Testicular biopsies from 33 infertile men with varicocele on the left side were processed for light and electron microscopy.
Both Johnsen score count and T/W ratio in patients with varicocele were lower than those in the controls. However, in comparison of Johnsen score count and TIW ratio between the left and right sides there were no significant differences, neither between the grades of varicocele.
Ultrastructural changes of seminiferous tubules in patients with varicocele were primarily occurred in tubular walls, and led secondarily to degenerations of seminiferous epithelium. In seminiferous epithelium degenerations in the apical portion of Sertoli cells were followed by disruption of germ cells. However, there were no changes in the basal portion of Sertoli cells, and the presence of varicocele in testis may not make seminiferous tubules Sertoli cell only.

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Specimens obtained from 20 cases of human renal cell carcinomas were studied by immunofluorescence technique using monoclonal antibodies against intermediate filaments of cytokeratin and vimentin to detect the potential malignancy.
1) Cytokeratin has been demonstrated to localize in the tubular epithelia, while vimentin was found in interstitial cells in normal kidneys.
2) Anti-cytokeratin polypeptide of monoclonal type reacted with human renal carcinoma cells in 65%. However, anti-vimentin antibody was found in 75% of cancer cells and 65% of interstitial cells.
3) It was found that the more the degree of grading and invasiveness proceeded, the frequencies of these filaments became less prominent.
4) From the present study it is assumed that the demonstration of epithelial type of intermediate filaments would be a hallmark of progression and differentiation in human renal cell carcinoma.

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A fluorescence study was performed on specimens from 20 primary and 2 metastatic sites and tumors themselves of TSU-R1, our new cell line derived from renal cell carcinoma, grown in nude mice using 3 lectins, soybean agglutinin (SBA), peanut agglutinin (PNA), and wheat germ agglutinin (WGA), and antibodies to renal tubular antigen (RTA).
Anti-RTA reacted with carcinoma cells in all specimens of primary tumors, while SBA reacted in 9 (45%), PNA in 3 (15%) and WGA in 11(55%). In carcinoma cells from metastatic sites, only SBA did not react with them. Although we observed the presence of RTA in the tumor of TSU-R1 transplanted to a nude mouse at the 10th passage, RTA could not be found in the tumor transplanted at thr 50th passage. WGA reacted with the carcinoma cells in both passages of the tumors of TSU-R1, but SBA and PNA did not bind to either of them.
This fluorescence study seems to be a simple and useful method to investigate the characteristics of renal cell carcinoma. Since changes of glycocompounds may correlated to malignant potential of the carcinoma cells, further study with lectins will be necessary.

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Frequency and causes of hematuria in urology clinic were studied. Pathology and prognosis of so-called idiopathic renal hemorrhage were also investigated in the present study.
Among 5, 518 outpatients, hematuria was found in 916 cases (16.6%), of which 265 were macroscopic. Urolithiasis (24.4%), cystitis (23.9%), so-called idiopathic renal hemorrhage (13.4%), and malignancy in the urinary tract (10.0%) seemed to be the main causes of hematuria.
Three hundred and fifty-eight patients with so-called idiopathic renal hemorrhage were most frequently in their teens and followed by twenties, thirties and forties, in this order. Male and female ratio was 1.2:1. According to renal biopsy conducted on 177 cases, lesions suggesting glomerulitis were noted in 24.3% which included mesangial proliferative glomerulonephritis (9.0%) and focal glomerulonephritis (8.4%) detected by light microscopy. Deposits of immunoglobulins (IgA 29.9%, IgG 10.7%, IgM 8.5%) and complement (C₃ 6.2%) were detected by immunofluorescence staining in 55.4% of the cases. From the above, the sensitivity of immunofluorescence staining was considered to be twice higher than that of light microscopy, and approximately half of so-called idiopathic renal hemorrhage was caused by glomerulitis.
The cases demonstrating less than 10 erythrocytes per high power field showed the highest ratio of recovery (59.3%) followed by patients with macroscopic hematuria (51.0%) and those demonstrating more than 10 erythrocytes per high power field (41.4%). With regard to prognosis, 49.4% of the patients recovered to normal and 23.5% improved, whereas 25.4% did not show changes and the condition deteriorated in 1.7%. These results showed that the prognosis of the disease was relatively good.

