Methylcobalamin (CH₃-B₁₂) was administered in a dose of 3000μg/day for 3 months to 62 oligozoospermic men with a presumed disturbance in spermatogenesis. Before and after treatment the ejaculate volume, sperum density, total sperm count, sperm motility, total motile sperm count, sperm velocity, bilateral testiculular volume, serum levels of LH, FSH and testosterone and concentrations of Zn, Mg, PAP and vitamin B₁₂ in the seminal fluid were measured. A significant improvement after treatment was revealed in sperm density, total sperm count, sperm motility, total motile sperm count and sperm velocity. Concentration of vitamin B₁₂ in seminal fluid was significantly elevated. Pregnancy occurred in 5 of the 62 partners, 1 of the 5 by AIH.

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The incidence of urinary incontinence was investigated through questionnaires sent to 952 healthy Japanese women aged 18 to 88 years. Thirty-two percent of them wetted the wear involuntarily. The incidence of urinary incontinence in parous women was significantly higher than that in nulliparous women. Parous women over the age of 40 years lost urine more frequently than those aged under 40 Menopause, history of enuresis, previous episodes of urinary tract infection and urinary symptoms were not related to the incidence of urinary incontinence. Most of incontinent women lost urine only with physical strain.

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One hundred and twenty-two consecutive cases with prostate cancer diagnosed at The University of Tokyo between 1973 and 1983 were folowed up. The number of patients increased rapidly in the sixties and reached its highest in the seventies. Almost two thirds of the patients were staged as C and D. Hormone therapy was carried out in 71.3 per cent of patients as an initial treatment.
Provided that deaths of other causes are treated in the same manner as those lost to follow up, the 5-year survival rate of stages A, B, C and D calculated with Kaplan-Meier method were 100%, 64.7%, 54.4% and 31.3%, respectively.
Forty-nine of 87 patients (56.3per cent) treated with hormones relapsed or did not respond at al.
These patients had a poorer prognosis than those who responded well and did not relapse in the subsequent course of the treatment.
This finding suggests that one half of patients with prostate cancer may get little or no benefit from hormone therapy.
In this context, a new diagnostic technique for quantitative prediction of hormone dependency, as well as a new treatment for hormone refractory prostate cancer, is awaited for improving the prognosis of patients with this cancer.

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Invasive bladder cancer has been treated with multidisciplinary treatment including surgery (total or partial cystectomy), chemotherapy, radiation therapy and non-specific immunotherapy since 1977 in our Department. Thus far, 45 patients were treated in this manner. Among them, 26 underwent total cystectomy and 8 partial cystectomy. The rest 11 were in far advanced stage and surgical excision of the tumor was impossible.
1) Patient group (A), who underwent total cystectomy, showed 33% of 3 year relative survival rate and 25% of 5 year relative survival rate. Among them, 15 belonged to negative N and M categories, who showed 50% of 3 year relative survival rate and 39% of 5 year relative survival rate.
Seven patients with negative N and M categories showed tumor down staging and had favourable prognosis (85% of 5 year relative survival rate).
2) Patient group (B), who underwent partial cystectomy also showed good prognosis. Five out of 8 patients belonged to negative N and M categories, all of whom are alive without evidence of tumor (Mean duration; 54 months).
3) Patient group (C), who had disseminated disease did not show significant prolongation of relative survival rates, in spite of chemoimmunotherapy.

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It was attempted to isolate Chlamydia trachomatis from untreated male patients with urethritis.
We used two methods to detect C. trachomatis. One was direct examination of urethral smear using C. trachomatis-specific monoclonal antibodies labeled with a high contrast fluorescein stain, and the other was tissue culture of C. trachomatis. Cycloheximide-treated HeLa cells were used for culture of C. trachomatis. Chlamydial inclusions were detected with May-Grünwald Gimsa stain or fluorescein-labeled monoclonal antibodies (Micro Trak culture confirmation test).
1. In the study of tissue culture, C. trachomatis was isolated from 14 (38.9%) of 36 patients with nongonococcal urethritis (NGU) and from 8 (21.1%) of 38 patients with gonococcal urethritis (GU).
2. In the study of direct examination, C. trachomatis was isolated from 12 (35.3%) of 34 patients with NGU and from 7 (26.8%) of 30 patients with GU.
3. Micro Trak direct specimen test was compared with the tissue culture method. Direct specimen test showed 73.3% sensitivity and 90.9% specificity compared to the tissue culture method.
4. It was suggested that C. trachomatis had a significant etiologic role in male urethritis also in Japan.

