One hundred-two calcium renal stone formes were treated by dietary measures for about 2.5 years. This was carried out after detailed research of individual dietary habits. The main points of our dietary treatment were high fluid intake, correction of unbalanced dietary nutrients, balanced meals throughout the day and prolongation of the time between dinner and sleep.
56 patients were treated by dietary treatment alone and 46 patients by medical and dietary treatment. The mean stone episode rates during treatment were 0.090 and 0.211 stones per year, respectively. The mean stone episode rate of 23 recurrent stone formers was significantly decreased from 0.850 to 0.106 stones per year by dietary treatment alone (p<0.01). The mean stone episode rate of 18 recurrent stone formers treated by medication (thiazide and allopurinol) was also significantly decreased from 1.444 to 0.446 stones per year by adding dietary treatment (p<0.01). From these results, individual dietary guidance is the primary measure for the prophylaxis of renal stone disease even with drug therapy.

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Transurethral removal of the ureter in surgical treatment for the tumors of the renal pelvis has been recently reported from several centers.
We have also employed similar techniques in 7 cases with renal cell carcinoma and 5 cases with tumor of the renal pelvis. Two methods of ours in removing the ureter were the transurethral ureteral pull-through and transurethral ureteral resection. It seems that the former is sufficient in the most of cases and the latter should be done only in cases with difficulties in detouchment of the ureter from the bladder wall. No appreciable clinical side effects such as retroperitoneal urine leak or hemorrhage during and after the operation was seen in all 12 cases. We recommend, therefore, that transurethral removal of the ureter is useful to remember because of its easiness and nonivasiveness.

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Androgen levels in both plasma and total tissue of the prostate have been assesed as a biochemical indicator for androgen dependecy of prostatic cancer (PC). Testosterone (T), 5α-dihydrotestosterone (DHT) and 5α-androstane-3α, 17β diol (A-diol) levels in both plasma and prostatic tissue were determined by radioimmunoassay in 62 patients with PC, 39 with benign prostatic hyperplasia (BPH) and 4 with bladder cancer, who had a normal prostate (NPR) on total cystectomy.
The results were as follows:
1) There were no significant differences in plasma T, DHT and A-diol levels among the three groups.
2) Tissue T levels in untreated patients with PC were significantly higher than those in other patients. However, tissue T levels showed great variations and were relatively lower than plasma levels. On the other hand, tissue DHT levels in patients with BPH were significantly higher than those in other patients, being above 2.0ng/g.t.w. in all of them. In tissue A-diol levels, there were no significant differences among the three groups.
Therefore, the so-called “biochemical differentiated” state was considered to be that the total tissue DHT level of above 2.0ng/g.t.w.
3) Untreated patients with poorly differentiated PC according to Mostofi's classification showed significantly lower tissue DHT levels compared to those with well and moderately well differentiated PC. However, 6 of 14 patients with well differentiated PC also showed low tissue DHT levels. Furthermore, significant relation was noted between tissue DHT levels and initial response to endocrine therapy despite of various histological grades. These results suggest that tissue DHT level is a useful indicator for androgen dependency of PC.
4) On the other hand, tissue DHT levels were below 2.0ng/g.t.w. in all patients with reactivated PC and, therefore, the reactivation of PC seemed to be independent of androgens.

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Eighty-three cases of adult non-seminomatous testicular cancer were treated at the Department of Urology, National Cancer Center Hospital, Tokyo, from 1962 to August, 1984.
The three year survival rate was 100% for Stage I and IIa (8 cases), 0% for Stage IIb (2 cases) and 25.9% for Stage III (13 cases) from 1978 to 1984, whereas it was 49.8% for Stage I (29 cases), 0% for Stage IIa (2 cases), 25% for Stage IIb (8 cases) and 4.8% Stage III (21 cases) before 1978.
Improvement of the survival rates after 1978 are due to the development of accurate staging methods such as tumor marker, CT-scan and ultrasonography and effective chemotherapy.
However, of 13 cases of Stage III from 1978 to 1984, only 1 patient had complete remission by chemotherapy. Therefore, cytoreductive surgery after chemotherapy appears essential for successful management of stage III testicular cancer.

