Recent advances in ultrasonography have resulted in an increase in the number of reports of intrauterine diagnoses of fetal anatomical malformations. We present 4 cases with urinary tract abnormalities, which were found by the prenatal ultrasonography.
Case 1. A mother with previous history of abnormal pregnancy was examined with ultrasound at 34 weeks. Multiple cysts were found in the abdonimal cavity. After the delivery. by cesarean section, the urological investigations revealed right ectopic ureterocele and severely dilated right ureter. The cele wall was resected transurethrally.
Case 2. A monther was examined at 37 weeks to confirm the stage of gestation. Ultrasound demonstrated bilateral dilatation of the renal pelvis. Urological examinations after a normal delivery showed right megaureter and left mild ureteropelvic obstruction. The uretero-ureteric anastomosis was undertaken on the right ureter.
Case 3. The ultrasound evaluation was done at 35 weeks in a mother with severe toxemia. Dilatation of the left renal pelvis was found.
Case 4. The ultrasonographic examination was done at 39 weeks in a mother with previous history of cesarean sections. Dilatation of the left renal pelvis was demonstrated.
Because dilatation of case 3 and case 4 remains equivocal and the urine is sterile, they are followed up conservatively. Amniotic fluid was normal in each cases.
In patients undergoing fetal ultrasonography, several errors in the diagnosis may occur, including differentiation of intestinal atresia, dilated urinary tracts and multicystic dysplastic kidney. Still more, ultrasonography is highly operator dependent.
In determining the management of the fetus, several factors, such like maturity of the lung, recoverability of the renal function and the volume of amniotic fluid, must be taken into consideration. The fetus with normal amniotic fluid volume will have normal renal function and pulmonary maturation, and can be observed expectantly for full term delivery. The fetus with gradual decrease of amniotic fluid will require in-utero drainage between the dilated urinary tracts and amniotic cavity.
It seems likely that increasing number of urinary tract abnormalities will be diagnosed through prenatal ultrasonography. It is now important to make consensus among the urologists for the management of these “patients”.

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To study the participation of Chlamydia trachomatis, in urogenital infections, antibodies (IgG and IgM) in sera collected from 179 outpatients were quantitated by means of the Microplate Immunofluorescence Antobody Technique (MAF), in which large inclusions of C. trachomatis L2 and C. psittaci Izawa strains were used as antigens. The antibody titers to both antigens in each specimen were determined by the endpoint at which serum dilution gave specific inclusion staining. When the titer (1:8 and more) to C. trachomatis was higher than that to C. psittaci, the serum was scored as containing antibody to C. trachomatis.
The results were as follows:
1) The antibody (IgG) was detected in sera from 101 patients (56.4%). These positive cases consisted of cystitis 85.7% (No. of positive sera/No. of disorders=6/7), urethritis 58.8% (47/80), prostatitis 54.5% (24/44), epididymitis 50% (6/12), cervicitis 100% (1/1) and prostatodynia 48.6% (17/35). Among 80 cases with urethritis, the frequency of gonococcal urethritis (GU), non-gonococcal urethritis (NGU) and undetermined cases were 12/23 (52.2%), 24/47 (57.4%) and 8/10 (80.0%), respectively. Serum from a healthy control was positive in 3.3% of cases (1/30).
2) Out of 96 sera positive for IgG examined, 17 sera (17.7%) possessed IgM antibody ranging from 4 to 16×. The presence of the IgM antibody may have resulted from recent exposure to the pathogen.
3) Paired, acute and convalescent sera were obtained from 18 patients. Of these, one showed a fourfold increase in IgM titer and a twofold increase in IgG titer, simultaneously. In the other 17 cases, no remarkable change in either IgG or IgM antibody titer was detected.
4) When patients with chlamydial urethritis (CU) and gonococcal urethritis (GU) were compared clinically, it was evident that the incubation period was about two weeks in CU and nine days in GU. The onset of urethritis was gradual in CU and rapid in GU, while symptoms were mild in the former and severe in the latter. This observation agrees well with observations reported in other reports.
5) Patients with chlamydial urethritis are generally treated with tetracycline, and our eleven cases were treated with doxycycline (200mg/day) for seven days. The clinical results were excellent in six cases, moderate in four cases and poor in one case.
Because of serological scars, all patients positive in IgG antibody are not necessarily with C. trachomatis infection. To confirm the diagnosis, direct detection of Chlamydial antigen by specific staining or isolation in susceptible cell cultures is requried. Further investigations to assess the diagnostic significance of the high antibody titer of single serum are in progress.

