Of several reflexes operating between bladder and urethra, the urethrodetrusor facilitative reflex (UDFR) originates in the urethra and is activated by intraurethral urinary flow, resulting in maintenance of detrusor contraction during micturition. This paper deals with the characteristics of bladder contractions induced by urethral perfusion, passive distention of urethra and active contraction of urethral muscle in female mongrel dogs anesthetized with α-choralose.
Contractile response of the bladder was recorded simultaneously with urethral pressure using a special preparation in which the urethra was isolated from the bladder. Of 35 dogs studied, 32(91.4%) showed a marked bladder contraction when the urethra was antegradely perfused with warm saline at the const ant urethral perfusion pressure of 100cm H₂O. The mean values±SD of contractile pressure and latency were 56.3±24.3cm H₂O and 0.80±0.08 second, respectively. The bladder contraction continued as long as the urethra was perf used with saline.
In order to distend the whole urethra passively, the urethral meatus was closed and saline was slowly infused from the bladder neck into the urethral lumen. The result showed that passive distention of urethra also caused bladder contraction with approximately the same magnitude as that in urethral perfusion.
Spontaneous, rhythmic urethral contractions were observed in 4 dogs. Immediately after each urethral contraction, the bladder contraction occurred with a constant latency, demonstrating that active contraction of urethra also induced a bladder contraction.
These results indicated that the neuroreceptors which primarily activated UDFR were stretch receptors in the urethral wall, and thus a contribution of friction receptors to this reflex was doubtful. It was also suggested that these stretch receptors were in series with the muscle fibers because passive distention and active contraction of the urethra could evoke detrusor contraction.

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A statistical study was made on 32 advanced bladder cancer patients who underwent patial cystectomy between 1970 and 1984 in our clinic. 12 patients of them were treated by multidisciplinary therapy including partial cystectomy, chemotherapy and radiation therapy.
In the patients treated by multidisciplinary therapy actual 3-years survival rate and 5-years survival rate were 83.3% and 74.1%, respectively. A significant difference between the patients treated by multidisciplinary therapy and non-multidisciplinary therapy was observed. Multidisciplinary therapy was effective for advanced bladder cancer at any stage, especially at stage pT2-pT3a. Multidisciplinary therapy has effect on cases of infiltrative type β, γ, and on lymphatic and venous invasive cases.
We consider that partial cystectomy is indicated for advanced bladder cancer when the following conditions are met.
1) Primary case
2) Localized bladder cancer
3) No atypical epitherium at other regions
4) Stage pT2-pT3a
5) No lymph node and sistant metastasis
6) Satisfactory bladder function
When the above described criteria, are fulfilled, adding to chemo-radiotherapy, partial cystectomy for advanced bladder cancer is a curative therapy. Furthermore, partial cystectomy can preserve bladder function and, therefore, is useful for keeping the quality of life.

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For clinical application of lymphokine-activated killer (LAK) cells in the treatment of urogenital cancer patients, basic study was undertaken to analyse the in vitro characteristics of PBL cultured with recombinant interleukin 2 (RIL 2) and to optimize culture period for LAK cell induction.
The results obtained were as follows:
1. Doubling time of PBL cultured with RIL 2 was approximately 65 hours.
2. PBL cultured with RIL 2 showed significant cytotoxicity activity against not only K562 but also freshly isolated autologous urogenital cancer cells.
3. The proportions of OKT3⁺, OKT8⁺, OKT9⁺, OKT10⁺, OKIal⁺, IL 2R⁺ cells increased after the culture with RIL 2, whereas the proportions of OKT4⁺, OKM1⁺, Leu7⁺, Leulla⁺ cells decreased.
4. PBL cultured with RIL 2 for several months continued to show significant cytotoxic activity against T24, and phenotypical analysis demonstrated that OKT3⁺ OKT4^- OKT8⁺ OKIal⁺ OKM1^- Leu7^- Leulla^- cells were predominant in them.
Then, we discussed the optimal in vitro culture period to induce highly activated killer cells as many as possible for clinical use in adoptive immunotherapy. Based on the kinetics of cell proliferation, cytotoxicity activity and proportion of IL 2R⁺ cells, 8-day culture period seemed optimal in the culture conditions (RIL 2:500u/ml) used in this study.

