The viability of preserved canine kidneys was experimentally examined by means of enzyme histochemical techniques. Kidneys were removed from intact mongrel adult maledogs, perfused with the medium (RPMI, # 1640, pH7.4-7.5) at 3-5°C, and preserved for up to 120 hours with continuous pulsatile flow with systolic pressure of 40 to 60mmHg and at pulse rate of 60 beats per minute. Specimens were obtained by biopsy at 0, 48th and 120th hour after the onset of the perfusion. Prefixed, frozen or non-frozen thick sections were incubated for the demonstration of alkaline phosphatase (ALPase), Mg²⁺-activated adenosine triphosphatase (Mg²⁺-ATPase), and K⁺-dependent p-nitrophenylphosphatase (K⁺-NPPase) activities employing the lead citrate method (Mayahara, H. et al. 1967, 1980), then processed for light and electron microscopy.
By light microscopy, ALPase revealed the positive activity in the brush border of the proximal tubule cells, Mg²⁺-ATPase in the basal region of the proximal and distal tubule cells, and K⁺-NPPase in the basal region of the distal and collecting tubule cells, respectively. By electron microscopy, reaction products representing ALPase and Mg²⁺-ATPase activities were found primarily in the apical plasma menbrane, while the product for K⁺-NPPase activity was localized along the cytoplasmic surface of the baso-lateral membrane. K⁺-NPPase gradually decreased in activity during the course of the preservation. ALPase and Mg²⁺-ATPase, on the other hand, did not show significant changes in activity. K⁺-NPPase activity appeared to be weakened before the occurrence of the morphological changes such as shortening of the infoldings of tubule cells. K⁺-NPPase histochemistry seems to be useful as a probe to estimate the viability of preserved kidneys in situ..

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The serum level of squamous cell carcinoma related antigen (SCC-Ag.), which is recognized as a tumor marker of cervical cancer of the uterine, was determined by radioimmunoassay and its clinical usefullness in urothelial malignancies was evaluated. A total of 94 sefa from 86 cases of bladder or upper urinary tract cancer, 5 of penile cancer, 1 of scrotal cancer, and 2 of urethral cancer were analyzed for serum SCC-Ag. levels.
The mean±standard deviation (S. D.) of serum SCC-Ag. levels and positive rate (>2.0ng/ml) in each desease were 3.4±0.98ng/ml and 27%, respectively, in uroepithelial cancer, 1.8±3.1ng/ml and 20% in penile cancer, 21ng/ml and 100% in scrotal cancer, and 16.9±12.1ng/ml and 100% in urethral cancer. Although there was no correlation between site of cancer and frequency of squamous cell carcinoma of urothelial cancer group, patients with cancers of the upper urinary tract (n=23) showed statistical high serum SCC-Ag. levels than those with bladder cancers (n=63), namely 7.2±3.5 vs 2.1±0.22ng/ml (p<0.03). serum SCC-Ag. level was 2.6±0.55ng/ml in transitional cell carcinoma (n=78), 16.1±14.5 in squamous cell carcinoma (n=5), and 2.1±0.067 in adenocarcinoma (n=3). Neither pathological staging nor cell grading of urothelial cancer showed no relation to serum SCC-Ag. levels. Serum SCC-Ag. values changed with clinical course in 4patients.
These results suggest that, because there is no specific tumor marker in uroepithelial cancer, the detection of serum SCC-Ag. values may be of use for detection of the cancer and monitoring the patients. With use of another non-specific marker, the accurancy for diagnosis of these malignancies is expected to increase.

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The tissue distribution of hematoporphyrin derivatives (HPD) was investigated 48hours after intravenous administration of HPD, using the bladders removed at radical cystectomy and compared with bladder mapping results.
Spectrophotometrically, a fluorescence emission spectrum with two peaks at 630 and 690nm compatible to that of HPD was observed in bladder tumor tissues including carcinoma in situ (CIS) and epithelial dysplasia. The intensity of HPD fluorescence in the visible tumor such as invasive or noninvasive papillary tumors was larger than that of CIS.
The macroscopic distribution of HPD red fluorescence on the mucous surface of the resected bladder, emitted with UV exposure, was in close accordance with the areas of the cancer and precancerous lesions revealed by histological mapping of the bladder.
These findings indicate that HPD distributes or accumulates in dysplastic and neoplastic transitional cell epithelium and HPD can be an effective photosensitizer for diagnosis and treatment of CIS of the bladder.