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The experimental ascending pyelonephritis was produced in mice by inoculating Escherichia coli in the bladder. The antibody-coated bacteria (ACB) was observed both in the urine and in the infected kidney by staining immunoglobulins with enzyme-labeled antibody. The following results were observed.
1. Since the first day of the infection, the bacteria were histologically detected in the kidneys, particularly forming colonies in the tubular lumina. On the tenth day, however, any bacteria were not seen in the kidneys.
2. The ACB were firstly detected in the urine at the third day of the infection, and those were also seen in the infected kidneys from the fifth day. All mice with the renal ACB presented ACB in the urine. Therefore, when the apparent inflammation existed in the kidney, the urinary ACB could have come from the infected kidney.
3. The ACB detected in the kidneys were localized in the tubular lumina. The immunoglobulins were also stained within the tubular cells, in the tubular lumina and in the interstitial tubular spaces. However, the cells containing immunoglobulins were not detected in the kidney until the seventh day, if the infection occurred. The ACB, which were detected in the kidneys for the first week of the infection, might have been formed by coating the bacteria in the tubular lumina with the specific antibody derived from the blood.
4. Immune-electron microsocpic observations presented the localization of immunoglobulins along the outer membrane of the bacterial cell wall. All of IgG, IgM and IgA were stained in a similar manner. These observation indicated that the antibody coating the bacteria would be directed against the O-antigen of bacteria.

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Clinical studies were performed on childhood urolithiasis treated in our clinic from 1960 to 1984.
The results were as follows:
1) The number of childhood urolithiasis was 41 accounting 1.4% of all urolithiasis during the same period.
2) Male: female ratio was 2:1 and the mean of the age was 10 years.
3) 45% of the cases showed bacteriuria and E. coli was the most common urinary pathogen.
4) The most common symptoms were hematuria and flank pain, like in adult cases.
5) Calculi were located in 9 cases in the renal pelvis, in 16 in the ureter and in 2 at both places. In 12 cases calculi were found in the urinary bladder.
6) Stone analysis showed a predominance of calcium oxalate or magnesium ammonium phosphate containing calculi.
7) The causative factors or cofactors we established were malformation of the urinary tract in 3 cases, urinary tract infection in 4 cases and metabolic disorders in 12 cases.
8) Recurrent lithiasis was seen in only two cases.

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Studied in the present report were relations of patients' age at the first presentation to the survival rate and various clinicopathological findings of 1, 120 patients with primary bladder tumor treated during the 22 years from 1960 to 1982 at the university hospital of Tokyo Medical and Dental University and its affiliated hospitals.
The patients age' averaged 63 years ranging from 18 to 89 and peaked in the seventh docade (32.4%).
Five and ten-year acturial survival rates became worse with age except for those over 80. The 5-year survival rate of patients under the age of 60 years was 73.6% and significantly high when compared with 53.3% of those over 60 (p<0.001). Although survival rates generally decreased with age, the results appeared to be also attributable to the increasing incidence of high grade and high stage cancers in aged patients.
As to initial treatment methods, the incidence of conservative surgery (TUR and partial cystectomy) was almost unchanged at the level of 70% in any age group, total cystectomy was carried out most frequently in the patients in the sixth decade and other treatments such as irradiation, instillation, hyperthermia and hydrostatic pressure increased in patients over 70.
The incidence of senescent patients over 70 years of age increased year by year. The trend was obvious after 1976.
Four hundred and eleven patients died with mortality rate of 36.7%. Death from bladder cancer was most frequent (53%) followed by death from intercurrent diseases (16%). Cancer death was more common in the young than in the aged and death from intercurrent diseases increased with age.

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The action potential of external urethral sphinter muscle was quantitatively analyzed by means of electromyography (EMG) in 13 patients without micturition disturbances, 9 patients with benign prostatic hyperplasia (BPH), 15 male patients with neurogenic bladder, and 6 female patients with micturition disturbances.
To analyse the action potentials of NMU, two methods were employed; they differed from one another mainly in the selection of action potentials to be evaluated. But they showed almost the same results.
The motor unit potentials had the mean amplitude of 470±40μV, duration 6.0±0.2msec, and 3.1±0.1 phases in control group.
There was a statistically significat decrease in duration time in BPH group. However, the decrease was closely related to the age.
Increases in duration time and the number of phase were found in male patients with neurogenic bladder with spinal cord injury at the level of S₂ and peripheral neuropathy. But, no statistical significance was found in patients with central and suprasacral spinal lesion.
It is concluded that the quantitative analyses of the action potential of external urethral sphincter musle by means of EMG is useful for the diagnosis of neurogenic bladder as an objective and quantitative test, and for the determination of the site of injury of the spinal level.

