The clinical usefulness of α subunit of urine S100 protein as a tumor marker for renal cell carcinoma was evaluated in 61patients with renal cell carcinoma, 32patients with other urological cancer, 84patients with benign urological disease and 448healthy volunteers.
Urine S100-α levels were measured by means of a newly established sandwich-type enzyme immunoassay method.
The mean urine S100-α value±SD in healthy volunteers was 0.179±0.121 (ng/ml), and the cut off value (mean+3SD) was 0.542ng/ml. The positive rate of urine S100-α was 63.9% (39/61) for renal cell carcinoma, 15.6% (5/32) for the other urological cancers, and 7.1% (6/84) for benign urological diseases. The urine S100-α levels in patients with renal cell carcinoma were significantly higher than those of healthy volunteers or those with other urological diseases (p<0.01).
The positive rate of urine S100-α for renal cell carcinoma was higher than those of ESR (60.0%), Fibrinogen (51.5%), and IAP (54.5). And the urine S100-α levels in patients with renal cell carcinoma increased as the tumor stage or grade progressed.
Although further study is needed, the urine 5100-α appeared to be a useful tumor marker in diagnosis and staging of the renal cell carcinoma from these results.

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Peripheral blood lymphocyte subpopulations both in 38 stage D prostatic cancer patients and in 20 age-matched healthy volunteers were analysed using monoclonal antibodies including OKT3, OKT4, OKT8, OKM1, Leu7 and Leulla.
In untreated stage D prostatic cancer patients, the proportion of OKT3⁺ cells and OKT4⁺ cells decreased, while the proportion of OKT8⁺ cells and Leu7⁺ cells increased significantly resulting in declined OKT4/OKT8 ratio. To determine whether hormone therapy including castration and administration of Estramustine phosphate (EMP) can alter peripheral blood lymphocyte subpopulations, we analysed them before and 3 to 4 weeks after hormone therapy. Although the serum level of prostatic acid phosphatase was significantly reduced 3 to 4 weeks after hormone therapy, there was no significant alteration in peripheral blood lymphocyte subpopulations either after castration or after a period of EMP administration.
These results suggest that quntitative changes in peripheral blood lymphocyte subpopulations may be one of the factors responsible for the immunosuppression in patients with stage D prostatic cancer patients.

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In order to investigate the early pictures of prostatic cancer, the following examinations were performed:
We examined the incidence, age distribution, site of occurrence in the prostate, and histopathology of latent carcinoma of the prostate by means of step-section technique in 283subjects who underwent autopsy in the Jikei University School of Medicine from 1983 through 1985.
Latent carcinoma of the prostate was detected in 63subjects: 24.6% of males over 40years of age. When different age groups were compared, latent carcinoma was frequently found in older patients, reaching 50% in the age group of over 80years.
The site were predominantly found in the 1/2 external regions and the frequency of occurrence was 50% in the anterior regions. When compared anteroposteriorly, latent carcinoma was found to occur frequently around the colliculus seminalis (verumontanum).
Histopathologic examinations revealed a higher incidence in well-differentiated adenocarcinoma than in clinical prostatic carcinoma.
We considered that latent carcinoma of the prostate might be discovered with difficulty during a patient's lifetime because of the lack of specific characteristics stated in the present study.

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The BB isozyme of creatine kinase (CK-BB) activity is known to be abundant in human semen.
It is aimed in this study to investigate (1) the relationship between sperm count or sperm motility and content of CK-BB in the seminal plasm. (2) tissue content in the male accesory organ and testis, (3) immunohistochemical localization of CK-BB in the testis and sperm. There was no correlation between sperm count or sperm motility and CK-BB level. As far as the tissue contents are concerned, CK-BB could be detected in a large amount in the tissue of seminal vesicle, prostate and ampulla portion of vas deferens. A lowest amount of CK-BB was found in the testicular tissue. However, immunohistochemical study demonstrated CK-BB localization in the cytoplasm of the Sertoli cell as well as the spermatid cell in the testis. Moreover, reaction products could be depicted in the cap, neck and tail of the ejaculated sperm. It is concluded that CK-BB is an important enzyme for the movement of the sperm and for the penetration of the sperm into the ovum.

