E. coli (06) endotoxin was inoculated into mouse bladder by transurethral technique. Histological studies were performed in mucin layer in mucosal epithelium of urinary bladder. And combined use of the endotoxin and E. coli in infectious crisis futher accelerated the process of infectious crisis.
The results obtained were as follows:
1 Endotoxin (06) 10μg/ml and 1mg/ml were inoculated into mouse bladder, and mucin layer in the mucosal epithelium and histological findings of urinary bladder were studied 2, 6, 24, and 72 hours after endotoxin inoculation.
(1) Histological findings in urinary bladder after inoculation of endotoxin 10μg/ml (50μl. PBS). Disappearance of mucin layer was not obtained. Submucosal edema of urimary bladder was manifest 2 hours after endotoxin inoculation in 40% cases and in 80% after 6 hours. But its edema was no obtained 24 and 72 hours after inoculation of endotoxin.
(2) Histological findings in urinary bladder after inoculation of endotoxin 1mg/ml (50μl. PBS). Disappearance of mucin layer was not obtained. Submucosal edema of urinary bladder was manifest 2 hours after inoculation of endotoxin in 100% and in 60% after 6 hours, and submucosal bleeding was manifest 2 hours after inoculation of endotoxin in 40% and in 20% after 6 hours. But both submucosal edema and bleeding were not observed 24 and 72 hours after inoculation of endotoxin.
2 Mixture of E. coli (06) 10³ cells/ml and endotoxin (10μg/ml or 1mg/ml) were inoculated into urinary bladder. Inoculation of mixture of E. coli (06) and endotoxin caused more marked disruption of the mucin after 6 and 24 hours after than did the inoculation of E. coli 10³ cells/ml alone. Disappearance of mucin, submucosal edema and bacterial invasion wereobserved more markedly in cases of mixture of endotoxin 1mg/ml than in cases of mixture of endotoxin 10μg/ml.

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Histochemical study was performed to investigate the localization of blood group isoantigens A, B and O(H) in the prostatic tissue including 49 of adenomatous hyperplasia and 17 of adenocarcinoma. For the histochemical approach Avidin-Biotin-Peroxidase Complex (ABC) method was applied because of the superiority to the other methods in terms of high sensitivity, easy procedure and reproducible results.
Isoantigens were found at acinal cells, prostate duct, secretion products in the acini, vessels and red blood cells in the prostatic tissue. Histochemical staining intensity was classified as non-, low and high staining groups according to the staining ratio in one section. When both low and high staining groups were regarded as positive isoantigen, the ratios of adenomatous hyperplasia and adenocarcinoma were 96% and 23%, respectively. However, marked differences of staining intensity were verified even in the adenomatous hyperplasia from case to case. The presence of isoantigens in the prostatic tissue was presumed to be related to the constitution of body fluid secretion. Therefore, salivary secretion of isoantigens was also studied in all patients to investgate the correlation with the tissue isoantigens. Secretory constitution was classified as non-, weak and strong secretory groups. The clear cut relationship was demonstrated between the secretory tendency in the salivary isoantigens and staining intensity in the prostatic tissue. In case of adenocarcinoma, on the other hand, no correlations could be found between salivary secretion and tissue isoantigens, as well as histopathological defferentiation of carcinoma and staining ability.
From the present study, we would like to conclude that the presence of isoantigens of A, B and H in the prostatic tissue depends upon not only malignant transformation but also the individual constitution of body fluid scretion.

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Fractional excretion rate of pelvic urine component in 35 cases of unilaterally hydronephrotic kidney was analysed to assess functional recoverability of obstructed kidney. Compariong these results with renographic findings, pelvic emptying time and the renal concentration of contrast medium were well correlated with low fractional excretion rate of sodium. However, the degree of dilatation of calices was not correlated with the fractional excretion rate of each urinary component.
On nine cases, arteriography was performed preoperatively. The ratio between the diameter of abdominal aorta and renal artery of obstructed kidney were compared with the fractional excretion rate of each urinary component. Higher aorto-renal arterial diameter ratio, more than 20%, were corresponded to lower fractional excretion rate of sodium. less than 3%, in obstructed kidney. Good operative results were obtained in only such cases.
Late operative results were assessed radiologically in 24 cases. Improvement was obtained in cases with lower fractional excretion rate of sodium preoperatively, i. e. less than 3%. Excellent results were oblained only in cases with preoperative fractional sodium excretion rate less than 2% and of the age at operation before 15 years old.
These results indicate that, pelvic urine analysis is useful to assess functional status and recoverability of obstructed kidney. We believe that functional recovery will be expected if fractional sodium excretion rate of hydronephrotic kidney is less than 3%.