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We studied clinical utility of intraarteral one-shot infusion chemotherapy in the treatment of urinary bladder cancer. To determine the suitable drugs for this method, we evaluated the affinity of thio-TEPA, CDDP and ADM for bladder tissue in dogs. Each agent was infused either from the iliac artery (IA group, n=5) or from the right cephalic vein (IV group, n=5). We measured the concentration of each agent in the serum and various tissues (bladder, kidney, liver and ileum) after 1 hour of infusion and investigated the difference of the concentrations between IA group and IV group. The results were as follows:
1. Thio-TEPA (7mg/kg); There were no differences in the serum and tissue (including bladder, kidney, liver and ileum) concentrations between IA group and IV group. There were no differences either in the concentrations between mucosa and muscle layer of the bladder in IA group and in IV group.
2. ADM (10mg/kg); In the bladder, IA group had significantly higher concentrations than in IV group. In the serum and in other tissues, IA group had lower concentrations compared with IV group. Concerning the urinary bladder, mucosa had significantly higher concentrations than muscle layer both in IA and IV groups.
3. CDDP (5mg/kg); IA group had significantly higher concentrations in the bladder mucosa and significantly lower concentrations in the serum and kidney than IV group. In the bladder, mucosa had significantly higher concentration than muscle layer both in IA and IV groups.
It was concluded that ADM and CDDP were the reasonable agents for one-shot intraarterial infusion chemotherapy to urinary bladder tumor, while thio-TEPA was not a suitable agent for this therapeutic method.

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We investigated the clinical usefulness of pre-operative one-shot intraarterial infusion chemotherapy of ADM and CDDP in patients with urinary bladder cancer.
We performed intraarterial infusion of 30mg ADM in 10 patients and 75mg CDDP in 10 patients from the internal iliac artery.
In 16 patients (ADM 7, CDDP 9), the reduction rate of tumor size could be assessed by means of cystography, cystoscopy and transurethral ultrasonic tomography performed before and 1 week after the infusion, the reduction of tumor size was observed in 6 out of the 7 patients after ADM infusion and in 4 of the 9 after CDDP. The reduction rate≥10% was seen in 5 after ADM and in 4 after CDDP. Among them, the rate≥20% was observed in 4 after ADM and in 1 after CDDP.
In all cases, we assessed the histological effect of these drugs. The injury of tumor cells was seen in 9 out of the 10 patients after ADM and in 9 of the 10 after CDDP. Among them, the destruction of tumor structure was observed in 4 after ADM and in 4 after CDDP.
Our observations demonstrated that one-shot intraarterial infusion chemotherapy of ADM or CDDP was a useful preoperative therapeutic method for urinary bladder cancer.

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A study of the upper and lower urinary tracts was undertaken in 41 boys with posterior urethral valves with regard to the radiological and functional changes after the valve ablation. All valvular structures were endoscopically confirmed as Young's Type I, and were incised with a miniature resectoscope.
The results indicates:
1) Vesicoureteral reflux was observed on 27 ureters in 16 boys (39%). Reflux stopped spontaneously after valve incision in 13 ureters (48%). There was apparent correlation between the age of operation and the spontaneous cessation of reflux. In 6 boys who were operated on under 1 year, all reflux was cured or improved.
Ring ureterostomy was made on 5 ureters. On 9 ureters, which remained unchanged after TUR, antireflux surgery was performed. Reflux recurred in 3 ureters. Nephroureterectomy was done on one renal unit with persistent massive reflux. The kidney had no function on routine examination, and the histology revealed renal dysplasia.
2) Prevesical ureteral stenosis was observed in 13 ureters in 10 boys (24%). In 6 ureters, ureteral dilatation improved after TUR. Among 6 boys who were operated on under 3 year of age, hydroureteric changes decreased in six of 9 ureters. Although ureterocystoneostomy was made on 4 ureters, three ureters remained dilated after the operation.
3) There were six boys with decreased renal function. Two patients with ESRD underwent hemodialysis.
4) Fourteen boys (35%) complained urinary incontinence after relief of obstruction. Enuresis nocturia continued in 10 boys, daytime incontinence in 10 boys. Two boys did not tell any sensation of bladder fullness even after they began to go to school. All boys who were treated on bladder neck either by TU-resection or Y-V plasty were incontinent. There was no relationship between the age of valve ablation and symptoms of urinary control.
5) Urodynamic assessment after the TUR was made on 13 boys, most of which complained abnormal voiding. Of the boys, seven showed hypertonic pattern on cystometry. The bladder of these children was severely trabeculated before the operation of obstructive valves. Five boys, who were evaluated after ureteral reimplantation, revealed severe hypertonic, low complianced bladder. Unihibited bladder contraction was apparent in 7 boys. High incidence of uninhibited contraction in this series suggests that congenital outlet obstruction may be one of the possible factors of this functional bladder dysfuction.