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Three hundred fifty patients with renal and or ureteral stones underwent extracorporeal shock wave lithotripsy (ESWL) mono-therapy during the ten months from Mar. 1986 to Jan. 1987. These cases were composed of 192 of renal, 139 of ureter and 19 of both site stones. 60per cent of these calculi were 1-2cm in diameter and 25per cent were above 2cm. Treatment required 42 minutes on average excluding the time of auxilliary procedures. Fluoroscopic exposure per patient was 138 seconds. The average number of shock waves delivered per patient was 1552. The incidence of stone street and of complications such as flank pain, obstruction, colic and fever became higher as the stone size increased. The ureteral stent was effective to reduce the complications after ESWL. The average hospital stay was 6.2 days in all patients. 235 patients had been followed for 3 months after treatment. The stone free rate was 65 per cent at 3 months after treatment. The stone free rate of patients with stones less than 2cm was 71per cent in the kidney and 83 per cent in the ureter, respectively. However, the stone free rate of patients with stones larger than 2cm was 40 per cent. Stones were not destructed in 16 cases (4.6%). Of these, 15 were ureter stones impacted for long periods of time. 7 cases with stones in a solitary kidney were treated successfully. The complication by ureteral manipulation was seen in 4 cases including 3 of ureteral perforation and one of extravasation due to rupture of occluding balloon. Renal function impairment was found in 6 cases, 5 of which were caused by urinary stasis due to stone street and infection.
The following conclusions were obtained based on our experiences. First, ESWL mono-therapy is a first choice treatment for small stones in the upper urinary tract. This treatment is safe, non-invasive and required short hospital stay. Second, ureteral stones can be destructed by ESWL. Dislodgement of ureteral stones should be tried since shock waves required reduced in number when the stones were pushed up to the renal pelvis. Third, most serious complication was the stone street formation after ESWL which may result in loss of renal function. The stone street became long as the stone size increased. Fourth, ureteral stenting seems to be an effective auxilliary procedure to reduce the complications following ESWL especially with stones larger than 2cm. Fifth, ESWL mono-therapy without stenting is not indicative to the staghorn calculi. Instead, divided stone destruction by ESWL with ureteral stenting or combined therapy with percutaneous nephrolithotomy and ESWL is recommended for these large stones.

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Twenty-seven patients with transitional cell bladder cancer were treated with intravesical bacillus Calmette-Guerin (BCG). Twenty-four of them were of papillary type, one was non-papillary and the remaining two were flat carcinoma in-situ. The patients were catheterized to empty the bladder and 80mg (1 ampule) Tokyo 172-strain BCG (Institute Nippon BCG co. Ltd) suspended in 40ml. saline were instilled into the bladder. In 6 cases who required multiple treatment course, increased doses (160-240mg) were employed as a trial. No intradermal BCG injections were given. BCG treatment was repeated weekly for 6 weeks. Among the twenty-four papillary growth patients, 12 patients showed complete disapperance of the growth, 6 showed partial response and the remaining 6 showed no response. One patient with non-papillary growth showed partial response. Two cases of carcinoma in-situ showed complete responses. Regarding the side effects, irritable bladder symptom (frequency on urination, residual feeling, and/or lower abdominal discomfort) occurred in 16 patients (59per cent), gross hematuria in 11 patients (59per cent) and elevation of body temperature over 37.5°C in 7 patients (26 percent). In 3 patients with severe side effects, oral isonoazid (0.3g/day) was employed for 14 to 28 days with good response. No chronic bladder disability was so far observed during the follow-up period of as long as 38 months. Favorable results obtained more frequently among patients who showed a remarkable inflammatory response of the bladder. These results are strongly suggestive of the effectiveness of intravesical Tokyo 172-strain bacillus Calmette-Guerin in the treatment of superficial transitional cell carcinoma and carcinoma in-situ of the bladder.

