110 patients underwent percutaneous stone extraction at our institution and we removed 99 per cent of renal stones and 77 per cent of ureteral stones.
For fragmentation and removal of large renal stones including staghoru calculi, Mazzariello-Caprini forceps and Kocher's forceps were found to be useful and safe instruments.
Indication and advantages of maneuver with these forceps were discussed.

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For further development of the phytin therapy, bindings of calcium by phytinextracted from ricebran, granules of the phytin drug, sodium phytate and magnesium phytate were investigated in vitro and were compared as to their binding abilities. Ethylenediamine tetraacetate (EDTA) and citric acid were also estimated and compared with those phytins. Futhermore, phytin effect on calcium absorption in the intestine was studied by the method of everted sac of rat ileum.
Calcium binding abilities of four phytins were increased in proportion to their phytin concentrations. Sodium phytate showed a higher ability to bind calcium than other three phytins which had a similar effect.
We also observed that the ability of calcium binding of phytin was far stronger than those of EDTA and citric acid, and that 3mM of calcium was able to bind to 1mM of sodium phytate.
The reduction of intestinal calcium absorption resulted from an addition of phytin, and the inhitition were increased in proportion to the phytin concentration.
These results suggested that rice-bran phytin is a suitable chealting agent which inhibits intestinal calcium absorption, and that phytin therapy is recommendable.

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For the purpose of developing the phytin therapy for idiopathic hypercalciuria with calcium urolithiasis, an amimal study was carried out in male rats. Rats were fed by high-calcium diet (Ca; 1.6g/100g) supplemented with phytin granule (two experimental group; 2.4% and 4.8%) for 6 weeks, and phytin effects or influences for calcium and other some mineral metabolism were evaluated by measuring of several urinary parameters (calcium, magnesium, phosphorus and oxalate), blood biochemistries (calcium, magnesium, phosphorus, iron and zinc) and some mineral contents of kidney, muscle and bone (calcium, magnesium and phosphorus).
The following results were obtained;
1) When rats fed with 4.8% phytin granule diet, their growth rates were significantly affected.
2) Urinary calcium excretion was significantly reduced by administration of phytin in both groups, while, urinary excretion of phosphorus and magnesium were markedly increased. Urinary oxalate showed an indefinite variation.
3) There were no significant differences in the effect for serum calcium, magnesium, phosphorus and iron between groups of phytin treatment and control. Whereas, serum zinc concentration markedly decreased in both groups of administration with phytin.
4) The whole groups of this study had no significant influences on calcium, magnesium and phosphorus contents of kidney, abdominal muscle and bone.

