In order to clarify the important initial renal lesions of ascending pyelonephritis, the fate of pyelonephritis, the fate of pyelonephritis experimentally produced in rats, which received transurethral inoculation of 0.5ml heart infusion broth containing 10⁴ cells of Proteus mirabilis into the bladder after deprivation of drinking water for 24 hours, was traced for a period from one hour to 30 days after inoculation using light and electron microscopes.
The results obtained are as follows:
1. Pyelonephritis occurred in 110 of the 219 kidneys examined, the incidence being 6.9, 13.8, 24.1, 71.9, 63.2, 79.3, 75.0 and 100%, one two, 4, 8, 24 hours, 3, 7 and 30days after inoculation, respectively.
2. A slight inflammatory change defined as grade I occurred in 46 of 157 kidneys in 5 groups studied for a period from one to 24 hours after inoculation. In 40 of the 46 kidneys, inflammatory lesions were confined to the renal fornix mucosa, and bacteria adhered to the superficial mucous epithelial cells with their pili, particularly to the cells bearing increased microplicae or microvilli.
3. Even in the case of slight pyelonephritis, the exfoliative epithelial cells incorporating the bacteria, fibrin precipitates from the inflammatory region and polymorphonuclear leukocytes phagocytizing bacteria were observed in the pelvic cavity.
4. The slight pyelonephritis progressed into the renal parenchyma 8 hours after inoculation, and the pelvic mucosa demonstrated a considerable multilayering indicating a reparative process 3 days after inoculation.
The results obtained indicate that the renal fornix mucosa can be considered as a preferential site for bacterial adhesion and penetration. For the development of this entity, an adhesion capacity of the bacterial pili to the superficial cells showing surface structual changes mentioned above was also thought to be an important pathogenic factor. In addition, the desquamation of the cells incorporating the bacteria was assumed to play an important role as a defense mechanism in the host in the early developing phase of the pyelonephritis in cooperation with the phagocytic action of granulocytes.

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Urinary secretion of arylsulfatase A (AS-A) was determined enzymatically in 110 individuals, of whom 30 were afflicted with bladder cancer, 22 with urinary tract infection, 30 normal and the others with miscellaneous urogenital diseases. Arylsulfatase A levels in spot urine from normal volunteers were 36±1.2units/mg creatinine (mean±S. D.). AS-A activity elevated as high as 83±35units/mg creatinine in the urine from patients with transitional cell carcinoma of the bladder (p<0.001). The enzymatic level was elevated as histological grade and tumor bulk increased, while it was normalized after the tumor had been effectively ablated.
The activity of AS-A in the cancer tissue was determined using tissue homogenates (14.7±4.1units/mg protein), and was confirmed to be higher than that of normal mucosa of the bladder (7.2±1.8, p<0.001). In view of the fact that urinary AS-A activity can ve determined without particular invasive technique and it has a potential role as marker protein of bladder cancer, its clinical application is commended.

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E. coli (06) 2×10⁷cells/ml was inoculated into mouse bladder by transurethral technique.
Immunohistochemical studies were performed on the infectious mechanism in experimental cystitis of mice.
The results obtained were as follows:
1) Development of infection and bacterial counts in urine: More than 10⁶cells/ml of urinary bacteria on an average were detected until 7 days after the inoculation of E. coli (06) but the number decreased below the detectable level after 14 days indicating the state of spontaneous healing.
2) Mucin layer in the mucosal epithelium of urinary bladder: In the normal bladder of control animals, disappearance of mucin layer was not observed, while in the bladder which had received bacterial inoculation, its partial disluption was observed 2 hours after inoculation, and after 6 hours the mucin layer dislupted from almost the whole area of the inner-coat of the bladder. It's disluption became even more marked after 3 and 7 days. There was no recover of mucin layer, and the attachment and growth of bacteria on the mucosal epithelium were more marked and vigorous. A recover of mucin layer was observed 14 days after the inoculaion.
3) Invasion of bacteria into urinary bladder: Invasion of bacteria into mucosal proper layer was already evident 2 hours after bacterial inoculation. After 6 hours, invasion of “free” bacteria which were not attacked by leucocytes could be found in the submucosal layer. After 12 and 24 hours, bacteria which had been attacked by phagocytic action of leucocytes were remarkable. After 3 and 7 days, there were practically no “free” bacteria but the attachment and growth of bacteria on mucosal epithelium were more marked.
4) Kinetis of the infiltrating cells in the urinary bladder: Submucosal edema of urinary bladder was manifest 2 hours after bacterial inoculation and became more marked after 6 hours. It regressed 12 and 24 hours after inoculation but became larger again after 3 and 7 days. Leucocytes were detected in the submucosal layer 2 and 6 hours after bacterial inoculation. After 12 and 24 hours, they increased in number and were detected also in the vesical cavity. The number of the leucocytes showed a marked increase 3 and 7 days after infusion, and infiltration of lymphocytes and plasma cells incresed simultaneously.
5) Immunocompetent cells: The amount of the T-lymphocytes in the urinary bladder 3 and 7 days after inoculation was 5 to 10% of the total infiltrating cells as determined by immunoenzyme antibody with Thy-1 antigen.

