³¹P NMR (nuclear magnetic resonance) is a noninvasive method of studying the metabolic state of biological tissue. The energy metabolism of ischemic rabbit kidneys was studied by ³¹P NMR. Some phosphorylate metabolites including ATP and inorganic phosphate could be detected. It was also possible to determine intracellular pH. The ischemic kidneys showed a rapid depletion of energy stores. After ischemia the intraceullular pH decreased as the ATP level in the renal tissue dropped. However, the intracelluar pH decreased slowly before reaching the minimum value (pH 6.5). After ischemia the kidneys were perf used with the perfusate which included fluorocarbon emulsion. The perfused kidneys showed recovery from the ATP depletion and intracellular acidosis. However, the kidneys subjected to long ischemic periods could not regain the preischemic ATP levels and intracellular pH. Intracellular pH measured by ³¹P NMR was found to be a usefull prameter of tissue viability. According to these experiments, ³¹P NMR, which is a noninvasive method, may be applied to the clinical practice of renal preservation.

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³¹P nuclear magnetic resonance (NMR) provides much information about the energy metabolism of living systems. Although the NMR is nondestructive, most studies have been carried out on excised, perfused organs and tissues. However, it is necessary to study the metabolism in vivo of living systems. NMR specta from a selected, localized place are obtained using topical magnetic resonance (TMR). The energy metabolism of a selected organ in a living animal can be measured with ³¹P TMR. I report here on the energy metabolism of kidneys in live, anesthetized rabbits measured by ³¹P TMR. Some phosphorylated metabolites could be detected. The ATP signal of a ischemic kidney disapperaed within 30 minitutes, while the Pi signal increased. The recovery of the parameter of ATP intensity/Pi intensity on ischemic kidneys was studied. Kidneys subjected to ischemia for a shorter time than one hour mostly recovered. However, kidneys subjected to ischemia for a longer time than two hours recovered poorly. This result agreed with the ability to regenerate ATP in different ischemic kidneys measured by high pressure liquid chromatography. It seemed that the parameter of ATP intensity/Pi intensity was suitable for the assessment of the severity of ischemic kidney damage. I think that ³¹P NMR can be a useful clinical tool.

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It was studied whether the sparing of sacral sensation could predict the later recovery of bladder function in patients with spinal cord injury. Eighty-six traumatic tetraplegic and paraplegic patients, 77 males and 9 females, ranging 16 to 74 in age were admitted to Iizuka Spinal Injuries Center within two weeks after injury. They were managed strictly by intermittent catheterization with a non-touch technique to prevent complications of the bladder during the period of spinal shock. When the icewater test turned positive, voiding training was started and subsequent urodynamic study was followed to evaluate the recovery of bladder function.
Depending on the neurological findings on admission the patients were divided into two groups for evaluation;
1) group S: 46 patients had incomplete spinal cord lesions with sparing of sacral sensation.
2) group N: 40 patients had complete spinal cord lesions without sacral sensation.
The results were as follows;
1) The period of spinal shock was significantly shorter in group S (56.0±59.5 days) than in group N (95.0±67.2) (p<0.05).
2) The urodynamic study during the recovery phase showed that normotonic bladders with synergic urethra were seen more frequently in group S than in group N, although more hypertonic bladders with detrusor sphincter dyssynergia were in group N than in group S (p<0.01).
3) Twenty-two patients in group S acquired controlled voiding function, although those in group N managed themselves either with intermittent catheterization or with trigger voiding requiring the urinary device.
In conclusion, the sparing of sacral sensation is an important clinical indicator for future recovery of the bladder function in patients with spinal cord injury.

