An ultrasonic duplex system, a pulsed Doppler flowmeter combined with a real-time B-mode scanner, has been used for the renal transplant blood flow measurement. We report the details of the method to detect transplant vessel echos and to measure these blood flows. Typical Doppler flow patterns from perirenal, renal hilar and intrarenal vessels are showed herein.
Several advantages of the ultrasonic “duplex” system are:
1) We can identify accurately the object from which vessel Doppler signal is issued out. Therefore, we can avoid to mistake the signals of extrarenal vessels for those of intrarenal vessels.
2) Arterial blood flows from the renal hilum, central echo and renal parenchyma can be measured individually. Consequently, intrarenal hemodynamics might be evaluated noninvasively.
3) Doppler signal can be detected far easily by B-mode combined use. Then examination requires neither technical facility and training nor lengthy time.
4) Canine experimental study suggests that parenchymal microcirculation in the renal cortex will be evaluated if the method becomes more sensitive and precise.
5) Renal blood flow volume will be measured quantitatively by this equipment if hilar blood vessel echo can be depicted in B-mode.
In clinical kidney transplantation this apparatus will be useful to investigate the pathophysiological hemodynamics in rejection, post transplant ATN and renal arterial thrombosis.

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The long-term effects of a cholesterol-rich diet (1% cholesterol) on the prostate and prostatic urethra of the mouse were investigated in 5 groups: non-treated, testosterone-treated, diethylstilbestrol-treated, castrated and saponin-treated groups. Cholesterol contents in the prostate were also evaluated.
In the non-treated group, the cholesterol-rich diet caused an increase in the weight and a papillary or cribriform hyperplasia of the acinar secretory cells in the ventral prostate. This hyperplasia was similar to the change of glandular epithelial cells observed in the testosterone-treated mice fed a standard diet. Hyperplasia caused by the cholesterol-rich diet was also found in the testosterone- and diethylstilbestrol-treated groups, but not in the castrated or saponin-treated groups.
As regards to the prostatic urethra, the cholesterol-rich diet caused dilatation of the lumen of the urethra and round dilatation of the duct in the ventral prostate. But, no remarkable change was found in the epithelium of the duct.
In the non-treated group, an increase in the total cholesterol content of the ventral prostate was obtained by the cholesterol-rich diet. However, there was no difference in the cholesterol content per unit tissue weight.

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The influence of renal surgeries on the intratenal arterial system was, studied by resin injection casting in rabbits. Simultaneously biochemical data and histopathological findings were also examined. Consequently we discussed the relative merits of each of these surgical procedures.
Twenty-five male rabbits served as experimental animals. The following surgical procedures were performed. 1. Control (Right nephrectomy) 2. Renal bisection 3. Multiple dissection nephrotomy 4. Partial nephrectomy (Wedge type) 5. Partial nephrectomy (Transverse type) 6. Electrohydraulic lithotripsy. BUN and serum creatinine were measured on pre-operative day, post-operative days for one week and once a week for the following 7 weeks. Resin injection casting and histopathological investigation were also performed.
From biochemical data minimum post-operative renal dysfunction was obtained in the electrohydraulic lithotripsy group. In the partial nephrectomy groups, recovery of renal function was slower than the other groups.
Cast was observed from two points of view: from cortical state and degree of arterial damage. We tried to express obtained results as score of index in each group and it was observed that inflluence on the intrarenal arterial system was minimum in the renal bisection group.
In histopathological study, fibrous belts containing atrophic nephrons were seen in every group. These fibrous belts were wider in area in the partial nephrectomy and electrohydraulic lithotripsy groups than the other groups, and this suggests that local circulatory disorder is more remarkable in these groups.
According to the results of our experiments the revascularization was not seen and we consider, in principle, that the procedures which resect a greater amount of renal parenchyme such as those performed on the partial nephrectomy groups prolong the period of renal dysfunction.
On the other hand, the procedures of the renal bisection and electrohydraulic lithotripsy groups seem to be much safer and it is assumed that electrohydraulic lithotripsy can be performed in the solitary kidney.

