Eighteen patients with renal neoplasm underwent magnetic resonance imaging (MRI) using a 1.5 Tesla superconducting magnetic system and spin echo images were obtained by quick scan technique under holding breath. MR images were interpreted independently of the computerized tomography (CT) findings.
The preoperative stagings of the 18 renal carcinomas, as judged by MRI, were compared with those obtained at laparotomy. The anatomic staging was correctly performed by MRI in 13 patients (72%). In the patients who had intrarenal small tumor with normal renal contour, MRI demonstrated a solid mass clearly distinguishable from surrounding renal parenchyma using the paramagnetic contrast agent (gadolinium-DTPA). When compared with results of evaluation by CT in staging, MRI appeared to have several advantages in determination of whole mass; the detection of tumor thrombus into renal vein and inferior vena cava; and the evaluation of direct tumor invasion of adjacent organs.
MRI should play an important role in the staging of renal cell carcinoma.

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Urinary low molecular fractions (less than 10, 000mol. wt.) were obtained by gel filtration chromatography of urinary nondialyzable materials from a male calcium oxalate containing stone former. It was found that the low molecular fractions promoted the aggregation of calcium oxalate seed crystals and resulted in the formation of small spherical bodies of the crystals. The volume-size distributions of the crystals were also measured to ascertain the aggregating activity of the fractions by means of Coulter counter method. The aggregating activity of the low molecular fractions to the crystals was decreased in the presence of urinary high molecular fractions which were fractionated from the same urinary nondialyzable materials and had an inhibitory activity of calcium oxalate crystal growth. It is supposed that the low molecular promoter is an uronic acid-rich glycoprotein, because the fractions having aggregating activity had high contents of uronic acid.

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We investigated differences in the density of muscarinic receptors between emptied and distended canine bladders after urinary diversion.
Adult female mongrel dogs were used. The experimental groups were as follows: 1) control bladders (n=8), 2) disused empty bladders (n=9), 3) disused bladders, distended with 100ml saline (n=5). Disuse was surgically achieved by bilateral ureterocutaneostomy. One week postoperatively, the bladder was removed and separated into body and base at the level of the ureteral orifices. A homogenate of each specimen was incubated with 10 different concentrations of ³H-quinuclidinyl benzilate. The maximal number of binding sites (Bmax), i. e. the receptor density, was derived by Scatchard analysis.
Compared to the controls, the density of muscarinic receptors in disused bladder body decreased significantly in the bladders which had been kept empty, but increased in those distended with 100ml saline (p<0.05). In bladder base, there was no significant difference in the receptor density between the controls and the emptied bladders, though the density increased significantly in distended bladders (p<0.05). The bladder body contained a significantly greater number of muscarinic receptors than the bladder base in all experimental groups.
We conclude that when filling and voiding cycles cease, tension on the smooth muscle governs the density of muscarinic receptors: loss of tension decreases the receptor density and maintenance of tension increases it.

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The sizes of the normal prostate were measured in 343 subjects aged 0 to 80 years by means of transabdominal sector scanning, and the growth of the prostate was studied. The weight of the prostate was computed using the formula for ellipsoid objects.
In the first decade, the prostate grew slowly, and the mean prostatic weight was 1.8g. in men between 6 and 10 years old. In the second decade, the prostate grew rapidly, and the mean weight became 16.0g. in men between 21 and 25 years old. There were good correlations between the prostatic weight and the age, the height, the body weight, or the body surface area in the first and second decades.
The prostate increased in weight slowly in men over 20 years old, too. After the mean weight became 21.1g. in men bewteen 36 and 40 years old, the prostate decreased in weight temporally in the fifth decade. In men between 51 and 70 years old, prostatic weight was stationary at 22 to 23g., and decreased again in men over 70 years old.

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Urological diseases in 159 cases of the severely mental and physical handicapped, aged 3 to 50 years, were studied. Urinalysis and ultrasonography were used as the screening examination.
Pyuria was recognized in 91 cases (57.2 percent), and the high incidence of pyuria were in females, especially nonmenstrual females, cases with serious motor disturbance and diapered ones. Organisms were isolated from 35 cases (38.5 percent).
On the imaging diagnoses, there were 49 urological diseases in 40 cases (25.2 percent), that is, 10 renal stones, 6 renal cysts, 6 hydronephroses or hydroureter, 17 bladder transformations or bladder neck opening, etc. In addition to the past history during the last year, there were 24 urolithiases (15.1 percent), that is, 13 spontaneous voiding of stones, 10 renal stones and one bladder stone.
In the study of cases with urolithiases, the more serious the motor disturbance was, the higher the incidence of stone formation and the less the incidence of spontaneous voiding of stones.
Ultrasonography was very useful in this study because many unexpected urological diseases were diagnosed by means of it.

