61 cases with hypospadias and 28 cases with male hermaphrodism have been studied radiographically in order to evaluate the significance of vaginal rest. We have compared the incidence and the size of vaginal rest and localization of vaginal orifice in these patients.
There was a vaginal rest in 25 per cent of the glandular, 29 per cent of the penile, 43 per cent of the penoscrotal, 71 per cent of the scrotal and 100 per cent of the perineal hypospadias, with over all incidence of 48 per cent.
The incidence of undescended testes associated with hypospadias was 41 per cent and that with male hermaphrodism 85.7 per cent.
Abnormal findings of excretory urography were observed 13.1 per cent with hypospadias and 21.4 per cent with male hermaphrodism.
To compare the size of the vaginal rest in each case, we express the size of vaginal rest as the relative length to the posterior urethra. In patients with hypospadias, the size was below two-thirds of the posterior urethra. In all male hermaphrodism it was greater than two-third of the posterior urethra.
In hypospadias the vaginal orifice opened at the normal position of the Vermontanum in the posterior urethra, but in male hermaphrodism, its orifice opened at lower position, close to the external sphincter.
Thus, hypospadias accompanied by vaginal rest was characterized by that its size is smaller than two-thirds of the posterior urethra and its orifice is located at normal Vermontanum in the posterior urethra.

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The chemosensitivity testing with a stem cell assay for renal cell cancer and urothelial cancer (renal pelvic cancer and bladder cancer) were examined.
Colony formation in soft agar dish were observed in 29 of 40 (72.5%) tumors of renal cell cancer patients and in 9 of 12 (75%) tumors of urothelial cancer patients. Plating efficiencies of them were 0.02 to 0.5% and 0.02 to 0.2%, respectively.
In vitro sensitivity to a few anti-cancer drugs was observed in only a few cases with renal cell cancer.
Whereas sensitivity was obtained in more than half urothelial cancer patients to several anti-cancer drugs, i. e., vinblastine, cis-platinum, adriamycin and aclacinomycin. These results seem to be consistent with the clinical situation of chemotherapy for these two urogenital malignancies.

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The clinical result was studied in 33 living and 27 cadaveric renal transplantations performed at our department during the period from November, 1979 to May, 1984.
In living transplantation, the one year survival rates of the patients and the grafts were 89.7% and 79.9%, respectively. The one year graft survival rate of early 9 cases (LD 1-9) receiving steroides and azathioprine as the immunosuppressants was 55.6%. On the other hand, it has improved to 95.2% in the recent cases (LD 10-33) after the immunosuppressive method was switched to the main combination of preoperative lymphapheresis, steroids and mizoribine (Bredinin).
In 27 cadaveric transplantations, of which 13 were performed with kidneys imported from the United States (U. S. kidneys) and 14 with domestic kidneys obtained from Shizuoka-ken (domestic kidneys), the one year survival rates of the patients and the grafts were 72.0% and 53.7%, respectively. When the graft survivals of the U. S. and domestic kidneys were compared, that of the domestic kidneys showed a better result -75.0% in contrast to 39.8% of the U. S. kidneys. From these results, public recognization of the necessity of harvesting domestic kidneys should be urged throughout Japan.
Serious complications, mainly interstitial pneumonia, were mostly observed during the ATN period after cadaveric transplantation.
Obtaining kidneys immediately after the death and finding out the proper immunosuppressive method during the ATN period might be stressed to avoid fatal complications.

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Our aim was to optimize the conditions of an exchange assay, based on the recently reported for rat and human prostate and to measure androgen receptor (AR) in the cytoplasm and nucleus of cells from those tissues.
The major technical problems in the detection of AR had been the paucity of AR in prostate tissue and its lability even at low temperatures as well as the development of a molybdate buffer that suppressed proteolytic enzyme activity and was beneficial on stabilizing AR and on yielding the enhancement of the number of binding sites. An additional, rather practical problem was obtaining sufficient tissue for biochemical assay. Single saturating dose method provided useful and reliable information on needle biopsy specimen for the microassay of AR. Use of hydroxylapatite was also efficient, especially if the cytosolic protein content was lower than 1mg/ml.
Measurement of nuclear AR was more instructive than simple concentration of receptor in the cytosol, because most of the AR found in human prostate would be concentrated in the nuclear compartment.
Optimization of an exchange assay for the measurement of specific binding appears to be the most promising approaches to date for the response to endocrine manipulation.