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To determine the stages of bladder tumor, which is most important to plan an adequate therapy, a 16 gauge 230mm long modified Menghini (Surecut^®) biopsy needle was guided transabdominally by ultrasound and a cystoscope to obtain the whole bladder tissue core.
In six cases, the muscle layer, the submucosal layer and the tumor tissue were obtained and pathologic staging of tumor was possible. However, in 4 other cases, tumor tissue only was obtained and staging was impossible. The bladder tumor in one case was diagnosed pT3b with Surecut tissue specimen, but after a combined treatment by radiation and chemotherapy, the second biopsy confirmed the absence of carcinoma because of tumor necrosis in the whole layer bladder tissue. Furthermore, the operation of total cystectomy also revealed no carcinoma anywhere in the bladder.

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For the purpose of studying the characteristics of external urethral sphincter and its innervation, human prostatic urethra and external urethral spincter were examined ultrastructurally.
The results were as follows:
1. Innervation
a) Periurethral smooth muscle layer.
(1) In the light microscopic study, the large axon bundle surrounded by perineurium was recognized. They were mostly unmyelinated, though a few were myelinated. (2) In the electron microscopic study, each axon bundle consisted of three or more unmyelinated axons surrounded by a Schwann cells. Each axon contains adrenergic dense core vesicles (about 50nm and 100nm).
b) External urethral sphincter
(1) Among the striated muscle cells, a large nerve bundle containing many axonbundles surrounded by perineurium was recognized. Each axon bundle contained a single or at most two or three axons. They contained adrenergic dense core vesicles. (2) The nerve ending formed so-called surface junction (1.1μm gap) to an adjacent striated muscle. These data sugest that; at distal end of the posterior urethra, autonomic nerve (mainly adrenergic) runs longitudinally in periurethral smooth muscle layer. It seems that sympathetic adrenergic nerve fibers are directly involved in the functional control of the external urethral sphincter.
2. The characteristics of EUS striated muscle fiber.
1) The human external urethral spincter (EUS) seems to be composed of three fiber types.
2) According to previous histochemical studies using mammalian EUS and this ultrastructual study of human EUS, it seems that they are two red types and one white type.

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A series of 234 patients treated by ileal conduit urinary diversion in the past 20 years were reviewed. Diversion was carried out for malignant diseases in 228 patients. The average followup period was 4 years. Patients were followed with periodic excretory urography (IVP) and loopograms. Preoperative and postoperative IVPs were compared to assess the effect of time on renal function and structure. IVPs taken 3 months after the urinary diversion in 190 patients disclosed pyelographic deterioration in nearly 15%, whereas only 8% of the cases were estimated to have developed further deterioration in the long term follow up (4 years or longer). The levels of intrinsic creatinine clearance which were measured at two different terms (1980, 1983) did not significantly change in 16 patients who were followed for over 6 months. Stone formation was a common late complication associated with significant long-term deterioration in either renal function or pyelographic appearance. The incidence of stone formation was 10.2% in 176 patients who were followed up for over 6 months. Complete laboratory examinations in these patients disclosed no metabolic abnormalities such as hyperchloremic acidosis and hypercalciuria. Surgery was necessary in 9 patients and all the stones extracted were composed of magnesium ammonium phosphate. In 17 out of the 18 stone formers, neither stomal stricture nor ureteroileal stenosis was identified. To evaluate the function of the ileal loop, myoelectric activities were measured from the conduit stoma in 6 patients with normal pyelographic appearance and in 4 patients who developed stones. This examination revealed a significantly decreased response of the ileal loop to furosemide administration in the latter (Group II), as compared to the former (Group I). The ileal conduit dysfunction estimated by this method was thought to be a major risk factor involved in the stone formation. Furthermore, this clinical study indicated that neostigmine bromide administration is a possible therapy for ileal loop dysfunction and one of the preventive therapies to be considered for stone forming patients.