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From January 1961 to June 1986, 738 patients with bladder tumors were treated at the Center for Adult Diseases, Osaka. A statistical study was made on these patients. The results are as follows:
1) As to age incidence, the peak incidence was found in the seventh decade. The age distribution was from 19 to 88 years old with the average of 61.8. Male to female ratio was 4.6:1.
2) As to main clinical symptoms, gross hematuria was found most frequently in 83%, pain on urination in 16%, pollakiuria in 14% and dysuria in 7%.
3) As to the cell type, transitional cell carcinoma was found in 705 patients (96%), squamous cell carcinoma in 11 patients (1%), adenocarcinoma in 11 patients (1%), undifferentiated carcinoma in 4 patients and inverted papilloma in 7 patients.
4) Solitary tumors were observed in 48% of 705 patients with transitional cell carcinoma, and multiple tumors in 47%. Small tumors (less than 1cm) were observed in 12%, medium sized tumors (1-3cm) in 58%, and large tumors (more than 3cm) in 23%.
5) As to the histological grade, of the patients with transitional cell carcinoma, 333 patients (47%) were classified as G1, 250 patients (35%) as G2 and 122 patients (17%) as G3.
6) As to the histological stage, of the patients with transitional cell carcinoma, 19 patients (3%) were in pTis, 240 patients (34%) in pTa, 251 patients (36%) in pT1, 80 patients (11%) in pT2, 29 patients (4%) in pT3a, 32 patients (5%) in pT3b, 21 patients (3%) in pT4 and 33 patients (5%) in pTX.
7) As to the first treatment, 436 patients underwent transurethral resection, 9 patients supravesical tumor resection, 33 patients partial cystectomy and 134 patients total cystectomy.
8) The overall actuarial survival rates after the first treatments were 68.5%, 54.2% and 40.6% at 5, 10 and 15 years, respectively. The relative survival rates were 80.2% and 77.1% at 5 and 10 years, respectively. As for tumor characteristics, transitional cell carcinoma rather than squamous cell carcinoma or adenocarcinoma, papillary rather than nonpapillary, low grade rather than high grade, low stage rather than high stage, solitary rather than multiple and small rather than large tumors yielded better survival.
9) The intravesical recurrence rates after transurethral resection were 29.6%, 44.2% and 55.4% at 1, 2 and 5 years, respectively. Intravesical recurrence was significantly more frequent in patients with high grade, high stage, multiple or large tumors at first treatment.

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The influence of renal surgery on postoperative renal function was studied by excretory urography (infusion method), biochemical measurement and urinalysis.
Eighty-eight patients were divided into 2 groups: the CNL group (44 Kidneys from 44 patients) underwent conventional nephrolithotomy: the PNL group (46 kidneys from the other 44 patients) underwent percutaneous nephrolithotomy.
The variables obtained from infusion urogram were the time required for ureteral visualization, the number of calyces, the area covered by the nephrogram and the thickness of the parenchyma at the incision or punction into the calyces. Biochemical measurements included BUN and serum creatinine concentration. In postoperative urinalysis, durations of hematuria and pyuria were determined.
Time required for ureteral visualization was longer in the CNL group at any given postoperation time. The nephrogram area decreased by 10.6% in the CNL group and by 3.5% in the PNL group. The number of calyces decreased by 66.7% in the CNL group and by 9.9%in the PNL group. Parenchymal thickness at the kidney incision decreased 20% in the CNL group and only 2.6% in the PNL group.
Postoperative elevation of serum creatinine concentration was observed in both groups, but the elevation in the CNL group remained more marked and was of longer duration than that in the PNL group.
The average duration of hematuria was 33.3±20.1days (mean±SD) in the CNL group and 26.3±12.5 days (mean±SD) in the PNL group.
The average duration of pyuria was 36.9±20.4 days (mean±SD) in the CNL group, 20.9±15.2 days (mean±SD) in the PNL group.
The present results demonstrate that percutaneous nephrolithotomy causes less renal dysfunction than conventional nephrolithotomy.