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In nephrotomy, important points are how simply and quickly it is performed and how accurately hemostasis can be achieved. One layer interrupted parenchymal sutute (one layer suture method) proposed by Taguchi is one of the methods which satisfy above requirements for nephrotomy and has been proven to be practical for nephrolithotomy with renal bisection. The present study is designed to investigate the postoperative degeneration of renal tissue and the process of wound healing after one layer suture method.
Aninals used were 24 mongrel dogs. Bilateral kidneys were incised through dorsal approach. The right kidney was bisected on Brödel line and sutured with modified vertical mattress suture. Then, the other kidney was sequentially bisected in a similar way and sutured by one layer suture method. In both methods, hemostasis was achieved by pressure on the cut surface caused by swelling of renal tissue after declampling of the renal pedicle without ligation of bleeding points. Clamping time was adjusted equally for each kidney. The animals were grouped by the time before sacrifying after the operation as follows; 6 dogs in group A were sacrificed within 5 days, 6 dogs in group B after 1 to 2 weeks, 5 dogs in group C after 1 to 3 months and 5 dogs in group D after 6 to 12 months. Two dogs were excluded from the experimental groups because of postoperative death.
Renal clamping time averaged 11′50″, raging from 5′30″ to 23′30″. Hemostasis was achieved in all animals by one layer suture method. Whereas with mattress suture it was insufficient in 4 animals, 2 of which were died postoperatively. Postoperative gross hematuria averaged for 2.6 days and no recurrence occurred. The renal volume decreased from 0 to 8.5% after the one layer suture metod, while from 6.6 to 18.9% after mattress suture. Histologically, wedge shaped infarction extending from the corticomedullay portion to the renal surface was formed around the incised plane in various degrees, which appeared less extensive in the left kidney after the one layer suture method than the other side. The ratios of postoperative parenchymal degeneration to incisional length calculated using microcomputer instruments averaged 3.2±0.3 (M±S. E. M.) in one layer suture method and 4.4±0.3 (M±S. E. M.) in mattress suture method (p<0.01). Collagen fiber was formed at the incised plane within a week. This healing process showed no remarkable differences between the two methods. Unabsorbed catgut was found in the parenchyma or on the pelvic mucosa of some kidneys even 6 to 12 months after the operation.
The present results demonstrate that the one layer suture method causes less postoperative degeneration of renal tissue with accurate hemostasis than the modified vertical mattress suture, indicating that damage of renal tissue after nephrotomy depends on the method of suture.

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Bacterial culture was performed on 45 patients of urinary tract infection with neurogenic bladder to investigate causative organisms, infective rate, bladder function, and urological management. Majority of the subjects were under urological management for more than 3 months. As the causative diseases of neurogenic bladder, 17 cases of brain bladder, 20 cases of spinal cord bladder, and 8 cases of peripheral neuropathic bladder were included. Urine specimen was obtained as scrupulously as possible in a sterile manner by the use of the Nélaton catheter. Cultures of roganisums were made aerobically and anaerobically on all the cases. Urodynamic studies performed were cystometry, urethral pressure profilometry, and sphincter electromyography to determine the types of neurogenic bladder.
The rate of positivity in urinary bacterial culture under our urological management was 24 cases out of 45 (53%), in which polymicrobial infection was observed in 12 cases (27%). The cystometric patterns were classified into 5 patterns, and in relation to infection, cases of flaccid bladder that had the largest amount of residual urine compared to any other patterns showed the highest infective rate of 61%. However, of 3 other bladder types, uninhibited bladder, spastic bladder, and normal type, all of which showed similar residual urine of 60-74ml, the normal type had a significantry low infective rate. As a result of isolation, 108 strains were detected in a total of 92 urinary microbial cultures. Among the aerobic organisms detected, Gram-positive Streptococcus faecalis was the largest in number, 34 strains (31.4%), followed by Gram-negative Proteus group in 15 strains (13.9%) and Escherichia coli in 13 strains (12.0%). Only 6 strains (5.0%) of anaerobic organisms were detected. From the results of the study in the present series, of the causative organisms, the Gram-positive Streptococcus faecalis became more frequent. Yearly changes in chronic urinary tract infection of neurogenic bladder, transition of bacterial species under urological management, and also problems of anaerobic infection were discussed.

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32 patients with chronic spinal cord injury with vesicoureteral reflux were subjected for the analysis of clinical and urodynamic findings.
These 32 pts were classified into two group with renal atrophy (14 pts) and without renal atrophy (18 pts) in follow up studies.
1) There were no distinguishable clinical findings in the two groups.
2) The grade of vesicoureteral reflux has relevance to renal atrophy.
3) The external urethral sphincter dyssynergia has relevance to the grade of vesicoureteral reflux.
4) Radical transurethral resection of prostate abolished the low grade vesicoureteral reflux and decreased urethral sphincter dyssynergia.