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Adult male rats of Wistar strain received an intra-abdominal administration of Cis-diamminedichloroplatinum (CDDP). The experimental aminals were devided into two groups; one was the high dose & short duration group (trio dose group) which received CDDP 2.8μg/gBW/day for three serial days, and the other was the low dose & long duration group (multi dose group) which received CDDP 0.8μg/gBW twice a week for one through eight weeks. The testicular tissue was observed by the electron microscope (TEM) freeze fracture method. The first changes in spermatogonia were, in both groups, the nuclear deformity and swelling of mitochondria. In a later stage, nuclear destruction, and mitochondrial myelinization and/or disarranged cristae were noted. The degree of these changes was more prominent in the multi dose group than in the trio dose group after equal amount of CDDP. In Sertoli cells, cytoplasmic vacuolation, swelling and/or myelinization of mitochondria were observed in both groups. However, the nuclei were not changed. The characteristic junctional configuration formed between neighbouring Sertoli cells and particles of cell membrane showed no significant changes in findings by the freeze fracture method. Thus the results in these experiments suggest that CDDP causing lethal damage to spermatogonia impairs local Sertoli cells. It is possible that the influence on the energy producing capacity of mitochondria in Sertoli cells retards the recovery of injured spermatogonia.

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To investigate whether or not the erections caused by papverine HCl can be utilised in the diagnosis of vaculogenic impotence, 40mg of papaverine HCl was injected locally into the right corpus cavernosum of the penis of 22 experimental subjects (nine with impotence and 13 others; average age: 52.5), and the penile erections and intracavernous hemodynamics at that time were observed. The penile erections were evaluated on the basis of physical findings (gross observotion and palpation) and measurements of the circumference of the penis. The intracavernous hemodynamics were observed by means of simultaneous recording of changes in the valuse of the tissue depolarizing current by open-tip type oxygen electrodes and changes in the penile circumference.
1. In evaluations of the erections by measurement penile circumference, a full erection was observed in 12 out of 22 subjects (54%).
2. Increases in the penile circumference in the full erection and incomplete erection groups were 15.2±3.3mm and 4.3±2.7mm (mean±SD), respectively.
3. The degree of arterial blood flow into the corpus cavernosum was significantly greater in the full erection group than in the incomplete group (p<0.01).
4. Among the 12 subjects in the full erection group, there were five cases of severe obstruction of the blood drainage route of the penile cavernous body (congestive type) and seven cases of mild obstruction (hyperemic type). In the former cases, the penile rigidity was better and duration of the erection significantly longer (p<0.01) than in the latter group according to a physical findings.
The above results indicated that it is possible to evaluate the erection and estimate the intracavernous hemodynamics which occurs with intracavernous administration of papaverine HCl, and it was clear that this can be utilized as a screening test for vasculogenic impotence, especially venous impotence.

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Laser light scattering effect of Intralipos were studied with a glass flask instead of the bladder and with an argon-dye laser. Red light was irradiated from the tip of a 400μm quartz fiber kept at the center of the flask containing 200ml of 0.5% Intralipos solution with a wavelength of 630nm and the output of 500mW. Homogeneous laser light scattering was most efficiently obtained with an average power density of 0.77±0.07mW/cm². Hematoporphyrin derivative (HpD) fluorescence intensity of frozen sections of V_χ2 carcinoma transplanted into the bladder neck of rabbits 48hr after injection was 20% greater than that of the normal bladder wall sections. In whole bladder wall photodynamic therapy (PDT) study of the carcinoma-bearing bladder 48hr after 0.5mg/kg body weight HpD i.v. injection, a light energy of 100Joules/cm² was used and definite necrotic changes mixed with vacuolar degeneration and pyknosis of the tumor cells were found. These results suggested the usefulness of 0.5% Intralipos as a scattering medium for whole bladder wall PDT.

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Backscattered ultrasound was analyzed by a digital computer system. The power spectrum of the ultrasonic vaves was expected to reflect acoustic characteristics of the tissue. The acoustic characteristics were measured by the distribution parameters of the power spectrum such as the statistical values of moment. Two kinds of phantoms composed of a large number of silicon balls were discriminated clearly by some of these parameter. Then, these parameters were clinically applied to 56 patients with B. P. H. and 41 patients with prostatic cancer. The value of power which is a kind of amplitude parameter was higher in the B. P. H. (p<0.01). With regards to the values of frequency parameters, the mean value of frequency histogram (μ₁/m₀) was nearly equal, but the variance of frequency histogram (m₂/m₀) was higher with prostatic cancer (p<0.05). Other frequency parameters, third and fourth order of central moment of frequency histogram (m₃/m₀, m₄/m₀) were also higher for prostatic cancer. Another parameter of SVAR =[m₂/m₀-(m₁/m₀)²], which means also the variance of frequency histogram, was higher for prostatic cancer (p<0.02). These statistical acoustic parameters were effective to discriminate the two prostatic diseases. This is the first report which shows the significance of ultrasonic tissue characterization of the prostate.

