Using canine electroerection models, intracorporeal blood flow changes induced by ligation of arteries such as the internal pudendal arteries, internal iliac arteries and abdominal aorta were investigated. 35 dogs (weighing 10.0-23.0kg) were used in this study. Pelvic nerve electrostimulation (4V, 4msec, 40Hz) was applied and electroerection was achieved in the dogs. During the electroerection, the arteries were ligated in three defferent orders. The depolarizing current in the right and left corpora cavernosa was measured by the open tip type oxygen electrode polarographic method to investigate the intracorporeal blood flow.
By pelvic nerve stimulation, the intracorporeal blood flow increased and the increased blood flow maintained a plateau during the stimulation. By ligation of the right internal pudendal artery, both right and left intracorporeal blood flow decreased. After each ligation of the internal pudendal artery and the internal iliac artery, intracorporeal blood flow was decreased and the decreasing ratios were 2 and 1, respectively. By the ligation of the right internal iliac artery, about 20% of right and left intracorporeal blood flow decreased. By the ligation of the right and left internal iliac arteries, about 50% of right and left intracorporeal blood flow decreased. By the ligation of the right internal pudendal artery, about 25% of right and left intracorporeal blood flow decreased. By the ligation of the right and left internal pudendal arteries, about 50% of right and left intracorporeal blood flow decreased.
These findings suggest that, in addition to the main blood flow supply to the corpora cavernosa by the internal pudendal arteries, many collaterals exist, furnishing the blood flow and playing an important role in penile erection.

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In September 1987, a second-generation extracorporeal shock wave lithotripter (Piezolith 2200) was installed in our clinic, and the first Japanese clinical trial has been carried out. In this report, our experience with the first 50 patients, treated and followed-up for more than 3 months, is presented.
Eleven patients were with bilateral renal stones. The locations of total 82 stones in 61 renal units of the 50 patients were renal calyces (55), renal pelvis (11), ureteropelvic junction (9) and upper third ureter (7). A total of 79 sessions were carried out for disintegration of the stones (1.3 session/renal unit). The auxiliary procedures performed before ESWL include flushing-up of 7 ureteral stones into renal pelvis, double-pigtail stent placement in 3 large renal stones and one PNL for a stag-horn stone.
Single session was satisfactory in 46 renal units (75%), while two or more sessions were necessitated in 25% of stones less than 10mm in diameter and 66% of those larger than 20mm. The number of sessions and shock waves given increased with the stone burden; in 35 patients who were satisfactorily treated with single session, the stone diameter and total stone load as well as the frequency of impacted stones (UPJ stone, calyceal stone in narrow inf undibula) were apparently smaller than in those who underwent multiple sessions. There was, however, no remarkable difference of stone component between these 2 groups. If the stone size is smaller than 10mm in diameter, 74 per cent of them disappears completely after one session. On the other hand, only one third of stones larger than 20mm were disposed of after single session.
Because of the relatively small size of the focal area of Piezolith 2200, the number of shock waves necessitated increases with the size of the stone. For the stone which is less than 10mm in diameter, about 3300 shock waves are satisfactory, while twice or three times shock waves are required for stone fragmentation of larger stones. The laboratory data in the first 35 out of the 50 patients did not differ before and 7 days after treatment, although transient increases in serum BUN level and white blood cell count was observed on the 3rd day after the treatment.
In order to examine the possible adverse effects on perirenal tissue by the shock waves of Piezolith 2200, the serum levels of creatine phosphokinase (CPK), amylase and aldolase were studied in 19 patients who received more than 4000 shock waves. There was, however, no significant changes of these values during the period studied.
The difficulty of stone localization with the ultrasound sectar scanner was encountered in a few patients who were either fat or had history of previous open surgery.
In the 3 month follow-up period, 34 out of the 50 patients became completely stone free, and 13 other patients turned out to have residual stones which were less than 3mm in size. Including all these patients, the ESWL with Piezolith 2200 was clinically successful in 94% in the present study. There was no major complication, and minor complications include fever at 8 percent and colicky pain at 4 per cent.
Although our experience is still limited, it is concluded that ESWL with this second generation lithotripter is effective for renal stones, and clinically much safer than other lithotripters. Because the procedure is totally anesthesia free, ambulatory treatment may be made in some selected cases in the future.