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To clarify the pathogenesis of congenital hydronephrosis, the walls of renal pelvis, pelvi-ureteric junction (PUJ) and ureter were studied by both light and electron microscopic techniques and the results were compared to those of secondary hydronephrosis and normal pelvis and ureter. Materials were obtained from 12 patients with congenital (idiopathic) hydronephrosis (I), 2 cases of congenital hydronephrosis with long narrowed segment (I′), 2 cases of secondary (idiopathic) hydronephrosis (II) and 5 patients with other diseases control (III).
The results were as follows.
1. In groups (I) (I′) and (II), there was no abnormality in the renal pelvic musculature.
2. In groups (I) (I′) and (II), excessive amounts of collagen fibers were noted around and between the smooth muscle cells in the renal pelvis.
3. In groups (I) and (I′), atrophic muscle cells were widely separated while the nexus was ruptured in the PUJ.
4. Unmyelinated nerve fibers were not observed in the narrowed PUJ in groups (I) and (I′).
5. There was no muscular abnormality, but nerve supplies were not observed in the normal calibre upper ureter in groups (I) and (I′).
On the basis of the above findings, we consider the narrow segment of the ureter to be of principal importance in the aetiology of the condition, and morphological changes proximal to this segment were thought to arise in responce to over distension.

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To elucidate the early phase of prostatic carcinoma, a retrospective study of 48 cases of incidental prostatic carcinoma was carried out. Tne biological significance of this disease was investigated on the basis of tumor size and histopathological features. A definite tendency was found between tumor size and its histological features. As the tumor progressed in size, there was a corresponding increase in its malignant potential. Namely, a large number of grade 1 (Gleason score 2-4) tumors were included in the group of less than 10mm in diameter, but a sufficient number of grade 2 or 3 (Gleason score 5-10) tumors measured more than 10mm in diameter. It is suggested that the early phase of prostatic carcinoma is devided into two biologically different groups. Management decision may be influenced by the classification of these groups such as stages A_{1 and A}2.

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Experiments were conducted in order to examine the mechanism of changes in the renal hemodynamic response to acute renal-pelvic pressure elevation.
Thirty mongrel adult dogs weighing from 10kg to 18kg were used. They were divided into four groups: control group (n=8), decapsulation group (n=8), ischemic group (n=5), and denervated group (n=9), All around detachment was conducted for detachment of the renal capsule, and complete surgical block, in which the renal nerves were completely dissected and reanastomosed at the bifurcated part of the abdominal aorta, was conducted for denervation.
Renal blood flow increased transiently in response to acute renal-pelvic pressure elevation and in the decapsulation group, the increase was more marked. The renal nerves did not participate in the mechanism of increase in renal blood flow.
The mechanism of transient increase in renal blood flow in response to acute renal-pelvic pressure elevation was considered to be a local response which occurred through the mechanoreceptors which existed in renal parenchyma and perceived renal interstitial pressure. Moreover, though renal blood flow increased transiently as renal-pelvic pressure was elevated up to around 55mmHg, it showed a decreasing tendency when pressure was elevated more than that. This decrease in renal blood flow was considered to occur by renal interstitial pressure which was influenced by renal-pelvic pressure acted on vasculature in renal parenchyma. However, this renal interstitial pressure did not necessarily respond to renal-pelvic pressure in one-to-one relation, but it was considered to be able to put pressure on renal vasculature and decrease renal blood flow even in a comparatively slight elevation of renal-pelvic pressure, because it was influenced by changes in the elastic modulus of renal parenchyma, the capacity of the renal pelvis, etc.

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The significance of vascular invasion of tumor cells in bladder cancer was estimated with surgical specimen of 43 patients treated by total cystectomy from January 1978 to February 1986. The results are summarized as follows:
1) The vascular invasion of tumor cells was observed in 14 out of the 43 cases (32.6%).
2) The survival rate of the cases without vascular invasion of tumor cells was significantly higher than that of the cases with vascular invasion (p<0.01).
3) Eleven of the 14 cases with vascular invasion of tumor cells (78.6%) were with high grade (grade 3) tumor. Eleven of the 26 cases with high grade tumor (42.3%) showed vascular invasion of tumor cells. On the contrary, only 3 of the 17 cases with low grade (grade 1 or 2) tumor (17.6%) exhibited vascular invasion of tumor cells.
4) Ten of the 14 cases with vascular invasion of tumor cells (71.4%) were with high stage (pT3 or pT4) tumor. Ten of the 13 cases with high stage tumor (76.9%) showed vascular invasion of tumor cells. On the contrary, only 4 of the 30 cases with low stage tumor (13.3%) exhibited vascular invasion of tumor cells.
5) There was no significant difference in the incidence of vascular invasion of tumor cells between the cases with and without preoperative radiotherapy.
6) Four of the 14 cases with vascular invasion of tumor cells received postoperative adjuvant chemotherapy. Their prognosis was much better than that of the remaining 10 cases without postoperative adjuvant chemotherapy. We emphasized that patients with vascular invasion of tumor cells should be treated as cases with early micrometastases, even though they cannot be detected clinically.