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In surgical management for urinary tracts, a tissue adhesive may be a useful replacement for the convensional suture procedure.
A new tissue adhesive, fibrinogen, thrombin, factor XIII, aprotinin and CaCl₂, in comparison with two layer suture for nephrotomy, was tested in male Beagle dogs weighing 11 to 14kg.
Both the tissue adhesive and the suture method were applied to the left kidney after right nephrectomy. Plasma concentration of urea nitrogen and creatinine and plasma PSP half life were measured before and after the operation. The kidneys were removed 4 weeks after the operation for histological examination.
The results were summarized as follows.
1) The adhesive has a strong ability of adhesion to the kidney tissue.
2) The degree of tissue damage in the adhesive was less than that of the sutured.
3) The reaction of the adhesive as a foreign body was not recognized.
It is suggested that the tissue adhesive is an excellent agent for clinical application.

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In previous studies on microexplosion lithotripsy, the strength of urinary calculi were measured. From the results, calculi could be classified into 2 groups: the high strength calculus group and the low strength calculus group. The pressure necessary to compress the former was about 180kg/cm² and that for the latter was about 65kg/cm².
According to the data, we made 2 kinds of model calculus as follows:
1) The high strength model calculus was made of flyash cement. The mean compressive strength of the model was 202kg/cm².
2) The low strength model calculus was produced as a mixture of plaster and emery powder. The compressive strength was about 65kg/cm² with emery powder more than 25% in weight, which was added to plaster.
In the experimental process of the project of microexplosion lithotripsy, the model calculi have been employed for destruction tests and proved effective for simulation study.

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The authors experienced 175 cases of percutaneous nephrolithotomy during the last 34 months. Complete stone removal was successful in 144 cases (92%). Success rate would have been up to 99%, if we had included cases which had small residual fragments although the greater part of stones was removed.
In 121 cases (69%) any or combination of three methods for stone destruction namely intesive ultrasound, electrohydraulic effect and laser beam were successfully used to disintegrate the stones.
No severe complication was seen in this series. Therefore, the method may supersede the conventional open surgery for the upper urinary tract stones in near future.

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To clarify the determinants of prognostic signinificance in epithelial tumors of the urinary bladder, 228 patients, who were initially treated at Department of Urology, Nagoya University Hospital in the last ten years from 1973 to 1982, were analyzed.
The overall 5-year actuarial and relative survival rates were 63.7% and 73.3%, respectively. For patients treated by TUR, TUC, transvesical resection, partial cystectomy and total cystectomy, the 5-year actuarial survival rates (5Y-ASR) were 84.8%, 100%, 79.0%, 39.2% and 39.4%, correspondingly.
Determinants of favorable survivorship were searched in such clinico-pathological factors as sex, age, symptoms, interval between onset of initial symptoms and hospital visit, and tumor characteristics: location, number, size, macroscopic appearance, histological type, grade, stage and growth pattern. The following major findings emerged from this particular analysis.
1) The relative survival outcome was slightly more unfavorable in females (56.7%) than in males (77.5%), and in those aged over 70 years (63.0%) than in those aged much younger (Age≤49: 77.5%, 50-59: 74.5%, 60-69: 75.7%), but significantly so in those with irritative bladder symptoms (45.9%) than in those without (85.2%).
2) Patients with tumors in the region adjacent to the ureteral orifices demonstrated a more favorable survivorship than those with tumors in the remaining regions (5Y-ASR for the region adjacent to the ureteral orifices: 78.5%, lateral wall: 57.6%, posterior wall: 48.5%, trigone: 58.3%, dome: 64.8%, bladder neck: 54.7%, whole wall: 53.0%).
3) Patients with tumors larger than 3 cm in diameter succumbed much earlier than those with less large tumors (5Y-ASR for≤1cm: 88.3%, 1.1-3cm: 65.8%, 3.1-5cm: 28.8%, >5cm: 32.0%).
4) Patients with papillary-pedunculated tumor experienced the most favorable survival outcome (5Y-ASR: 95.3%), followed by those with papillary-sessile tumor (68.4%) and nonpapillary-sessile tumor (43.7%).
5) The 5-year actuarial survival rates were 84.3%, 71.9%, 50.6%, 29.3%, 26.8% and 7.7% in the patients with histological stage of pTa, pT1, pT2, pT3a, pT3b and pT4, respectively.
6) Among patients with transitional cell carcinoma, the 5-year actuarial survival rate was 94.4% for grade 1, 75.9% for grade 2, and 42.3% for grade 3. In those with non-transitional cell carcinoma the rate was 45.0%.
7) The 5-year actuarial survival rates were 86.5%, 62.0% and 35.0% in papillary non-invasive, papillary invasive and non-papillary invasive type, respectively.
8) Survival outcome was not significantly associated with the number of tumors and the interval between onset of initial symptoms and hospital visit.
In short, the determinants of prognostic significance in epithelial tumors of the urinary bladder were concluded to be sex, age, irritative bladder symptoms and such tumor characteristics as location, size, macroscopic appearance, histological type, grade, stage and growth pattern.