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The bulbocavernosus reflex (BCR) was investigated electrophysiologically in 69 male patients with disorders of voiding and/or sexual ability. Thirty-five patients had no neuropathic lesion, 16 had suprasacral lesions, 10 had sacral and cauda equina lesions, 5 had peripheral neuropathy and 3 had functional impotence. The BCR was absent in 8 patients, of whom 6 were with sacral and cauda equina lesions and 2 without neuropathic lesion. The sensory threshold of the electrostimulation on the penis showed the highest value when the patients had sacral and cauda equina lesions. The longest mean latency value of the BCR was also obtained from patients with sacral and cauda equina lesions (41.0msec), which was significantly different from that in patients without neuropathic lesion (30.5msec). Sixty-eight out of the 69 patients had cystometry. Twenty-five patients revealed normal detrusor function, 23 overactive, 15 underactive, and 5 remained equivocal. The BCR was absent in over one third of patients with underactive detrusor function. The sensory threshold showed the highest value when the patients had underactive detrusor function. The longest mean latency value of the BCR was 34.8msec, which was also obtained in patients with underactive detrusor function. In 13 patients, the latency of the BCR was measured with either concectric needle electrodes or an anal plug. In only two patients, the latency of the BCR measured with an anal pulg was slightly longer than that measured with concentric neddle electrodes. In other 11 patients, they were similar. In conclusion, the BCR evoked by electrosimulation on the penis may be more useful in detecting neurologic lesions, when it is combined with cystometry.

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The renal cell carcinoma is usually not considered to be radiosensitive. But, uncertainty exists at the present time about the place of irradiation in the treatment of renal cell carcinoma. In order to study the sensitivity of renal cell carcinoma to irradiation, the case records were examined of 162 patients who had attended The Jikei University Hospital between January 1957 and December 1980 inclusive. Seventeen case records were rejected because of incomplete or inadequate information. The remaining 145 case records were available for study. Of the 145 nephrected patients, 58 (Group I) were irradiated and 87 (Group II) were not.
The survival rates of these two groups were almost the same. Of these irradiated patients (Group I), 20 were treated by chemotherapy, but there was no difference to the irradiated patients with respect to survival.
With regard to the stage and the grade of the tumor in the irradiated and non irradiated groups, further survival analysis were made. Comparison of these two groups showed no difference as to survival rate in each stage and each grade.
Of the irradiated patients, 18 were treated by pre-operative irradiation, 32 were treated by postoperative irradiation, and 8 were treated by pre-operative plus post-operative irradiation. Comparision of the these groups showed that the post-operative irradiated patients were in lower stages and lower grades and had good prognosis. There was little difference in survival rate between the group of preoperative patients and the group of pre-operative plus post-operative patients.
Comparison of the occurence rate of distant metastasis between the irradiated group and non irradiated group revealed no difference.
The aim of this study was to investigate whether irradiation made any difference in the outlook of this series of patients with renal cell carcinoma. A slightly better survival rate was slown by the postoperative irradiation group. However, no improvement of survival attrivutable to irradiation was observed in any group.

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Growth of VX2 carcinoma transplanted in the rabbit bladder was monitored by measuring nuclear magnetic resonance (NMR) relaxation times in the tumor, non-tumorous tissue of the tumor-bearing animals and serum. Rabbits injected with saline into the bladder wall were used as the control animals. The sampled materials were kept frozen with dry-ice until NMR analysis. Spin-lattice relaxation time (T1) and spin-spin relaxition time (T2) were measured with FT-NMR spectrometer at 2.1tesla and tumor-bearing 27°C within 24 hours after sampling.
T1 values of tumor tissue gradually increased along with tumor growth, being greater than the control values which remained constant. T1 values of the non-tumorous bladder tissue were lower than those of the tumor throughout the middle stage of tumor growth (4 week), and then showed prominent increase at the end stage of tumor growth (5-6 weeks). Advanced tumor growth may have caused water retention in the surrouding non-tumorous tissue.
T2 values of the tumor tissue did not show any characteristic changes as compared with the controls throuhout the progress of the tumor. T2 values of the non-tumorous bladder tissue also presented no peculiar change until the middle stage, but again showed a rapid increase as observed in T1 monitoring, in the end stage.
T1 and T2 values in both the non-tumorous tissue and the control bladder tissue well correlated with the tissue water content throughout the tumor growth, while these on the tumor tissue represented no significant correlation with the water content as a whole. However, the relaxation times in the tumor tissue well correlated with water content in the individual tumor stage, suggesting that relaxation times in tumor is influenced not only by water content but also by water-macromolecular interaction.
T1 and T2 in the serum of both the tumor-bearing and control animals showed no characteristic changes with unstable fluctuation of the values, but these of the tumor-bearing rabbit increased rapidly in the end stage of the tumor. Changes of T1 and T2 well correlated with total serum protein, indicating that prolongation of serum T1 and T2 reflects the nutritional condition.

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From January 1979 to August 1984, 65 patients with all types of hypospadias underwent One-stage Urethroplasty with Parameatal Flap (OUPF). The patients ages ranged from 2 to 33 years with 53 patients (81.5%) being<5 years old. 62 patients were classified as distal type while 3 patients were proximal type.
In 50 cases (77%), the procedure was primarily successful at first attempt while in other 15 cases further repair was indicated for variety of complications. In them ultimate success was obtained in 10 at the 2nd repair, and in only one patient the total repairs numbered 4 before the cure.
OUPF techniques seem to offer exellent functional and cosmetic results with a reasonable rate of complications.