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Fifty-nine patients with prostatic cancer of the prostate were treated with LH-RH agonist. LH-RH agonist was administered by subcutaneous injection (SC), non-biodegradable delivery system (vinyl polymer composite, VPC), biodegradable delivery system (poly lactic acid composite, PLAC) and intranasal spray application (IN). Leuprolide was used for SC, VPC and PLAC, and Buserelin for IN.
Serum testosterone level was decreased below 1ng/ml by these administration methods in all patients except one who was treated by IN. Fifty-two patients who had not been treated before and had been treated for up to 3months were evaluated according to NPCP criteria. Of these fifty-two patients, thirty-one had partial response, and 18 were stable and 3 with progression. All five patients previously treated by estrogen and/or progesterone were stable.
Serum testosterone level in the patients who were treated for the longest period by one VPC was suppressed below 1ng/ml, and serum leuprolide level was still detectable for more than 616days. It was also shown that serum testosterone level was suppressed below 1ng/ml for more than 5weeks by PLAC which contains 5mg of leuprolide. However, in the cases treated by SC, it is difficult to decrease daily leuprolide dose below 1mg because serum leuprolide concentration was rapidly decreased after one shot subcutaneous injection and it was not detected after 24 hours. Judging from these results, it was concluded that the continuous administration method (VPC and PLAC) is superior to intermittent one (SC) in cost effectiveness.

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The effect of autonomic drugs on ureteral urine transport was studied using the canine in vivo model by perfusing of saline into the renal pelvis in the constant pressure condition. Administration of norepinephrine caused elevations of renal pelvic pressure and intraureteral pressure, an increase of the peristaltic rate, and decreases of bolus volume and urine flow rate. Phenylephrine, which acts primarily as an α1 adrenergic agonist, increased the intraureteral pressure and the frequency of ureteral peristalsis, and decreased bolus volume and urine flow rate. Clonidine, an α2-receptor agonist, showed a tendency to stimulate ureteral peristalsis. In contrast, isoproterenol lowered the renal pelvic and intraureteral pressure to the extent of pressure wave disappearance and caused a complete inhibition of ureteral peristalsis for variable period.
Terbutaline, a β2-adrenergic agonist, lowered the intraureteral pressure and caused a decrease of the peristaltic rate and an increase of bolus volume. Phentolamine produced the almost reverse effect as norepinephrine or phenylephrine. Prazosin, a selective α1-adrenergic antagonist, lowered the intraureteral pressure and caused a decrease of the peristaltic rate, and an increase of bolus volume and urine flow rate. Yohimbine, an α2-adrenergic antagonist, lowered the intraureteral pressure and produced a disappearance of ureteral peristalsis.
Propranolol, metoprolol, and butoxamine caused no significant change on ureteral peristalsis. Acetylcholine slightly reduced the renal pelvic pressure, but elevated the resting pressure of the intraureteral pressure, and caused an increase of the peristaltic rate, and decreases of bolus volume and urine flow rate. Atropine produced no obvious effect on ureteral peristalsis. It was suggested that α-adrenergic agents caused an increase of pelviureteral muscle tonus which produced a decrease of urine flow rate, because bolus volume decreased significantly in comparison with an increase of peristaltic rate. It seemed that the ureter had α1 and α2-adrenergic receptors, and both receptors produced acceleration of ureteral peristalsis. On the other hand, β-adrenergic agents might cause a decrease of pelviureteral muscle tonus and inhibition of ureteral peristalsis, but an increase of bolus volume. Cholinergic agents might directly affect the ureter and increase ureteral muscle tonus to cause decreases of bolus volume and urine flow rate.

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For the purpose of establishing a most reliable parameter of organe viability, variation of several populer enzymes, such as LDH, GOT, GPT, Al-P, and CPK in perfusate were studied in the experimental system of the isolated perfusation of the dog kidney.
Prior to preservation, each kidney was subjected to a warm ischemic intervention, varying from 0min to 120min.
The kidney was perfused using with dog fibrinogen free plasma for 18hours at 8°C by specially deviced machine (ORPH 2000C). A variation of each enzymes in perfusate was analysed based upon not only warm ischemic time (WIT) but also the graft function after the auto-re-transplantation and discussed about its availability as index parameter of viability from the view point of the severity of a mitochondrial damage indused by WIT.
In this experiment, several following results could be confirmed, which was assumed to be a valuable for clinical application, especially in renal cadavor transplantation.
1) LDH and GOT in perfusate increase linearly up to as high as 9.6 times of initial value in LDH, and 4.8 times in GOT at 18 hours of preservation, and their variation showed a significant dependence on WIT.
2) CPK in perfusate showes a linear increase along with time course of the preservation, as same as variation of LDH and GOT, but does not show any dependence on WIT.
3) GPT in perfusate showes a slight increase on its variation during the preservation, and no effect of WIT could be recognized.
4) Al-P showes little variation during the preservation, and effect of WIT was recognized.