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Thoracic duct drainage (TDD) pretreatment and low dose steroid immunosuppressive treatment was applyed to ten living related kidney transplant patients (low dose group). TDD was maintained for five weeks following kidney transplantation. Total number of removed lymphocytes through TDD, ranged from 56×10⁹ to 190×10⁹, with the mean±SD, of 129±34×10⁹. Posttransplant immunosuppressive treatment was consisted of prednisolone and azathioprine. A three-day burst of prednisolone was begun at a dose of 5mg/kg/day from-1 posttransplant day and then the dose was abruptly reduced to 30mg/day, the initial maintenance dose on 2 posttransplant day.
All ten patients are alive and have a functioning graft 12 to 26 months after transplantation. Their recent serum creatinine level ranged from 0.8mg/dl to 4.7mg/dl with the mean±SD of 1.8±1.2mg/dl. The recent dosage of prednisolone ranged from 10mg/day to 15mg/day. None of the ten patients had severe infectious diseases or diabetes except a patient with diabetes mellitus originally.
Evaluating the beneficial effect of low dose steroid treatment in living related kidney transplant patients receiving TDD pretreatment, we compared the result in low dose group with that in high dose group. Other ten patients (high dose group) received TDD pretreatment and high dose steroid treatment (A 3-day burst of prednisolone was begun at the dose of 5mg/day from-1 post-transplant day and then the dose was gradually reduced from 2mg/kg/day to 40mg/day on 30 day and to 30mg/day on 60 day). The patient survival was 100% vs. 100% at 1 and 2 years in high dose group and low dose group. The graft survival was also 100% vs. 100% at 1 and 2 years.
These results indicate that low dose steroid treatment might not deteriorate the graft survival in living related kidney transplant patient receiving TDD pretreatment.

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Transabdominal ultrasonography of the prostate was done by means of the electronic sector scanner. Transverse and longitudinal sections of the prostate were obtained easily without interference of the pubic bone, so that we could estimate the size and the shape of the prostate and display the internal structure within the prostate. In addition, this method is atraumatic and requires no special apparatus. Transabdominal electronic sector scanning is useful for the screening examination of prostatic diseases.

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The pacemaker activity of the major calyx and the sphincter action of calyceal-pelvic junction (CPJ) were simultaneously examined in five human kidneys by measurement of the pressure fluctuations of the upper major calyx and renal pelvis with elevation of the renal pelvic pressure. Renal pelvic fluctuation could appear in the upper calyceal pressure recording first when the renal pelvic pressure exceeded 25cmH₂O. This finding shows that CPJ has a sphincter action which can stand against the pelvic pressure of about 25cmH₂O. The upper calyx, pacemaker, contracted rhythmically at a rate of 10 times per minute when the pelvic pressure remained low, but came to contract more slowly although regularly when the pelvic pressure became high enough to interfere with the calyceal pressure. The frequency of renal pelvic contraction increased with pelvic pressure elevation, in a 1:1 correspondence with the pacemaker contraction of the upper calyx. These findings suggest that the operation of calycovesicostomy should be applied more cautiously, because the strong back pressure from the bladder contraction during voiding may affect the pacemaker activity of the renal calyx.

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The beneficial effect of TDD pretreatment on graft survival has been reported in cadaveric kidney transplantation. Since July 1980, we have employed TDD pretreatment in our living related kidney transplant program. TDD was maintained for 4 to 6 weeks prior to kidney transplantation. Post-transplant immunosuppressive treatment consisted of azathioprine and steroid. In this presentation, we compared the graft survival and the graft function between TDD pretreatment and non TDD pretreatment patients to comfirm the beneficial effect of TDD pretreatment in one haploidentical living related kidney transplantation.
From February 1979 to February 1982, twenty-four patients received kidneys from one haploidentical living related donor. Nine patients had TDD pretreatment (TDD pretreatment group) and 15 did not have TDD pretreatment (non TDD pretreatment group). These 24 patients were treated with the same steroid and azathioprine regimen postoperatively. Non TDD pretreatment patients received a short course of ALG treatment.
The graft survival was 100% vs. 66% at 6 months, 100% vs. 60% at 1 year, 100% vs. 60% at 2 years and 72% vs. 60% at 3 years in TDD pretreatment group and non TDD pretreatment group. In TDD pretreatment patients, the levels of serum creatinine were<2mg/dl during the first 18 months after transplantation. Thereafter, the levels gradually raised in 3 patients and 2 of these 3 patients lost their graft in 29 and 31 months. However, in non TDD pretreatment patients, the levels of serum creatinine fluctuated and 5 of 15 patients lost their grafts during the first 9 months. Thereafter, the levels were<2mg/dl.
These results indicate that the beneficial effect of TDD pretreatment in one haploidentical living related transplant patients was a 40% improvement of graft survial during the first 2 years.