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The present study was performed to examine whether irrigant solution is absorbed to the systemic circulation by percutaneous ultrasonic nephrolithotripsy (PUN) enough to cause any significant changes of serum electrolytes or hematocrit level. Using 2.7% D-sorbitol-0.54% D-mannitol or 3% D-sorbitol solution as irrigant, serum electrolytes, osmolarity and hematocrit were measured before and immediately after PUN in 10 patients with renal stones. The osmolarity gap, which is the difference between the measured osmolarity after PUN and that calculated from the formula {2Na+1/3 BUN+1/18 glucose}, was thought to be a useful indicator to estimate the amount of irrigant fluid absorption. The irrigant bag was placed 100cm above the level of the kidney, while the fluid in the renal pelvis was constantly aspirated by the equipped peristaltic pump. The intrapelvic pressure, thus, was maintained between 40 and 60cmH₂O.
After PUN, there was a slight, insignificant decrease in serum sodium concentration. The hematocrit level, however, decreased significantly (p<0.05) and this decrease correlated well with the amount of irrigant fluid used in PUN. The measured osmolarity gap after PUN averaged 10.4±7.4mOsm/L (mean±S.D.). The amount of irrigant absorption, which was estimated from the osmolarity gap, ranged from 300 to 800ml under the particular irrigation method mentioned above. There was, however, no single patient who complained of any clinical symptoms caused by water intoxication, and the postoperative convalescence was uneventful in all the patients.
From these observations, it is concluded that PUN is a safe procedure and the amount of fluid absorption during this procedure is within acceptable range, if the intrapelvic pressure is kept below 60cmH₂O.

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Distributions of urethral compliance, closure pressure and cross sectional area were measured in 12 male patients with lower urinaly tract dysfunction, including 5 individuals without urological disorder, through a new instrument based on a field gradient principle.
The following results were obtained.
1) Normal male; the urethral compliances were 0.071-0.11cm³/mmHg at the proximal segment higher than the other segment, 0.034-0.056cm³/mmHg at the external sphincteric urethra and 0.028-0.036 at the distal segment.
The urethral closure pressure was 40.4-52.7mmHg at the external sphincteric urethra, which was the highest in the urethra. The maximum urethral cross sectional area was 1.2-1.83cm² at the proximal segment, 1.1-1.6cm² at the external sphincter and 1.1-1.4cm² at the distal segment.
2) In patients with benign prostatic hypertrophy, the urethral compliance was almost the same as in normal men, but the maximum urethral cross sectional area was smaller than that of normal individuals.
3) In patients with prostatic cancer, the urethral compliance was significantly low, the cross sectional area was also small and urethral closure pressure was high.
4) The urethral closure presure was 0-25.6mmHg in patients with incontinence, which was lower than other individuals.