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The significance of retroperitoneal lymph node dissection (RPLND) associated with radical nephrectomy for renal cell carcinoma was studied in 65 patients admitted and treated in Cancer Insitute Hospital between June 1975 and September 1985, who were divided into two groups without lymph node dissection (LND-) and with lymph node dissection (LND+).
In _(p)T classification, LND- group consisted of one patient with category _pT₁, 15 patients with category _(p)T₂, 6 with T₃ and 4 with T₄. The 3-, 5- and 10-year survival rates of 26 patients (by Kaplan-Meier's method) were 50.1, 42.9 and 26.8%, respectively.
LND+ group included one patient with category _pT₁, six with _pT_2a, 19 with _pT_2b, 7 with _pT₃ and one with _pT₄. The 3-, 5- and 10-year survival rates of 34 patients were 63.6, 48.5 and 48.5%, respectively. The prognosis became worse with higher staging.
In _(p)N classification, LND- group included 15 patients with category N₀, 3 with N₂ and one with N₃. The 3-, 5- and 10-year survival rates of N₀ group were 60.0, 50.0 and 33.3%, respectively. On the other hand, the 3-year survival rate of N+ group was 0%.
LND+ group included 21 patients with category _pN₀, two with _pN₁ and each one with _pN₂, _pN₃ or _pN₄. The 3-, 5- and 10-year survival rates of _pN₀ group were 67.5, 50.0 and 50.0%, respectively. The 3-year survival rate of _pN+ group was 40.0%.
The statistical analysis by generalized Wilcoxon test, was meaningful (p<0.025) between N₀ and N+ groups, but was not meaningful between _pN₀ and _pN+ groups. And in only two cases (5.9%) of LND+ group, RPLND was effective and meaningful.
In M classification, LND- included 11 patients with category M₀ and 20 with M+. The 3- and 5-year survival rates of M+ group were 20.0 and 0% respectively. LND+ included 21 patients with M₀ and 13 with M+ and the 3- and 5-year survival rates of M+ group were 18.5 and 0% respectively.
In _(p)V and Grade classification, the prognosis became worse with higher staging and grading.
Because, according to our results, RPLND achieved only 5.9% improvement of survival rate, the aggressive operation including RPLND and the resection of tumor emboli should be recommended for radical treatment of renal cell carcinoma. But it has a limitation from the standpoint of improvement of survival rate of renal cell carcinoma because the prognosis is dependent upon the presence of distant metastasis, mainly.
The general treatment including immunotherapy and/or chemotherapy should be developed and studied.

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During the period between July, 1971 and April, 1985, 1428 transurethral resection of the prostate (TUR-P) for clinically benign diseases were done at the kitasato University Hospital. Sixty-seven cases of incidental (stage A) carcinoma were found with an incidence of 4.7per cent. For the purpose of this study, we tried to classify between stage A₁ and stage A₂ prostatic carcinoma from TUR-P specimens, according to the current literature and the expected outcome of our study that were derived from the number of tumor tips and the degree of differentiation. For each patient. 3.6 slides, 16.4 tissue chips/slide and 59 mean tissue chips/patient (26-240 tissue chips/patient) were examined microscopically. The survival rates of patients with well, moderately and porly differentiated tumors were 76, 61 and 28per cent, respectively, at 10 years. The survival rates at 10 years of Gleason pattern groups 2 to 4, 5 to 7 and 8 to 10 were 88, 54 and 29 per cent, respectively. The survival rates of patients with 1, 2 or less 3 or less, 4 or less, 5 or less and 6 or less tumor chips were 77, 84, 80, 79, 79 and 80 per cent respectively, at 10 years. Three tumor chips and 6 tumor chips were found at 5.01 and 10.1 per cent, respectively, in 59 examined chips.
The survival rates at 5 and 10 years with well differentiated and 3 or less tumor chips group were 90 and 90per cent, respectively. We proposed as a preliminary classification:
stage A₁: well differentiated (or Gleason pattern sum 2 to 4) and tumor chips≤5% of examined specimen
stage A₂: anything other than stage A₁
Our classification system was derived from a limited number of the prostatic carcinoma cases. More refined and precise staging system in incidental prostatic carcinoma at TUR-P should be produced from a large number of series.

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Both echo levels of a urinary stone and destructive power of shock waves depend on acoustic properties of the stone and its surroundings. Relative echo level of a stone (RES value) was calculated before extracorporeal shockwave lithotripsy (ESWL) in 93 upper urinary stones, and RES values were compared with destruction effects of ESWL. The RES values were significantly higher in the group of 60 stones with good effect than in the group of 33 stones with poor effect. Magnesium ammonium phosphate stones showed good effect of ESWL in spite of their low RES values. Cystine stones showed poor effect of ESWL in spite of their high RES values.
Calcium oxalate stones and mixed stones of calcium oxalate and calcium phosphate are most common. Stones of these components were analized. Stones with RES values higher than 1.45 showed good effect in 92.9%, and stones with RES values equal to or lower than 1.45 showed poor effect in 80.0%. Ureteral stones were more difficult to destroy compared to renal stones and the RES values of ureteral stones were relatively low.
In a water bath, echo levels of a stone were measured. Surgically removed 50 stones were placed in a sponge phantom. Echo levels were higher when there was a gap between the stone and the sponge than when there was no gap. This result showed that the gap between a stone and renal or ureteral tissue is one of the important factors of ESWL effects.
It is suggested that detruction effects of ESWL can be predicted by pretreatment measurement of RES values.