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Investigation was made on 52 patients who underwent radical cystectomy for bladder cancer in order to estimate the significance of histological findings, to predict the probability of pelvic lymph node metastasis and to establish the survival rates. The following results were obtained:
1) Of 52 patients, nine (17%) had positive pelvic lymph node metastasis.
2) As regards the pathological stages, 17 patients with pTis-pT1 tumors had no pelvic lymph node metastasis. Positive lymph node metastasis appeared in 1 of 11 patients with pT2 tumors (9%), in 1 of 7 with pT3a (14%), in 1 of 8 with pT3b (13%) and in 6 of 8 with pT4 (75%). This suggests that the incidence of lymph node metastasis increases when the muscle layer has been invaded and that it further increases dramatically when neighboring organs are involved.
3) Of 46 patients with transitional cell carcinoma, positive lymph node metastasis appeared in 1 of 14 patients with grade 2 tumors (7%) and in 7 of 32 with grade 3 (22%).
4) As to the pattern of growth, patients with non-papillary tumors tended to have a higher incidence of nodal metastasis than those with papillary tumors. As regards mural lymphatic invasion, patients with ly₂ had the highest incidence of lymph node metastasis, followed by those with ly₁ and ly₀. As to the infiltration pattern, patients with INFγ had the highest incidence of nodal metastasis, followed by those with INFβ and INFα. These findings suggest that the growth pattern, infiltration pattern and lymphatic invasion have some correlation to pelvic lymph node metastasis.
5) The degree of peritumoral infiltration of lymphocytes had no apparent correlation to stage, grade, growth pattern, infiltration pattern, mural lymphatic invasion or lymph node metastasis.
6) In patients who had metastasis in just one or two lymph nodes, the hypogastric and/or obturator lymph nodes were most commonly involved. In patients with more than two positive nodes, the common iliac lymph nodes and/or external iliac lymph nodes were also involved. Positive lymph nodes tended to locate ipsilaterally to the primary tumors of the bladder. These findings suggest that lymph node dissection should be meticulously made in the ipsilateral hypogastric and obturator regions.
7) The one, three and five-year survival rates for the 52 patients were 82.1%, 62.0% and 62.0%, respectively.
8) The 3-year survival rates by grade of transitional cell carcinoma were 84.6% for patients with grade 2, and 51.4% for those with grade 3. The 3-year survival rates by histological stages were 100% for pTis-pT1, 64.6% for pT2, 68.6% for pT3a, 23.8% for pT3b and 0% for pT4. The results for pT2 and pT3a suggest that the depth of muscle invasion does not affect the survival rate of patients who undergo radical cystectomy.
9) The 3-year survival rates for patients with and without node metastasis were 22.2% and 69.9%, respectively. A significant difference was found between their survival curves (p<0.01).
10) Pelvic lymph node dissection has two important functions: to improve the chances of completely eradicating the cancer, and to provide accurate information on the extension of the disease in order to determine the most appropriate post-operative adjuvant therapy.

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The localization of glutathione S-transferase (EC 2.5.1.18) (GST) in the human renal tissue was investigated by peroxidase anti-peroxidase (PAP) method using the primary antibody to the human renal GST. Materials for the study were chosen from 6 cases of normal human renal tissue and 28 cases of renal cell carcinoma tissue. Pathology of renal cell carcinoma was classified according to the “General rule for clinical and pathological studies on renal cell carcinoma” (as defined by JUA).
1) In the normal renal tissue, the GST localization was recognized in the cytosol of the proximal convoluted tubules and the pans recta of the proximal tubule, and not recognized in the glomerulus, distal tubules, collecting duct and blood vessels.
2) In the renal cell carcinoma tissue, the GST localization was recognized in the cytosol, and the classification of the enzyme localization was defined as follows; (++) was identified in the all renal cell carcinoma cells (9/28 cases), (+) was localized spotty in it (11/28 cases), (-) was not localized in the specimens (8/28 cases).
3) There was no statistical correlation between nuclear grading and the GST localization.
4) In the sarcomatoid type, the GST localization was not recognized (p<0.05).
5) In the granular cell subtype, 4 cases were (++), 1 case was (+), 1 case was (-), indicating a tendency of GST localization in the majority of granular cell subtype.
These results of GST localization in renal cell tissue appear to be instrumental in histochemical characterization of renal carcinoma as well as in ascribing its origin to proximal renal tubules.

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Interviews, an intelligence test, a personality test and an electroencephalography were given to 13 cases of Klinefelter's syndrome to study the syndrome from a psychoneurological and psychopathological standpoint. All of the above cases are termed “non-institutionalized” as they were not in hospital.
1) A tendency to have a “submissive” or “passive” personality was found to be common in all cases by the interviews, but mental faculties were not found to be lower, and no difficulty in adapting to the society was discerned.
2) The average score on the I. Q. test was 86.5±10.8. The intellectual faculties of seven cases were slightly or moderately retarded. Eight cases showed a discrepancy between verbal I. Q. and performance I. Q., the scores of performance I. Q. being higher. Also in the subtest, subjects had difficulty with “verbal comprehension” (the vocabulary subtest revealed the lowest scores).
3) There was no specific pattern found in common in the personality test, but the cases exhibited certain neurotic symptoms.
4) In the electroencephalography, there were six normal cases, two within normal limits, two borderline cases and three abnormal cases. Flat waves that revealed no waxing and waning were found in 12 cases. Low frequency waves were often mixed even in the three normal cases. Including two borderline and three abnormal cases, eight out of thirteen cases showed a tendency of low frequency waves.
As mentioned above, there was no case that was admitted to be normal after various psychological tests and electroencephalography. Considering the result of subtests altogether, some psychoneurological abnormalities, including intellectual disorder, were certain to be present. An organic brain dysfunction due to the abnormal sex chromosome complements was therefore indicated.