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To elucidate the clinical importance of candiduria, the antibody-coated bacteria (ACB) test of urine and measurement of serum concentration of D-arabinitol, a major metabolite of Candida species, were performed in 20 patients with candiduria. All patients, 16 males and four females, had underlying diseases in the urinary tract and were aged from 39 to 80years with a mean age of 65years. The organism isolated from the urine was Candida albicans in 19 patients and Candida tropicalis in one. A direct immunofluorescence technique was used for the ACB test and the serum D-arabinitol concentration was determined by gas-liquid chromatography. Of 13 patients tested, 12 (92 per cent) showed a positive ACB test regardless of the clinical findings. The serum D-arabonitol level exceeded 0.2μg/ml of the detection limit in 10 of the 20 patients, including 7 of 10 febrile patients (70 per cent) and 3 of 10 afebrile patients (30 per cent). The detection rate of serum D-arabinitol in the febrile patients was significantly higher than that in the afebrile patients (p<0.05). The mean serum D-arabinitol concentration was 4.8μg/ml in the febrile patients, while it was 0.1μg/ml in the afebrile patients (p<0.1). Of all patients, six infected with C. albicans were treated with 5-fluorocytosine orally for 7 to 22days. C. albicans in the urine was eradicated in all cases and elevated serum D-arabinitol levels in four patients were normalized after the treatment. There was no drug-related adverse reactions. From these results, D-arabinitol in serum might be a useful biochemical marker for diagnosis and treatment in patients with candiduria. In addition, 5-fluorocytosine was considered to be an effective antifungal drug for the treatment of C. albicans urinary tract infection.

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A method of measuring attenuation coefficient of reflected ultrasound was developed and a study of tissue characterization in various organs an space occupying lesions was perfomed in vivo. Attenuation coefficeient was calculated with 2 power spectrums obtained by reflected ultrasound from intrested areas in different depth respectively. The principle of this method based on that attenuation coefficient of hyperechoic region is different from that of hypoechoic region. The attenuation coefficient was measured in the liver of noraml individual, solid tumor and cystic lesion in the kidneys and retroperitoneal angiomyolipoma and clinical value of this method was demonstrated. This coefficient is expected to be a useful parameter of tissue characterization.

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It is known that immune response is decreased in patients during chronic hemodialysis (HD), but there have been few reports on the immune response of patients undergoing continuous ambulatory peritoneal dialysis (CAPD). We recently carried out a comparative study on the immune response of patients in CAPD and HD, employing non-specific immune parameters as indexes. The results were as follows. 1) The incidence of OKT8 positive cells was significantly lower in the CAPD group than in the HD group, and the OKT4/OKT8 ratio tended to be higher in the CAPD group. 2) The ADCC activity was closer to the normal level in the CAPD group than in the HD group. 3) In the CAPD group, a possibility of improvement in the PHA skin test soon after the initiation of CAPD was suggested. 4) The serum complement components level, especially the C3 level, was significantly higher in the CAPD group than in the HD group, and the level was found to have been normalized. These results indicate improvement in some of the immune parameters in the CAPD group in comparison with the HD group. It was thus suggested that, in the treatment of patients with chronic renal insufficiency, CAPD is a better dialysis method than HD from the aspect of preventing immunodeficiency.

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We have developed a new system to record urethral pressure curves separately for the anterior, posterior, right and left walls of the urethra. It consists of a catheter with four channels running radially along the axis in 90° sectors from the bladder to the external urethral orifice and expresses the data stereographically with a computer system. We call the graph obtained by this recording system “stereographic urethral pressure profile” (stereo-UPP).
The overlapping innervation of the two sides of the canine urethra by the hypogastric and pudendal nerves was investigated by this method. Unilateral transection and stimulation of the two nerves were performed and the effects on the stereo-UPP were studied in 22 female decerebrated dogs.
1) In the decerebrated preparation, a highly reproducible shape of the stereo-UPP was demonstrated.
2) Unilateral hypogastric nerve transection and stimulation resulted in the pressure drop and rise, respectively, over the four directional proximal urethra almost equally. The ipsilateral urethral response was not significantly different from the contralateral response.
3) Unilateral pudendal nerve transection resulted in a pressure drop over the four directional distal urethra almost similarly. On unilateral pudendal nerve stimulation, the pressure rise over the four directional distal urethra was produced almost equally in 7 out of 10 dogs. The ipsilateral urethral response was significantly greater than the contralateral response in 3 out of 10 dogs.
These results suggest that there is a substantial overlap in the hypogastric and pudendal innervation of the 2 sides of the spincteric urethra, but the pudendal innervation is partially unilateral.