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In the process of cancer invasion, the important role of proteolytic enzymes released from the cancer cells has been indicated. But there has been hitherto no report about proteolytic enzymes in bladder cancer. From this point of view, we investigated elastase-like activity in bladder cancer to predict the potential of bladder cancer invasion.
Enzymatic assay was done by the use of succinyl trialanine paranitroanilide (Suc-Ala₃-NA), a synthetic substrate of elastase. Elastase hydrolyzes Suc-Ala₃-NA into Suc-Ala₃ and NA. But recently, the production of NA by proteases other than elastase has been reported. The mechanism of liberating NA consists of two steps of enzymatic reactions, that is, Ala-Na and Ala₂-NA are produced by endopeptidases and then NA is liberated from Ala-NA and Ala₂-NA by aminopeptidases. In order to distinguish elastase-like activity from the liberation of NA in the process described above, we added amastatin, an inhibitor of aminopeptidases, in the enzymatic assay. And, by using the high performance liquid chromatographic system, we detected Suc-Ala₃-NA hydrolyzing activities in cancer tissues taken from 20 patients with bladder cancer and in 17 specimens of bladder epitheliums without cancer invasion. The results were as follows:
1) Elastase-like activity and endopeptidases activities in the bladder cancer tissues were significantly higher than those in the bladder epitheliums.
2) Elastase-like activity in the invasive bladder cancer with muscle invasion was significantly higher than that in the superficial bladder cancer.
These results suggest that elastase-like activity might serve as a biochemical marker for the invasive potential of bladder cancer.

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The relatively high incidence of urological complication in renal transplantation, with associated morbidity, mortality and graft loss is well documented.
Of 107 consecutive renal transplantations performed between February 1973 and January 1983, 100 received kidneys from living related donors, while 7 received cadavar kidneys.
Urinary tract reconstruction in all cases was ureteroneocystostomy (modified Paquin's technique).
The incidence of urological complication was 4.7% (5 cases). Urinary leakage occurred in 3 patients (2.8%). Ureteral obstruction due to lymphocele occurred in 1 patient (0.9%) and urolithiasis occurred in 1 patient (0.9%).
The incidence of graft loss and patient mortality due to urological complication after renal transplantation were 0%.

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Urodynamic evaluation in benign prostatic hypertrophy (BPH) was performed through a comparative analysis of transrectal ultrasonotomography and urethral pressure profile (UPP).
Ultrasonically calculated weight, presumed circle area ratio (PCAR) of prostatic adenoma, functional profile length (FPL) and Area in BPH patients complaining of urinary retention were all significantly larger than those in non-retention cases. Above all, Area showed the most prominent difference between these two patient groups. A significant correlation was also proved between PCAR and FPL, PCAR and Area, and FPL and Area.
A UPP pattern with pressure peaks at the prostatic region besides the external sphincter was recognized in a few cases. It was supposed that this double peak type of UPP could be recorded as a result of disturbance of the urethral pressure gradient (UPG), a new concept proposed in the current study, evoked by some uropathic factors.
The data presented here suggest that the combination of the transrectal ultrasonotomography and UPP would provide both morphorogical and functional informations to clarify the pathogenesis of urinary obstruction in BPH.

