Urinary citrate excretion was measured in the morning spot urine of 112 calcium stone formers and 87 non-stone formers (control). Citrate excretion was significantly lower in male stone formers than in age-matched male controls, whereas there was no significant difference in citrate excretion between female stone formers and age-matched female controls. But citrate excretion in female recurrent stone formers was significantly lower than that in female single stone formers and controls.
The influence of dietary load on urinary citrate excretion was investigated in 11 male normal healthy subjects. There was no difference in the citrate excretion under the acute load of various diets (standard diet, high protein diet, oxalate-rich diet and high protein and oxalate-rich diet) although citrate excretion correspondingly varied with urine pH under the dietary loads. Also there was a significant direct correlation between citrate excretion and urine pH. However, under the same dietary conditions, the urinary citrate and urine pH in 13 male stone formers were consistently lower than the controls. From these results, we assume that the stone former is in the condition of acid excess, which may be referred to as “subclinical metabolic acidosis”.
For investigation of the effect of ingested animal protein on citrate, calcium and oxalate excretion, three groups of Wistar rats were fed a standard protein diet (SPD), a high protein diet (HPD: added casein to the SPD), or a low protein diet (LPD) for eight days. Citrate excretion in the HPD group was much lower than in the other two groups. Conversely, calcium excretion in the HPD group was higher than that of the other two groups. Oxalic acid excretion in the HPD group was lower than that of the SPD group and was similar to that of the LPD group. One per cent sodium bicarbonate was given orally for eight days ad libitum, with an increase in urine pH, while citrate excretion in the HPD group was much increased to the level of the SPD group. Conversely, calcium excretion in the HPD group decreased to the level of that in the SPD group. Oxalic acid excretion in the HPD group was not affected by sodium bicarbonate. These results showed that overconsumption of animal protein led to acid excess in the body and consequently hypocitraturia and hypercalciuria.
It is sugested that the hypocitraturia of the stone former is mainly due to overconsumption of acid foods which is the important factor in stone formation.

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Nephrotoxicity is the major dose-limiting side effect of Cis-Diamminedichloroplatinum (II) (CDDP) and it develops tubular damage. The mechanism of the damage has not been elucidated clearly. To clarify the mechanism, an experimental pathomorphological study was performed.
Approximately 80 Wistar strain rats weighing 200 to 250g. were submitted to the study. Attention was directed to the damage and the recovery process of the epithelium of the proximal tubules, especially those of the pars recta. Together with the morphological study, biochemical study, determination of Platinum concentration in serum and X-ray microanalysis were also done. The animals were divided into two groups and in one of them, 2, 3, 4, 6, and 10 mg/kg/day CDDP were administered intraperitoneally as single shots. In the other the same doses were injected twice on every other day.
To evaluate early changes two animals were sacrified 6, 12, and 24 hours after the administration. For damages of the highest degree and the recovery, two animals were sacrificed every other day from the second experimental day to the third week.
From electron microscopic observation in this study and mercuric induced tubular damage in the literature, administered platinum is assumed to be transferred into epithelial cells of the proximal tubules through two ways; it is partly reabsorved directly from the tubular lumen and partly from the circulating blood in the interstitial vessels through the basement membrane. The reabsorved platinum binds to SH groups of the cytoplasmic membrane and organellas resulting in impaired mitchondrial function and this mechanism is assumed to be most important in the aspect of damage process. Changes of the brush border in early stage suggest ischemia in the tissue is another affecting factor in the process.

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Cyclosporine (Cs) nephrotoxicity is harmful to recipients of renal transplantation and its pathogenesis remains unclear. To elucidate Cs nephrotoxicity, we carried out biochemical and morphological experiments in rats.
Adult male Wistar rats weighing 200g were used. Rats were divided into 3 experimental groups; the Cs group (Cs 100mg/kg/day was orally given for 9 consecutive days), the GM group (gentamicin 20mg/kg/day was subcutaneously injected for 9 consecutive days) and the control group. All the rats were sacrificed and examined on the 10th day of the experiment. Blood urea nitrogen (BUN) and concentrations of N-acetyl β-D-glucosaminidase (NAG), alanine aminopeptidase (AAP) and lipoperoxide (LPO) in renal tissue were estimated in each group. Kidneys were also examined with light and electron microscopes.
The Cs group showed significant increases of BUN, NAG and LPO and more vacuoles in the proximal tubular cells, compared with the control group. On the other hand, the GM group revealed an increase of AAP activity in renal tissue and marked destruction of brush borders and many myelin-like structures in the cytoplasm of proximal tubular cells.
In proximal tubular cells, NAG and AAP are localized in lysosomes and brush borders, respectively. LPO is reported to be a possible marker of membrane destruction. Therefore, our results suggest that Cs directly damages proximal tubular cells via blood vessels in contrast to the GM injury mediated mainly through tubular lumens. The estimation of blood and urinary NAG and LPO may be useful for early detection of Cs nephrotoxicity.