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Local immunocompetence in patients with bladder tumors was evaluated by immunohistochemical technique with monoclonal antibodies. In the current study, we examined the subpopulations of tissue infiltrating lymphocytes. Simultaneously, subsets of peripheral blood lymphocytes were investigated by flow cytometry.
Frozen specimens examined were from 25 bladder cancers and 4 non-canerous tissues. Six serial sections were stained with Leu4, 7, 10, M3, OKT4 and OKT8. Also, the degree of tissue infiltrating lymphocytes was compared with clinical manifestations of the patients.
Survival rates in the severe tissue infiltrating lymphocytes group were significantly greater than those in the scanty infiltrating group. T cells were predominant over B cells in 19 out of 25 bladder tumors. T cell infiltration was prominent around tumor cells, whereas B cells were scarce in the stroma. T cell infiltration was marked in the non-invasive group. In patients with low stage tumors, OKT8 cells were more prominent than OKT4 cells. NK cells accmulated around the cancer cells and infiltrated within cancer nests, unlike T cells. The infiltration of NK cells was scanty in high stages. Macrophages were scattered only slightly in 13 cases. On the other hand, subsets of peripheral blood lymphocytes measured by flow cytometry were not correlated with stages.
These findings suggest the presence of local immunosurveillance against bladder tumor. It may be important to clarify the characterization of tissue infiltrating lymphocytes to elucidate host immune response against tumor.

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The host immunoresponse of nude mice (BALB/c-nu/nu) and hetero mice (BALB/c-nu/+) in subrenal capsule assay were studied using bladder cancer (NM-B-1), prostatic cancer (PRO-1) and renal cancer (NM-R-3) transplantable to nude mice.
The implantation under the renal capsule in this study was carried out according to Bogden's basic method. After the sacrifice of these mice, the final tumor sizes were measured and the changes in tumor size were calculated on Day-4, Day-6 and Day-8 in hetero mice, and on Day-11 in nude mice. H-E and Azan stainings were also performed for histological analysis.
In hetero mice, changes in tumor size were most marked on Day-6 in NM-B-1 and NM-R-3, and on Day-8 in PRO-1. Histologically, in nude mice, all these tumor fragments (NM-B-1, PRO-1, NM-R-3) had many vivid cancer cells without host cell infiltrations. On the other hand, only minimal host cell infiltrations were observed and cancer cells appeared well preserved in these fragments of hetero mice on Day-4. But cancer cells were decreased and almost replaced by host cells with fibrous changes on Day-6. This tendency appeared remarkable on Day-8.
The present study has demonstrated that Day-6 subrenal capsule assay using immunocompetent mice have a problem of host immunoresponse which should be solved. There fore, it is more suitable to use athymic mice than immunocompetent mice as host animals in the subrenal capsule assay.

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Regional differences in contractile responses of rabbit urinary bladder smooth muscle strips induced by acetylcholine and norepinephrine were examined. The urinary bladder was dissected from New Zealand white rabbits and separated into the anterior dome (Dome ant), the posterior dome (Dome post), the anterior base (Base ant) and posterior base (Base post). Both acetylcholine and norepinephrine significantly induced contraction of muscle strips from all regions of Dome ant, Dome post, Base ant and Base post. The contractile response induced by acetylcholine was more marked than that induced by norepinephrine in Dome ant, Dome post and Base ant, while the contractile response induced by norepinephrine was more marked than that induced by acetylcholine in Base post, the trigonal area. These findings suggest that the urinary bladder may be separated pharmacologically into the trigonal region and the other regions, not into the urinary bladder dome and the base.