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It was shown in our previous data that the depolarizing current measured by the open tip type oxygen electrode polarographic method in the corpus cavernosum altered in response to the blood outflow change as well as the inflow. In this paper the hemodynamic causes of the alteration in the depolarizing current of each erection phase in the corpus cavernosum were analysed by study of humans and two types of dog model. In the human study, the alteration of the depolarizing current in the corpus cavernosum and the penile circumference change during all phases of penile erection (tumescence phase, erection phase and detumescence phase) were simultaneously measured in five male volunteers (18-21 years; average age 19.8 years).
The two types of dog model were similarly studied. In the first model, by inserting 2 electrodes into the center and the peripheral end of the corpus cavernosum the depolarizing current alterations were observed at various blood perfusion rates through the 19 gage butterfly needle which was inserted in the corpus cavernosum distal end. From these results we confirmed that the depolarizing current in the corpus cavernosum altered in response to the blood perfusion rates. In the second model, which was a penile circulation model, the relations between the depolarizing current alteration and the penile circumference change of each erection phase of humans could be reproduced. The status of the blood inflow and outflow of the penile circulation model at the time of the reapperrance repesented the status of the blood inflow and outflow of the corpus cavernosum of each erection phase. The results obtained were as follows.
1) At the flaccid state the sinusoid space of the corpus cavernosum contained a small amount of blood. Therefore, it is presumably that there was a blockade at the vascular tree in the corpus covernosum.
2) In the tumescence phase the blood inflow to the sinusoid space suddenly increased by the relief of the blockade in the hellicine artery. In this phase, the blood outflow from the sinusoid space also increased according to the inflow increment.
3) In the erection phase, the resistance to the blood inflow due to the passive contraction of the outflow pathway resulted in a gradual decrease of the blood inflow, but at the point where the inflow was equal to the outflow, it was kept in a steady state. The level of this point was still higher than that in the flaccid state.
4) In the detumescence phase, a sudden stop of the blood inflow and a transient increase of the blood outflow concomitantly occurred and the reopening of the blood outflow pathway was thought to be necessary for the prompt penile detumescence.

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Abnormal increase in the pressure in the upper urinary tract is frequently observed clinically. The circulatory dynamics in the ureteral wall in such an abnormality is unknown. Akasaka et al have reported on the influence of formalin on ureteral peristalsis, but the circulatory dynamics in the ureteral wall is not known. Experiments A and B were performed to elucidate the above two points and the following results were obtained.
As experimental animals, adult mongrel dogs weighting 11.2-23.2kg, (average 16.4kg) were used.
Experiment A) By keeping unilateral upper urinary tract in an occlusive condition, physiological saline was infused into the urinary tract at a speed while record internal ureteral pressure and an oxygen tension in the ureteral wall. Subsequently, the occlusive condition was relieved and the oxygen tension was recorded continually. The internal pressure increased sharply to 63.3±10.6cmH₂O after the liquid infusion, then decreased temporarily and subsequently continued to increase gradually. The oxygen tension in the wall started decreased during the liquid infusion, reached 76.6±22.9% of the control (significant at p<0.01) at the end of the infusion, and remained unchanged as long as the occlusive condition continued. However, it tended to return to the control value when the occulsive condition was relieved.
Experiment B) By keeping contralateral upper urinary tract under the same condition as in Experiment A, 5% formalin was infused in a similar manner. The internal pressure showed the same transition as in Experiment A. The oxygen tension started to increase gradually during the infusion and reached 157.4±58.8% of the control (p<0.01) by the time the occlusive condition was relieved. The pressure remained at a significantly high level even after the occlusive condition was relieved.
No significant change was observed in the blood pressure throughout the processes.