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The results of clinical application of Extracorporeal Shock Wave Lithotripter (ESWL) were presented. The studies were carried out on 30 patients suffering from in total of 55 urinary stones of the upper urinary tract. The treatments were performed from December 1984 to February 1985 at the University of Tokyo. On the X-ray film obtained four weeks after single ESWL treatment, 21 patients (70%) were free from stone concrements, two (7%) had stone fragments less than 5mm and seven (23%) had ones equal to or greater than 5 mm. In view of therapeutic purposes, 24 patients (80%) had obtained satisfactory results and the remaining six patients needed further therapeutic managements, including second ESWL treatment in 4 patients, ureteral meatotomy in one and ureteral stone manipulation in two.
No serious adverse effect was observed on blood chemistry although mild and transient changes in the blood levels of enzymes indicated that tissue injury took place in muscle, kidney, liver and blood cells. It is concluded that ESWL treatment is applicable to patients with stones in the upper urinary tract without serious clinical complication when indication is appropriately decided.

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Recently, NPT (nocturnal penile tumescence) recording has been regarded as a useful method in differentiating between organic and functional impotence. In this study we present our results of the method.
1. NPT recording was carried out on 13 normal subjects. In all normal subjects NPT was observed 3 to 7 times. The maximum increase in penile circumference ranged from 16 to 35 mm (mean±S. D.: 24.0±5.8mm) and the mean duration time of NPT ranged from 14.0 to 34.2 minutes (23.9±6.0min.). 26.4% of total sleeping time was spent in penile tumescence.
2. NPT recording was performed on 31 impotent patients (17 patients with and 14 patients without organic factors). NPT in all patients without organic factors were almost normal. 4 patients with organic factors showed normal NPT, while the maximum increase in circumfernce was diminished obviously in the other patients.
3. From these results, it is presumed that the diagnosis of organic impotence could be made if the maximum increase in circumference is within 9 mm or the mean duration time is within 10 minutes. However, if the maximum increase in circumference is over 10mm and the mean duration time is more than 10 minutes, no diagnostic conclusion could be derived from NPT alone. A multidisciplinary ap-proach will be necessary to the differential diagnosis of impotence, becanse the diagnostic capacity of NPT is still limited.

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An erectometer was reported as a simple tool for the measurement of nocturnal penile tumescence (NPT). The erectometer consisted of a band applied to the penile shaft, and showed an actual length of circumferential increase that may occur during sleep.
We have developed an erectometer suited to Japanese penile size, and obtained measurements of nocturnal erections on 23 impotent men and 6 normal males.
We compared the actual measurement of NPT by the erectometer with the strain gauge, and studied the reliability of the erectometer on the differential diagnosis of impotence. In 21 of 23 impotent men (91%) the results of erectometer were consistent with those of the strain gauge for the differential diagnosis of impotence.
Then we studied NPT in another 18 cases with both the erectometer and the stamp technique, described by Barry and associates as a simple screening test for organic impotence. The results of erectometer with those of stamp technique were compared in 2 of 18 cases (11%), who had breakage of the stamp ring but no indication of penile erection by erectometer over 3 nights.
The use of an erectometer is proposed as an effective procedure for differential diagnosis of impotence. This method is thought to give a more reliable quantitative measurement than the stamp technique.

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In order to ascertain the relationship between sexual dysfunction and psychosomatic findings, the three different personality test: Rorsach test, thematic apperception test, sentence completion test were performed in 13 patients with psychogenic impotence, 3 patients with organic impotence, 42 patients with Klinefelter's syndrome, 13 patients with hypogonadotropic hypogonadism.
Male gender role, aggressiveness and physical inferiority were evaluated by these psychological tests.
Psychological evaluations suggested that most of psycogenic impotence had poorly etablished Male gender role and loss of aggressivenss.
The same psychological characteristics were noticed in patients with Klinefelter's syndrome and hypogonadism. It is suspected that loss of aggressiveness is the most important psychological factor for sexual dysfunction in patients with psychologic impotence.
The psychological evaluations are useful to diagnosis and treatment for psychogenic impotence.