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The present investigations were performed to know whether microscopic chromocystoscopy (MCC) could predict the histology of bladder urothelium. The study included 57 patients with bladder tumors. Staining of urothelial surface cells was accomplished with intravesical instillations of 0.1 per cent methylene blue solution. MCC observations were undertaken using a contact-microcolpohysteroscope with 1-150 magnifications. The microscopic findings of the stained areas were classified into 5 groups (group X, 0, 1, 2 and 3), depending on configuration, size and distribution of the cell nuclei: Group X; the nucleus could not be recognized because of amorphous diffuse staining, group 0; almost normal nuclear features, group 1; relatively minimal abnormalities, group 3; a large number of abnormal features, group 2; intermediate changes of group 1 and 3.
In tumorous carcinomas which could be detected by conventional cystoscopy, 78 of 92 tumors were stained; the staining rates were higher in grade 2 and 3 carcinomas compared to grade 1 tumors.
Comparison of MCC with histological grading in 233 areas of flat epithelium were as follows. Of 125 areas which were stained, 53 were estimated to be in groups 1-3. Histologically, forty-seven of these 53 were diagnosed as either carcinomas (41) or dysplasia (6).
Out of 66 in group 0, only 6 areas were carcinoma in situ or dysplasia. In 108 areas where no staining was seen, 9 carcinomas and 8 dysplasia were found. These data show that the observations with MCC are roughly parallel with the histological examinations.
The results indicate that MCC examination is useful not only in estimating the grade of visible tumors, but also in detecting the abnormal vesical epithelia which can not be recognized by a conventional cystoscopic examination.

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Functional androgen receptors (ARa) and estrogen receptors (ERa) were measured in fresh prostatic carcinoma tissues using the viable cell assay method originated by Splesberg et al.
The results of this viable cell assay were compared to the conventional biochemical methods and also to the fluorescent staining method which uses mibolerone FITC conjugate.
The results are summarized as follows.
1) Cytosolic AR measured by DCC assay had a tendency to increase with stage and tumor grade, while ARa measured by the viable assay method decreased with stage and grade.
2) The amounts of ARa in stages B, C, D₁ were 266±49 (n=54), 248±51 (n=30), 151±42 (n=24) (fmol/mgDNA, Mean±S.E., followings were the same), respectively. ARa in grades 2, 3, 4 were 239±45 (n=47) 235±43 (n=56), 210±80 (n=5), respectively.
3) The amounts of ERa in stages B, C, D₁ were 1229±256 (n=37), 635±221(n=16), 414±91 (n=17), respectively. ERa in grades 2, 3, 4 were 1241±285 (n=28), 684±175 (n=37), 171±140 (n=5), respectively. A statistical difference (p<0.05) was present between stage B and D₁, and between grade 2 and 4. Thus ARa and ERa in the prostatic carcinoma tissues tended to decrease with stage and grade, suggesting that prostate cancer loses its hormonal dependency with an increase of the tumor grade.
4) The comparison of viable cell assay to histochemical staining demonstrated that, in 17 (65%) out of 26 samples, the results of both methods were well correlated. 8 (31%) out of 26 samples showed positive in AR by the histochemical method, but negative by the viable cell assay. These results suggest that, among the AR detected histochemically, there exist non functional AR which bind to cytosolic receptors, but are unable to bind to nuclear chromatin sites.