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Transurethral radial scan echotomography was used for fifty-nine cases with uterine cervical carcinoma to diagnose tumor invasion to the urinary bladder.
The three landmarks of the vesicocervical border, namely, the bladder muscle layer, the spatium vesicocervicale, and the uterovaginal fascia were individually identified as a white line, a lower echoic layer, and a linear echo, respectively in echotomogram.
The echotomograms of the vesicocervical border in the cases of cervical carcinoma could be classified into four patterns of water filled bladder, which were normal, rigid irregularity (of white line), high amplitude echo (of linear echo), and white line disruption.
By comparison between the echo patterns and the depth of invasion in thirty-eight cases, the new criteria were established as follows:
Type I includes the normal pattern and the rigid irregularity pattern, indicating the tumor to be confined within the cervical muscle layer.
Type II is the pattern of high amplitude echo, with or without the rigid irregularity pattern, indicating a growth invading the uterovaginal fascia.
Type III is the pattern of white line disruption associated with a rigid irregularity pattern, indicating a growth extending beyond the uterovaginal fascia or into the bladder muscle layer.
The study on the correlation between the new criteria and the accurate depth of invasion in the thirty-eight cases showed a satisfactory correlation; accuracy was 89%. In evaluating the invasion extent beyond the uterovaginal fascia, sensitivity was 90%, specificity, 96%.

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Electromyograms of the external urethral and anal sphincters were compared, and localization of the lumbosacral spinal neurons innervating these two muscles were investigated by means of the horseradish peroxidase (HRP) method and the fluorescent double labeling method in dogs.
In decerebrate dogs, electromyogram of each muscle showed different patterns during cystometry and during bladder compression.
After HRP injection to the external urethral or anal sphincter, HRP-labeled neurons were found in the ventral, or dornal part of Onuf's nucleus between L7 and S3.
After HRP application to the external urethral sphincter branch of the pudendal nerve in one side and the external anal sphincter branch in the other side, HRP-labeled neurons were found in the ventral and rather rostral part and the dorsal and rather caudal part of Onuf's nucleus between L7 and S3.
Following propidium iodide (PI) application to the external urethral sphincter branch and bisbenzimide (BB) to the external anal sphincter branch of the pudendal nerve on the same side, PI-labeled neurons were located in the ventral and rather rostral part of Onuf's nucleus, and BB-labeled neurons in the dorsal and rather caudal part of that nucleus. There was no neuron that was labeled with both PI and BB.
These results suggest that the external urethral sphincter and the external anal sphincter are innervated by different neurons, and there no complete agreement on the activities of these two muscles.

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From October 1983 to September 1985, 79 patients with either recurrent superficial papillary tumors (61) or carcinoma in situ (18) of the bladder underwent sequential instillation therapy with mitomycin-C and adriamycin (MA therapy).
Patients who achieved CR received randomly assigned prophylactic treatment of either MMC instillation or oral medication of 5-fluorouracil for at least 1 year. The following results were obtained.
1. Forty-three patients (54%) achieved CR and 11(14%) achieved PR, resulting in a 68% overall response.
2. Tumors smaller than 1cm in size and less than 5 in number showed significantly better responses to MA therapy than those otherwise (p<0.05). Though not significant, patients with CIS, no previous instillation and manifesting severe toxicity (bladder irritation) to MA therapy appeared more responsive than those with papillary tumors, previous instillation and manifesting mild or no toxicity.
3. Of 43 CR-patients, 15 underwent prophylactic treatment with MMC instillation and had a favorable 2-year non-recurrence rate (73%) compared to 18 patients receiving 5FU medication (30%). Though not significant, patients with CIS, G3 histologic anaplasia, and no previous instillation appeared to have a high 2-year non-recurrence rate when compared with those with papillary tumors, G2 tumors and a history of previous therapy.
4. Although the rate of malignant progression among these patients was not so high as predicted, further follow-up study would be necessary to assess the effectiveness of MA therapy for prophylaxis of malignant progression.

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Retrospective clinical analysis of 84 relapsed prostatic cancers hormonally treated at Tokushima University and TEKK group is reported.
The criteria for the diagnosis of relapse were any of the following: (1) increase in acid-phosphatase level, (2) local progression, (3) appearance or progression of bone metastases, (4) appearance of new metastases (excluding bone) and (5) significant cancer-related deterioration in symptoms.
Analysis of the modes of relapse showed that, of the 84 patients, 31 (36.9%) had eleveted acid-phosphatase level and 46 (54.8%) had local progression. Thirteen of 38 patients (34.2%) had bone metastases and 37 of 46 patients (80.4%) had progression of bone metastases. Of the 84 patients, 9 (10.7%) had new metastatic lesions in other than bone and 50 (59.5%) had deteriorations in symptoms.
The mean interval between the initiaion of hormone therapy and the relapse was 24.1±15.6 months. The interval was 39.0±23.4 months for Stage A₂, 25.4±14.9 months for Stage B, 24.1±16.5 months for Stage C and 21.4±12.4 months for Stage D with a significant difference observed between Stage A₂ and Stage D. The intervals of relapsed patients with well, moderately and poorly differentiated adenocarcinoma were 25.2±16.2 months, 28.6±15.0 months and 22.6±17.3 months, respectively, with no significant difference. The intervals of relapse in patients showing elevated acid-phosphatase level before therapy, as compared to those in patients with normal levels, were significantly longer. There was no difference in intervals between the patients with and without acid-phosphatase normalization by hormone therapy.
The actuarial survival rates after relapse in the 84 patients were 55.4 per cent at one year and 11.5 per cent at 5 years.