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A study was conducted to evaluate the effects of irradiation against a human renal cell carcinoma serially transplanted to nude mice. (JRC1 and JRC11). Three irradiated doses were given: 10Gy, 20Gy, and 30Gy, delivered from an 8 MeV X-ray linear accelerator.
Histopathological changes of irradiated mice bearing renal cell carcinoma were estimated by the degree of histological degenaration, proposed at National Cancer Research Institute (Shmosato's classification). Histological criteria for evaluation of irradiated effects were classified from grade I to grade IV.
Significant effects were obtained in all irradiated groups except at the dose of 10Gy against JRC1 strains.
On the basis of histopathological evaluation, significant effects (more than grade III degenaration) were obtained only in one strain (at 30Gy against JRC11). The other strains which showed statistically significant effects disclosed hardly anyhistopathological changes.
The results suggest that there is no correlation between the results obtained in statistical evaluation and histopathological evaluation. The strain of JRC11, which showed more malignancy than the strain of JRC1, had a higher radiosensitivity. This difference of radiosensitivity may be due to the difference in histopathological malignancy (a grade of growth fraction) between JRC 1 and JRC 11.
Uncertainty still exists at the present time about the place of irradiation in the clinical treatment of renal cell carcinoma. The aim of this study was to discover direct radiosensitivity of renal cell carcinoma serially transplanted to nude mice. There was some radiosensitivity against the groups of renal cell carcinoma which showed high malignancy histopathologically. These results suggest that we should treat renal cell carcinoma with irradiation as an adjuvant to surgical methods or other chemotherapeutic methods.

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Photographs of the bladder tumor were taken cystoscopically in 81 cases and the relationship between the cystoscopic appearance and the clinicopathological findings of the tumors was studied. All tumors were transitional cell carcinoma but inverted papilloma was not found in our cases. 4 cases were grade 0, 10 were grade 1, 43 were grade 2 and 24 were grade 3.17 cases were stage pTa, 32 were pT1, 11 were pT2, 10 were pT3, 7 were pT4 and 4 were pTX.
These tumors were classified photocystoscopically in to 6 types according to the pattern of growth (i. e. type I: sea anemone-like, type I-II: transitional or intermediate, type II: grapes-like, type II-III: strawberry-like, type III: knoll or smooth surfaced nodular or type X: unclassified). 8 were classified as type I, 5 type I-II, 44 type II, 9 type II-III, 13 type III and 2 type X. Most sea anemone-like type I tumors were less than 1cm in diameter and low graded and all of them were confined to the mucosa or the submucosa. Of grapes-like type II tumors, approximately 70% were grade 2 and about one-half were pedunculated. All pedunculated type II tumors less than 1-3cm in diameter were still confined to the submucosa. But about one-half of sessile type II tumors from 1 to 3cm in diameter were beyond the submucosa and some of them took bad clinical course. Of knoll-like or smooth surfaced nodular type III tumors, 77% were grade 3 and 83% were sessile tumor. Regardless of the size of the tumor, 85% of type III tumors had infiltrated more than half-way through the muscularis and most of them took the worst clinical course.
It was concluded that there were clinicopathological contrasts in relation to the pattern of infiltration and proliferation between type I, type II and type III, especially between type II and type III, that is, type I and type II grew as papillary tumor and infiltrated downward slowly according to tumor growth or recurrence but type III grew origianlly with downward infiltration. Clinically type I-II tumor must be treated as type II tumor but strawberry-like type II-III tumor must be treated as mixed or intermediate tumor of type II and type III. It is likely that the difference in the growth pattern depends upon the difference of histopathological architecture and the pattern of infiltration is also influenced by the histopathological architecture.
Finally, the new clinical cystoscopic classification of transitional cell carcinoma of the bladder was proposed based on those studies.

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A KN-41 cell line established from a human renal cell carcinoma was used for this study. The KN-41 cells cultivated in exponential and plateau phases were studied in terms of DNA histogram and chemosensitivity to 8 anticancer drugs, using static cytofluorometry and a colony formation method, respectively. DNA analysis was also performed in KN-41 cell tumors heterotransplanted in nude mice and in surgical specimens from 18 renal cancer patients. The percentages of cells in G_1/0 fraction and of S fraction in the plateau phase cultures were more similar to those of the cells from the KN-41 cell tumors and surgical specimens than those in the exponential phase cultures. Two hour-exposure time was used for bleomycin (BLM), adriamycin (ADM), carbazilquinone (CQ), mitomycin C (MMC), cis-platinum (CDDP) and ACNU, and 24 hour-exposure time for vinblastin (VBL) and 5-fluorouracil (5-FU). BLM, ADM, CQ, VBL and 5-FU exhibited a lower lethal effect on the plateau phase cells than on the exponential phase cells. MMC, CDDP and ACNU showed almost the same effect on cells in both phases. None of the anticancer drugs exerted a dominant cell killing effect on the plateau phase cells. Chemosensitivity tests using plateau phase cells may be useful for selection of more effective drugs for clinical use.