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In vitro effect of MPA (medroxy progesterone acetate) on the established cell line from human renal cell carcinoma (NUR) was examined by observing growth curve, incorporation of ³H-thymidine and DNA histogram of tumor cells. As controls, human bladder cancer cell line (NUB), human testicular cancer cell line (NUT), normal human kidney cell (NHK) and BHK cell were examined. The results obtained were as follows.
1) Effect of MPA on growth curve.
The growth of NUR cells was suppressed as compared to control by MPA at concentration of more than 0.1μg/ml, but other cell lines were not suppressed at concentration of less than 1.0μg/ml MPA.
2) Effect of MPA on incorporation of ³H-thymidine.
Significant suppression was observed in NUR as compared to other cell lines. At concentration of 10μg/ml MPA, % inhibition was 52% to NUR, 20% to NUB, 19% to NUT and 6% to NHK.
3) Analysis of DNA histograms of tumor cells.
The G₀₊₁ phase fraction increased and S+G₂M phase fraction decreased in NUR by exposure to MPA for 72hrs. But in other cell lines, there appears to be no significant changes in DNA histograms.

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Oral administration of ethylene glycol (EG) to rats, and resultant renal depositions of microcrystal of calcium oxalate were studied in terms of various urinary metabolites following intakes of dietary levels of calcium and magnesium. We employed an experimental hyperoxaluria protocol involving the administration of 1% EG for initial 3 days and 0.1% EG for the following 2 weeks by drinking water ad libitum. The manner of administration of EG was based on the “trigger theory” by Vermeulen and associates. Renal tubular deposits of calcium oxalate were estimated using a histological grading (Grade 0-Grade 3) and calcium contents of the whole renal tissue.
There were direct correlations between dietary calcium and magnesium and their excretions in urine. The microcrystals of calcium oxalate in renal tubulus were hardly seen in rats of the group receiving low-Ca diet, although they remained hyperoxaluria like the groups of high-Ca middle-Ca diet. With increasing calcium intakes there was a marked increase in the amount of the deposits of calcium oxalate. In addition, there was a significant increase in the calcium contents of renal tissue. When the rats fed middle-Ca diet, the depositions of calcium oxalate were reduced markedly in the group of 0.1% EG maintenance for 2 weeks. It is suggested that resultant microcrystals may disappear or can not develop without a maintenance of severe hyperoxaluria or hypercalciuria.
Apatite crystal was observed only in the group receiving low-Mg diet, and both crystals, calcium oxalate and apatite, were seen in the same group with EG. Although it was showed that magnesium deficiency accelerated renal tubular calcium oxalate deposition in rats on this hyperoxaluric protocol, the protection of calcium oxalate deposition was not achieved with excessive dietary magnesium.
A higher correlation was found to exist between intratubular calcium oxalate depostion and renal calcium content in rats administered EG except the group of magnesium depletion. It is suggested that a determination of renal calcium content in experimental stone study is useful for estimation of the severity of crystal formation or the efficacies of some anticalculous agents.

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Previous study has shown that high-Ca diet develops severe renal tubular calcium oxalate deposition in rats on a hyperoxaluric protocol of ethylene glycol administration. The present study was conducted to investigate the preventive effects of phytin (extracted from rice-bran) and sodium citrate on intratubular calcium oxalate. These objectives were estimated using a histological grading (Grade 0-Grade 3) and calcium contents of whole renal tissue.
When rats fed by high-Ca diet were supplemented with phytin (3g/100g diet), a partial but significant protection aginst calcium oxalate deposition was achieved histologically and biochemistrically. It appeared that the hypocalciuric action of phytin was attributed to the inhibition of crystal formation.
Investigations of the effect of citrate on calcium oxalate crystal in rats were carried out continuous by administration of sodium citrate (0.5%-2.5%), giving drinking water ad libitum. There were significant inhibitions of renal deposition of calcium oxalate by addition of citrate, even at the lowest concentration (0.5%). The effectiveness of the protection of calcium oxalate crystal was ocrrelated directly with the level of citrate concentration.