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The change of normal value of ^99mTc-dimercaptosuccinic acid (DMSA) renal uptake with age was investigated, and the correlation between total renal uptake of ^99mTc-DMSA and 24-hour endogenous creatinine clearance was studied in each age group separately.
(1) ^99mTc-DMSA renal uptake was measured in 107 normal controls without renal or urinary tract diseases between 0 and 67 years old and nomral values were analyzed in each age group. The normal value was highest in the age group of 0-9 years old and was gradually decreased with age. Over 20 years old, the normal value hardly changed.
(2) The lower limit of normal values of ^99mTc-DMSA renal uptake in each kidney was 19.62, 13.89, 13.18, 11.58, 12.00, 10.24% in the age groups of 0-9, 10-49, 20-29, 30-39, 40-49, 50-59 years old, respectively.
(3) Correlations between total renal uptake and 24-hour endogenous creatinine clearance were investigated in each age group in 248 patients between 0 and 79 years old. Positive linear correlations were found in the age groups of 0-9, 10-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70-79 years old, and especially above 50 years old closer correlations were found.
It is concluded that although ^99mTc-DMSA renal uptake is a useful method for renal function test through life, the change with age must be considered in the evaluation of its value.

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Pressure flow study (PFS) of congenital hydronephrosis was performed in 27 cases (15 men and 12 women) in renal pelvis puncture under ultrasonographic guide. We believe that if the flow rate exceeds the urine transport capacity of the upper urinary tract, the renal pelvis may dilate and the intrapelvic pressure will elevate. PFS was done at various flow rates from 1ml/min to 10ml/min. We designated the maximum flow rate which coincided with no elevation of the intrapelvic pressure as “Maximum Passable Flow (MPF)”. We believe that MPF could be an available index of the upper urinary tract transport capacity. The results obtaind were as follows:
1) The cases in which MPF was 2ml/min or less were thought to have PUJ stenosis and to be good indications for pyeloplasty from X-ray findings, renal function test and postoperative recover of the renal function. Postoperatively, MPF was 3ml/min or more in all these cases.
2) In the cases who were thought to need no operation from the renal function test and the symptoms, the MPF was 3ml/min or more. The follow-up studies revealed no obvious deteriorations in the renal function and the hydronephrosis.
3) Our results not always corresponded with the results of Whitaker test and diuresis renography.
Thus we emphasize that MPF is a good index of the urine transport capacity of the upper urinary tract and presents a good indication for the operation of congenital hydronephrosis.

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Flow cytometric DNA-histograms of bladder irrigation specimens were studied in 52 patients with superficial bladder carcinoma who were treated by transurethral resection (TUR) of the visible tumor followed by a course of intravesical bacillus Calmette-Guerin (BCG).
The 52 patients were divided into two groups. One group consisted of 24 patients who were thought to have incomplete TUR and/or the presence of histologically proved carcinoma after multiple random biopsies (Bx) of the bladder performed concurrently with TUR (Therapy group). The remaining 28 patients formed the other group (Prophylaxis group).
Positive FCM results were found in 18 out of the 24 patients (75%) in the therapy group before BCG treatment. Eleven out of the 28 patients (39.3%) in the Prophylaxis group showed positive FCMs.
Intravesical BCG at a dose of 80mg (Tokyo strain) was given at first weekly for six weeks (initial instillation) then monthly for a year.
Seventeen out of 29 patients (58.6%) with positive FMC before BCG treatment converted to negative FCM. Eleven out of 13 patients (84.6%) who had recurrent tumors and/or did not respond to BCG treatment showed positive FCM or converted from negative to positive FCM. Conventional urine cytology performed simultaneously with FCM examination revealed positive results in only 25%. (6 out of 24 patients) of the Therapy group before BCG treatment and in 38.5% (5 out of 13 patients) of those who did not respond to BCG treatment.
These results indicated that FCM analysis of bladder irrigation specimens was objective, quantitative and sensitive compared with conventional urine cytology. Therefore, FCM may be a useful technique for detecting and monitoring patients with bladder carcinoma treated with intravesical BCG.