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Dismembered pyeloplasty, Anderson-Hyne's procedure, was performed on 29 kidneys of 27 patients during the past four years (1982-1985). Functional and morphological studies were carried out in 23 kidneys with intravenous pyelogram and revealed satisfactory improvement in 14 (61%) kidneys. Neither improvement nor deterioration was shown in nine kidneys post-operatively. Pressure flow study (pyelometry) was performed post-operatively in 15 out of 23 kidneys. Absolute pressure in the renal pelvis was less than 25cm of water in seven kidneys, having improvement in IVP and renogram. This suggested that there was no stricture or obstruction in these renoureteral units. The pressure was higher than 25CM of water in two kidneys, despite improvements in renogram and IVP. However, both kidneys acquired good drainage through the junction afterwards, and the nephrostomy tubes were removed 24 days after operation. Diuresis renogram with I131-Hippuran was performed in 7 kideys pre-operatively and in 5 post-operatively. Three kidneys having an improvement with IVP after the operation, were revealed to be in a non-obstructive condition. While two of the three kidneys having no improvement with IVP were revealed to be in an obstructive condition. The pressure flow study is of value for readily evaluating drainage of urine at the ureteropelvic junction and indicating the time when the nephrostomy tube should be taken out after operation. The diuresis renography much more sensitively evaluates the function of the kidney and the status of drainage and is useful for monitoring clinical course after operation.
Obstruction of the ureteropelvic junction was treated with endoscopic procedures in a 25-year-old woman. A 20 French of cystoscope and a woking apparatous with a urethrotome on it were used for the purpose of opening the stricture of ureteropelvic junction. The sheath was passed through the tract of nephrostomy and the knife was inserted and guided carefully to the site of stricture. The stricture was widely opened by two deep incisions made on the posterior wall of the junction and a stent tube, 8 French in size, was indwelt for 9 days after the operation. The latest examination done 15 months after the operation revealed good urinary drainage at the junction.

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The efficacy of prazosin hydrochloride was studied in patients with micturition disturbance. The study was made on a total of 40 patients (33 men and 7 women) with a mean age of 55.0 years. The efficacy was assessed by uning “nomogram” reported by Yachiku et al. calculated from maximum urinary flow rate and urinary volume in urinary flow curves. The result revealed significant improvement (p<0.001) of nomogram score in whole patients ofter administration of prazosis hydrochloride.
When classified by underlying disease, improvement was significant for bladder neck contracture (20), chronic prostatitis (18), and neurogenic bladder (5), whereas no improvement was obtained in patients with benign prostatic hyperplasia (7). This suggests that prazosin hydrochloride may not be expected to work in patients with organic obstruction. In our clinic urethral phentolamine test has been performed as one of routine examinations to differentiate organic obstruction from functional bladder outlet obstruction. Prazosin hydrochloride has been found to be significantly effective in phentolamine-responders. This indicates that the test is a useful means for selection of patients who are expected to repond to prazocin hydrochloride.

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We have already applied microwave surgical treatment to urologic diseases. For example, bladder cancer, prostatic hypertrophy and prostatic cancer have been treated by transrethral microwave irradiation. Therefore, it is very inportant for us to know the thermal distribution in biological tissue when microwave irradiation is applied to a human. There are many methods to measure thermal distribution. In this study, we gained new informations about thermal distribution by usidg several phantoms and urological applicators.
In our study, three urological applicators were used. As phantoms, we chose cow liver, sliced ham, egg white, and a gauze with saline (25%, 50%, 75%). An applicator was inserted into each phantom and then irradiated with a microwave energy of 100w for 30 to 120 seconds at the frequency of 2, 450MHz. Thrmal distribution was measured using three methods: infrared thermography, coagulation method of egg white, and liquid crystal sheet. Thermal distribution in each phantom was compared.
Results were obtained as follows. (1) There were no remarkable differences in thermal distribution between the cow liver and sliced ham. (2) As the saline content of the gauze was increased, its thermal distribution became wider. And a gauze with 50-75% saline had the same thermal distribution as that of cow liver. (3) The infrared thermography gave us exact data, being coplicated, it lacked simplicity. (4) We could measure accurately and easily with a liquid crystal sheet. (5) We were able to confirm the three-dimentional thermal distribution by using the coagulation method of egg white. However, sometimes this method had small errors in measurement because egg white was slightly deformed by heating by microwave irradiation.
There are many methods for measurement of thermal distribution. We conclude that the liquid crystal sheet is very useful clinically because it gives us exact data without difficulty.