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Contralateral testicular function after testicular torsion was studied in 5 cases as follows.
1) Microscopic examination of contralateral testes at orchiectomy of affected testes. (4 cases)
2) Semen analysis several years after surgical detorsion. (3 cases)
3) Semen analysis and microscopic examination of contralateral testes several years after affected testes were orchiectomized. (9 cases)
(1 case was followed as Group (1))
In Group (1), atrophy of contralateral testes was found in 2 cases.
In Group (2), spermcount of 1 case was under 10×10⁶/ml more than 3years after surgical detorsion.
In Group (3), sperm count of 3 cases was under than the above and degeneration of contralateral testes was found microscopically in 2 cases.
Of all the 15 cases contralateral spermatogenic disturbance was found in 6 cases. (In 1 case spermatogenic disturbance was found not only when testicular torsion occurred but also in several years after torsion.)
Except for 2 cases with contralateral testes which were cryptorchid and 2 cases with imcomplete torsion, in contralateral testis spermatogenic disturbance was found in 3 of 11 cases. Mechanisms of spermatogenic disturbance is still unclear and further study should be performed.

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The glycerinated muscle was prepared from the rabbit's external urethral sphincter and analysed by O'Farrell's two-dimensional electrophoresis. The majority of myosin light chains (MLC) was the fast type. Crude myosins were prepared from the external urethral sphincter, the psoas and the soleus muscles. Peptide maps of myosin heavy chains (MHC) were made using S. aureus V8 protease and papain. The pattern of peptide map of MHC of the external urethral sphincter muscle was different from that of the soleus (slow twitch muscle) and quite similar to that of the psoas (fast twitch muscle) in both S. aureus V8 protease and papain digestions. Therefore both MLC and MHC of the external urethral sphincter muscle were concluded as the fast type.

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For evaluation of ^99mTc-DMSA renal scintigram as a renal function test, 1. ^99mTc-DMSA uptake was compared with split renal clearances or renal vein catheterization. ^99mTc-DMSA uptake was stated in percent of the dose injected two hours ago. 2. Correlation between ^99mTc-DMSA uptake and histological changes of the renal cortex, evaluated as tubular volume, were examined in operated kidneys. 3. Correlation between ^99mTc-DMSA uptake and findings of excretory urography (IVP or DIP) was investigated. The results were as follows: 1. A close linear correlation was found between ^99mTc-DMSA uptake and split renal clearances (n=37, r=0.89 for C_PAH, n=37, r=0.90 for C_thio), measured by individual urine collection from the nephrostomy tube, ureterostomy tube or solitary kidney. 2. A good correlation was found between ^99mTc-DMSA uptake and E_PAH (n=43, r=0.63), measured by renal vein catheterization and also C_PAH (n=23, r=0.72) and renal venous blood flow (n=25, r=0.57), measured by local thermodilution method. 3. A close linear correlation was found between ^99mTc-DMSA uptake and tubular volume in the renal cortex (n=22, r=0.82). 4. The author concluded that ^99mTc-DMSA uptake indicates renal cortical function exactly and that it might be the ideal method at present as split renal function test because of its convenient, innocuous procedure. 5. The pyelograms (IVP 104 kidneys, DIP 53 kidneys) were classified into three groups (fine, moderate and poor or none) according to contrast medium excretion at five minutes films. A good correlation was also found between ^99mTc-DMSA uptake and the three groups of urographic findings.

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Seventeen patients with primary vesicoureteral reflux and marked proteinuria (5.1 per cent of 334 patients with primary VUR treated between 1975 and 1984) have been followed clinically. Among them 11 patients underwent antireflux operations and 6 patients were observed conservatively. Their renal functions were followed by IVPs, radioisotope renograms and serum creatinine values. Except two child patients receiving antireflux operation who showed normal renal function preoperatively, in all of the remaining 15 patients their renal function deteriorated progressively, no matter whether they had undergone operations or not. 3 patients of them developed chronic renal failure and received hemodialysis or renal transplantation. Antireflux surgery had no beneficial effect on renal function and proteinuria except for control of urinary tract infection in these patients.
On the other hand in most VUR patients without proteinuria the outcome of antireflux operation appears to be satisfactory even though renal scars were revealed on IVPs. Proteinuria seems to be a more reliable prognostic factor of renal deterioration than the presence of renal scar. We propose that vesicoureteral reflux should be prevented surgically before proteinuria and reflux nephropathy occur.