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From 1978 to 1982, we had 61 cases of hypospadias. We analysed clinical features and also did endocrinological study on these patients. The mean age of these patients was 4.4 years old. The type and incidence of hypospadias were glandular 22 (36.1%), penile 18 (29.5%), penoscrotal 10 (16.4%), perineal 3 (4.9%) and chordee without hypospadias 8 (13.1%).
16 of 59 boys with hypospadias (28.1%) were born prematurely or small for date. 36 of 61 boys with hypospadias (59%) had associated anomalies.
18 of 59 boys with hypospadias (30.5%) had a history of maternal progestin ingestion. LH-RH and hCG tests were performed to examine the pituitary gonadal axis in 31 prepubertal boys with hypospadias.
Gonadotropins responses to LH-RH in these boys with hypospadias were significantly higher than those in prepubertal control subject. Prepubertal boys with hypospadias had remarkably reduced testosterone responses to hCG stimulation compared to these in controls.
In boys with hypospadias who had a history of maternal progestin ingestion, gonadotropin to LH-RH was also significantly higher in these subjects than in controls, but the basal level and responses of testosterone to hCG were not different from these of controls.
Tests conducted to determine LH, FSH and testosterone levels using LH-RH and hCG stimulation revealed no statistical differences between the boys with hypospadias who had a history of maternal progestin ingestion and those without such a history.
The majority of prepubertal boys with hypospadias has varying degrees of deficient testicular activity.

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Determination of factors influencing the prognosis is important in the management of patients with urinary bladder carcinoma. A clinico-histopathological study was undertaken in 106 patients with infiltrating carcinoma in accordance with the General Rules for Clinical and Pathological Studies on Bladder Cancer.
The 5-year survival rate was estimated by the Kaplan-Meier method in relation to the clinical and pathological factors. The survival curves were comparatively analyzed by the generalized Wilcoxon test. The factors affecting the survival consisted of cystoscopic growth pattern, size, histological stage (pT), histological grade (G), intramural lymphatic invasion (ly), intramural venous invasion (v), histological growth and spread pattern (INF).
We then attempted to determine the significance of histopathological factors that were considered important, namely, pT, G, ly, v and INF. INF and pT were closely correlated to the survival.
Furthermore, the following formula was obtained for calculating the estimated survival months (M) on the basis of these 5 factors; M=58.1384-6.9006(pT)+9.8769(G)+3.1088(ly)+5.4930(v)-18.6684(INF). (R=0.7652, F=4.8047).

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The aim of this study is to investigate the antiproliferative effect in vitro of various human interferons (IFNs) on tumor cell lines derived from urinary tract tumors. IFNs used in this study were IFN-α, -β and reconbinant IFN-γ, and the properties of IFN-mediated inhibition of cell proliferation was assessed by various experimental methods; anti-proliferative assay where the growth curves of the target cells were obtained following treatment with IFN, anticancer drugs (ADM or BLM) and conbinations of the former two categories, colony formation in soft agar, measurement of ³H-thymidine incorportation and flow-microfluorometric examination.
The above studies demonstrated the followings; (1) the growth inhibitory effect of IFN-α was shown to be time and dose-dependent; (2) Although IFN-α generally exhibited an appreciable antiproliferative effect on all 5 target cells tested, IFN-γ had greater effect in target cells of renal carcinoma origin (KU-2, Caki-1); (3) With combined treatment with IFN-α and IFN-γ or anticancer drugs tested, the antiproliferative effect was more pronounced than that with either treatment alone; (4) In soft agar, small doses of IFN-α (5-50IU) inhibited colony formation of the target cells; (5) In the target cells pretreated with IFN preparations for 48 hours, incorporation of ³H-thymidine was obviously inhibited as compared to the control cells pretreated with culture medium alone. Of those IFNs, more appreciable inhibition was seen in cells pretreated with IFN-γ to others; (6) Following the 48 hours' treatment in high concentration of IFN-α (500IU/ml), accumulation of S-phase cells was seen with relative decrease in cell numbers in G₂ plus M phase.