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The characteristics of spontaneous contractility in isolated rabbit renal pelvis in response to isoproterenol are examined. Isometric studies are done on upper and lower renal pelvic muscle strips dissected radially as well as on whole segment which is dissected longitudinally to include both upper and lower pelvic muscles. Control study without the administration of isoproterenal shows a higher contractile frequency in upper pelvic muscle (8.4±0.9m^-1) than in lower pelvic muscle (2.3±0.4m^-1). Isoproterenol causes a concentration dependent increase in contractile force of upper renal pelvic smooth muscle. Conversely, isoproterenol causes a concentration dependent decrease in contractile force of lower renal pelvic smooth muscle. The contractile force of longitudinal whole muscle strip decreases in response to isoproterenol.
These data show that upper pelvic smooth muslce, which is thought to be a pacemaker region of pelviureteral peristalsis, has a contractile response to isoproterenol similar to that of cardiac musice and that the contractile response of lower pelvic muscle to isoproterenol is similar to that of the ureter and other smooth muscles.

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The effects of transcatheter embolization of the renal artery on the total kidney function were assessed in terms of changes in serum creatinine and blood urea nitrogen in patients with renal carcinoma. The patients were divided into two groups. One was those who received transcatheters renal embolization (Embolization group) and the other was those who underwent nephrectomy only (Non-Embolization group).
White blood cell counts and the blood urea nitrogen, serum creatinine, GOT, GPT, and LDH were increased more in the embolization group than in non-embolization group. The deterioration of renal function assessed by the increases in serum creatinine and blood urea nitrogen seemed due to the nephrotoxic action of contrast medium used during embolization. The increase in white blood cell counts might be the consequence of tissue necrosis. The increase in serum GOT, GPT and LDH might be the result of release of renal enzymes.
The results indicate that reduction of contrast media and adequate hydration are necessary for reserving renal function during renal embolization.

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Fifteen patients were treated by infusion of antitumor agents via the internal iliac artery. Of these patients, twelve patients had advanced bladder cancer and other three cases included the pelvic invasion from a cervical cancer, from a uterine sarcoma and from a rectal cancer.
Drugs of arterial infusion were Mitomycin C, 5-Fluorouracil, Carbazilquinone and Cisdiamminedichloroplatinum.
Six cases in the all were combined arterial embolization for purpose of antitumor and hemostasis. And other combination treatments were done before and after arterial infusion therapy. Those included surgery, radiation, hyperthermia and intravesical instillation with antitumor agents.
As a result, this arterial infusion treatment was suitable, safety and effective method in aim to antitumor and hemostasis for advanced bladder cancer.

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It has been reported that the pacemaker of ureteral peristalsis exists at the pelvicalyceal region in the upper urinary tract. However, the specific character of the pacemaker of ureteral peristalsis remains to be discussed.
For studying the specific character of the pacemaker of ureteral peristalsis with regards to β-receptors, we chose the adenylate cyclase assay. We investigated the influence of β₁- and β₂-adrenoreceptor agonist on the adenylate cyclase activity of the rabbit renal pelvis and ureter.
Dobutamine, β₁-adrenoreceptor agonist, elevated the adenylate cyclase activity of renal pelvis significantly. However, the dobutamine-induced increase in the adenylate cyclase activity of ureter was not significant. On the other hand, terbutaline, β₂-adrenoreceptor agonist, elevated the adenylate cyclase activity of both renal pelvis and ureter.
From these results it is thought that the β-adrenoreceptors exist in both renal pelvis and ureter. Furthermore, it is suggested that the β₁-adrenoreceptors are located at the renal pelvis and β₂-drenoreceptors at both the renal pelvis and ureter. However, it is reported that dobutamine and terbutaline are not pure β₁ and β₂-agonists. Therefore, strictly speaking, identification of β₁ and β₂-adrenoreceptor by these drugs seems to be impossible. Moreover, whether or not the receptor difference between renal pelvis and ureter has any relationship with the pacemaker activity awaits further study.