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The purpose of this study was to evaluate the MRI in angiomyolipoma. MRI was performed in five cases of angiomyolipoma and compared with X-ray computed tomography. The MRI, Toshiba model MRT 15A with resistive magnet of 0.15 Tesla, was used and images were produced in transvers and coronal directions with different repetition times, delay times and echo times. The characteristic images associated with angiomyolipoma were demonstrated.
Angiomyolipoma is a hamartoma that contains vascular, smooth muscle and mature fatty elements. Generally the attenuation values on X-ray CT scans are low and are one of the most important points for diagnosis of angiomyolipoma. Since the fat cells are normal in appearance and resemble the cells found in the retroperitoneal fat and subcutaneous fat, the NMR signal intensity from angiomyolipoma is very high on MRI using T1-weighted images; such as short SE image or IR image. Four of five cases of angiomyolipoma demonstrated this characteristic and actual T1 values of these cases are rather shorter than the parenchyma of the kidney. One case of angiomyolopoma can be followed by MRI without operation in one year.
Magnetic resonance imaging appears to be an accurate way of detecting, identifying angiomyolipoma.

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Experiments were done to determine if age-related changes occur in responses of rabbit bladder detrusor to prostaglandins E1, E2 and F2α. The contractile response to prostaglandin E1 was greater in isolated detrusor muscles from mature rabbits than in those from premature rabbits. In contrast, the contractile responses to prostaglandin E2 and F2α were greater in muscles from premature rabbits than in those from mature rabbits. These results suggest that prostaglandins E1, E2 and F2α have an important role in the change of bladder contraction with age.

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A questionnaire was circulated in order to investigate the current status of erectile function tests in Japan. A total of 21 institutions replied that they employ an erectile function test.
Fourteen of the institutions reported that they use a method of recording the erotic erection arising from sexual stimulation. These methods employ a variety of stimulation loading techniques and penile change measurement techniques. For the purpose of preparing a uniform set of diagnostic criteria, it is first necessary to standardize the recording methods. At the same time, it is thought necessary to carry out studies on a method by which it is possible to quantitatively determine the degree of stimulation loaded to the test subject.
Nocturnal penile tumescence was being recorded at 16 institutions. For judging the sleep phase, 7 institutions were capable of conducting overnight recording of the sleep state. The other institutions were employing either measurement of the change in the penile circumference using a strain gauge or measurement of the maximum penile circumference using erectiometer. At present, these methods are the most objective test methods available, but there is a concern about the technical difficulty in putting these methods into common use as general laboratory tests.
The stamp technique, a simplified version of the nocturnal penile tumescence measurement methods, is being performed at 9 institutions, and the technique of this method is considered to be established. However, in view of the facts that this test method is carried out by patients himself and that it is unclear at what degree of erection the stamp perforation will tear, this method still has some problems.
In addition, research on the recording of artificial erections has just started. The evaluation of this method as a erectile function test method is still incomplete.
In conclusion, the conducted survey revealed that erectile function test methods are achiving steady acceptance as one kind of general laboratory examination, but still not without some problems.

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The activity of phagocytosis of polymorphonuclear leucocytes (PMN), isolated from the peripheral blood, was investigated under immersion in urine with different osmotic pressure for different durations. The activity of phagocytosis was maintained well, provided that PMN was immersed in urine for 5hrs under an osmotic pressure between 300-500mOsm/kg. However, the activity decreased by one third, when PMN was immersed in urine for 3hrs under an osmotic pressure greater than 550mOsm/kg or less then 200mOsm/kg and disappeared in one hr under an osmotic pressure greater than 800mOsm/kg.
Urinary PMN from patients (24 cases) with acute cystitis were also examined to determine the viability, cell population and activity of phagocytosis of infecting bacteria and yeast. The mean rate of viability was 84per cent. Although neutrophils were recognized in 99per cent of urinary PMN, macrophages were also seen. Although the mean rate of phagocytosis of infecting bacteria was 3.87per cent in original urine, it increased to 24.7per cent in PBS fortified with 10per cent of serum. Disregarding the urinary osmotic pressure, the mean rate of phagocytosis of yeast in PBS fortified with 10per cent of serum was 39per cent. However, it increased to 68per cent when PMN were removed from urine of 280-520mOsm/kg. The mean rate of phagocytosis of yeast in the original urine fortified with 10per cent of serum was 63per cent provided that urinary osmotic pressure was between 300-550mOsm/kg.
It was concluded that urinary PMN sufficently preserved the activity of phagocytosis and engaged in the defense function in the bladder.