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The recorded data obtained through monitoring nocturnal penile tumescence (NPT) is an objective method for determining the erectile status of patients who complain of impotence. But, the validity of NPT as a means of distinguishing between functional and organic impotence has not been firmly established. Recently, many authors have assessed NPT on the basis of penile circumferense. Because of the periodic occurrence of NPT in association with rapid eye movement sleep, periodicity shold also be considered an important aspect of NPT.
Therefore, we devised a classification standard for NPT on the basis of periodicity and degree of distention and compared the results with clinical appraisais and data obtained during treatment. The following results were obtained.
1. Five healthy adults who all displayed periodic, vigorous NPT were classified as MSIa.
2. Of 21 patients complaining impotence, 7 were classified as MSIa, 2 with periodicity but week NPT were classified as MSIb, 6 with no periodicity but strong NPT as MSIIa, 3 who displayed no periodic and week NPT as MSIIb, 1 with hardly any NPT as MSIII, and 2 without any observable NPT as MSIV.
3. When these results are compared with clinical findings, it is certain that MSIa represents functional, and MSIII and MSIV organic impotence. In the cases of MSIb and MSII, however, it can not be decided, on the basis of NPT alone, whether they represent functional or organic impotence.
The recorded NPT data provides an excellent method for diagnosing potency, follow-up studies of a much larger sample are needed to adequately assess such data. The classification standard devised for this study may be thought of as a servic eable, objective way of expressing recorded NPT.

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Anti-androgen therapy has been used widely for prostatic cancer, without constant success. In addition, there are some cases which respond to the therapy initially but do not later. Since androgen acts via androgen receptors (AR) in the target cells, the presence of AR in the tissue of prostatic cancer must be essential for effectiveness of the anti-androgen therapy to the cancer.
Previously we reported a method to detect the localization of AR within the human prostatic tissues by means of autoradiography. We examined the localization of AR in the prostatic cancers and investigated the relationship between AR and effectiveness of the hormone therapy and between AR and pathological grade of prostatic cancers.
12 prostatic cancer tissues and one metastatic lymph node tissue were obtained by needle biopsy from 10 patients. Cryostat-frozen sections of the tissues were cut at 10μm thick, air-dried, fixed in 10% formalin in PBS (pH7.4) for 5 minutes and washed in three baths of PBS. The tissue sections were trated with 50μl of 100nM tritiated dihydrotestosterone (³H-DHT) in a humid box at room temperature for two hours, washed and air-dried. The sections were then dipped into Sakura NRM-2 autoradiographic emulsion, dried at room temperature, followed by dipping into scintillator solution consisted of 7% PPO and 0.02% POPOP dissolved in dioxan and exposed in the dark for two weeks. After exposure the emulsion sheets covering the sections were developed, and the sections were stained with hematoxylin.
By autoradiography we examined AR in the prostatic cancers and got the following conclusions:
1) There are three types of prostatic cancers. The first type of the cancers consists of AR positive cells only, the second type consists of AR negative cells only, and the third type consists of both AR positive cells and AR netative cells.
2) In the prostatic cancer tissues with AR positive cells and AR negative cells, each group of cells forms a mass of various size.
3) With regard to the relationship between AR and pathological grade of cancers, of 4 cancers with AR positive cells, one was well differentiated adenocarcinoma, two were moderately differentiated adenocarcinomas and one was poorly differentiated adenocarcinoma. On the other hand, of 3 cancers with AR positivecells and AR negative cells, one was of moderately differentiated type and three were of poorly differentiated types. And 2 cancers with AR negative cells were both of poorly differentiated type.
4) With regard to the relationship between AR and effectiveness of anti-androgen therapy, of 4 cancers with AR positive cells, all four responded to the therapy. Of 4 cancers with AR positive cells and AR negative cells, three (75%) responded. And of 2 cancers with AR negative cells, one (50%) responded.

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Eighty-one patients with superficial papillary tumors of the urinary bladder were studied as to the presence of the ABH (O) cell surface isoantigens by specific red cell adherence test. Patients with blood group 0 were excluded from this study. The red blood cell adherence to more than 25% of the epithelium was defined as positive. The isoantigens on the cell surface of the bladder tumors tended to delete as the histologic anaplasia of the tumor progressed. Of 40 patients with grade 1 tumor, 25 (63%) had ABH (O) cell surface isoantigens. On the contrary, of 30 patients with grade 2 and 11 with grade 3, only 12 (40%) and 2 (18%) retained isoantigens respectively. (G1 vs. G3: p<0.05)
In 60 patients who underwent conservative procedures (TUR or transvesical tumor resection) for primary tumors, the relation of the deletion of the isoantigens to the recurrence rate of tumors was studied with intervention of the histologic anaplasia, and the numbers of tumors.
In patients with low grade tumors (grade 0 and 1) the tumor recurred in 21% (5/24) when isoantigens were retained, but in 100% (9/9) when they were not (p<0.005). On the other hand, in patients with high grade tumors (grade 2 and 3) the high recurrence rate was observed regardless of the results of SRCA test: 55% (6/11) in positive cases and 75% (12/16) in negative cases (p>0.25).
In patients who initially presented with a single tumor, the tumor recurred in 15% of patients (4/26) when isoantigens were retained. Otherwise it recurred in 82% (9/11) when they were not (p<0.005). However, in patients with multiple tumors, 78% (7/9) showed recurrence when isoantigens were retained and 86% (12/14) when they were not (p<0.5).
In view of the above results, SRCA test was considered to be useful in predicting the recurrence of tumors in patients with a low grade or a single tumor. It may have been due to the frequent coincidence of microscopic lesions such as carcinoma in situ and dysplasia which could not be found cystoscopically that the recurrence rate was higher in patients with high grade or multiple tumors regardless of the results of SRCA test.
The relation of the deletion of isoantigens to the later development of invasive cancer could not be analysed in our series because only a few patients showed malignant progression.