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From 1976 to June, 1986, twenty-eight patients with metastatic renal cell carcinoma were treated by arterial drug infusion. The majority of them had pulmonary metastases, and others had bone, liver, and retroperitoneal lesions. For pulmonary lesions, drugs were infused through the bronchial and/or intercostal arteries; and for other lesions, through the lumbar, hepatic, splenic, and internal iliac arteries. Chemoembolization was sometimes combined for bone, liver, and retroperitoneal metastases. Mainly, mytomycin C, and sometimes carboquone, adriamycin, and ACNU were used as cytotoxic agents.
Only pulmonary lesions with abundant blood supply from feeders showed tumor regresson, but the response rate (CR+PR) were 23.5% in the right lung, and 25.0% in the left lung. No objective response was observed in other metastatic lesions, but subjective symptoms, such as lumbago, gait disturbance caused by bone and retroperitoneal metastases were drastically relieved. Side effects by this treatment were not remarkable and all patients tolerated well.

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Five hundred and eleven patients with benign prostatic hyperplasia or bladder neck contracture who had undergone transurethral resection from 1978 to 1982 and had shown no evidence of malignancy were reviewed as to postoperative complications and long-term results. Operative death occurred in 2 patients who had septicemia. Postoperative hemorrhage developed in 2.5 percent of all patients, epididymitis in 7.6 percent, urethral stricture in 5.5 percent, bladder neck stricture in 1.4 percent and recurrence of benign prostatic hyperplasia in 3.9 percent. Reoperations including additional transurethral resection were required in 6.8 percent of all patients. Preoperative urinary infection or indwelling catheter were not significantly related to the occurrence of epididymitis. Questionnaires sent oafter an average of 3 years 5 months clarified that 94 percent of the patients were satisfied with their urination, while patients who had undergone a resection of small amounts of tissue or an incomplete resection, or who had shown a low urinary flow rate at discharge from the hospital tended to be unsatisfied with their urination.

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Hydronephrosis of pregnancy has been known for over 200 years. Ultrasonographic examination of the kidney in 30 pregnant women was performed to measure the kidney size (length, thickness and width) and maximum renal pelvic diameter. Renal morphological changes during pregnancy and after delivery were observed to determine the degree of dilatation and the time of onset. Whether the dilatation affects renal function was investigated from chemical examinations (U-NAG and U-BMG).
1. As to the kidney size of pregnant women, the width was increased markedly compared with the kidneys from non-pregnant women.
2. The onset of hydronephrosis was seen from the second trimester of pregnancy and 73 percents of pregnant women showed some degree of dilation of the renal pelvic diameter.
3. Hydronephrosis in pregnancy was more freguent and more intense in the right kidney than the left.
4. The degree of hydronephrosis in pregnancy did not correlate with renal function.
5. The degree of hydronephrosis did not correlate with the symptom of toxemia.
6. It is thought that hydronephrosis in pregnancy restores within one month after delivery.
Ultrasonographic examination demonstrated that pregnancy provoked hydronephrosis, but restoration after delivery was pronounced. Changes of physiological milieu in pregnancy provoke transiently hydronephrosis, but it is thought that the effects upon renal function were slight during pregnancy and after delivery.