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During a 2-year period from April, 1982 to March, 1984, infrared spectroscopic analyses were performed on 625 urinary calculi obtained from Kanazawa University Hospital and its affiliated hospitals. From the viewpoint of chemical composition, the clinical manifestations of urinary calculi were studied. In the calculi mixed with calcium oxalate and calcium phosphate, the percentage of each composition was determined by measuring its absorbance in the spectrum. The results obtained are as follows:
1) The ratio of male to female patients was 2.74 to 1. The ratio of the upper urinary tract calculi to the lower one was 6.8 to 1.
2) Calcium oxalate and uric acid calculi were found more frequently in males than in females (p<0.01). On the other hand, struvite and calcium phosphate calculi were found less frequently in males than in females (p<0.01).
3) The ages of patients with struvite and uric acid calculi were significantly higher than those of patients with calculi of the other compositions.
4) Multiple (and/or recurrent) and passed calculi were counted according to their chemical compositions. The precentage with multiple (and/or recurrent) calculi was significantly lower in pure calcium oxalate calculi than in calcium oxalate mixed calcium phosphate (below 10%), pure calcium phosphate and uric acid calculi (p<0.01). The percentage with passed calculi was significantly higher in calcium oxalate and lower in struvite than in all calculi (p<0.01).

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Surface morphology of myoid cells in mouse and human seminiferous tubules treated with HCl was studied with a scanning electron microscope.
Mouse myoid cells were very thin and had smooth cell surface. They showed a rectangular, pentagonal or hexagonal shape. They arranged like a pavement. As to the size, they were 28.3±4.3μm in length and 20.3±3.2μm in width.
Human myoid cells were also very whin and had smooth surface. They showed a stellate or polygonal shape and arranged like a pavement. They measured 29.1±3.4μm in length and 21.5±3.1μm in width. The size of human myoid cells was similar to that of mouse ones. The arrangement of myoid cells in seminiferous tubules was considered to be suitable to induce local constraction.

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A study was conducted to the carcinostatic agent benzaldehyde derivative (BG) and combination therapy with BG and irradiation used to treat human renal cell carcinoma serially transplanted to nude mice (JRC 11).
Two different doses of BG were examined: 25mg/kg, i. p. and 50mg/kg, i. p. (once a day for 28 days). Two different timings of administration were also examined: early treatment (initial dose given three days after tumor transplantation) and late treatment (inital dose given 31 days after tumor transplantation).
In order to evaluate the effects of the treatment, the relative tumor-growth ratio (T/C-ratio) was determined and histopathological estimates were made. The two-dimensional tumor measurements taken periodically were transformed into estimates of tumor weight using the formula (s²×1/2, s: short legth, 1: long length). Histopathological changes of treatment were estimated by the degree of histological degeneration proposed at National Cancer Research Institute (Shimosato's classification). The histological criteria for the evaluation of treatment were classified from grade I to grade IV; any degeneration more than grade III was considered positive.
Based on T/C-ratio evaluation, significant effects were obtained only in the early treatment groups; no remarkable changes were noted in the late treatment groups. Based on histopathological evaluation, significant effects were noted only in the early treatment groups.
In the groups treated with a combination of BG and irradiation, a single irradiated dose (10Gy) was given 31 days after tumor transplantation; after that, BG was given 25mg/kg, i. p. and 50mg/kg, i. p. once a day for 55 days.
Based on the T/C-ratio evaluation, significant effects were noted in the combination treatment groups, but no remarkable histological degeneration was noted.
The results suggest that there is a correlation between the results noted in the T/C-ratio evaluation and in histological evaluation in the groups receiving early BG treatment. As regards the mature tumors, significant effects on the T/C-ratio and the long-term survival of hosts (nude mice) were also noted in our treatment.