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Pelvic arteriography was performed in 35 patients with prostatic cancer to assess its diagnostic value for evaluation of tumor extension. Arteriographic findings were characteristic according to T classification of the tumor.
T0 tumor showed dilatation and tortuosity of the inferior vesical artery of the affected side.
T1 tumor showed hypervascular appearance of the artery in addition to T0 arteriographic findings and the middle rectal artery of the affected side was dilated, tortuous, hypervascular and stretched.
In T2 tumor, neovascular and anastomotic findings of the inferior vesical arteries to the unaffected part of the prostate were observed in addition to T1 arteriographic findings. The middle rectal artery showed simular changes to those of T1 and the inferior pudendal artery was hypervascular and tortuous.
Pooling and dense network pattern of inferior vesical arterial tributaries were shown in T3 in combination to vascular characteristics of T2 tumor. Venous phase was delineated at the early time.
In T4 tumor, the superior vesical artery tended to anastomose with the inferior vesical artery in addition to T3 tumor arteriographic findings.

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Herein we report 20 cases (22 ureterorenal units) of ectopic ureterocele which were experienced in our institution from 1965 to 1982. Two cases (2 ureterorenal units) were male and 18 (20 ureterorenal units) female. All patients complained of symptoms referrable to urinary tract infection, while dysuria and prolapse of cele were also encountered in 5 and 3 cases, respectively. The age fo the first consultation was as follows: under 1 year (4 cases), 1 to 3 (5), 4 to 6 (3) and over 15 (8). Basically they were treated surgically and our choice of operative procedure was usually decided after the assessment of the following features: (1) types of union of the ureters and vesicourethral wall (common or separate hiatus) (2) function of corresponding renal unit (3) reflux or not to mate ureter (4) eversion or not of cele wall. For these assessments, excretory urography, cystourethroscopy, renoscintigram and voiding cystourethrography were utilized fully. In cases of type S hiatus, heminephroureterectomy with cele wall resection was indicated because all the corresponding kidneys were dysplastic in our histological examination. In cases of type C hiatus, renal conserving procedures (twin ureteroneocystostomy with cele wall resection or TUR of cele wall) were indicated, because renoscintigram often shows significant renal function even whthout apparent visualization on excretory urography. Essential points of our surgical procedures are illustrated.

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Statistical study was performed on cases of bladder tumors, hospitalized and treated in the Department of Urology, Nagoya University School of Medicine for the past ten years, from January 1973 to December 1982. Among them were two hundred and twenty-eight inpatients with primary epithelial tumors of the bladder initially treated in this period.
In this study, these 228 cases were analyzed from clinical and pathological aspects. They were 182 males and 46 females, with the ratio of 4 to 1. The ages distributed from 25 to 87 years. In both sexes the peak incidence was found in the sixth decade of age. In addition, patients over fifty years of age occupied 82.9per cent of the whole.
As to occupation, dye workers were seen in 5 of 213 cases whose occupation could be identified. The habit of smoking was noted in 81.5% of the males and 33.3% of the females. Ten cases (4.4%) had antecedent history of malignant neoplasms in other organs.
Among clinical symptoms, hematuria was found most frequently, in 90.8% of the whole. Pain on urination, pollakisuria and difficulty of urination were observed in 18.0, 17.5 and 10.1% of the patients, respectively. Approximately half of the patients consulted within three months after the manifestation of initial symptoms, while 22.0per cent of the whole were examined so late as after the course of one year.
As to the location of tumor, the region posterolateral to both ureteral orifices was noted and studied separately from other sites. This site showed a high frequency of tumor, in 93 of 223 cases (41.7%). At this site, compared with other sites, solitary, small, and papillary or pedunculated tumors were significantly frequent, and they were predominantly low stage or low grade tumors.
The stage and grade were examined in relation to symptoms, patient's age, number, size and shape of tumor. It has become evident that cases with irritative bladder symptoms, large tumor, or non-papillary sessile tumor were seen significantly frequently in the group of high stage or high grade tumors, whereas cases with asymptomatic hematuria, small tumor, or papillary pedunculated tumor were seen frequently in the group of low stage or low grade tumors. Patient's age or number of tumor had no apparent correlations to the stage or grade.