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A 39-year-old female visited our clinic on August 13, 1983, complaining of asymptomatic microscopic hematuria found by a mass medical examination. On physical examination slight bruit was audible leftside on her back with otherwise normal findings. Her blood pressure was 140/80mmHg with a regular rhythm. With regard to the laboratory data, complete blood count and blood chemistry were within the normal limit. The urinary sediment showed microscopic hematuria (12-13/HPF). On the scout film there was a digital-fingertip-sized calcification near the right renal hilum. Intravenous pyelography demonstrated bilateral notches on the renal pelves (Fig. 1). Computed tomography showed a small mass and calcification at around the right renal hilum (Fig. 2). Aortography was done on a tentative diagnosis of the bilateral renal artery aneurysm and it showed clear bilateral aneurysms, right one measuring 2.2×2.1cm and left one 1.6×1.0cm (Fig. 3A and 3B). Both aneurysms were saccular in type and located at the first bifurcation of the renal artery.
On February 14, 1984, the right renal artery aneurysm was resected and the renal arterial branches were anastomosed side-to-end in situ (Fig. 4A, 4B, 5A and 5B). The left renal artery aneurysm was not operated on and was left to be followed up because the left one was seemed to be less dangerous than the right in view of the size and the configuration. In the near future the left renal artery aneurysm is to be operated on. The resected aneurysm (Fig. 6) was 2.4×2.0×1.7cm and had a small channel, 1.5mm in diameter, to the lumen of the right renal artery. The wall of the aneurysm was 2-3mm thick, yellowish white and elastic hard and had calcification in several places (Fig. 7). The convalescence was uneventful.
In addition, 171 cases of renal artery aneurysm in Japan were briefly reviewed. There were only 14 cases of bilateral renal artery aneurysms in the Japanese literature including this case, 83.3% of which were female.
In conclusion, it should be noted that microscopic hematuria could be a clue to the renal artery aneurysm.

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A 29-year-old man with ulcerative colitis was seen complaining of severe urinary urgency. The urinalysis showed numerous red blood cells, a few leucocyte and no bacteria cultured. He had also suffered from bronchial asthma and nasal allergy. Maximum bladder capacity was about 150ml. Some erosions were found by cystoscopy. The specimen of vesical wall revealed prominent eosinophilic and basophilic infiltrations with moderate edema and fibrosis in the subepithelial connective tissue. By the skin test, rag weed, mite, house dust and candida were positive at immediate reaction. IgE RAST score is Rag weed and House dust (2), Mite (3).
On instilation of rag weed extracts into vesical cavity, urinary urgency, diarrhea, cutaneous exanthema, nausea and general fatigue appeared. After provocation, the histamine level in urine increased to a peak after an hour and urinary red blood cell increased gradually. By instilation of steroid into the bladder, the symptoms were relieved and the bladder capacity increased about 250ml.

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A kindred with many cases of pheochromocytoma and medullary thyroid carcinoma was presented and two additional cases of multiple pheochromocytoma occurred in this family were reported. One of them was a rare case of ACTH producing pheochromocytoma.
The present kindred, which was reported in 1976 for the first time by the authors (Ikegami et al.), has had 3 comfirmed cases of Sipple's syndrome, 5 of pheochromocytoma and 2 of medullary thyroid carcinoma up to date (Fig. 1). Six cases of them were surgically treated by the authors. In addition, there were 11 suspected cases including 5 dead in this family. The present kindred has the largest number of cases among 15 kindreds of familial pheochromocytoma which have been reported in Japan.
Additional cases Case 1:34 year old female with a pulsating headache. Clinical diagnosis was bilateral multiple adrenal pheochromocytoma. After removing the right adrenal gland (600g) and 4 left adrenal tumors (4, 1. 0.5g and fine), the symptoms disappeared. Case 2: 29 year old male with palpitation attack. Plasma ACTH was significantly high and the diagnosis of ACTH producing bilateral multiple adrenal pheochromocytoma was made. The right adrenal gland (142g) and 3 left adrenal tumors (50, 16 and 0.3g) were removed. Plasma ACTH and catecholamines in blood and urine were normalized. ACTH producing pheochromocytoma was very rare and only 6 cases have been reported in Japan up to date.
To know the genetic pattern of inheritance, chromosomes were analyzed by High Resolution G-banding Method, but no abnormalities of chromosomes were detected.

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