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α1-microglobulin (α1-MG), a low molecular weight glycoprotein of 33, 000 daltons, was discovered and isolated from human urine by Berggård in 1975. α1-MG is noted as one of the low molecular urine proteins similar to β2-microglobulin (β2-MG) etc.. In this study, we refer to accuracy of measurement of α1-MG (using^® Imzyne α1M) in our laboratory as well as correlation between various α1-MG levels and various renal function tests. In total 36 subjects, without malignant diseases, were studied. They were 8 normal individuals, 5 renal transplantation donors, 10 renal transplantation recipients and 13 more with obstructed urinary diseases.
The following results were obtained: 1) The mean values of coefficient of variation was 7.55% in 5 standard solutions. 2) The mean values of coefficient of variation was was 3.43% in 3 serum samples. 3) The mean values of the recovery of α1-MG was 102.1%. 4) The mean values of coefficient of variation was 8.41% in 3 serum samples for 6 consecutive days. 5) The serum level of α1-MG was 9, 61±4.84mg/l (mean±2SD) in the normal subjects. 6) A good correlation was obtained between serum α1-MG and creatinine (r=0.68, p<0.001). 7) A good correlation was obtained between serum α1-MG and creatinine clearance (r=0.55, p<0.001). 8) A good correlation was obtained between serum α1-MG and β2-MG (r=0.67, p<0.001). 9) A good correlation was obtained between serum creatinine and %TRα1-MG (r=0.64, p<0.001).
Measurement of α1-MG seems to be useful as one of the indices of renal function.

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A case of renal pelvic tumor accompanying double malformations of the urinary tract, primary obstructed megaureter and preureteral vena cava, in a 53-year-old man is reported.
Histologically the tumor was grade 2-3 transitional cell carcinoma, invading the contracted right renal parenchyma to the renal capsule. Though some part of the tumor looked like a renal cell carcinoma, histochemical examination revealed clear cell change of transitional cell carcinoma, that is, the tumor cells were negative on oil red O staining and showed only few PAS-positive granules.
This is the third case of renal pelvic tumor accompanying preureteral vena cava in Japan. No case of primary obstructed megaureter with preureteral vena cava and renl pelvic tumor has been reported.
On the basis of histological examinations, the cause of the primary obstructed megaureter is suggested to be ureteral valve formed at the junction between the right ureter and the bladder.

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A sixteen-year-old boy, whose ureters had been diverted by ureterocutaneostomy 10 years earlier, underwent a urinary undiversion with bilateral end ureteroureterostomy.
A small capacity of 30ml and bilateral reflux in ureteral stumps were the preoperative findings. Cyclic bladder hydrodilation through a suprapubic cystostomy was effective in increasing the bladder capacity gradually and eradicating the bilateral reflux. Micturition was perfect without residue or incontinence. We believe cyclic bladder hydrodilation is useful for accurately observing voiding ability and continence before undiversion and for predicting whether augmentation cystoplasty or ureteral reimplantation are necessary during undiversion.
Because of repeated previous bowel surgeries, bilateral end ureteroureterostomy associated with mobilization and downward displacement of the kidneys was the choice of treatment through retroperitoneal approach. The stenosis, developed at the site of ureteral anastomosis in the right side, necessitated an indwelling of a double-J ureteral stent for 5 months. He is doing well 12 months after undiversion, with stable renal function and good urination. His daily life has been much improved.

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The patient was a 30-year-old man with a painless nodule within the right hemiscrotum. Serum levels of tumor markers (HCG, HCG-β, and AFP) were within normal limit. The patient underwent operation to determine the nature of the nodule. The nodule was located inside the tunica albuginea at lower portion of the right testis and sharply demarcated. After vascular occlusion of the cord, the nodule was excised. The frozen section confirmed an adenomatoid tumor. The vascular occlusion was released, and the wound was closed. The nodule was round in shape, 7mm in diameter, and solid. On cut section, it was uniformly white. Microscopically the nodule was composed of epithelium-like cells and fibrous stroma. Epithelium-like cells formed glandular or tubular structures lined by flattened, cuboidal or columnar cells, some of which contained vacuoles, which were negative for mucin by PAS stain. Adenomatoid tumor in the testis is extremely rare. Careful palpation, examination of tumor markers and ultrasound studies would prevent unnecessary orchiectomy.

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