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Our previous study showed that the frequency of uric acid containing stones was 9% by infrared spectroscopy. Of this, 49% was simple and 51% was mixed uric acid stones. The most frequent mixed component was calcium oxalate.
Serum calcium, phosphorus and uric acid as well as 24-hour urinary excretion of calcium, phosphorus, uric acid, magnesium and pH of the urine were measured in four groups of individuals including 13 patients with uric acid stones, 23 with uric acid mixed stones, 30 with calcium oxalate stones and 30 healthy controls. All patients were male and had no evidence of endocrine or metabolic disorders.
No significant difference was found in serum calcium and phosphorus among the four groups. The serum uric acid level in the uric acid and uric acid mixed stone groups were higher than that in the other two groups. Urinary calcium excretion was lowest in the uric acid and highest in calcium oxalate stone group. The value for the uric acid mixed stone group fell between them. Urinary phosphorus, magnesium, uric acid and oxalate excretion had no significant differences among the four groups. Magnesium/Calcium ratio was highest in the uric acid and lowest in calcium oxalate stone group, while the ratio for the uric acid mixed stone group was intermediate. pH of the morning urine was almost the same in the four groups. The same results were seen when hyperuricemic stone patients were substituted.
These results suggest that in case of acidified urine, when uric acid level is sufficiently increased, high calcium excretion induces calcium oxalate stones; low calcium excretion induces uric acid stones and intermediate calcium excretion induces uric acid calcium oxalate mixed stones.

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The frequency of androgen insensitivity in infertile phenotypically normal men was assessed from the hormonal levels in blood. Androgen insensitivity was presumed to be present if androgen insensitivity index {LH (mIU/ml)×testosterone (ng/ml)} was over 200. Nine azoospermic men out of 90 azoospermias (10%) were thought to be with androgen insensitivity. Androgen insensitivity was not found in 22 cases of severe oligozoospermias. Therefore, the frequency was 8% in azoospermias plus severe oligozoospermias. Since the androgen insensitivity index is said to identify only 30% of infertile men with a reduced androgen binding capacity in scrotal skin fibroblasts, these figures will become 30% and 24%, respectively.
To see the propriety of diagnosing the androgen insensitivity from androgen insensitivity index, this index was calculated in Klinefelter's syndrome. In 4 cases out of 23, the index was over 200. The androgen insensitivity index was compared among the groups of azoospermia, severe oligazoospermia, oligozoospermia, normozoospermia, and Klinefelter's syndrome. The index increased when the disturbance of spermatogenesis advanced. Furthermore, there was no clear cut differences in LH and testosterone between the groups of androgen insensitivity index over 200 and under 200. The implicaiion of these results is that elevation of androgen insensitivity index does not necessarily indicate an androgen insensitivity.

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A case of interstitial cystitis treated successfully with steroid and bladder distension is reported.
A 53 years old male was admitted to our departemt with complaints of pollakisuria and pain on bladder region.
Histological examination by cystopunchbiopsy revealed epithelial erosion and submucosal nonspecific fibrosis. Cystography revealed an extremely low bladder capacity and bilateral VUR. After differential diagnosis, the patient was diagnosed as interstitial cystitis.
At first, antibiotics were administered intravenously bacause of concomitant urinary tract infection. However, severe symptoms continued after infection disappeared. Then we started steroid therapy and bladder distension by instillation of saline with antibiotics from an indwelling Foley catheter. Because of the existence of VUR, bladder instillation was performed at a capacity of 100-150ml and the bladder was inflated moderately. Increasing the instillation capacity gradually, bladder distension was performed every day with steroid therapy.
About 40 days thereafter, the bladder was inflated to the normal capacity and the pain disappered Then the Foley catheter was removed.
After removal of the Foley catheter, the patient showed no symptoms and was discharged.

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