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In recent years, the Nd: YAG laser has been successfully applied in endoscopic urology for the bladder tumor. All of the methods, however, are no-contact i. e. beam irradiation, and there are limits in ability of laser surgery for bladder tumor. We have successfully developed a new contact laser probe, namely “Laser Micro Rod” for transurethral endoscopic laser surgery. So far Trans Urethral Laser Destruction of Bladder Tumor (TULD) has been performed in 25 cases. TULD has a lot of advantages: 1. applicability to large tumors (more than 3cm in diameter) and invasive type tumors, 2. accurate and fast operation, 3. bloodless, 4. less damage to surrounding tissues, 5. easy to get skilled in the operation, in comparison of Laser surgery for bladder tumor using no-contact light guide or TUR-Bt.
In conclusion, we may suggest that TULD exceeds usual surgery i. e. TUR-Bt, as a new treatment for bladder tumor.

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Urinary steroid metabolites were measured by glass capillary column gas chromatography in normal subjects, fourteen patients with adrenal tumor and nine patients with congenital adrenal hyperplasia (CAH). The method is described for simultaneous estimation of the following neutral steroids in urine: androsterone (An), etiocholanolone (Et), dehydroepiandrosterone (DHEA), 11-oxoetiocholanolone (O-Et), 11β-hydroxyandrosterone (OHA), 11β-hydroxyetiocholanolone (OHE), pregnanediol (PD), pregnanetriol (PT), tetrahydro-11-deoxycortisol (THS), pregnanetriolone (PTL), Δ⁵-pregnenetriol (Δ5-PT), tetrahydrocortisone (THE), tetrahydrocorticosterone (THB), tetrahydrocortisol (THF), allo-tetrahydrocortisol (a-THF), cortolone (Co), cortol (Cor). The method involves an ethyl acetate extraction of the urine after enzymatic hydrolysis and gas chromatographic separation of the steroid as their methoximetrimethylsilyl ether derivatives on a 0.3mm×30m OV-101 glass capillary column.
Profiles of urinary steroid metabolites in normal subjects (14 males an 5 females) were studied. Higher values of 5β/5α steroid ratio were obtained in female subjects than in male subjects. These differences may be related to sex differences in liver enzyme activities of 5β/5α reductases.
Fourteen patients with adrenal tumor consisted of two non-functioning adenomas, one virilizing adenoma, four primary aldosteronomas, four adenomas causing Cushing's syndrome and three carcinomas. A unique pattern dominated by the 5β and 11β-hydroxy steroids was confirmed in five patients with Cushing's syndrome, including two carcinomas. Excessive excretions of THS and Δ⁵-PT which resulted from relative deficiencies of 11β-hydroxylase and 3β-hydroxysteroid dehydrogenase, were found in all three carcinomas. These findings were considered to be characteristic of carcinoma, although the excessive excretions of THS and Δ⁵-PT were also detected in another patient with a large adenoma associated with virilization. One patient with carcinoma was responsive to ACTH stimulation while the others showed almost no response to exogenous ACTH.
Nine patients with CAH (21-hydroxylase deficiency) consisted of four untreated adult cases and five cases treated by administration of hydrocortisone. A typical gas chromatographic profile composed of markedly elevated excretion levels of OHA, PT, PTL and moderately elevated levels of other androgens (An, Et, DHEA, O-Et, OHE), as well as those of PD and Δ⁵-PT was observed in untreated patients. A pattern of cortisol metabolites dominated by the 5α steroid was also observed. Elevated excretion levels of OHA, PT and PTL persisted in well-treated cases.
Analyses of urinary steroid profiles by our capillary column gas choromatography is a good method for detection of characteristic changes in patients with adrenal tumor and CAH.