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A new applicator was prepared for microwave coagulation of urinary bladder tumor. The urinary bladder of the dog was irradiated experimentally with a microwave energy of 2450MHz, to examine thermal distribution after the irradiation and to confirm the safety of the procedure. Furthermore, 21 patients with urinary bladder tumor were treated by this technique.
The results obtained were as follows:
1) In the bladder wall, a semispherical portion of 1cm in radius of the tissue which contacted with radiator was heated by microwave energy to 50°C or more.
2) The bladder mucosa changed in color to white immediately after the microwave irradiation. Histological examination revealed a recovery of the mucosal layer, submucosal bleeding and fibrosis in six weeks.
3) Microwave coagulation procedure was performed in 21 patients with transitional cell carcinoma of the urinary bladder. Seventeen patients, except for 4 patients who received radical cystectomy, showed a complete response, although within several months, 2 patients subsequently showed recurrence in a different part of the bladder. Histological examination of the excised specimen revealed complete erradication of the tumor in two patients. In the remaining 2 patients with high stage tumor (T4), vivid tumor cells in the urethra or vaginal wall were noted.
4) Although technical difficulties and severe complications were not encountered, transient urinary frequency and calcification of the bladder wall were noted.
The results of this study indicate the possibility of the microwave coagulation procedure not only for superficial bladder tumor, but also for invasive tumors.

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Between September, 1984 and June, 1986, Extracorporeal Shock Wave Lithotripter (ESWL) has been installed in 11 hospitals. During this period, totally 3, 702 patients were treated. The male to female ratio was 2.7, being higher than natural ratio of stone formers. The stone position was predominant in the renal pelvis and ureteropelvic junction (71%). Ajunctive endourologic treatments were required in 7% of the patients. The stone fragments passed completely by 6 months in 79% of the patients. The retained fragments larger than 4mm were encountered in 4%. Major complications were renal hematoma, gastrointestinal bleeding and septicemia which required careful urological management of all patients. Relatively larger stones require adjunctive endourological treatment to reduce the complication, to reserve renal function and to obtain good clinical result.
ESWL will be a first choice for stones above the iliac crista when appropriately utilized.

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Two cases of urethral polyp with prostatic-type epithelium were reported. One was a 36-year-old male and the other was a 69-year-old male. They were presented with hematuria and hematospermia, respectively. Polyps were recognized at the prostatic urethra in the vincinity of the vermontanum in both patients. These lesions were treated with TUR.
One (36-year-old) developed recurrence 4 years after the initial TUR. These polyps in both patients were found to be covered by columner cells which were stained positively by PSA (prostate specific antigen) and PAP (prostatic acid phosphatase) using immunohistochemical methods. This suggested that the epithelium of these lesions were of prostatic type. In some areas of the recurrent specimen from the 36-year-old case, the head of this polyp was lined by transitional cell epithelium and the foot by the prostatic-type epithelium. These observations were discussed with special emphasis on the nature and histogenesis of this lesions.

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A 62-year-old man was hospitalized for evaluation of a mass above the right kidney discovered incidentally during ultrasonography for long-lasting microscopic hematuria. He was asymptomatic except for gait disturbance and dysarthria. Past history was unremarkable except for spino-cerebellar degeneration. Physical examination revealed no palpable abdominal masses. Laboratory data were all within normal range except for slight leucocytosis. The hormonal and various radiological examinations disclosed the mass to be a non-functioning adrenal tumor. The tumor was removed operatively and the pathological examination, including immunohistochemical study against laminin, revealed adrenal cavernous hemangioma. Adrenal hemangiomas are rare and seldom found ante mortem. This is the 36th reported case in world literature. The pertinent literature is reviewed.

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Bilateral spermatocytic seminoma in 50-year-old man was described. Bilateral orchiectomy and preventive irradiation therapy for retroperitoneal lymphonodes were performed. The patient is doing well after 3.7 years' postoperative follow-up without clinical evidence of metastatic disease.
The literature on the spermatocytic seminoma was reviewed. The review of 2981 testicular seminomas disclosed 115 of the spermatocytic type. The patients with spermatocytic seminoma were distinctly older than those with classical seminoma: the peak incidence on the 40 to 49 and 65 to 74 age groups, mean 55.7 year-old. Bilaterality in 8 of 74 cases with spermatocytic seminoma in the literature was more frequent than that with classical seminoma. This neoplasm had good prognosis and was rarely associated with metastasis.

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