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Renal dysplasia designates abnormal development of the ureteric bud and metanephric blastema. Renal dysplasia is regarded as a group of malformations associated with urinary tract anomalies.
The purpose of this report was to make clinicopathological study of 40 renal dysplasias which were operated on in the past 12 years.
This anomaly was found 3 times more commonly in females than in males. Children under 5-years accouted for 65%. All kidneys were associated with urinary tract anomalies: ureterocele 18, ectopic ureter 15, ureteral atresia 5, VUR 1 and posterior urethral valve 1. The ureteral orifice of the dysplastic kidney was normal in 6, medially ectopic in 32 and laterally ectopic in 2. One kidney revealed some uptake on renal scintigraphy and 4 kidneys opacified on enhanced CT, but the other kidneys appeared to be nonfunctioning. The incidence of the abnormalities of contralateral kidneys or urinary tracts was 43%.
Histological criteria of the dysplastic kidney was based on the persistence of primitive duct, in which the columnar epithelium remains undifferentiated and around which the connective tissue becomes fibromuscular collar. Other dysplastic structures, such like primitive tubule, metaplastic cartilage, cysts of various sizes and abnormal glomeruli, were also observed but not uniform in amount or distribution on each specimen.
In general the conservative plastic surgery of the urinary tracts leaves intractable infection because of the small urine volume excreted by the dysplastic kidneys and abnormal ureteric musculature. Every efforts must be taken to seek out contralateral abnormalities before the surgical removal of the kidney or renal segment.

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Renal dysplasia is defined as arrest of metanephric development, failure of differentiation and persistence of incompletely developed structures. It is ordinarily diagnosed histologically.
The purpose of this report is to classify the renal dysplasia from the histological stand point. Forty kidneys from 40 patients, who were operated on in the past 12 years, were examined under the light microscope.
Histological criteria of the dysplastic kidney was based on the persistence of the primitive duct. Other dysplastic structures, such as primitive tubule, metaplastic cartilage, cysts of various sizes and abnormal glomeruli, were also observed but not uniform in amount or distribution on each specimen. In some kidneys, loose connective tissue was predominant with a few islands of primitive ducts and cortical metanephric structures. In other kidneys, normal nephrons occupied more than 70-80% with a few primitive ducts in the medulla.
According to the quantification of normal metanephric differentiation, renal dysplasia was graded into 4 groups;
Group I: normal cortex and medulla occupied more than half of the cut surface of the kidney
Group II: normal cortex and medulla occupied less than half of the kidney
Group III: dysplastic structures only
Group IV: no differentiation of metanephric blastema
This classification revealed the following features. Among the anomalies of ureteric orifices, the dysplastic grade was higher in ureterocele than ectopic ureter. Multicystic kidney had been considered one of the most severe form of dysplasia, but four fifth of this series showed grade II dysplasia. Moderate-sized kidney and sac-like parenchyma with dilated pelvis appeared low graded dysplasia. There were histological evidences of normal metanephric differentiations in the kidneys which were visualised by renal scintigraphy or enhanced CT. Microscopically, there was some relationship between the dysplastic grade and dysplastic structures, such as primitive tubule or metaplastic cartilage.

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The development and clinical significance of protrusion of hypertrophic prostate into the bladder estimated by transrectal ultrasonotomography were discussed in this paper.
It was proved clearly that the protrusion of hypertrophic prostate did not affect dysuria in benign prostatic hypertrophy (BPH) patients but that the presumed circle area ratio (PCAR) on horizontal section of the prostate did it.
Independent from the weight of hypertrophic prostate, the protrusion of hypertrophic prostate did not appear until PCAR became over 0.75. Cases of BPH with PCAR over 0.75 could be classified into 2 groups according the presence or absence of the protrusion.
It was presumed from these observations that the development of protrusion depended upon the growth rate and elasticity of the surgical capsule of the prostate.

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The presence of Thomsen-Friedenreich (T) antigen has been demonstrated in a variety of cancers, including bladder tumors. However, not many reports are available on this subject. We evaluated serum anti-T antibody titer in bladder tumor patients by enzyme linked immunosorbent assay (ELISA) and the following results were obtained.
1. Bladder tumor patients had depressed levels of anti-T IgM antibody.
2. Levels of anti-T IgG antibody in bladder tumor patients were significantly increased. (p<0.05)
3. No correlation was found between anti-T IgA antibody titers and the presence of bladder tumor.