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In 114 patients with spinal cord injuries, sexual function was investigated by use of questionnaire and erection ability was examined by genital skin temperature, by dividing the patients into four groups: accrding to the level of the spinal cord injury into upper and lower paralysis cases with 9th and 10th thoracic cord as the dividing level, and according to the degree of paralysis into complete and incomplete paralysis cases. The patients age ranged from 16 years to 58 (mean: 34.2 years). The mean duration of the illness was 3 years and 4 months. Results of the questionnaire revealed that reflex erection was present in 90.1% and intercourse was possible in 72.5% of cases for the upper complete paralysis group. In another hand, the lower complete paralysis group ejaculation was possible in 15.3%. psychic erection and orgasm feeling were present in less than 10% of cases for both groups. Curves of changes in genital skin temperature in response to sexual stimulation-visual sexual stimulation (V. S. S) and penile mechanical stimulation (P. M. S) showed five patterns: normo-response, reflex-response, hypo-response, mixed-response and non-response. The reflex-response pattern was observed in 88.2% for upper complete paralysis group. The mixed-response pattern accounted for 40% and the normo-response pattern 33.3% of cases for upper incomplete paralysis group. The non-response pattern in 38.4% and hypo-response pattern in 30.7% of cases for lower complete paralysis group. The normo-response pattern in 63.6% of cases for lower incomplete paralysis group.
In each group a strong positive correlation was seen between the genital skin temperature curve and the degree of erection. However, no erection was observed in 5 cases (22.7%) of lower incomplete paralysis group despite of elevation in skin temperature. These findings suggest that blood stresm is not only the factor that is responsible for the phenomenon of erection.

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For the assessment of the etiologic role of Chlamydia trachomatis (C. trachomatis) in acute epididymitis, the authors survayed 42 outpatients with acute epididymitis (the average age was 35.8 years). Chlamydia organisms were examined by the direct immunofluorescence antibody technique (DIF) using the Micro Trak and isolation in cell cultures. Serum antibodies were also examined by means of the microplate immunofluorescence antibody technique (MFA) using C. trachomatis L₂/434/Bu strain and C. psittaci Izawa strain as antigens.
The reuslts are summarized as follows:
1) C. trachomatis was detected in 6 cases (33.3%) out of 18 cases. Positive rates of serum antibody titers in all cases were IgM 19.0%, IgA 38.1% and IgG 66.7%, respectively. The younger the patients were in these two tests, the higher was the positive rate.
2) Changes of antibody titers in the paired sera were observed from 7 cases for 4 months (at the longest). The number of the cases that indicated changes over 4 times as many were 2 cases of IgM, one case of IgA and three cases of IgG. In four cases out of 7 cases, antibody titers in the paired sera changed more than 4 times.
3) In 6 patients with antigen, the average age was 23.0 years (the range was 18-31). The positive cases of serum antibody titer were 2 cases of IgM, and all cases were positive in IgA and IgG group. Pyuria was recognized in 5 cases. The bactera to cause epididymitis were not proved in 4 cases.
4) The proportion between C. trachomatis infections and acute epididymitis was examined. There were 6 cases with antigen, 7 cases with IgM and 5 cases with IgA. These 18 cases were diganosed as C. trachomatis infection. The authors estimated that about 80% of IgG antibody positive cases were caused by recent infection. By adding 10 cases with IgG antibody which were caused by recent'infection, 28 cases (66.7%) out of 42 cases were presumed to be C. trachomatis infection. It was found that like other authors' findings C. trachomatis was the predominant pathogen for acute epididymitis in the younger age group (younger than 35 years), and acute epididymitis in the younger age group should be treated as the sexually transmitted disease (STD).

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Computed tomography was performed in sixteen patients who had acute pyelonephritis without urinary tract obstruction or vesicoureteral reflux. The computed tomographic (CT) findings were positive in thirteen of sixteen patients. The interrelation between the CT findings and the laboratory findings (ESR, CRP, peripheral white blood count, pyuria), symptoms (flank pain) or clinical outcome were studied. In nine patients who had fever for less than 2 weeks (average 5.7 days), there was correlation between the laboratory findings, flank pain and the CT findings. Disappearance of the CT findings of pyelonephritis was demonstrated after two to four months of convalescence. In three patients who had fluctuating fever for more than 4 weeks (523 days) and in one diabetic patient who had fever (18 days), there was good correlation between the CT findings and ESR or pyuria. However, improvement in the CT findings was particularly delayed, even though laboratory findings were normal and flank pain had resolved. It took more than 6 months for the CT findings to resolve in these patients with fluctuating fever. CT aided in the diagnosis, assessment and followm-up in patients with acute pyelonephritis.