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The response of the in vivo urethra to autonomic agonists administered intraarterially was studied by measurements of motility and pressure changes in female dogs. Phenylephrine developed an increase in urethral pressure with shortening of the transverse axis. Isoproterenol produced a decrease in urethral pressure with elongation of the transverse axis. Both acetylcholine and 1, 1-dimethyl-4-phenylpiperazinium (DMPP) did not produce consistent pattern in the urethral response. It seems that distribution of adrenergic receptors which respond to adrenergic drugs in the in vivo urethral smooth muscle is predominant in the circular layer and the distribution of cholinergic receptors which respond to cholinergic drugs in the in vivo urethral smooth muscle is uniform in both circular and longitudinal layers.

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Urethral action to electrical hypogastric and pelvic nerve stimulations in the proximal urethra of the female dog was examined in control conditions and after administration of five autonomic blocking agents to investigate the effect of autonomic antagonists on the proximal urethra. Autonomic antagonists administered intraarterially and the response of the in vivo urethra was studied by measurements of motility and pressure changes.
In the control condition, hypogastric nerve stimulation produced a monophasic contractile response in the urethra, and pelvic nerve stimulation produced a variable and complicated response in the urethra.
Proximal urethral responses to hypogastric nerve stimulation were blocked by administration of phentolamine and guanethidine, increased by propranolol, and not influenced by hexamethonium and atropine. These responses seem to be mediated through the long postganglionic adrenergic fibers which arise from the inferior mesenteric ganglia.
Proximal urethral responses to pelvic nerve stimulation were blocked by administration of phentolamine, guanethidine, hexamethonium and atropine, and not influenced by propranolol.
The mechanism of the inhibition of the pelvic nerve responses by phentolamine and guanethidine remained unknown. The present study strongly suggests the importance of adrenergic action on the lower urinary tract function.

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Sixty-two patients with the transitional cell carcinoma of the urinary bladder were treated by simple cystectomy without pelvic lymph nodes dissection at the department of Urology, National Cancer Center Hospital, Tokyo from 1962 to December, 1984.
Clinical staging proved accurate in 57 of 62 patients (91.9%) and clinical grading proved accurate in 52 of 62 patients (83.9%).
Two different types of intravesical ectopic reccurrences after bladder-preserving treatment were observed, i. e., rapidly growing, fulminant reccurrence and slowly growing reccurrence. Of 22 patients who had low grade (Grade 1-2) low stage (pTis-pT1) diseases treated by bladder-preserving methods previously, 3 patients (13.6%) developed higher grade (Grade 3) tumors and only one (4.5%) later developed invasive (≥pT2) carcinoma.
The 5-year survival rate according to pathological stage was 100% for 5 patients in pTis, 89.5% for 11 patients in pTa, 80.9% for 26 patients in pT1, 46.3% for 8 patients in pT2 and 0% for 12 patients in pT3 and pT4. There was no significant difference between 5-year survival rate of patients with pTis-pT2 disease who were treated by simple cystectomy without pelvic lymph nodes dissection and that of patients with pTis-pT2 diseases who were treated by radical cystectomy with pelvic lymph nodes dissection, but the 5-year survival rates of patients with pT3 and pT4 disease treated by simple cystectomy was significantly lower than that of patients with pT3 and pT4 diseases treated by radical cystecomy.