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During the last 5 years noninflatable penile prostheses were inserted in 37 patients with spinal cord injury. An operation was done for securing adequate stability of the penis so as to hold an external urinary device, for easy self-catheterization and for the treatment of erectile impotence. In the 37 patients (10 tetraplegic, 23 paraplegic and 4 walking patients with caudal lesion), 10 with self-catheterization were dry and 27 with trigger voiding required external device for urinary incontinence. A pair of Shirai-type silicone penile prosthesis with soft ends of silicone elastomer which is designed in the shape of a rib to protect the spongiosum penis were inserted into the corpus cavernosum through dorsal skin incision of the penile base. Observation period was from 6 to 46 months, average 19 months. Thirty-two out of the 37 patients had excellent results with complete satisfaction. Unilateral and bilateral extrusion of the prosthesis occured in two cases one month after surgery due to infection and a patient who has had causalgia in the lower extremities insisted that his prostheses should be removed because of irritation. A tetraplegic patient who used to turn on his stomach during clothing showed backward retraction of the prostheses. One patient complained that his prostheses were smaller than expected. Transurethral operations just before and after the surgery made no influences on the prosthesis though the combination of this operation should be avoided. Questionaire survey revealed that 32 (86%) were satisfied and 5 (41%) were unsatisfied with the prosthesis, while in the sexual aspects, 15 (41%) were satisfied, 18 (48%) were unchanged and 4 (11%) were unsatisfied. Penile prosthesis is an effective maneuver for the management of urinary incontinence and sexual disability of patients with spinal cord injury.

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Forty-six male patients with calcium urolithiasis and 55 normal subjects were studied of bone mineral content (BMC) by ¹²⁵I-photon absorptiometry.
These patients were classified in to 15 cases with normocalcicuria (NC), 23 with absorptive hypercalciuria (AH), 5 with renal hypercalciuria (RH) and 3 with primary hyperparathyroidism (PHPT).
The mean value of BMC with NC was higher than the control mean, but the difference was not significant. The mean value with AH was significantly higher than the control mean (p<0.05). The mean value with RH was significantly lower than the control mean (p<0.05). Three male cases with PHPT had the values of BMC within normal range.
After administering thiazide in 3 patients with AH and 5 patients with RH, the tendency to decrease of BMC was observed in the patients with RH.
The measurement of BMC seems to be useful in the differential diagnosis of idiopathic hypercalciuria and the examination of calcium metabolism of calcium urolithiasis.

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Between April 1977 and September 1982, monolayer cultures of 33 human testicular germ cell tumors (16 seminomas and 17 non-seminomatous germ cell tumors) were attempted and three embryonal carcinomas were established as proliferating long-term culture, but long-term culture of seminomas was not successful. These were designated as NEC8, NEC14 and NEC15, respectively.
The characteristics of these three cell lines and a cell line, ITO (embryonal carcinoma) were investigated. Morphologically, they are alike in character. Chromosome studies revealed that these cell lines have numerical and structural change involving chromosome 1. The involvement of chromosome 1 in aberrations may be associated with malignant nature of embryonal carcinomas.

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A new cell line, KO-RCC-1, has been established from a primary renal cell carcinoma of a Japanese woman. The cells have been maintained for 43 months and over 130 in vitro passages. The cells are epithelioid and exhibit multilayering. Electron microscopic study showed large nuclei with prominent nucleolei, abundant glycogen particles and microvilli. The doubling time was approximately 38hr and the cells formed colonies in soft agar with an average plating efficiency of 10.4%. Chromosome number of the cell line was aneuploidy. Inoculation of the cultured cells into nude mice caused tumors at the site of inoculation. Histology of the nude mice tumor resembled the original tumor.

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The immunoperoxidase techniques for prostatic acid phosphatase, prostate specific antigen and gamma-seminoprotein were used to evaluate autopsy materials from 9 patients with multiple prostatic metastases and 52 with primary prostatic carcinoma.
All specimens of primary and metastatic prostatic carcinomas stained positively.
Histochemical observation of prostatic acid phosphatase, prostate specific antigen and gamma-seminoprotein was useful for the detection of the prostatic origin of the metastases.