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Eighty-five cases of germinal testicular tumors were treated at the Department of Urology, Hokkaido University School of Medicine, from 1969 to 1983. Of the 85 patients 23 had pure seminomas without elevated AFP. Of the 23 pure seminomas seven were advanced seminomas (stage IIB and III). Three were stage IIB, three were stage IIIA and one was stage IIIC. The patients with advanced seminoma underwent high inguinal orchiectomy, radiotherapy, chemotherapy as for non-seminoma tumors, and debulking of retroperitoneal lymph nodes as a principle. The follow-up periods were from twelve months to 102 months with an average of 36 months. Evaluation of efficacy of the therapy was performed on six cases. One was not evaluated because the therapy is still in progress. Five of the six patients achieved a complete response, while the remaining one obtained a partial response. Four patients underwent debulking of retroperitoneal lymph nodes. No remnants of tumor cells were seen in the lymph node tissues of these four cases.
It is sure that the first choice of treatment for advanced seminoma is chemotherapy as for nonseminoma tumors. Debulking of remnant of metastatic tumors is certainly needed for the treatment of patients who have obtained no complete response in spite of the chemotherapy. Radiotherapy for advanced seminoma is thought to be a supplemental therapy. Radiotherapy should not interfere the chemotherapy.

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Since our previous investigation clarified that the Taihoku district is the highest in morbidity of bladder tumor among 10 districts in Nagano Prefecture, a further epidemiological study was made on 40 patients with bladder tumor inhabiting in this district. They were first diagnosed during the 10 year's period from 1974 to 1983. The results were as follows:
1) Annual morbidity of bladder tumor in the Taihoku district was 6.0 per 100, 000 inhabitants of both sexes, 8.9 in males and 3.2 in females. Consequently, the male to female ratio was 2.8:1.
2) The age, sex, occupation and favorite dishes were not found to be etiologically significant, and the grade and stage of tumor distributed without special tendency.
3) Among 7 municipalities constituting the Taihoku district, the highest morbidity (14.7), particularly that in female (13.0) was found in A village.
The results indicate the necessity of epidemiologically examining inhabitants of A village.

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Glutathione S-transferase (EC, 2, 5, 1, 18) was purified from human kidney. The purification was a four-step procedure; 105, 000G, 60min centrifugation of the homogenate, ammonium sulfate precipitation, DEAE cellulose, GSH-affinity column. The molecular weight of the subunit was calculated as 19, 000 by the relative mobility. The isoelectric point of the enzyme was 11.1 by the isoelectric focusing.
The human fetal tissue specimens from 5 to 12 weeks were stained by peroxidase antiperoxidase method (PAP) using the primary antibody obtained from an immunized rabbit. The enzyme staining was observed mainly in the liver, kidney and adrenal gland.
1) Diffuse staining of hepatic cells was already noted at 5 weeks, and remained to 12 weeks.
2) Metanephros was not stained before 7 weeks. After 8 weeks, the renal proximal tubles began to be stained.
3) The adrenal gland was stained in the fetal cortex at 5 weeks, and after 7 weeks strong stained nuclei were also observed in fetal cortical cells.
Special discussion was made on the glutathione S-transferase activity in the fetal adrenal cortex by referring to probable feto-specific steroidal metabolism.

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Nephrogenic adenoma is generally presumed to be induced from urothelium by a metaplastic process, although pathogenesis still remains undefined.
Nephrogenic adenoma usually occurs in the lower urinary tract, especially in the urinary bladder. The histological feature of nephrogenic adenoma is characterized by proliferation of glands which resemble the renal tubles. Nephrogenic adenoma is clinically and histologically regarded as a benign lesion, and resection of the tumor is an adequate treatment. However, recurrence has been reported in some cases.
Two cases having nephrogenic adenoma have been reported and 61 cases published in the literature have also been reviewed. In Case 1, the tumor was found at the site of a calculus in the left ureter, and at the sites of a staghorn calculus in the right kidney and a calculus in the right ureter in Case 2. Occurrence of nephrogenic adenoma in the upper urinary tract is very rare.

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A 67-year-old woman was admitted to our hospital because of weight loss. The diagnosis of right renal cell carcinoma was made by extensive roentogenographic studies. She could not be transfused with blood because of non-specific Ig-G antibody and the direct and indirect Coombs' positivity. There was no evidence of hemolytic anemia and metastasis. After plasmapheresis to reduce antibody and right renal artery embolization, transabdominal radical nephrectomy was carried out. Since blood loss was massive, washed RBC were transfused after hydrocortisone intravenous administration. The post operative course was uneventful. Coombs test was negative one and a half year after surgery. Herein we report a case of renal cell carcinoma with non-specific antibody and its successful treatment using plasmapheresis.

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