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Numerous staging systems have been proposed for Stage A prostatic cancer, despite the fact that quantitative criteria distinguishing stage A₁ from stage A₂ have not been established definitively. For this reason we have undertaken the present study on 48 patients with clinical stage A prostatic cancer. In the 48 patients tumor extent and grade were related to the tumor progression and survival rate.
The tumor extent in the specimen was classified into focal (≤10%) and diffuse (>10%) by the pathologist's estimate of percentage of the tumor.
1) The histologic pattern in focal lesions was well-differentiated in 77.0%, while that in diffuse lesions in 40.9%. There was a correlation between tumor extent and grade.
2) Of the 48 patients 6 patients suffered from tumor progression. Of 26 patients with focal lesions only one patient with poorly differentiated lesion had tumor progression, while of 22 patients with diffuse lesions 5 had tumor progression. Of 29 patients with well-differentiated lesions only one patient had tumor progression, while of 19 patients with moderately and poorly differentiated lesions 5 had tumor progression.
3) The patients with focal and well-differentiated lesions were classified as stage A₁ and of these 20 patients no patient had progression. Others were classified as stage A₂ and of these 28 patients 6 had tumor progression.
4) The overall 5-year-survival rate in patients with stage A prostatic cancer was 74.2%. Of 28 patients with stage A₂ lesions 96.4 per cent were treated, there was no significant difference in survival rate between stage A₁ and stage A₂. From our study, we concluded that tumor extent and grade were the 2 factors that accurately predicted tumor progression. And it is concluded that uniform substaging system of stage A prostatic cancer based upon tumor extent and grade should be established.

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We have measured the androgen binding capacity (B_max) of human genital skin cytosol and nuclear extract using ³H-methyltrienolone (R 1881) as a ligand. The sample was incubated for 20h at 4°C, and dextran coated charcoal was used to separate bound from free steroids. The specific binding was defined as the difference between total binding and nonspecific binding which was not displaced by the 100 fold excess cold R 1881. The binding studies were performed in the form of Scatchard plot analysis.
The results were as follows:
1) Steroid specificity studies revealed that dihydrotestosterone and testosterone displaced ³H-R 1881 from the receptor, whereas estradiol and progesterone were much less effective competitors.
2) The dissociation constant (Kd) of R 1881 receptor in genital skin cytosol and nuclear extract were 0.42±0.17 (mean±S.D.) nM and 0.26±0.06nM in 11 normal adult males. Furthermore, those of both cytosol and nuclear fractions were 0.54±0.21nM (n=9) and 0.31±0.18nM (n=7), respectively in patients with abnormal genitalia, and no significant difference was noted compared to normal adult males.
3) B_max of R 1881 receptor in genital skin cytosol and nuclear extract was 5.91±1.84fmol/mg-protein and 18.0±5.18fmol/mg-protein respectively in 11 normal adult males. Although, B_max of R 1881 receptor in cytosol showed wide variations from nondetectable level to high level, those in nuclear extract showed low levels in all patients with abnormal genitalia. Especially B_max with both cytosol and nuclear extract was not detectable in one patient with complete testicular feminization syndrome.
Therefore, it is suggested that this technique is a simple and rapid method to study the androgen receptor in human genital skin and useful for diagnosis of intersex.