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One hundred and thirty-six patients with transitional cell carcinoma of the urinary bladder were treated with radical cystectomy with pelvic lymph nodes dissection at the Department of Urology, National Cancer Center Hospital, Tokyo from 1962 to December, 1984.
Twenty-nine patients had positive nodes (21%): 2 of 43 (4.7%) in the stage of pT1, 3 of 16 (19%) in pT2, 9 of 28 (32%) in pT3 and 15 of 23 (65%) in pT4. None of the 26 patients in pTis and pTa had lymph nodes metastasis. Obturator lymph nodes were most frequently involved (72%) followed by external iliac lymph nodes (52%), hypogastric lymph nodes (48%) and common iliac lymph nodes (38%).
The 5-year survival rate according to pathological stage was 100% for patients in pTis, 72.2% in pTa, 79.6% in pT1, 39.5% in pT2, 35.8% in pT3, 25.9% in pT4. Patients with positive nodes irrespective of their stage had poor prognosis (5-year survival rate: 25.7%).
Among 67 patients with low stage disease (pTis-pT1) having negative lymph nodes, only 4 died of cancer (3 of them died of urethral reccurrence, 1 died of distant metastasis). Eighty-five per cent of 27 patients with invasive disease (pT2-pT4) Who died of cancer was due to distant metastases, indicating urgent necessity to develop effective adjuvant chemotherapy.

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To evaluate tumor markers in renal cell carcinoma, plasma Fibrinogen, ACTH, Renin and Prostaglandins, and serum FSH, LH, Prolactin, Cortisol, PTH and Erythropoietin were measured in 25 renal cell carcinoma patients.
Plasma fibrinogen levels were elevated in 11 of 23 patients (47.8%). The elevation was more frequent (8 of 10 cases) in high stage patients. The elevated plasma fibrinogen levels were normalized after the curable nephrectomy. Plasma fibrinogen levels were significantly correlated with tumor stages.
Plasma prostaglandin F level were elevated in 7 of 16 patients (43.8%). The levels were elevated in 6 of 9 high grade patients (66.7%). Plasma prostaglandin F levels were obviously correlated with tumor grades.
No significant relationship between other parameters and tumor stage or grade were found in this study.

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Recently much attention has been focused on the receptor for 1α, 25-dihydroxyvitamin D₃ [1α, 25(OH)₂D₃], which is an active form of vitamin D₃, in cancer cells and on growth-inhibitory effects by 1α, 25(OH)₂D₃. In the present study, we examined the presence of receptors for 1α, 25(OH)₂D₃ and the sensitivity to 1α, 25(OH)₂D₃ of renal carcinoma cell line KU-2 and its 4 clones as a cumulative study for heterogeneity of human renal cell carcinoma.
Radioreceptor assay and sucrose density gradient analysis showed that all of the clones have 3.2S cytosolic receptor proteins with high affinity (Kd=20-30nM) which was the same as the receptor in normal kidneys. Binding capacity of the receptors in KU-2, N-7, N-8, N-10 and N-13 was 87, 69, 57, 60 and 106fmol/mg protein, respectively. Of these clones, N-13 is thought to be the most differentiated because of its high receptor capacity together with morphological features and poor tumorigenicity. 1α, 25(OH)₂D₃ dose-dependently suppressed proliferation of these clones in a monolayer culture and also suppressed their clonogenicity in a soft agar culture. N-8 was relatively resistant to the inhibitory effect of 1α, 25(OH)₂D₃, although its receptor capacity was similar to that of N-7 or N-10. In other clones, the growth suppression by 1α, 25(OH)₂D₃ was correlated with the amount of receptor binding sites in each clone. These indicate that the effect of 1α, 25(OH)₂D₃ in inhibiting proliferation and clonogenicity are affected by the receptor capacity of the target cells.
Although the clone cells are genetically very closed, the results indicate that KU-2 consists of cells heterogeneous in sensitivity to the bioeffects by 1α, 25(OH)₂D₃ and in amount of 1α, 25(OH)₂D₃ receptors. Also these clones may propose useful informations in analysis of the role of 1α, 25(OH)₂D₃ and its receptor in renal carcinoma cells.