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It has been generally accepted that alpha-adrenergic receptors predominate in the proximal urethra and urinary bladder base. The difficulty on voiding in patients with prostatic hypertrophy and bladder neck sclerosis is caused by not only the mechanical obstruction due to the prostatic adenoma or bladder neck narrowing but also the increased resistance of the urethra induced by the sympathetic nerve. In the first place the author determined the subtype of the alpha adrenergic receptor in the prostatic urethra and urinary bladder base using human specimens obtained from patients with bladder tumor who underwent total cystectomy. alpha adrenergic receptor agonists, noradrenaline and phenylephrine, induced contraction dose-dependently in these tissues. Alpha adrenergic receptor antagonists, prazosin, YM-12617 and yohimbine, competitively antagonized the contraction induced by these agonists in the bladder base as well as the prostatic urethra. The mean pA₂ values for the antagonists in the bladder base and prostatic urethra were as follows: 8.89 and 8.96 for prazosin, 9.95 and 9.94 for YM-12617 and 6.30 and 6.45 for yohimbine, respectively. This experiment indicated that the postsynaptic alpha adrenergic receptor subtype in the human urinary bladder base and prostatic urethra was alpha-1 type not alpha-2 type. Then the effects of roally administered prazosin hydrochloride (2mg) and YM-12617 (0.4mg) on the micturition were investigated in 20 patients with prostatic hypertrophy and 11 patients with bladder neck sclerosis, employing urodynamic studies. There were significant changes in the maximum urethral closure pressure and prostatic urethral pressure (p<0.05). The maximum ruinary flow rates increased significantly (p<0.05). Thus these clinical deta suggested that the selective alpha-1 antagonist was effective on the difficulty of patients with prostatic hypertrophy and bladder neck sclerosis.

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Releations of sex to various clinicopathologic findings of bladder carcinoma in 1120 patients treated at university hospital of Tokyo Medical and Dental University and its related hospitals, were statistically investigated. The overall ratio of male to female was found 3:1; the ratio significantly decreased in patients over 60 years old (p<0.025); and the prognosis or women was significantly poorer than that of men. To explore insight to factors affecting the different prognosis by sex, histologic grade, stage, number and size of the tumors, and treatment modalities were statistically analysed in the present study. Since it has been recognized by statistical analysis of the same patient group in our previous report that patients over the age of 60 years had significantly poorer prognosis than those under 60 years of age, patiants of each sex were divided into two groups by ages over and under 60 years. In the younger group, the difference of the survival rate between male and female was not significant, while in the older group, five years relative survival rate was significantly low in female (56.4%) than male (71.9%) (p<0.05). In patients under 60 years of age, the above factors except for tumor stage revealed no significant difference between male and female; the incidence of invasive tumors (>T2) was significantly higher in female (43%) than male (28%) (p<0.05). In patients older than 60 years, incidences of high grade tumors (grade 3), invasive tumors (>T2) and multiple tumors was found higher in female (42%, 44% and 45%, respectively) than male (35%, 34% and 35%, respectively) (p<0.05). When compared to men, the incidence of the treatment with transurethral resection was low and that of palliative therapy was higher in female patients older than 60 years (p<0.005). Those factors may integrate together and result in poor prognosis of aged women with bladder carcinoma.

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A prostatic detaching blade and a new endoscopic method have been devised for complete removal of benign prostatic hyperplasia as well as open prostatectomy. The Hiraoka's prostatic detaching blade which has the same function as the finger used in open prostatectomy was used, which was inserted into the resectoscope instead of the loop. The continuous irrigation method was useful. Circular incision of the urethral mucosa and periurethral fibromuscular layer was performed deeply to the adenoma at its apex with an electric knife. Circular resection of the central region of the adenoma was done with the loop and hemostasis of the main arteries was made at the bladder neck. The detaching blade was inserted into the urethral mucosal incision line and the apex of the adenoma was detached from the adjacent tissues. The detachment took place from the apex to the bladder neck except at the 6 o'clock region underneath the bladder neck for the prevention of perforation and dropping of a big mass into the bladder. The resection was completed with the loop. 100 cases were operated by this method and all were succeeded in total resection. The operation time was from 20 to 120 minutes with an average of 62 minutes. The weight of resected tissue ranged from 1.5 to 75g. (average: 22.9g). As intra and post operative complications were one case of perforation, two blood transfusion, one transurethral coagulation for hemorrhage on the day of operation and two internal meatal stenosis. Transurethral enucleation of benign prostatic hyperplasia provides complete removal of the adenoma safely and easily. We believe this new method provides a significant advantage over the routine transurethral resection.