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Acute renal failure (ARF) is defined as rapid deterioration of renal function associated with accumulation of nitrogenous wastes and electrolyte imbalance in the body. Postrenal ARF results from mechanical or functional obstruction of the urinary tract, and is a relatively rare condition in children. We analysed causative disorders and clinical courses of 18 children with postrenal ARF who had been treated in our clinic from July, 1973 to December, 1987.
1) Conditions causing postrenal ARF.
Congenital urinary tract obstruction accounted for 90% of the patients, and posterior urethral valve was the most common lesion (8 children). Among other congenital conditions were pelvi-ureteric junction stenosis (hydronephrosis), bladder diverticulum, ectopic ureterocele, and hydrometrocolpos. Acquired obstructive lesions caused the condition in 2 patients; a 2-year-old girl with bilateral ureteral stone and a 1-year-old boy with false anuria from extended prostatic rhabdomyosarcoma.
2) Clinical presentations and their onset
Abdominal swelling due to distendd bladder or enlarged kidney was seen in 11 patients (61%). High fever from acute pyelonephritis or sepsis was the clue in 6 patients to the underlying urological disorders. In 5 patients, symptoms of gastrointestinal tract, such as diarrhea or vomiting, led to urological check-up. Decreased amniotic fluid and severe urinary tract dilatation was detected in a boy with posterior urethral valve through prenatal ultrasonography.
In about two thirds of the patients, clinical presentations became apparent within one month after birth. Two patients with acquired lesions presented their symptoms after they reached 6 months old.
3) Management
The emergent management of postrenal ARF consists of three principles; infusion therapy and/or dialysis to correct metabolic and electrolyte imbalance, antibacterial therapy to cope with pyelonephritis and sepsis, and immediate urinary drainage. Urethral catheter drainage was made in 11 patients, nephrostomy in 4 and cystostomy in one.
4) Prognosis
Adequate medical treatment and urinary drainage permitted prompt normalization of serum electrolytes. Improvement of renal function determined by serum creatining or BUN was observed during the first 2 or 3 weeks after the relief of obstruction. Follow-up studies for more than 3 years revealed impaired renal function in 10 children (55%). To predict the recovery of renal function, fractional excretion of sodium (FE_Na) and renal failure index (RFI) 2 or 3 weeks after urinary drainage were found useful.

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The problem and its improvement in the measurement of urinary tissue polypeptide antigen (TPA) are described, Tween 40, a surface active agent, was used in the management of urine samples. The results of the studies in urinary TPA determination and the clinical investigation in bladder cancer patients, chemical workers and patients with other urological diseases are reported here.
By the treatment with Tween 40 the TPA values were elevated in almost all urine samples. However, the justification of its treatment was confirmed from the results in recovery test and dilution test. In the study on the preservation of urine samples it was revealed that the stability of urinary TPA was achieved by the dilution with 4% Tween 40 solution, and that the treatment with Tween 40 just before TPA measurement was neccesary if urine samples were stored in the room temperature.
The usefulness of urinary TPA as a tumor marker for bladder cancer was indicated from the results that the positive rates were 72.7% in spot urine and 75.0% in 24-h urine of bladder cancer patients. On the contrary, among the benign urological diseases studied, the patient groups with cystitis and urolithiasis revealed a substantial falsepositive rate, 34.8% and 39.1%, respectively. Although there was no significant difference in the mean levels of urinary TPA between chemical workers and healthy controls, the risk group had about twice more positive rate of urinary TPA than controls.

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The clinical availability of flow cytometric DNA analysis of prostatic carcinomas was investigated and the results thus obtained were compared with those based on conventional histological examination. The specimens were provided by transrectal and/or transperineal needle biopsy from patients with clinically diagnosed prostatic carcinoma (26 patients) and those with benign prostatic disease (18 patients). The specimens were routinely prepared for the aforementioned examinations. The results showed diploid patterns in all patients with benign disease, aneuploid and diploid patterns in 10 (38.5%) and 16 (61.5%) of the 26 patients with histologically proved prostatic carcinoma, respectively. Higher Proliferation Indices (16.51±10.32%) and Heterogeneity Index Scores (31.35±19.21) as well as the higher incidence of aneuploid patterns were observed closely associated with prostatic carcinoma of histologically high grade. Also shown were changes in DNA-histogram patterns after instituting the treatment of prostatic carcinoma. Therefore, flow cytometric analysis of DNA-histograms is useful as an objective parameter of the tumor grade, an adjunct to diagnosis of prostatic carcinoma and monitoring patients with the disease after instituting the treatment.