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In order to clarify the clinical usefulness of serum LDH in the patient with testicular tumor, a retrospective study was made on 112 cases of testicular tumors (68 seminomas and 44 non-seminomas) collected from the Department of Urology, Yokohama City University and its seven related hospitals during a period from 1968 to 1983.
Positive ratio of serum LDH, correlation of serum LDH level with tumor weight, fluctuation of serum LDH level during clinical course and pattern of serum LDH isozyme distribution were studied.
1. Positive ratio of serum LDH prior to orchiectomy was 72% for seminoma and 59% for non-seminomas.
No statistical difference was noted between the two groups despite of high incidence of abnormal LDH level. In advanced cases (stage II and III), serum LDH level remained abnormal in 64.3% three weeks after orchiectomy.
2. Fluctuation of serum LDH level was well related with rise and fall of clinical course.
3. A good correlation was observed between weight of resected tumors and serum LDH values prior to orchiectomy (coefficient of correlation γ=0.68).
4. Increase of serum LDH isozyme 1 was distinctively observed in 65% (13/20) of seminomas and 63% (7/11) of non-seminomas.
5. Ratio of LDH isozyme fractions was in the order: LDH₁>LDH₂>LDH₃>LDH₄≈LDH₅.
The above results suggest that serum LDH and its isozyme 1 can be clinically utilized as reliable testicular tumor markers.

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We have been performing the operation of inserting a penile prosthesis as a therapy for organic impotence. Actually, not so many patients in Japan want to be subjected to this procedure, and the development of noninvasive techniques is desirable. Considering this, we examined the possibility of therapeutic application of the intrapenile-cavernous injection of prostaglandin E1 (PGE1), which has a strong dilatating effect on vascular smooth muscles, for organic impotence.
The injection of 20μg of PGE1 dissolved in 2 to 20ml of saline into the penile cavernous body was performed by employing a small gauge Gordh neeedle of 22 to 27G; the effect was detected by an Erectiometer and a thermometer measuring the change of the temperature of the penis. The intraarterial infusion of 20μg of PGE1 dissolved in 20ml of saline was also performed by means of a vascular catheter.
As a result, among 71 patients who received the PGE1 injection into the penile cavernous body, perfect erections were observed in 51 (72%), imperfect erections in nine (13%), only enlargement of the penis in six (8%) and no change in five (7%). In the patients exhibiting perfect erections, the penis enlarged in two to three minutes following the PGE1 injection and this condition persisted for two to three hours. Most of the patients exhibiting almost no erection were those suspected of having penile cavernous body atrophy or vascular deficiencies, or were elderly men. But the fact that PGE1 injection into the penile cavernous body could induce sufficient erection for sexual intercourse even in cases of peripheral nerve injury due to pelvic surgery or organic deficiencies within the central nervous system including the cerebrum and the spine, has proved the future possibility of therapeutic application of PGE1 for organic impotence.
On the other hand, internal pudendal arteriography was performed in a patient with pelvic fracture and two with diabetes mellitus, who did not exhibit perfect erections by the PGE1 injection into the penile cavernous body. In the case of pelvic fracture, the internal pudendal artery was impaired and the penile artery was not filled with the contrast medium. That is to say, due to the complication of vascular impotence, the PGE1 injection into the internal pudendal artery could not raise the temperature of the penis appreciably or reestablish the erection. In both cases of diabetes mellitus, however, the penile artery was sufficiently filled and the PGE1 intraarterial infusion could raise the penile temperature and recover erection, though transitory.
These results lead to the expectation that PGE1 would be applicable in therapy for vascular impotence in the future, after suitable improvement of the methods of administration.