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8 cases of severe hypospadias ranging in age from 2 to 6 years, including 2 cases of perineal type, underwent One-stage Urethroplasty with Parameatal Flap (OUPF) IV. The procedure consisted of concurrent chordectomy, extended wing flap urethroplasty (Koyanagi, 1983), and glanulomeatoplasty, all performed in one stage.
In 6 cases, the procedure was successful at the first attempt with excellent functional and cosmetic results. In the remaining 2 cases, further repair was indicated for meatal regression in one, and glans dehiscence in the other.
The success was attributed to viability of parameatal wing flap despite its extensive mobilization and firm subcutaneous closure done in several layers. Some discussion was included in reference to previous works such as those by Russel, Broadbent, DesPrez, and Ehrlich.

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A new simple procedure for the treatment of vesicoureteral reflux (VUR) by cystoscopic injection of blood into the submucosa of the ureteral orifice is reported.
Preoperative cystourethrography exhibited bilateral VUR in one adolescent female dog, but no VUR in 14 adult female dogs. The adolescent dog was operated upon when it grew up and VUR disappeared. Cystourethrography was performed in the supine, and right and left lateral positions, because the frequency of the presence of VUR was different among these three positions. Artificial VUR was produced by opening the bladder, slitting the anterior roof of the mucosal ureter, and suturing the divided mucosal edges. Approximately one month after creation of the artificial reflux, cystourethrography was carried out to confirm the presence of VUR in all 10 dogs. Five dogs died during or immediately after the operation of VUR production.
An endoscopic needle was inserted about 1.2cm below the widely opened ureteral orifice, and heparinized blood was injected until the submucosal swelling was sufficiently large. Then Indigocarmime^® was injected intravenously, which was seen to trickle into the bladder through the ureteral orifice. Before the needle was drawn out, small amounts of Thrombin and Protamine were injected of prevent the leakage of blood. The procedures were performed on only one side, and the other side was followed up as the control.
Four to six weeks after the injection of blood, cystourethrography was done to determine the presence or absence of VUR. If VUR persisted, the above procedure was repeated. Cystourethrography showed the absence of VUR in 3 dogs after the first injection, in 2 dogs after the second injection, and in 2 dogs after the third injection. Three dogs had persistence of VUR after the second injection. These dogs were not given the third injection and were used to study the histopathological appearance of the uretervesical injection in the unsuccessful cases. Postoperative IVP with 76% Urografin^® 1ml/kg body weight showed no evidence of ureteral obstruction. VUR of the control side did not disappear spontaneously. The recurrence of VUR was seen in only one dog 6 months after the second injection. This recurrence was successfully treated after further injection. The dogs were followed up for an average period of 14 months.
Histological examination of the vesicouretural junction showed that there were remarkable submucosal swelling, mild inflammation, and fibrosis of the bladder muscle in the cured cases. The changes were not observed in cases which did not respond to the treatment.
This study shows that it is technically feasible to correct VUR by intravesical injection of blood. The advantage of the method consists in the fact that the injection is easy to repeat without stressing the patients. The reasons of the failure were probably a leakage of blood after withdrawing the needle, or the needle passing the bladder wall, and blood not being correctly located in the submucosal and intramuscular sheath, because, after Thrombin and Protamine were used on the way of the experiment, the results became better.