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Architecture of small urinary stones were studied with special attention to the crystal-matrix interrelations. Scanning electron microscopic observation revealed that, regardless of their crystalline components, all the stones had one or multiple core areas which were composed of randomly aggregated crystals. The core area was easily identified because it had free space among the crystals. The core area was enveloped by the laminated mantle layers which were composed of compactly packed crystals, although small free space was found occasionally between the layers. In such space, randomly oriented crystals were observed as in the core area. Transmission electron microscopy (TEM) showed that the organic matrix of the mantle layers was laminated itself and filled the intercrystalline space.
From these findings the following conclusions were drawn. There seems to be two mechanisms of stone growth. The first is the crystal adhesion. In this case crystals are randomly oriented, and there is free space among the crystals. Consequently, the stone construction is brittle. The second is the crystal growth in the gel-state matrix which continuously encrust on the stone surface. This type of growth mechanism resembles that of the pearl. It allows no free space among the crystals resulting in a firm architecture. Such a crystal-matrix interrelation should be the mechanism of concretion.

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Between March 1974 and December 1985, 997 patients underwent TUR-P at the Oita Urological Hospital. This paper is to report the clinical statistics of TURP cases with special reference to preoperative risk factors and surgical complications.
Of the 997 patients, 958 were preoperatively diagnosed as BPH and the remaining 39 were as malignant. Histopathological examination of surgical specimens revealed 31 latent carcinomas in the 958 patients whose preoperative diagnosis was benign by rectal examinaiton and echosonography.
Routine preoperative evaluation demonstrated a variety of risk factors or complications such as cardiovascular disorder (19%), hypoproteinemia (8.8%), renal dysfunction (7.6%), and abnormal glucose tolerance (5.1%). Surgical and postoperative complications were profuse bleeding requiring blood transfusion (5.9%), hyponatoremia (2.7%), fever (2.6%), urethral stricture (1.7%) and urinary incontinence (0.3%). Although majority of these patients were successfully treated by conservative therapy, three patients died of acute heart failure, cerebral bleeding and sepsis. Hypoproteinemia and renal dysfunction were common preoperative complication in these 3 patients. This is strongly suggestive of importance of preoperative check-up of hypoproteinemia and renal dysfunction as dangerous and mortile preoperative risk factors of TURP.

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Forty-five patients with testicular tumor received palliative retroperitoneal lymph node dissection and chemotherapy, and their prognosis and ejaculatory problems such as loss of emission and retrograde ejaculation were evaluated. In these patients, lymph node dissection was limited to the metastatic nodes and/or nodes suspected metastatic including surrounding fatty tissues. Chemotherapy was done prior to and/or following dissection using cis-diamminedichloroplatinum, vinblastine, bleomycin and peplomycin. Ejaculatory function could be evaluated in 36 patients. Nine patients were excluded because their postoperative ejaculatory function was unknown.
A case of suprahilar dissection and 23 of 24 cases dissected from the renal pedicle to the root of the inferior mesenteric artery presented seminal ejaculation. Bilateral dissection from the renal pedicle to the common iliac artery for 7 patients resulted in dry ejaculation in 5 and partial ejaculation in 2, while ejaculation was observed in all of 4 patients who recieved unilateral dissection of the same area. Four of these patients were examined and three had retrograde ejaculation.
Sympathetic fibers reach the superior hypogastric plexus via the anterior aortic area and via the bilateral sympathetic cords. The present finding indicates: 1) Ejaculatory function is not influenced by injury of sympathetic fibers at the anterior aortic area superior to the root of the inferior mesenteric artery. 2) Sympathetic fibers regulating the internal urethral sphincter appear to enter the superior hypogastric plexus from the bilateral sympathetic cords via the lateral wall of the aorta between the root of the inferior mesenteric artery and the bifurcation but not via the anterior wall of the aortic area. Bilateral injury of these lateral fibers results in retrograde ejaculation. To preserve the above lateral fibers, big bundle of the superior hypogastric plexus should be identified at the aortic bifurcation and then the lateral fibers can be recognized as fine neurofibers connected to the above plexus. 3) Seminal emission was preserved in the patients whose bilateral sympathetic cords appeared to be intact in spite of radical dissection.
Of 31 patients with metastases, 26 were alive with no evidence of disease, one alive with disease and 4 were dead. Of 18 patients with lymph node metastases only, followed for more than 2 years, 17 are alive with no evidence of disease.
In view of recent progress in cancer chemotherapy, dissected area should be minimized to preserve as many sympathetic fibers as possible, which prevents ejaculatory disturbance of young males.