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Ultrasound-guided renal cyst puncture was performed on fourteen renal cysts in the Department of Urology, Nara Medical University Hospital from September 1982 to December 1983.
Twelve of them were instilled absolute ethanol as a sclerosing agent to prevent recurrence of renal cyst.
Puncture of cysts were performed through the renal parenchyma using 21G venule, 5F pigtail stent catheter was advanced over angiographic guide wire into the cyst with the object of complete aspiration of cyst contents and safety ethanol instillation.
Instilled volume of absolute ethanol was 10-70ml (average 33ml), these were equivalent to 5-41% (average 21%) of aspirated volume. Retention time was 5-15 minutes (average 9 minutes).
All but one were followed by CT scan. Follow up period was 2-16 months (median follow up period 7.6 months). Reduction rate of cyst volume was 82.3-99% (average 94.4%).
On the other hand, relapse of renal cyst were observed within 8 and 14 months in two patients who received cyst puncture without absolute ethanol instillation.
Minor complications such as local pain, low grade fever and palpitation were observed in this series, but no major complications due to puncture and ethanol instillation was occured.
Ultrasound-guided renal cyst puncture is useful procedure not only for the diagnosis of the space occuping lesions of the kidney but also for the treatment by using ethanol.

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We studied early changes in serum creatinine of 134 nephrectomized cases (81 males, 53 females, mean age 52.1 y. o.) in 8 years. Underlying diseases resulting in nephrectomy were renal tumor (45.5%), renal pelvic or ureteral tumor (23.1%), renal dysplasia or hypoplasia (9.0%). There was one case of solitary kidney with renal tumor, which was excluded from this study. Of the other 133 cases, 16 cases (12%) showed increased serum creatinine concentration (Scr) over 2.0mg/dl and 8 cases over 3.0mg/dl after unilateral nephrectomy. Hemodialysis was necessary in 3 cases (2.2%).
In the 16 cases of decreased renal function, 14 cases were male and renal tumor was the most frequent cause of nephrectomy. In considering the risk factors, cases of decreased renal function showed older ages at operation and higher rates of concomitant hypertension, heart disease or diabetics than unchanged cases. The mean Scr before operation was 1.40mg/kg in the impaired group, which was slightly higher than the value in the unchanged group (1.16mg/dl), but not significantly different. At operation, operation time, bleeding and episode of hypotension were higher in the impaired group than in the unchanged group.
In the impaired group, there were 4 patterns of changes in Scr after unilateral nephrectomy. A) Scr rose in straight line immediately after nephrectomy and resulted in hemodialysis in one cases. B) In 6 cases, Scr increased gradually until about 4 days after operation and decreased thereafter. c) in 7 cases, Scr rose only on the next post-operative day and improved soon. D) There was delayed appearance of high Scr after about one week in 2 cases.
Because daily changes of Scr are calculable according to the following formula, Scr=(SynCr-Ccr×Scr)/(B. W.×0.6+Ccr), causes of decreased renal function may be predictable. The increases of Scr in a straight line immediately after unilateral nephrectomy means anephric state, which reflects severe renal functional impairment of the residual kidney. Kidneys with organic changes preoperatively with or without trouble at operation showed gradual increase in Scr for several days and gradual improvement thereafter. On the contrary, healthy residual kidney showed only transient rise of Scr after circulatory disturbance at operation. The increase in Scr after several days of normal values might be related to other causes such as heart failure or drug intoxication.
The result of our study indicates that, damaged kidney may not show compensatory changes or hypertrophy immediately after unilateral nephrectomy, usually observed in healthy residues. Special care must be taken for such cases.

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Pressure-flow studies of radiologically normal human ureters were performed in 10 cases with nephrostomy after percutaneous nephrolithotripsy. Intrapelvic pressures were measured at various flow rate (from 0.5 to 10ml/min) which was adjusted by the infusion rate of saline into a nephrostomy tube.
The transit time required for the pigment to descend from the pelvis into the bladder was measured at an infusion rate of 0.5ml/min.
By infusing contrast medium, the mode of urine transportation of the ureter at various flow rates was also observed radiologically, and assessed together with the results of the pressure flow studies.
The results obtained were as follows:
1) Intrapelvic pressures at spontaneous urine flow (F=0ml/min) ranged from 12 to 22.5cmH₂O (16.2±3.0cmH₂O).
2) Intrapelvic pressures were elevated at low infusion rates (3ml/min or less), but were unchanged or decreased at high flow rates (4ml/min or more).
3) Transit times ranged from 350 to 850sec (610±158sec), suggesting that they might be affected by the grade of hydronephrosis. The mean transit time from 3 cases with normal pelvis was 417sec.
4) Radiologic findings suggested that the ureter might transport urine mainly by peristalsis when the infusion rate was 3ml/min or less, but might function as a tube at rates higher than 4ml/min.
5) The correlations between the resistance and the flow rate were examined. The regression lines of low (3ml/min or less) and high (4ml/min or more) infusion rates were distinctly different.