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Serum placental leucine aminopeptidase (P-LAP) activities were measured using leucyl-p-nitroanilide as a substrate and coexisting other LAP activities were blocked with 2mM of L-methionine and evaluated clinically as a tumor marker of renal cell carcinoma. From the mean±2S. D. in normal male subjects, 22-67G-R unit was decided as normal range in male cases. Based upon Mizutani's report, 20-49G-R unit was similarly regarded to be normal range of females. A total of 243 sera from various urological diseases including 47 of renal cell carcinoma were examined for serum P-LAP values. Positive rates in major diseases were as follows; 3% (4/135) of normal males, 50% (15/30) of male and 18% (3/17) of female renal cell carcinoma, 14% (6/44) of male and 11% (1/9) of female uroepithelial tumor, and 5% (1/20) of male and 38% (3/8) of female chronic renal failure. By students't test, a group of renal cell carcinoma showed statistical high serum P-LAP values in male cases (p<0.05). Serum P-LAP values in 14 patients with renal cell carcinoma changed in parallel to clinical courses. However, serum P-LAP and LAP activities showed a strong correlation (r=0.799). These results suggest that determination of serum P-LAP activities may be useful for detection and follow-up of renal cell carcinoma, especially in male cases. Moreover, development of an immunological assay for specific determination of P-LAP must be necessary for avoiding cross reaction with other aminopeptidases and this assay system will clarify the significance of P-LAP as a tumor marker of renal cell carcinoma (Supported in part by Grant-in-aid from Ministry of Education, Japan).

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Ten patients with advanced refractory non-seminomatous germ cell tumors of the testis were treated with VP-16 alone or in combination with cisplatin (CDDP). All patients had previously undergone PVB therapy (cisplatin, vinblastine and bleomycin). One patient showed complete response, while 3 showed partial response. Therefore, the overall response rate was 40%. One patient with complete response remained disease free for 40 months. Three patients with partial response showed progression of disease after 1.5-4.5 months. The toxicity was moderate and reversible. All 10 patients had alopecia and nausea. Six patients had granulocytopenia (<3, 000/mm³), 2 thrombocytopenia (<10×10⁴/mm³), and 2 anemia (Hb<10g/dl). Responses to prior PVB therapy and tumor burden were recognized as being of prognostic value. Patients who had responded to prior therapy or patients with minimal disease were more likely to respond to salvage therapy; the response rates were 57% and 75%, respectively. VP-16 is an active agent for salvage therapy in refractoy germ cell tumors of the testis.

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Chemotherapeutic effects of anticancer drugs were studied using human Wilms' tumor transplantable to nude mice. Tumor fragments were implanted subcutaneously into nude mice. Drugs were singly administered in schedule of q4d×3 when the estimated tumor weight reached from 100 to 300mg. The drugs used for the experiments were actinomycin D (ACTD), vincristine (VCR), cyclophosphamide (CPA), cisplatin (CDDP), and carboplatin (CBDCA). The doses of drugs for total administration were LD₅₀, 1/2 LD₅₀, 1/4LD₅₀ and 1/8LD₅₀ for mice. Chemotherapeutic effects were evaluated by retardation of tumor growth and histological findings. Significant effects of retardation of tumor growth were seen at the doses of LD₅₀ and 1/2LD₅₀ with all drugs, and at the dose of 1/4LD₅₀ with ACTD, VCR and CPA. Histological effects were seen at the dose of LD₅₀ with ACTD, VCR, CPA and CDDP, and at the dose of 1/2LD₅₀ with CPA. Histological effects were not always in parallel to effects of retardation of tumor growth.

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It was examined whether prophylactic administration of antibiotics was required after the treatment of urolithiasis by extracorporeal shock wave lithotripter (ESWL). Eighty-four patients with totally 91 stones in the upper urinary tract were included in the study. The patients were randomly divided into the two groups; i.e., chemotherapy and control (non-chemotherapy) group. In the chemotherapy group, bacteriuria was observed in seven cases both before and after the treatment by ESWL. In the control group, it was observed in five cases before and in seven cases after the treatment. There was no significant difference in the frequency of bacteriuria between the two groups. Similary there was no significant difference between the two groups in the frequency of pyuria, erythrocyte sedimentation rate, white blood cell count of the degree of fever.
The freguency and degree of urinary tract infection were further examined in the relation to the urinary tract obstruction by disintegrated stone fragments. White blood cell counts were significantly higher in the obstracted group than in non-obstracted group at one and three days after ESWL. The frequency of pyrexia and pyuria were also higher in obstructed group than in non-obstructive group.
It was concluded that prophylactic administration of antibitoics was not necessary for all patients even if accompanied with pyuria. However, prophylactic treatment was necessary for patients with relatively large stone (greater than 3cm) which might result in obstruction of the urinary tract after ESWL.

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Immunohistochemical study with monoclonal anti Leu-M1 antibody was performed on 25 cases of renal cell carcinoma because it was known that Leu-M1 could be used as a marker for proximal convoluted tubules. The overall positive reaction was observed in 17 out of the 25 cases. 14 out of 16 low grade cases (grade 1 & 2) showed positive reaction, suggesting that renal cell carcinoma was originated from proximal convoluted tubules. One of the negative cases was thought to be derived from distal convoluted tubules because the tumor cells were positive with Tamm Horsfall Mucoprotein. The other negative case was thought to be due to inadequate fixation. 3 out of 9 cases of high grade cases (grade 3 & 4) showed positive reaction, which suggests that Leu-M1 reactivity decreases as dedifferentiation progresses. One of the high grade cases with strong positive reaction showed good response to the treatment. The result of this study indicates that Leu-M1 may be used as a useful marker for evaluatin of renal cell malignancy.