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Rectosigmoidoscopy was performed in 10 patients who had undegone radical cystectomy and bilateral ureterosigmoidostomy more than five years before. All cases were males with their mean age at operation 58.7 years and their mean duration of ureterosigmoidostomy 8.8 years. 13 ureteral orifices in the 10 patients were found at a mean distance of 17.6cm from the anal dentate line. The appearances of the ureteral orifices were classified into two. 10 sites in 9 patients had polypoid appearance and 3 sites in 2 patients had flat appearance. 1 patient out of the 10 (10%) had adenocarcinoma just above the dentate line and an adenomatous polyp between bilateral ureteral orifices. Biopsies of macroscopically normal mucosa around the ureterocolonic anastomoses performed for all cases proved to be histologically mild inflammation. In 3 cases, biopsies of the polypoid ureterocolonic anastomoses showed granulation tissue and mild inflammation.

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Between 1980 and 1985, we performed CT scananalyses in 33 cases of renal trauma except one. As a evaluation, we classified these cases into 7 groups.
Stage 0: no discernible injury, Stage 1: contusion, Stage 2: subcapsular hematoma without laceration, Stage 3: perirenal hematoma without laceration, Stage 4: subcapsular hematoma with laceration, Stage 5: perirenal hematoma with laceration, stage 6: pedicle injury.
The results of our study revealed that our classification on renal trauma by using CT scan was useful for the evaluation of clinical status and the diecision of the operative indication especially emergency operation.

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One hundred bladder carcinomas (T1 16, T2 18, T3 28, T4-M1 38) subjected to intra-arterial infusion of microencapsulated anticancer drugs (microchembolization) were retrospectively compared with 102 bladder carcinomas (T152, T213, T3 24, T4-M113) treated without chemoembolization. The median follow-up periods were 74 months (19-116) and 66 months (15-121), respectively.
The median number of microchemoembolization was 1 (1-3) and the median doses of mitomycin C-, peplomycin- and cisplatin microcapsules were 20mg, 40mg and 80mg, respectively. Forty-three (55%) of 79 measurable tumors had an objective response greater than 50% in reduction rate. Side effects and complications were generally mild and tolerable without requiring any treatments except for the gluteal skin ulcer in 7 patients.
The five year-survival rates of T1, T2-3 and T4-M1 were 94%, 58% and 5% in the chemoembolization group and 83%, 37% and 15% in the control group, respectively. Although these survival rates did not differ significantly between the corresponding groups, the survival rate of T2-3 in the chemoembolization group showed a trend to be better than that of the control (p<0.1).
Of thirty-eight cases (T2 18, T3 20), 15 underwent complete tumor resection by TUR, 5 partial cystectomy (PCX) and 18 total cystectomy (TCX) after chemoembolization. Of thirty-three cases (T2, 12, T3 21) in the control group 19 underwent complete tumor resection by TUR, 2 PCX and 12 TCX. There were statistically significant differences in 5-year disease-free survival (59% for the chemoembolization group versus 32% for the control group [p<0.05]) as well as 5-year survival (66% for the chemoembolization group versus 42% for the control group [p<0.05]).
The results suggest that chemoembolization provides an enhanced antitumor effect and can be used as an preoperative adjuvant for locally invasive bladder cancer with an improved prognosis.