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Thirty cases of human testicular germ cell tumors, including 14 seminomas, one spermatocytic seminoma, 4 embryonal carcinomas and 11 yolk sac tumors, are studied by TEM for the ultrastructural features and histogenesis of each tumor.
The nucleoli of the tumors were generally well developed with dispersed nucleolonema and pars amorpha. The nuclei of seminomatous tumors were round to ovoid in shape with smooth contour, having homogeneously dispersed chromatin, whereas the nuclei of non-seminomatous tumors were polygonal in shape with irregular contour and even segmental in embryonal carcinoma. Two cases of seminomatous tumors seemed to be “anaplastic” from the fine structure of their nuclei.
Basement membrane like material was seen around the tumor cells in half cases of seminomatous tumors and moreover, such structures were prevailing in yolk sac tumors.
Intratubular atypical germ cells were seen light microscopically in 6 cases and three cases were available for ultrastructural examination.
When the fine sturctures of these tumors were compared with those of germ cells, seminomatous tumors had a close resemblance to germ cells in some aspects, but we could hardly find any resemblance between non-seminomatous tumors and germ cells, including human primordial germ cells.
Embryonal carcinomas have been proposed to be the stem cells of non-seminomatous germ cell tumors, but this theory should be reexamined further with the intratubular atypical germ cells.

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The response of rat bladder epithelium to bacterial products such as endotoxin and enzymes was examined by scanning electron microscopy (SEM). Endotoxin concentration was measured in urine from 13 patients with urinary tract infection.
1) Endotoxin concentration in urine was 0.01-1μg/ml in acute cystitis, 0.1-10μg/ml in chronic cystitis and lower than 0.001μg/ml in healthy control.
2) Rat vesical luminal surface was observed by SEM after the inoculation of 0.2-0.3ml of 10⁸/ml E. coli and milipore filtrated culture soup of E. coli which contained 1-5μg/ml of endotoxin and several enzymes. Both inoculations resulted in similar changes of vesical luminal surface, which consisted of swelling of microplicae of superficial cells, swelling and exfoliation of some epithelial cells, appearance of red and white blood cells. These changes increased with time and approximately half of the area of luminal surface was affected at 4 hours after inoculation. Increased bacterial adherence to luminal surface with time paralleled the epithelial alteration. Inoculation of 5μg/ml of endotoxin or 4.4×10⁴/ml E. coli caused only moderate or minimal changes, respectively, after 4 hours.
These observations indicate that some toxins and enzymes contained in culture soup, despite the absence of bacteria, caused alteration of the bladder epithelium, which may trigger attachment of bacteria and subsequent bacterial inflammation.
It is likely that clinically high concentration of some toxins and enzymes in urine may play an important role in the onset of cystitis, in co-operation with a large number of bacteria.

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A new transplantable human testicular cell line (NUT) was established. The original material of NUT was metastatic lymph node, predominantly containing components of embryonal carcinoma. NUT produced the β-HCG, not the native HCG. The chromosomal analysis revealed a hypotriploid with 63 modal number and loss of Y chromosome.

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Mouse monoclonal antibodies (MoAb) were obtained from hybridoma clones prepared by a fusion between mouse myeloma cells and spleen cells of mice immunized with KU1 human bladder cancer cell line (MoAb HBA4, HBE3, HBG9, HBH8), T24 bladder cancer cells (MoAb HBJ8, HBJ9, HBJ67, HBJ71, HBJ104, HBJ112, HBJ127) or 5637 bladder cancer cells (MoAb UB22, UB90, UB114, UL27, UL30, UL96, UR17, UV12, UV55). These MoAb were studied for their reactivity with different paraffin sections of bladder tumor specimens using the immunoperoxidase staining technique. Positive reaction of anti KU1 MoAb to bladder cancer tissues ranged from 36.6% to 48.6% of the total specimens tested. Each antibody of this group had a similar reactive rate. In contrast, positive rates of anti-T24 and anti-5637 MoAb ranged from 0% to 85.7%. Among the MoAb tested HBJ9 from T24 series, UR17 and UY55 from 5637 series showed a high percentege of reaction but low or no reactivity was observed with HBJ67, HBJ127 from T24 series, UB114, UY12 and UL30 from 5637 series. HBE3, HBJ9 and UR17 MoAb were found to stain red blood cells: 2 of 30 specimen responded with HBE3, 2 of 28 specimen with HBJ9 and 4 of 30 specimen with UR17. HBH8 MoAb was reactive with normal epithelium (5 of 8 specimen).
Some of these monoclonal antibodies apparently recognize a tumor-associated antigen possibly specific for epithelial tumors and could be provided as valuable probes for the diagnosis of bladder tumors.