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During the past 10 years (1974-1983), we have treated 67 patients with prostate cancer, of whom 14 have undergone total perineal prostatectomy for clinically stage B prostate cancer. The mean age at operation was 60.3 years, and the mean follow-up period was 26.3 months (range: 6-105 months). All patients have survived without any sign or symptome of disease recurrence. In this series, the length of prostatic urethra on urethrography and the mean weight of the resected prostate were less than 40mm and 27.3g, respectively. Operation time was 4 hours on the average and blood loss was averaged 912ml. Only 1 patient was confirmed to be stage C postoperatively. Indwelling catheters could be removed on the 16th day after operation. In spite of low bladder capacity and short function urethral profile length which were examined with lower urinary tract function study, all patients are under almost normal voiding condition at the present time except for slight stress incontinence in 7 patients. This was thought to be due to normal urethral closure pressure. However 12 patients complain of erectile impotence. These results suggest perineal total prostatectomy, despite some problems such as radicality and staging, have a good applicability to localized prostate cancer.

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Electrical activity of the ureter and intrapelvic pressure were recorded in 20 dehydrated dogs by the intrapelvic perfusion method. The dogs were tested in both the supine position (8 dogs) and the upsidedown position (12 dogs). The following results were obtained:
1. The discharge interval shortened with increasing perfusion rate in the oliguric condition in both groups.
2. The conduction velocity slowed with increasing perfusion rate in both groups. It was 25.8±2.5mm/sec (Mean±S. D.) at 0.2ml/min and 17.6±1.5mm/sec at 5.0ml/min in the supine position group, and 26.5±4.5mm/sec at 0.2ml/min and 17.3±2.2mm/sec at 5.0ml/min in the upside-down position group. There was no significant difference between the two groups at all perfusion rates.
3. The intrapelvic pressure increased proportionally to increasing perfusion rate in both groups. It was 3.9±0.9 cmH₂O (Mean±S. D.) at 0.2ml/min and 12.1±2.3 cmH2O at 5.0ml/min in the supine position group, and 4.3±1.8 cmH2O at 0.2ml/min and 24.4±3.4 cmH2O at 5.0ml/min in the upside-down position group. There was no significant difference between the two groups below the perfusion rate of 0.75ml/min.
4. Considering the relationship among the discharge interval, the intrapelvic pressure and the conduction velocity, it seemed that urine was transported from the kidney to the bladder smoothly by ureteral peristalsis against gravity below urine flow rate of about 0.75ml/min.

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Three cases of psychogenic urinary retention occurring in 71, 16 and 23 years old females are presented. The patients had chronic urinary retention without evidence of neurological abnormality or organic obstruction of the lower urinary tract. In 2 cases urinary retention occurred after an emotional stress. Routine urological examinations were negative except that the first case had bilateral vesicoureteral reflux and mild trabeculation of the bladder. In all the cases the bladder capacity was larger than 500ml and urodynamic studies showed that the action potentials of the external urethral sphincter increased during the act of urination. Psychiatric evaluation clarified that the first case had a kind of depression, and medication with anti-depressant improved urinary symptoms. The second case was diagnosed as having hysteria and became normal after the treatment with transquillizers and autogenic training. Urinary symptoms in the third case were regarded as being due to schizophrenia. Although the symptoms were not improved by various treatments, they disappeared spontaneously after marriage and reappeared after divorce. She is satisfied with indwelling urethral catheter. The treatment of psychogenic urinary retention should be made with cooperation of urologist and psychiatrist.

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Four cases of psychogenic urinary retention were reported.
All cases were female the ages ranged from 42 to 57, the average age was 49.5. There were no neurological abnormalities. Urological examination including urodynamic study revealed no organic causes of urinary retention.
In all the cases domestic troubles preceded their urinary disorders. All the patients were imporved after psychotherapy, plus temporary self-catheterization in 3, diazepam administration in one and antidepressant administration in one.

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The case was a 4 year and 7 month-old female who had the chief complaint of painless gross hematuria for the past one month. Radiological examination showed a tumor in the left kidney with parahilar lymphnode metastasis. Left radical nephrectomy with lymphadnectomy was performed. Diagnosis of renal cell carcinoma was established on the basis of papillary formation by clear and granular cells. She received postoperative prophylactic chemotherapy with interferon. She is living well without metastasis one year after surgery.
47 cases of renal cell carcinoma under 10 years of age in the literature including our case were reviewed. Symptoms, pathological findings, differential diagnosis, treatment and prognosis of renal cell carcinoma in childhood were discussed.

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