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Lactobacillus casei is considered to be as one of non-specific immunostimulating agents. The antitumor activity of lactobacillus casei, viable (YIT-9018) and/or heat-killed (LC-9018) specimen, was investigated on the experimental murine bladder tumor (MBT-2).
The purpose of this study is to evaluate the effect of lactobacillus casei as to:
Whether or not lactobacillus casei works;
a. as host immune defense mechanism.
b. as an immunostimulant in tumor bearing mice.
c. as an immunoprophylaxis.
d. as an immunostimulant in the immunosuppressive status induced by DNA synthesis inhibitor Mitomycin C and/or Cisplatin.
The result was satisfactory, showing a significant inhibitory effect on the tumor growth (p<0.05-p<0.005) and tumor weight (p<0.01-p<0.001) and much less metastasis to the lung.
Lactobacillus casei in various routes of administration prolonged survival rate of the tumor bearing mice. Significant increase in spleen weight was observed in the treatment groups with LC-9018 and Cisplatin plus LC-9018, although significant decrease was noted in mice receiving Cisplatin alone.
Lactobacillus casei in various oral, intraperitoneal and/or intravenous routes of administration inhibits the growth of MBT-2 tumor of mice.
This suggests that lactobacillus casei is classified as one of the biological response modifiers.

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The prognosis of anaplastic seminoma has remained controversial, but the diagnosis has been confirmed based on the histologic characterisitics. Among the histologic features of anaplastic seminoma such as increased mitotic activity, cellular irregularity and nuclear pleomorphism, Mostofi stressed that “increased mitotic activity (i.e. 3 or more mitotic figures per high power field) is the single most important, easily recognizable, and reliable feature”, and his criteria have been generally accepted.
However, in our observations of 43 testicular pure seminomas, 32 cases (74%) had 3 or more mitoses per high power field. It was considered that this high proportion was aroused from the difference of the width of visual field of the microscope, and the improvement of the mitotic index in order to correct the difference of microscopes was necessary.
Our study on the correlation between the counts of mitotic figure and seminoma cell revealed the mitotic rate (the count of mitotic figure/the count of seminoma cells×100) well corresponded to the result of measuring the mitotic figures in high power field, and a mitotic rate of 0.5% or more was an indication of anaplastic seminoma.
We propose that the mitotic rate is a possible new criterion for diagnosis of anaplastic seminoma.

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During the period from 1976 to 1985, 28 cases with adenocarcinoma of the prostate localized in the pelvis (Stage A₂; 3, Stage B₁; 4, Stage B₂; 1, Stage C, Nx; 13, C, pN₀; 5, C, pN₁ (D₁) 2) underwent curative external radiotherapy. 21patients were treated by 100-431 TDF of fast neutron combined with or without Lineac X-ray and 7 cases were treated by 6, 000-7, 000rad of Lineac X-ray. The radiation fields were prostate in 13, small pelvis and prostate in 13, and small pelvis in 2.
16 patients were well controlled by radiation therapy, but 12 patients relapsed and were followed by endocrine therapy. The types of relapse were local growth in 3, distant metastases in 7, both in 1 and unknown in 1. These relapses occurred in the cases of large prostate cancer, small radiation field in Nx patients or low radiation dose.
The three-year disease-free survival rates of Stage A₂, B, C were 100%, 53%, 52%, respectively, and the five-year overall survival rates were 100%, 100%, 59%, respectively. Since 64% of the patients who were added with endocrine therapy were controlled for more than 2 years, endocrine therapy seems to be effective in the case of failure after radiotherapy. Severe complication which needed surgical treatment was in 1 case of sacral decubitus.
It was concluded that external radiotherapy was a good modality for prostate cancer localized in the pelvis.