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Clinical results of percutaneous nephrolithotripsy (PNL) using an ultrasonic lithotrite were analyzed. Upper urinary tract calculi were successfully removed 97 patients (86.6%) out of 112 patients. In our early series, five patients required open surgery because calculi were not reached percutaneously. The rate of stone extraction increased to 96.7% in the most recent patients.
No severe complications were experienced. The most common complication was fever (36.6%) in the postoperative course. Other complications included perforation of urinary tract (25.9%), hemorrhage (17.0%) and intrapleural fluid (4.5%).
Percutaneous nephrolithotripsy was considered to be an appropriate alternative to an open surgery in patients with upper urinary tract calculi.

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36 patients of cancer of the bladder were treated by partial or total cystectomy during the 4 year period from November 1981 to October 1985.
26 of the 36 cases were positive for vascular invasion in pathologic findings and 18 to the 26 cases received postoperative adjuvant chemotherapy with cisplatin to prevent postoperative metastasis.
In the observation period for an average of 32 weeks two of the 18 cases died of regional recurrence of cancer, however distant metastasis was not evident. The three year survival rate was 83.3%.
10 of negative cases of vascular invasion did not receive adjuvant chemotherapy with cisplatin and the three year survival rate was 85.7%.
Of the eight positive cases of vascular invasion to which cisplatin was not used, three died with regional recurrence or distant metastasis and the two year survival rate was 33.3%.
The side effects were mostly anorexia, nausea and vomiting and myelosuppression was mild and nephrotoxicity was not observed.
The prognosis for positive cases of vascular invasion was poor and it was considered that adjuvant prophylactic chemotherapy with cisplatin for positive cases was effective for prevention of postoperative metastasis.

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The results of 52 cases of testicular seminomas, treated at Tokushima University Hospital and TEKK group hospitals, were analysed after subdiving into typical and anaplastic seminoma.
According to Mostofi's criteria to anaplastic seminoma (mitotic counts are more than 3 per high power field), 41(78.8%) were subdivided to anaplastic subtype. As the result was too high comparing with the literatures, we changed the criteria into more than 7 mitoses per hpf.. Then 12 were classified to anaplastic seminoma. Such difference in frequency of anaplastic seminoma was thought to be attributed to the width of microscopic view field. The new criteria, correcting the variation of the width of view field, should be established.
The five year suvival rate with 12 anaplastic seminomas was 88% (8/9) for stage I, 100% (2/2) for stage II and 0% (0/1) for stage III. Of the two failures, one of stage I refused treatment and another was treated with irradiation only. The five year suvival rate with 40 typical seminomas was 100% (34/34) for stage I, 100% (2/2) for stage II and 71% (3/4) for stage III. One of stage III, treated with irradiation and Cyclophosphamide died. The remaining 3 stage III were treated with combination chemotherapy including CDDP.
When staging is taken into concideration, the prognosis of anaplastic seminoma is as good as typical seminoma.

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90 cases of chance hematuria were examined by selective renal biopsy since 1977. All the cases were diagnosed histologically: 29 were normal; 54 (60%) were with chronic glomerulonephritis; 30 (33.3%) with minimal change; 11(12.2%) focal glomerulonephritis; 7 (7.8%) proliferative glomerulonephritis; 2 (2.2%) membranous glomerulonephritis; 3 (3.3%) menbranous proliferative glomerulonephritis and 1(1.1%) focal glomerulosclerosis.
Complications were noticed in 3 cases (3.3%): each one case of hematoma, lumbago and fever elevation. We recommend selective renal biopsy for patients with chance hematuria strongly, because the procedure is simpe and safe.

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One hundred and eleven patients of renal cell carcinoma without distant metastasis were treated by radical nephrectomy during the last 25 years. In 92 of these patients, several forms of postoperative adjuvant therapies were performed. These include irradiation to the tumor bed, various forms of anticancer chemotherapy and progestin therapy. The remainder of these patients received no adjuvant therapies, and are regarded as the control group.
To evaluate the effects of adjuvant therapies, survival rates of each of the two groups were compared. And these patients were classified by pT category and pathological grade. Patients with pT1 or pT2a tumor had good prognosis regardless of the form of adjuvant therapy. The survival rate of patients with grade 1 tumor was improved by any of the aforementioned adjuvant therapies. Moreover, chemotherapy significantly improved the survivfal rate of patients with pT2b tumor. But these adjuvant therapies showed no benefit for the patients with pT3, grade 2 or 3 tumor. For such patients, another method should be investigated.

