significantly decreased the prostatic cytoplasmic R1881 receptor contents (53.2 vs. 30.4fmol/mg cytosolic protein).
These data suggest that R1881 receptor analysis is a valuable prognostic tool for prostatic adenocarcinoma in short term response, and that antiandrogenic therapy seems to decrease the androgen dependency of human prostatic adenocarcinoma during this treatment.

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By Fujimoto's method (1963), the author attempted to induce anexperimental pyelonephritis immunologically without using micrrorganisms.
Bovine Serum Albumin (BSA) was injected into the left renal pelvis, during clamping of pelvioureteral junction of the same side for 24 hours, in rabbits which had been immunized by BSA, and after one month interval BSA injection was repeated into the homolateral renal pelvis. Rabbits were sacrificed and dissected 3 days to 10 weeks after the last provacative injection for morphopathological study.
In one time-injection group, earlier stage of pyelonephritis was established and it was suggested that immunological response plays an important role in the extension and progress of pyelonephritis.
In twice-injection group, recurrent and later stage of pyelonephritis was established by twice immunological responces in association with wide spread occurence, mixture of early and later stage of inflammation and damage of tubular epithelium.
It is suggested that lymphatic route plays an important role in the extension of pyelogenous inflammatory processes into renal tissue.

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The aim of this study is to investigate the mechanism of both the effects of a streptococcal preparation (OK 432) on augmentation of human natural killer (NK) cell activity of peripheral blood lymphocytes (PBL) and antiproliferative activity of OK 432 for cell lines derived from urinary tract tumors.
PBL were isolated from healthy donor and patients with urogenital disorder, and were, then, cultured with OK 432 or supernatants from 15-hr OK 432-stimulated PBL cultures (sample medium). Cell lines derived from carcinoma of the prostate (DU 145 and PC 3) and kidney (KU 2) were used as the target cells. K 562 cells, well known for their high susceptibility to NK cell-mediated cytolysis, were also used as the control target. NK cell activity was tested by a short-term ⁵¹Cr-release assay.
To assess the possibility of OK 432 inducing interferons (IFNs), the culture medium of PBL pretreated with OK 432 was analyzed for anti-viral activity. Determination of the type of IFN induced by OK 432 was made by both acidification (pH 2.0) and neutralization of sample midium. IFN-titer in the medium was neutralized by anti-IFN-α or-β antibody.
Antiproliferative activity of OK 432 was evaluated by examing the growth curves of KU 2 and DU 145 cells following treatment of these cells with OK 432, IFN-α or sample medium.
The present study demonstrates the following: (1) NK cell activity is significantly enhanced by treatment of PBL with OK 432; (2) OK 432 exerts direct antiproliferative effect on cell lines tested; (3) most of IFNs induced by OK 432 are IFN-α and-γ; (4) IFN which is found to be chiefly responsible for the enhancement of NK cell activity elicited by OK 432 treatment is IFN-γ and (5) the sample medium comprising both OK 432 and IFNs has greater antiproliferative effect than OK 432 medium alone.

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Using cystometry and uroflowmetry, we examined 24 patients with benign prostatic hyperplasia and 12 patients who underwent prostatectomy and computed five parameters: bladder work, bladder energy loss, bladder wall contraction velocity, bladder wall tension and urethral resistance.
After prostatectomy, bladder work, wall tension and urethral resistance were decreased, and bladder wall contraciion velocity was increased. As the urethral obstruction was relieved by prostatectomy, the improvement in these parameters may have been induced by the decrease in urethral resistance.

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Sixteen cases of benign prostatic hypertrophy (BPH) have been followed up for 6-8 years by size measurements using transrectal-ultrasonotomography. During the observation the weight of the prostate increased in 3 cases but in the remaining 13 it was almost stationary. There was a significant difference between these two patient groups. This means that the weight of hypertrophic prostate is not always increasing with age and suggests that the enlargement of the hypertrophic prostate may occur only in rather short duration.
The distribution of Presumed Circle Area (PCAR) on the horizontal section of the prostate in 16 cases was separated clearly into 2 groups with PCAR over and under 0.80. The former group with high PCAR over 0.80 without significant residual urine should be followed up carefully to clarify the mechanism of urinary disturbance in BPH cases.