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The microsections from the 63 consecutive patients upon whom transurethral resection of the prostate gland (TUR-P) was performed at Machida Municipal Hospital, from 1983 through 1985, were the original source of material for study.
Out of 63 cases with preoperative clinical diagnosis of benign prostatic hyperplasia (B. P. H.), 13 cases of incidental adenocarcinoma were found in TUR-P specimens. These 13 cases represent 20.6% of the total number of TUR-P specimens and form the basis of this report.
The patients of B. P. H. and the patients of incidental carcinoma were compared in such clinical features as preoperative serum acid phosphatase values (examined by the method of radioimmunoassay), the mean age of affected patients and the mean weight of resected specimens. But, no significant differences were found between these two groups.
For the purpose of pathological study of incidental carcinoma, we classified cancer according to three pathological factors: the presence of margins of cancer (Circumscribed type), the absence of margins of cancer (under circumscribed type) and the degree of differentiation of the cancer (well differentiated type, moderatelly differentiated type and poorly differentiated type). Out of 13 cases, 6 (46.1%) were circumscribed, 4 (30.8%) under-circumscribed, and 3 (23.1%) mixed. Well differentiated carcinoma was found in 6 (46.1%), moderatelly differentiated in 3 (23.1%), mixed differentated in 3 (23.1%) and poorly differentiated in 1 (7.7%).
For each patient, 108 to 628 (mean 265) resected chips were examined microscopically. Of the 13 patietns with incidental carcinoma, 8 (61.5%) had lesions that were classified as small (under 5 chips) and 5 (38.5%) had lesions that were classified as large (over 6 chips).
Combining the factors of margins of cancer and the spread of cancerous lesions, these 5 patients must be followed up strictly in the clinical course, even though they were the case of incidental prostatic carcinoma.

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Nuclear magnetic resonance (NMR) imaging was performed in 30 patients (20 benign prostatic hyperplasia and 10 prostatic carcinoma) using a 0.35 Tesla superconducting magnetic system and spin echo images were obtained. T₁ and T₂ relaxation times were calculated from these images. The prostates were identified in the median sagittal images which clearly demonstrated relationships between the enlarged prostate gland and surrounding structures and provided an important morphological information. Benign prostatic hyperplasia gave a homogeneous intensity signal. The finding in half of cases with prostatic carcinoma was heterogeneous signal pattern, and invasion to surrounding tissues was better seen in advanced stages. Differentiation between benign hyperplasia and carcinoma by T₁ or T₂ relaxation time was difficult by this method. For more accurate pathophysiological information from NMR, more fundamental and clinical studies will be required.

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The analysis of the blood group isoantigen (BGA) in bladder tumor is valuable for the prediction of malignant potential. We have employed PAP method to detect the loss of BGA and made classification of staining patterns of BGA. In order to obtain clinically valuable and useful criteria for the loss of BGA, 129 bladder tumors including 86 superficial tumors were examined. Carcinoembryonic antigen (CEA) and fibronectin (FN) were also detected in the same tissue by PAP method and clinical usefluness was invesitigated in the correlation with the loss of BGA.
BGA staining pattern was classified into 5 types as follows,
Type I: Stained homogeneously as intensely as normal urothelium.
Type II: Stained homogeneously but less intensely than normal urothelium.
Type III-a: Stained non-homogeneously with negative area. (less than 50%)
Type III-b: Stained non-homogeneously with negative area. (more than 50%)
Type IV: Stained negatively with no positive area.
No correlation was found between histological grade and BGA staining pattern. CEA was detected in 13 of all 129 tumors (10.1%) and in 10 of 86 superficial tumors (11.6%). CEA was detected at a high incidence in grade 3 bladder tumors. Negative rate of tissue FN was 26.6% in all cases and was correlated with histological stage.
Analysis of the loss of BGA is the most valuable for the prediction of malignant potential of bladder tumor especially in low stage, because out of 86 cases of low stage bladder tumor all 10 cases with subsequent invasive recurrence belonged to type III-b or type IV. In conclusion, it was possible to propose new criteria for the loss of BGA i. e., type I & type II: positive, type III-a: borderline, type III-b & type IV: negative.