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Superficial bladder tumors of the stages of T2 or below pT2 were studied in 161 patients admitted and treated in our Department with special reference to the recurrence rate. The recurrence rate was determined by the actuarial method and tested by χ² test.
1. Superficial bladder tumors as a whole tended to show a markedly high recurrence rate in 0.5-1.5 years.
2. When compared between the papillary and non-papillary tumors and between the mono-and multi-tumors, no significant differences were noted in the recurrence rate.
3. When analyzed from the histological stage, pT1 showed a significantly higher recurrence rate in 2-4 years compared to pTis. However, no significant differences were found in other stages.
4. When analyzed from the histological grade, a significantly higher recurrence rate was demonstrated by G3 in 1-1.5 years compared to G0, G1 and G2, and by G2 in 3-4 years compared to G0.
5. When viewed from the opeartive technique, there were no significant differences in the recurrence rate as to the type of surgical techniques. Oral administration of SLA combined with intravesicular instillation of antitumor agents had an effect of prolonging the non-recurrence duration.
6. Early postoperative intravesicular instillation of anti-tumor agents to be continued by long-term intermittent instillation is considered desirable for the control of tumor recurrence.

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The present investigation was undertaken in order to clarify urine transporting ability in the pelviureteral system in the absence of peristalsis.
Twenty-nine preparations of renal pelvis and ureter from 16 dogs were used. When 5-10% formalin solution was infused into the pelviureteral lumen, peristaltic activity ceased for about 5 minutes. Measurements of intrapelvic pressure, ureteral electromyogram and urine volume were made simultaneously before and after formalin infusion and during the period when peristaltic activity was absent. Aperistalsis was defined as the condition in which the peristaltic frequency was less than twice per minutes.
Results:
1) Although formalin solution was infused into the pelvi-ureteral system, in 8 out of the 29 renal pelvis and ureter specimens used, peristaltic activity did not cease.
2) In 21 pelvi-ureteral systems, peristaltic activity ceased within 1 min 27sec after infusion of formalin solution and the aperistaltic condition continued for an average of 5min 6sec.
3) There was no significant difference between the frequency of contraction before infusion of the formalin solution, during the time from the start of infusion to the cessation of peristalsis and after the recommencement of peristalsis.
4) There was no significant difference in intrapelvic pressure among before infusion of formalin solution, during the absence of peristalsis and after the recommencement of peristalsis.
5) Urine volume during the absence of peristalsis was significantly higher than that under other conditions.
Since intrapelvic pressure and urine volume in the absence of ureteral peristalsis showed no significant differences in comparison with those before and after infusion of formalin solution, it is suggested that the aperistaltic ureter is able to transport urine without marked elevation of intrapelvi-ureteral pressure if there are no morphological changes in the pelvi-ureteral system.

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Fifteen patients with severe urinary incontinence, whose vesical function was characterized by uninhibited detrusor contraction and poor compliance, were subjected to nerve blocking procedures.
Cure of incontinence was obtained in 14 while the remaining one was rendered to mild stress incontinence.
Vesical function after the nerve blocks showed the following changes.
a) increase in bladder capacity+200% by subarachnoidal block+127% by caudal block and+91% by bilateral S₃ block,
b) suppression of uninhibited detrusor contractions and
c) increase in bladder compliance.
Although electromyography potential after block became silent in 50% of subarachnoidal block cases, generally it was maintained well above 100μV in the rest and after caudal and S₃ blocks.
Reduction in maximal urethral colsing pressure was also small in the most of the examined. These features seem to speak for good response to nerve blocks seen in these patients.
Indications and side effects of each procedure are discussed. These blocks are recommended as simple, and reliable methods in the management of severe urinary incontinence.

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5, 308 intravenous urographies were studied with reference to the incidence and clinical characteristics of reactions to urographic contrast medium. No clinical response was recorded in 94.7%. Mild reactions were noted in 4.9%, and intermediate reactions in 0.3%. Severe complications occurred in 0.1% and no death was encountered. The clinical characteristics of severe complication were hypotension in 5, and cyanosis in 1. The pretests in these cases gave us no available information to predict the reactions.
Since the pretest have proved to be unreliable in predicting reactions and no medical justification for pretesting exists, we emphasize that pretesting should be abandoned.

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Measurement of the major constituents of urinary calculi in urine is essential in investigating some of the risk factors of urolithiasis and in proposing prophylactic treatment for stone recurrence. Normally, each constituent of urine is measured in 24-hour urine specimens, and the results are sometimes affected by the condition during urine collection, which might result in unreliable data or lead to inaccurate conclusions in considering the cause of urinary calculus disease.
The purpose of this study was to examine the effects of urine pH and temperature during urine collection and to evaluate several methods of urine collection.
Urine Ca, Mg, inorganic phosphorus, uric acid and oxalate levels were determined and the following results were obtained. Measurement of Ca, Mg, and inorganic phosphorus under alkaline conditions may introduce sampling errors. On the other hand, in measurement of uric acid, sampling errors may be introduced under acidic and low temperature conditions. The oxalate level may be affected at pH greater than 5. Precipitation of Ca salts or uric acid may be responsible for these sampling errors.
Although addition of EDTA or citric acid to the urine prevented this precipitation and made it possible to analyze Ca, Mg, P and uric acid simultaneously, it is questionable whether these methods are applicable in clinical use because of other practical problems. It seemed preferable to have different conditions for uric acid from those for Ca, Mg and inorganic phosphorus to obtain reliable results for urinary excretions of these substances.