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The purpose of this research is to study if there are any harmful effects of the focused shock wave on various tissues and organs in animal experiments (mongrel dog of either sex, 10-15kg). In the experiment, we used 9 non-treated dogs and 8 treated dogs in which human renal calculus or activated alumina had been placed in the kidney previously. The dogs received 20-500 times focused shock waves, which were generated by explosion of a 10mg lead azide pellet. And the animals were divided into 2 groups: in the first group, the dogs were sacrificed immediately after the experiments. In the second group, the dogs were sacrified 3 months after the experiments. Specimens were taken from different tissues and organs and examined microscopically. The following results were obtained.
1. The first group: i) Kidney: red blood cells were found in the lumen of the tubules, and peritubular capillary bleeding was noticed in all dogs. The severity of these findings correlated with the number of explosions. Glomerular bleeding was noted in a case which was received 500 times of shock wave. ii) Lung: in all cases alveolar bleeding was observed on the lower margin of the lung, which was the same side of the targeted kidney. And the severity of these findings correlated with the number of explosions. iii) Other organs: In a case which was received 500 times of shock wave, the bleeding was noticed on the head of the pancreas and mesenterium. The bleeding side was the same as the targeted kidney. No particular finding was noticed in other organs.
2. The second group: i) Kidney: none of the changes observed in the first group was noticed except some glomerular fibrosis, which was noticed in the dog which received 500 times of shock wave. But when the stone destruction was incomplete and a fragmentated stone obstructed the ureter, the kidney led to hydronephrosis and parenchymal atrophy. ii) Lung: none of the changes observed in the first group was noticed, but proliferative change was found in some parts. iii) Other organs: no particular finding was noticed in not only the pancreas and mesenterium but also the other organs.
The results indicate that the main harmful effect of shock wave was bleeding. But little microscopic changes were noticed after 3 months in the kidney and lung. This finding suggests that the changes in various organs induced by shock wave were not severe. From the data of parenchymal atrophy in the case of urinary obstruction, fragments, if they remain and cause the obstruction of the ureter, should be removed as soon as possible. And precise targeting of the stone is important, otherwise bleeding in the pancreas and mesenterium may occur due to inadvertent focusing of shock wave on these organs.

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Presented is bilateral renal cell carcinoma with intracaval tumor thrombus in a patient undergoing chronic hemodialysis.
A 38-year-old man visited our clinic with the complaint of hematuria after 11 years of maintenance hemodialysis. Bilateral renal tumor with intracaval tumor thrombus was diagnosed by CT scan, echography, renal angiography and inferior venocavography. There were no clinical signs of distant and lymphogenous metastases. Right radical nephrectomy with extirpation of tumor thrombus and left nephrectomy were done. Pathologically, tumors occupied almost the whole area of the right kidney and the lower-pole of the left kidney. The remaining bilateral renal parenchyma had been replaced by small cysts. Histological examination revealed clear cell adenocarcinoma (grade 1) in the bilateral renal tumors and caval thrombus.
Previous reports indicate an extraordinarily high incidence of renal cell carcinoma in acquired cystic disease of the kidney (ACDK) in patients undergoing chronic hemodialysis, which suggests the indication of prophylactic bilateral nephrectomy for ACDK.

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One case of histologically verified renal cell carcinoma with pulmonary metastasis that attained complete regression by UFT was reported. The patient was a 57-year-old man. He was asymptomatic, but by physical examination an abnormal shadow of the left lung was pointed out. From the results of examinations, the patient was diagnosed to have pulmonary metastasis of renal cell carcinoma. He underwent redical nephrectomy. The pathological diagnosis was renal cell carcinoma of mixed subtype, grade 3, pT₃N₂. For the pulmonary lesion, transbronchial biopsy was performed and pulmonary metastasis of renal cell carcinoma was verified. As an adjuvant therapy, interferon was administered with no response. Therefore, a treatment with UFT at 3 capsules (300mg)/day was started 5 months postoperatively. On the 69th day of this treatment, partial regression was seen for pulmonary metastasis and complete regression on the 158th day. After that he received UFT continuously. At lyear and 5months after the operation complete regression of the pulmonary metastasis had persisted for 7 months. He has survived with no relapse till now.

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