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The Tokai Urological Tumor Registry was founded in 1980 as a part of the educational project of Tokai Section of Japanese Urological Association. For 4 years from 1980 to 1983, 1474 cases (1185 males and 289 females) with primary tumors of the bladder were registrated in the registry. Among the 1474 cases, 1448 were selected from the registered cases for the present study. The discarded 26 cases included the followings: no treatment; 24, durign treatment; one, lack of details for analysis; one.
Curable treatment was performed in 1215 cases (84%), of which 320 (22%) received total cystectomy, and 895 (61%) were controlled without cystectomy. 77 (5%) cases were thought to be far advanced carcinoma at the initial visit to the hospital.
1299 cases (90%) were treated by surgery. Chemotherapy and radiotherapy were given in 590 (41%) and in 101 cases (7%), respectively. Chemotherapy and/or radiotherapy without surgery were effective in 26 tumors (3%).
Histologically, 1233, 32, 19 and 25 tumors were of transitional cell, squamous cell, adenocarcinoma and mixed cell, respectively.
Grading of 1233 transitional cell carcinomas consisted of 2%, G0, 27% G1, 40% G2, 28% G3 and 3% Gx. Incidence of superficial tumors (under T1) was 73% in the group of curable treatment and 22% in the non-curable treatment group.
After the curable treatment, reccurrence in the vesical cavity occurred in 171 cases (22%) of 785 cases who showed evaluable follow-up period after the treatment. Among them 20 received total cystectomy and the remainders (144 cases) were controlled by TUR. Distant metastasis developed in 44 of the 171 cases.
The total cumulative 3 year survival rate of this series was 73%. The 3 year survival rate of each therapeutic grop was 90% in conservative curable treatment, 67% in total cystectomy, 30% in non curable cases, and 3% in advanced cases.

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The Tokai Urological Tumor Registry received registration of 204 primary tumors of renal pelvis and ureter for 4 years from 1980 to 1983. 201 cases (164 males and 37 females) have been selected from the originals in the tumor registry. The series includes 121 tumors of renal pelvis and 80 ureter tumors, of which 158 were treated by curable surgery, 21 had malignancy still after treatments, and the remaining 22 diagnosed as advanced tumor at the first visit to the clinic.
The 176 cases underwent surgery: including 5 nephroureterectomy with cystectomy. Chemotherapy and/or radiotherapy were performed in 60 cases after curable surgery. Histological diagnosis were: 177 transitional cell carcinoma, 2 squamous cell carcinoma, one adenocarcioma, and 5 transitional cell carcinoma with squamous cell carcinoma. The remainding 16 had no pathological report.
Grading of transitional cell carcinoma was one of G0, 24 of G1, 85 of G2, 57 of G3, and 10 of Gx. Stage of infiltration was 3 of Ta, 64 of T1, 43 of T2, 10 of T3, 24 of T4 and 58 of Tx.
Metastasis of tumors was diagnosed initially in 26 cases and 17 cases had distant metastasis after surgery. Recurrence in the vesical cavity after resection of the primary tumors occurred in 23 of 113 follow-up cases. Three years survival rate of the series was 59% and no case was alive over 3 years without radical treatment of the tumors.

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One hundred and twenty-two cases with renal (blunt) trauma were reviewed and analyzed in order to obtain the best clinical guideline in terms of conservative or operative treatment. The cases were classified as renal contusion, slight renal laceration, severe renal laceration, renal rupture and renal pedicle injury by the clinical findings and the image diagnosis. The preoperative classification and the postoperative one including the findings of the operation agreed with 30 of 41 cases (73.2%).
According to the present investigation, our current therapeutic policy has been summarized as follows. Renal contusion is managed expectantly. Slight renal laceration is also conservatively observed. However, operation should be taken into consideration in patients with severe renal laceration, because most cases after conservative treatment were obliged to undergo nephrectomy once in a while. The immediate surgery would be the best management for renal rupture as well as renal pedicle injury.
Of special emphasis is that surgical intervention should be employed in cases of sever renal laceration, after an accurate staging is obtained with the aid of image diagnosis.

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Two cases of renal arterial thrombosis occurring after retroperitoneal lymphadenectomy for testicular tumor are presented in this paper.
Complete obstruction of the trunk of the right renal artery occurred in one case. Four months after lymphadenectomy, nephrectomy was performed for treatment of renovascular hypertension. In the other case, renal arteries on both sides were obstructed, and 5 days after lymphadenectomy, selective intraarterial infusion of Urokinase was given for treatment. Although the function of the left kidney recovered, the function of the right kidney was not restored.
It was presumed that the major cause of this serious complication was excessive traction of the blood vessel in the kidney during the operation with a vascular tape resulting resulting in dropping off of the vascular endothelium. A finding supporting this speculation was obtained in an experiment using dogs.

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