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A case of medullary sponge kidney associated with right renal cell carcinoma is reported. The patient was a 64-year-old man, who was admitted to our hospital on February 3 1983, with the complaint of asymptomatic grosshematuria. He was diagnosed as bilateral medullary sponge kidney on the basis of radiological findings by excretory urography and retrograde pyelography which showed fanlike images and grape-like clusters in 1976. The diagnosis of right renal tumor was established by CT scan and selective renal angiography in 1983. Right radical nephrectomy was done in February 15, 1983. Histological diagnosis was renal cell carcinoma. Japanese cases of medullary sponge kidney were reviewed and complication of medullarv sponge kidney was discussed.

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A case of bilateral lower ureteral obstruction caused by aberrant blood vessels (umbilical ligament) is reported. The patient was 18 months old boy suffering from gross hematuria. Intravenous urogram showed bilateral hydroureteronephrosis and transverse filling defect of the distal ureters above the juxtavesical portion. Cystography and voiding cystography, however, did not show vesicoureteral reflux, and cystoscopy revealed no abnormal findings. Surgical exploration revealed that bilateral lower ureters were obstructed at the juxtavesical portion by bilateral umbilical arteries. Since the left dilated ureter did not decrease in size after division of the aberrant vessel, and did not show urine flow, ureterovesiconeostomy with ureteral tapering was performed. In the right ureter, ureterovesiconeostomy was not performed bacause it kept elasticity and peristalsis after division of the aberrant vessel. The postoperative course was uneventful, and intravenous urogram 3 months postoperatively showed complete improvement of bilateral hydroureteronephrosis.
We reviewed 15 cases (17 ureters) reported in Japanese litarature. The obstruction is found more commonly on the left side. We suppose the etiology of obstruction due to aberrant vessel is essentially an embrvonal anomaly of aberrant vessel, combined with abnormal ascending of the lower ureter

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A mentally retarded 6-year-old boy with scaphoid megalourethra and urethrocutaneous fistula is presented. He was referred to Kochi Municipal Central Hospital when he was 2 months old, because of his large sausage-like phimotic penis and poor stream. Scaphoid megalourethra was discovered during phimotomy, then urethroplasty was immediately accomplished. After 13 days, however, it became clear that urethrocutaneous fistula had occurred.
On admission at the affiliated hospital of our medical school, a large defect of the distal urethra was revealed. His general health was otherwise excellent and he had no other apparent anomalies. A repair of the urethrocutaneous fistula was done.
We have reviewed 35 well-documented cases of megalourethra without hypospadia including the present case. Megalourethra has two clinical varieties, scaphoid and fusiform types. In the scaphoid type the lesion is caused by a defect of the corpus spongiosum only while in the fusiform type the lesion is caused by defects of both erectile tissues, the corpus cavernosum and spongiosum. The scaphoid megalourethra is the most common type. Except for 8 cases (22.8%) out of the 35, megalourethra was associated with various congenital disorders such as renal dysplasia and/or hypoplasia, hydronephrosis, megaloureter, megabladder, prune-belly syndrome, imperforate anus, undescended testes, etc. We discussed the embrvolosrv and the treatment of this disorder.

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