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The restoration of the prostate after subcapsular prostatectomy was discussed on 31 cases of benign prostatic hypertrophy using transrectal ultrasonotomographye.
Both the anterior-posterior (A-P) diameter and the superior-inferior (S-I) diameter of the prostate were shortened significantly after the operation. The prostatic weight, the lateral diameter, the A-P diameter and S-I diameter on 31 cases after the operation were proved to be equal to those of the normal prostate on the average.
Transrectal ultrasonotomograms after the operation on 31 cases were classified into 3 groups, namely, Type I; showing sonograms of the normal prostate, Type II; those of chronic prostatitis, and Type III; those of acute prostatitis.
Based on these data on ultrasonotomograms, it was presumed that the prostate after the operation went through the stage of the restoration from Type III toward Type II and its restoration was completed at the stage of Type I. It was also proved that no damage on the seminal vesicles was visualized on sonograms after the operation.

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Since March, 1981, 13 patients with locally advanced transitional cell carcinoma were treated by combined cisdiamminedichloroplatinum (cisplatin) and full dose radiotherapy. They were 10 men and 3 women. The patient ages ranged from 42 to 79 years, with a median of 59. 5 years. The primary sites of transitional cell carcinoma were bladder in 5, ureter in 6, renal pelvis in 1 and prostate in 1. Radiotherapy consisted of a mean tumor dose of 48.7 gray, with a range of 40 to 66.4 gray, was administered with cobalt 60. Cisplatin was infused 5 days a week with a daily dose of 20 to 30mg. 4 patients recieved 2 courses of cisplatin infusion and others 1 or less. Of the 4 evaluable patients 3(75%) achieved a complete response. Toxicity was evaluated for the 13 patients. Mainly gastrointestinal toxicity was noted: appetite loss in 9 (69.2%), nausea and/or vomiting in 5 (38.5%) and diarrhea in 5 (38.5%). Leukocytopenia was noted in 7 patients (53.9%), but in no one leukocyte count was less than 2000/mm³. Mild thrombocytopenia was noted only in 3 patients (23.1%). All of these toxicities were mild, and the patients recovered soon after the therapy. Herein it is discussed about future problems such as solution of interaction mechanism, detection of practical dose and administering method of cisplatin and radiation.

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Optical internal urethrotomy is nowadays considered by many urologists to be a very usefull method of treating urethral strictures because of its simplicity, safety and less burden to the patient compared to urethral dilatation, blind internal urethrotomy or urethroplasty.
This surgical procedure for the male was employed on seventy-four patients in the period between April, 1978 and September, 1984 and these patients have been followed up over one year. The etiology, surgical technique, complication and postoperative management are discussed.
Seventeen strictures were traumatic, twelve gonorrhoeal, four inflammatory, one tuberculous, two congenital, fourteen iatrogenic and twenty-four idiopathic. The results were considered excellent in thirty, good in twenty-four, fair in eleven, poor in four and failed in three out of estimable seventytwo patients. Therefore, our over-all success rate following over one year observation was seventy-five per cent. On the other hand, complications were seen in ten patients, with a over-all morbidity rate of about fourteen per cent. Urinary incontinence occurred in five patients with non-membranous strictures but it was transient and slight in extent. Three patients had false passage formation and in one of them extravasation of the irrigating fluid occurred into the intrascrotal tissues. Two patients had post-urethrotomy bleeding when the indwelling catheters were removed.
Inexpensive and simplified technique, uroflowmetry, is favourable for postoperative evaluation of strictures. In cases suspected of recurrent strictures, we performed urethrography and/or urethroscopy. Most of the recurrences in our series (four out of five cases) appeared during the first postoperative year.
No correlation was demonstrated between the results and the number of incision onto the urethral wall in the separate operation. The duration of postoperative catheterization was recommended to be one to two weeks. The most important factor affecting the prognosis was the length of strictures. Strictures short in length (3cm or less) were most effectively treated by this procedure and the results of treatment for strictures in the region of membranous and bulbous urethra were better than that of pendulous one.
It is concluded that optical internal urethrotomy, which is performed easily and which does not impede a secondary urethroplasty, should be tried as a procedure of first choice for treating urethral strictures.

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