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During the 14 months from August 1983 to September 1984, nephrotomy was performed using the cavitron ultrasonic surgical aspirator (CUSA) in six cases of renal calculus. These six cases consisfed of two cases of staghorn calculus and four cases of multiple renal calculi. Nephrolithotomy was performed in four cases, both nephrolithotomy and partial nephrectomy in one, and partial nephrectomy in one. The power of CUSA was 30 to 50% (90 to 150 micron) and pressure for aspiration was 180 to 250mmHg. In five out of the six cases, nephrotomy could be performed without clamping the renal vessels. In one case, the renal artery had to be occluded since bleeding was seen on the incised surface. In all of these six cases, postoperative course was uneventful. Gross hematuria disappeared one day after the operation, with no after-bleeding. CUSA aspirated the renal tissue after imploding and fragmenting it. Since elastic blood vessels are conserved without being damaged, they can surely be coagulated electrically or ligated with ease. Fimer blood vessels can be coagulated through heat of friction resulting from shaking. Therefore, this technique assured safe nephrotomy without occluding the renal vessels. We consider that CUSA is useful for nephrotomy such as partial nephrectomy and nephrolithotomy.

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A systemic chemotherapy with cisplatin (DDP) followed by sodium thiosulfate (STS) was deviced. Basically, STS was given repeatedly 6 hours after DDP administration and metoclopramide, methylprodnisolone and pre-hydration were combined. Effects of this regimen (STS-rescue) on DDP-induced toxicities in BALB/c mice were studied.
The maximal tolerable dose of DDP in mice given DDP alone, DDP with physiologic saline and DDP with STS-rescue was 9.0, 10.5 and 16.5mg/kg, respectively. Likewise, LD50 values were calculated as 12.5, 15 and 20.5mg/kg, respectively. Combination of STS-rescue also increased the resistance of mice to DDP-induced nephrotoxicity measured by BUN. It required approximately 6mg/kg more of DDP to increase its BUN level than in control and hydrated mice.
To my knowledge, this is the first report that demonsrates STS administration even 6 hours after DDP administration can reduce the DDP-induced nephrotoxicity and increase the rate of survival after an otherwise lethal dose of DDP. This success seemed to depend both on combination of metoclopramide and repearted administration of isotonic STS solution.

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In a total of 172 cases of renal cell carcinoma that received treatment at the Jikei University Hospital during the 21 years from 1963 to 1983, a review was made for host factors and tumor factors which would affect prognosis. It was found that the factors which were related to prognosis most closely were the histological grade and the stage of tumors, with the latter factor affecting more greatly. Namely, the prognosis was poor irrespective of the stages in cases with a high histological grade, while in cases with a low histological grade the prognosis tended to be influenced by stages. As to the extension of tumors, distant metastases and nodal involvement were related to prognosis most closely. As compared to these factors, venous invasion appeared to be less important. With respect to clinical findings, the prognosis was good in cases showing hematuria only and the survival rate was apparently lower in cases associated with palpable mass, nonurologic symptom and fever. The prognosis was also apparently poor in cases showing accelerated ESR and elevation in α₂-globulin.

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In 1975, we started an original mass screening program for prostatic diseases using transrectal ultrasonotomography as the primary study and ordinary urological examinations with digital examination and/or needle biopsy as the secondary study. The subjects for screening were all over 55 years old. Through model and field experiment carried out to 325 subjects in the first 4 years, the efficiency and reliability of the program were proved.
Based on the data obtained in the experiments, a mobile unit equipped with 2 chair-typed scanners for transcrectal ultrasonotomography was developed in 1980. By this unit, the average time of examination in the primary study was shortened to 3.3 minutes per subject. Thus 150 subjects could be managed a day. The total cost for the primary study was calculated as within 4, 000 yen per subject.
Since 1975, the mass screening in practice has been carried out on 3, 050 subjects whose average age was 64.5. The secondary study was performed on 1, 067 of them and prostatic cancer was detected in 18 (0.6%) including 7 early cases under Stage B. Benign prostatic hypertrophy in Stage I was found in 697 (22.8%) and that in Stage II in 186 (6.1%).
Thus the program was thought to be profitable enough for general use. We expect that it would be considered at national political level.

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