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The clinical therapeutic efficacy of radical transurethral resection of the prostate was studied in 100 spinal cord injury patients who had voiding disorder and were not responsive to conservative therapy.
90 of the 100 patients became free of catheter after radical TUR-P by attaining satisfactory voiding parameters. Postoperative deterioration of incontinence was not seen and incontinence was rather improved in most of the cases.
The vesicoureteral reflux was abolished in 16 of 28 ureters and ameliorated in 3 ureters. Hydronephroureters were normalized or improved in 10 of 11 patients.
In 13 cases voiding disturbance recurred but 10 patients were rendered catheter-free again after appropriate treatments.
5 patients of mostly high level cervical cord injury were with frank failures.
This study confirmed that radical TUR-P is clinically effective for the spinal cord injury patients except high level tetraplegics.

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We evaluated the urodynamic effects of radical transurethral resection of the prostate in 100 spinal cord injury patients. Vesical compliance increased after the operation in almost all cases. Detrusor hyperreflexia disappeared in 6 of 16 cases and the reflex was suppressed in 7 cases. Electromyographically, detrusor sphincter dyssynergia was abolished or suppressed in 30 of 35 dyssynergic patients. On urethral pressure profile, there was a tendency for the maximum urethral pressure to be lowered.
The urodynamic effects of radical TUR-P may be ascribable to “sympathectomy” effect of the denervated urethra.

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After 350 transurethral resections of the benign prostatic hyperplasia, six post urethral stricture cases were studied. All post urethral stricture cases occured in small benign prostatic hyperplasia patients with resected tissue weight of less than 10g. The origin of the stricture was at the middle point between the bladder neck and verumontanum. When the bladder neck is cut deeply, the stricture may occur. It is suggested that the capsular group of prostatic arteries, which supply the anatomical true capsule and external gland, are injured by deep cutting at the bladder neck and that post urethral stricture may occur as a result of it. In order to avoid post urethral stricture after TUR-P, the resector should not cut the scar tissue deeply again.

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The first case of barium granuloma involving the bladder is reported. A-72-year old woman was admitted for non-papillary sessile bladder tumor. Transurethral biopsy revealed a xanthogranulomatous lesion with foam cells and inflammatory cells. Partial cystectomy and hysterectomy were carried out for en bloc removal of the tumor. The histological diagnosis was foreign body granuloma with xanthogranulomatous inflammation. The foreign body was revealed to be barium by analytical electron microscopy.

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This paper reports urinary bladder dysfunction due to transverse myelopathy in two patients with systemic lupus erythematosus (SLE). One was a 48-year-old female with lumbago and limb numbness which developed in 1982. The symptom had never inproved and, furthermore, the patient began to complain of sensation of residual urine and difficulty of voiding. Cystometrography revealed hyperreflexia or uninhibited contraction of the bladder. Residual urine disappeared almost completely and good control was obtained about two years after treatment with clean intermittent self-catheterization and medication. The other patient was an 18-year-old female who developed limb tremor and fever in 1983 and was diagnosed as SLE. Loss of sense of urinary fullness and difficulty of voiding developed in the patient. As a result of clean intermittent self-catheterization, the patient at present is free of pyuria and residual urine.
Although uninhibited contraction of the detrusor persisted in these patients after the treatment, careful managements of micturition could keep the patients in a balanced condition, free of urinary tract infection, impermissible volume of residual urine and catheterizaton, with careful advice and training by neurourologists and well-trained paramedical staffs.

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A 59-year-old woman visited our hospital because of gross hematuria and left flank dull pain in May 1985. On IVP left renal function was severely deteriorated. Retrograde ureteropyelography revealed an irregular filling defect in the left lower ureter. She underwent left nephroureterectomy and left pelvic lymphadenectomy. Histological examination disclosed transitional cell carcinoma in the left lower ureter invading the ureteral smooth muscle and not penetrating it. Of 16 excised left pelvic lymph nodes only one external iliac node had metastatic lesion. After the operation adjuvant chemotherapy with cisplatin and methotrexate was carried out. She was well without recurrence in 18 months after the surgery. We discussed the significance of lymphadenectomy for the renal pelvic and ureteral tumor.

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A 59y/o male patient underwent a nephroureterectomy with partial cystectomy with the diagnosis of left renal pelvic tumor. Pathological examination of the nephroureterectomy specimen revealed a submucosal invasion of adenocarcinoma with a small focus of transitional cell carcinoma. Primary adenocarcinoma of the renal pelvis is rare. Only 57 cases have been reported since Grohé reported the first case in 1901. Furthermore, primary adenocarcinoma of the renal pelvis mixed with other histological types have been reported only in 6 cases. The histogenesis of primary adenocarcinoma of the renal pelvis was discussed.

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