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Many of the studies on nonspecific granulomatous prostatitis are concerned with its histology and only a few deal with its pathogenesis, in particular its bacteriological cansality. Inspired by the report indicating that, in malacoplakia which develops similar granuloma, E. coli is involved in its pathogenesis, we performed immunohistochemical staining, using anti-E. coli antibodies, in 3 cases.
The immunological staining was carried out by Avitin Biotin Peroxidase Complex method, using anti-E. coli antibodies (5 types from serotypes A to E were used). In all of the 3 cases positive staining was observed only with anti-E. coli antibody of serotype C. The staining was found within parenchyma which formed granuloma and within plasma of histocytes which appeared in glandular cavity.
These results strongly indicate the possibility that E. coli is involved in the pathogenesis of non-specific granulomatous prostatitis.

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To examine the physiological property of detrusor reflex system, a new detrusor function test, —“Isometric test”— was undertaken on 62 cases of neurogenic dysfunction of the bladder which were recognized as detrusor hyperreflexia by cystometrography.
At 80% of maximum bladder capacity, the infusion of pressure medium (saline solution) was stopped, then we compared the pattern of uninhibited contraction of detrusor before and after the stop of infusion. If uninhibited contraction disappeared or was diminished by stopping the infusion, the result was defined as “positive”.
15 cases out of the 62 showed positive findings. In these cases, it seems that detrusor hyperreflxia mainly depends upon the stretch stimulus of detrusor. On the other hand, in the negative cases, the hyperreflexia depends upon another sensory modality, bladder volume itself.
Furthermore the high incidence (84%) of positive isometric test in OPCA cases (oligoponto-cerebellar atrophy) suggested that there were a certain specific mechanism and topography which contributed to the detrusor reflex system.
On these problems, discussion was attempted.

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A new cell line (YCR-1) was established from a renal cell carcinoma of a 62-year-old woman. Primary cells were seeded in soft agar medium. Formed colonies in agar were transferred to liquid culture after 2 weeks and have been maintained for 19 months. They are now over 100 transfer generations. The cells are epithelioid morphology and free of contact inhibition in liquid culture. Their doubling time in culture was 26.5 hours. The chromosome number of the cells were hyperdiploid.
Heterotransplantations of the cells into the back of nude mice produced tumors that were histologically akin to the original tumor. Electron microscopic study revealed abundunt microvilli on their cellular surface and the polarity in the arrangement of cellular organelles.

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We reported five cases of urinary extravasation and discussed the role of diagnosis and treatment.
Three cases of them had unknown causes, two were cured within several days and the other for about two weeks. The rest cases were ureter stone and postoperative ureteral stricture of uterine cancer. The former had persistent slight fever and flank pain, therefore, ureterolithotomy was performed. The latter had paralytic ileus caused by extavasated urine and the operation was performed.
Excluding insufficient cases, we studied 104 cases of urinary extravasation which were reported in Japan from 1968 to 1984 including these cases. It was greatly difficult to perform an accurate diagnosis which was spontaneous rupture of the ureter, that of the renal pelvis or spontaneous peripelvic extravasation. Therefore, on the exprience of our percutaneous renal surgery, we proposed new clinical diagnostic criterias for them and reviewed 104 cases agin and discussed the diagnosis and teatment of theme.

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Transitional cell carcinoma of the urinary bladder that develops in children and the young is very rare. We have recently encountered two cases of transitional cell carcinoma of the urinary bladder which developed in girls aged 17 years. One case was seen at the hospital with macrohematuria as the chief complaint in 1974. Under the diagnosis of urinary bladder carcinoma, partial cystectomy and rt. vesicoureteroneostomy were performed. The histological diagnosis was TCC, PNT, G₂. The other case was seen at the hospital likewise with macrohematuria as the chief complaint in 1984. Under the diagnosis of urinary bladder carcinoma, TUR-Bt was performed.
Histologically, she was diagnosed as TCC, PNT, G₂. At present, no recurrence is observed in both cases. Generally, transitional cell carcinoma of the urinary bladder in the young is said to be characterized by (1) low incidence, (2) good prognosis, (3) low rate of recurrence and (4) low grade. Of 17 cases reported in Japan, 2 had recurrence and metastasis. When cases reported in Japan including our two cases were put together for classification, they were broken down to total cystectomy 1 case (5.2%), partial cystectomy 7 cases (36.8%), TUR-Bt or TUC-Bt 8 cases (42.1%), not operated 1 case (5.2%) and unknown 2 cases (10.5%).

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