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A piece of E-PTFE (expanded polytetrafluoroethylene) which has been clinically used as an artifical blood vessel and pericardium is recently investigated for its possibility as a prosthesis for urinary tract replacement.
The possible usability of an E-PTFE piece as an artificial ureter has been investigated. The main purpose of this study is to observe the water-proof ability, the adaptation of E-PTFE to tissue and the regeneration process of urinary tract.
Two kinds of E-PTFE sheet graft, Cardiovascular patch^® (fibril length; 30μ) and Pericardial sheet^® (fibril length; under 1μ) were implanted into the defected bladder walls in 8 dogs. Cystographic examinations were performed, and macroscopic and microscopic findings of E-PTFE graft and regenerated bladder walls were observed from 1 week to 6 months after the operation. The results were as followsed:
1) Cystographic examination showed no marked deformity of the bladder wall and no urinary leakage in an anastomotic line.
2) Macroscopically, E-PTFE graft showed the tendency of detachment from the bladder wall.
3) Histologically, granulation tissue was stretching from bilateral ends toward the mid portion of the graft, but there was no neointima 2 weeks after the operation. Thin neointima covered the whole length of the serosa site of the graft 1 month after the operation.
As time passed, neointima grew. And we could observe the regeneration of transitional cell epithelium with partial muscle regeneration 6 months after the operation. However, we could not see the regeneration tissue on the mucosa site of the graft at any time.
4) Cardiovascular patch and Pericardial sheet showed almost the same results.
5) E-PTFE graft made little injurious biological reaction and was useful to assist the regeneration of bladder wall for some period although it was eventually excluded.

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A case of intestinal type adenocarcinoma including paneth cells originating in the bladder was reported.
The patient was a 40-year-old man. His chief complaint was asymptomatic macrohematuria. Cystoscopy found a broad-base tumor in part with ulceration of a size of thumb's head near the apex part of the bladder. The biopsy showed mucous secreting adenocarcinoma. Radiography of the digestive organs showed no abnormality. A broad partial cystectomy was performed for the suspected urachal cancer. Histologically the tumor was limited up to submucosa, that is, _pT_Ib. PAS staining revealed mucous cells similar to those in the intestinal tract. HE staining revealed paneth cells with eosinophilic granules and silver staining revealed the cells with argentaffin granules. Immunohistological staining using muramidase antibody (PAS method) revealed brown stained granules. These findings led to diagnosis of an intestinal type adenocarcinoma originating in the bladder containing paneth cells. Most of paneth cells exist in the proximal Lieberkühn's crypts, the function and physiological significance of which are still uncertain.
The case of intestinal type adenocarcinoma originating in the bladder, where paneth cells were found, was reported for the first time by Pallesen in 1981, and our present case seems to be the second.

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A 73 year-old man visited our hospital with a complaint of gross hematuria on August 24, 1983. Cystoscopy revealed a large pedunculated papillary tumor arising from right side of the trigone. Physical examination showed a large movable mass on the left side of the abdomen. Transurethral resection was performed for the bladder tumor. Pathological diagnosis was TCC, G3, pTaNOMO (transitional cell carcinoma, grade 3, stage pTaNOMO). The abdominal mass was studied by gastrointestinal fluoroscopy, endoscopy and CT scan and diagnosed as submucosal tumor of the stomach. The abdominal tumor was removed by subtotal gastrectomy with a resection of transverse colon. Regional lymph nodes were dissected. Histologically it was a leiomyosarcoma of the stomach invading into the colon. Both tumors recurred 5 months after the abdominal surgery. Transurethral resection was performed again for the multiple recurrent bladder tumors. After the transarterial embolization of the right hepatic artery, laparotomy was perfomed but the liver metastasis of leiomyosarcoma was not resectable. The patient died of cancer on July 23, 1984.
In the Japanese literature, we have collected 46 cases of multiple primary malignant neoplasms of genitourinary organs composed of at least one non-epithelial malignancy. Male patients were dominant at the sex ratio of 3 to 1. Of These, synchronous cases were 69% (22/32). The combination of genitourinary cancer and non-epithelial malignancy in the other organs were 40 cases. Of the 40 cases, the bladder cancer in the genitourinary cancer (23 cases) and sarcoma in non-epithelial malignancy (20 cases) were the most frequent. 7 cases of malignant lymphoma and 5 of rhabdomyosarcoma were found. Leiomyosarcoma was found only 2 cases. This is the first report of bladder cancer associated with gastric leiomyosarcoma.

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