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Ultrasonograms of the prostate were measured by the digitizer microcomputer system. The prostate was scanned transrectally and photographed at 5 mm intervals. Horizontal diameter (H), vertical diameter (V), area (S), and perimeter length (L) of the prostatic images were measured. The following 4 criteria were calculated in the biggest tomogram of the prostate: ratio of vertical diameter to horizontal diameter, C=V/H×100 (%), presumed circle area ratio, R=4πS/L²×100 (%), ellipse deformation degree, D=|SπVH/4|/S×100 (%), and weight, W=∑S/2 (g). These parameters were calculated in 13 patients with prostatic cancer, 21 with B. P. H., 30 with prostatitis and 51 normal subjects. The weight W and the presumed circle area ratio R were higher in the patients with prostatic cancer and B. P. H. than in those with prostatitis and normal subjects. The ratio of vertical diameter to horizontal diameter C was greatest in the prostatic cancer group, next in the B. P. H. group, and lowest in the prostatitis and normal groups. The ellipse deformation degree D showed a low value in the B. P. H. group than in the prostatic cancer group.
The discriminant analysis of the prostatic cancer group with the other three groups was carried out, calculating 4 data of W, R, C, and D as explanatory variables. A discriminant function of cancer-score=0.169C+0.133R+0.00860W-0.00803D was obtained. The cancer-score effectively separated the prostatic cancer group from the prostatitis and normal groups, but separation between the prostatic cancer and B. P. H. groups was incomplete. For the purpose of external check of the cancer-score, another group consisting of 22 patients with prostatic cancer, 36 with B. P. H., 52 with prostatitis, and 79 normal subjects were tested.
The cancer-score well differentiated the prostatic cancer group from the prostatitis and normal groups.

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Congenital anomelies of the scrotum are rare and among them the accessory scrotum is extramely rare.
A case of accessory scrotum associated with imcomplete penoscrotal transposition was reported. A 3-year-old boy who was 96.4cm in height and 16.6kg in weight, well nourished, and normally developed was admitted to our depertment of February 14, 1983 because of anomalies of external genitalia. A scrotum-like tunor was noticed in the left side of perineum between the scrotum and anus. The left side of this structure was circumscribed by the raphe which was normal in position at the penis and the anterior scrotum. Both testicles had descended into the anterior scrotum. The condition was associated with imcoplete penoscrotal transpostion. The clinical laboratory study including chromosomal check, U.C.G. and I.V.P. reveald no abnomalities. Scrotoplasty which was made by a modified Glenn-anderson procedure and an accessory scrotumectomy were performed on February 25, 1983. The histologic picture and architecture of this specimen was that of scrotum. The clild's postoperative course was entirely satisfactory.
Seven reported cases of the accessory scrotum including our own were reviewed and discussed. Probably midperineal accessory scrotum may result from the triple anlage of the labioscrotal swelling. Left perineal accessory scrotum may result from a division of the labioscrotal swelling with abnormal migration of the inferior division.

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A case of sertoli cell tumor of the testis with prostatic cancer is presented. The patient, a 62-year-old man, visited our hospital with complaints of dysuria and painless swelling of the left scrotum on September 27, 1978. Under a diagnosis of benign prostatic hypertrophy and left hydrocele testis, TUR-P was performed. Put histological examination revealed a poorly differentiated adenocarcinoma. Thereafter, bilateral orchiectomy was performed as anti-androgenic hormonal therapy. The left testis was hard and measured 8.5×4.0×4.0cm, weighing 102g. The cut surface was yellow-white and firm. The testis was Completely displaced by the tumor and no normal tissue was macroscopically visible. The tumor had the microscopic appearance of a malignant sertoli cell tumor of the mixed type, and capsular invasion of the tumor was presented. About ten months after the orchiectomy, the patient developed enlarged retroperitoneal and left supraclavicular lymph nodes. On February 26, 1981, left supraclavicular lymph nodes were excised. Pathological diagnosis showed metastatic sertoli cell tumors of the tubular pattern. Electron-microscopically, tumor cells contained abundant cytoplasmic organelles and lipid droplets, and were attached to each other by desmosomes. Soon after the operation, he undelwent several cheinothecapies but they weie less effective than expected and died of lung edema and cardiac failure on Novermber 10, 1982. Autopsy revealed a retroperitoneal tumor, which was considered a metastatic sertoli cell tumor but proved to be a metastatic tumor of prostatic cancer by histological examination and antibody-peroxidase-antiperoxidase method. However concerning supraclavicular tumors, the histological differentiation between sertoli cell tumor and adenocarcinoma of prostate was quite difficult and further histological reexamination is necessary.

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