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The vesical and urethral function after radical prostatectomy was studied urodynamically.
Two men with clinical stage A₂ and four with stage B₂ prostatic cancer underwent radical retropubic prostatectomy between May 1986 and April 1988. The ages at the time of the operation ranged from 58 to 69 years, with an average of 65 years. They underwent a direct urethrovesical anastomosis. Urodynamic evaluation was performed preoperatively and at 1 month, 3 months, 6 months and 1 year after radical prostatectomy.
Anastomotic stricture occurred in four of the six patients, three of whom had successful soft dilatation, while one required the periodic dilatation. Uroflowmetry was useful for early detection of the anastomotic stricture.
One patient undergoing nerve sparing radical prostatectomy presented urinary incontinence for three weeks after the operation. Among three patients whose neurovascular bundles were undissectable because of severe adhesion around prostatic capsule, two recovered continence at 8th and 12th month postoperatively but one remained with slight stress incontinence over 18 months. Two patients, whose neurovascular bundles were resected bilateraly because of tumor invasion, became continent 2 and 3 months after the operation. The findings of pre and postoperative cystometry and external urethral or anal sphincter electromyography were almost normal in all of the six patients.
Postoperative maximum urethral closure pressure was remarkably low but it increased gradually during 2 and 3 months postoperatively in parallel with the improvement of continence with time. Postoperative functional urethral length was remarkably short and somewhat increased with time. Vesicourethrography revealed opened vesical neck and the lack of proximal urethral mobility in a patient with postoperative incontinence.

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The patient is a 60 years old female who visited our hosptial complaining of vesical irritability and gross hematuria for the preceding 3 months, Cystoscopy, intravenous urography and computed tomography revealed a noduler and apparently invasive tumor at the posterior wall of the bladder without evidence of distant metastasis. The patient underwent radical cystectomy including histerectomy.
Histopathological and electromicroscopic study revealed a small cell carcinoma with neurosecretory granules. The postoperative course has been uneventful without any evidence of tumor recurrence for 9 months up to present.

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A 70-year-old male patient was found to have a right renal mass with tumor thrombus extending into the inferior vena cava. Right nephrectomy, excision of the vena cava and ligation of the left renal vein were performed. Postoperatively, there was neither episode of hypotension nor edema in the lower extremities, but the patient experienced transient renal failure. The serum creatinine level elevated to 12.5mg/dl on the 6th postoperative day, but decreased to 2.8mg/dl on the 48th postoperative day. It was 1.4mg/dl 3 years after surgery without any specific treatment. He was clinically free of disease and in good health 3 years after surgery.

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A 44-year-old man presented with left flank pain and macrohematuria. The roentgenographic examination disclosed left hydronephrosis and stenosis of the left distal ureter. The patient was operated with the diagnosis of ureteral stricture. The frozen section during the operation revealed no malignancy. Therefore, autotransplantation of the left kidney was performed. Congo red staining revealed amyloid deposition in the resected segment of the ureter. No evidence of amyloidosis was obtained in rectal and renal biopsy. The other laboratory tests for amyloidosis were negative.
Consequently, primary localized amyloidosis of the ureter was confirmed.
Amyloidosis of the ureter is a rare entity. Review of the literature disclosed that this was the 32nd case in the world.
Clinical features of localized amyloidosis of the ureter are similar to those of ureteral tumor. Since preoperative diagnosis is difficult, nephroureterectomy is usually performed for this disease. There were only two cases prior to ours which were treated by autotransplantation of the kidney.
In the discussion, localized amyloidosis of the ureter was statistically analysed by reviewing the literature. The indication and advantages of autotransplantation of the kidney were also described.

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