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Ultrasonography is widely performed for screening of diseases in the upper abdomen. From April, 1985 to March, 1987, we carried out transabdominal ultrasonography of the entire abdomen for screening all the abdominal and pelvic diseases in the regular health check-up. Thirty-four cases out of 16, 377 screened patients were ultrasonographically suspected of bladder tumor and received cystoscopic examination. Cystoscopy confirmed bladder tumors in 26 out of the 34 cases. Six among the 26 patients showed no urological symptoms and were seen as nonurological outpatients. Four of them revealed transitional cell carcinoma of low grade and low stage, while the rest of them transitional cell papilloma. The smallest tumor detected by ultrasonography was 3mm in diameter.
Transabdominal ultrasonography of the entire abdominal organs proved useful for diagnosis of the bladder tumor at the early stage in the mass screening. Therefore, it is recommended to perform the lower abdominal scanning at the time of the ultrasonographical abdominal examination.

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Data from 550 renal cell carcinoma cases treated at the Yokohama City University Hospital and its affiliated hospitals during a 21-year period from January 1965 through December 1985 were analyzed in a study undertaken to investigate long-term treatment results and factors of prognostic importance in this particular type of malignancy, with the results leading to the following conclusions: 1. The 5-, 10- and 15-year survival rates for the entire cases were 48%, 36% and 27%, respectively, indicating thus that a good number of cases had an ominous prognosis even 5 years or more after surgical treatment. 2. Among patients under 40 years of age none died more than 2 years after receiving operation, the prognosis for this particular group of cases being relatively good. 3. Fever, weight loss, anorexia, general malaise as well as increased ESR, positivity for CRP, elevated α2-globulin, increased AL-P and anemia were proven to be associated with poor prognosis as alleged hithertofore, whereas a negative tuberculin test, elevated LDH and X-ray evidence of calcification in the kidney were not. 4. The prognosis for cases undergoing a translumbar nephrectomy was virtually the same as that for those treated by transpertioneal nephrectomy, which can be construed as implying that surgical treatment by the former procedure may suffice for therapeutic purpose in properly selected cases. 5. The grade classification was found to reflect prognosis fairly well. Robson's system of staging turned out to be unacceptable, there being no difference in prognosis between stage I and stage II by this staging method. 6. Renal cell carcinoma is classified into slow growing type and rapid growing type, based on biological behaviors. The former type has been mistakenly believed to have a good prognosis. It would seem more appropriate to assume that renal cell carcinoma of this type will begin to metastasize some 5 years after operation, causing death in a progressively increasing number of cases thereafter, and consequently the survival rate for this tumor is likely to become comparable with that for the rapid growing type in 15 years.

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The results of 272 patients who underwent percutaneous removal of renal and ureteral stones were presented. The stones were completely removed in 199 kidneys or ureters (70.8%), incompletelyremoved in 66 (23.5%) and could not removed in 16 (5.7%). The residual rate was 81.8% in complicated staghorn calculi, 33.3% in staghorn calculi, 48.2% in multiple calculi, 8.6% in simple calculus and 16.6% in ureteral calculus.
Major complications consisted of arteriovenous fistula (1 patient), pseudoaneurysma (1 patient), complete obstruction of ureteropelvic juncion (1 patient), sepsis (1 patient) and massive bleeding requiring more than 1000ml blood transfusion (13 patients). Two patients with vascular complications were managed by angiography with embolizations and the patient with ureteral damage had a reconstructive surgery ureterocalicostomy. The patient with sepsis was managed by appropriate antibiotic treatment.
The rate of residual calculi and major complications in this procedure were higher than that in the open surgery. There were some difficulties in completely removing complicated staghorn calculi and multiple calculi through this procedure. The indication of this procedure was discussed.

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Efferent neural pathways from the spinal nuclei to the lower urinary tract were examined in the cat. To do this, horseradish peroxidase (HRP) was applied to the following 15 sites; bladder wall, bladder trigone, proximal urethra, external urethral sphincter muscle, pelvic nerve and its vesical branch, pudendal nerve and its urethral branch, hypogastric nerve, inferior mesenteric ganglion (IMG), central and lateral fibers projecting to the IMG, gonadal ganglion (GG), L4 and S1 sympathetic chain ganglia (SCG).
Identified spinal nuclei innervating the lower urinary tract included the intermediolateral and medial nuclei (IML, IMM) between caudal thoracic and middle lumbar cord, sacral IML, IMM and Onuf's nucleus. Careful analysis relating to the HRP application site and the region where HRP-labeled neurons were recognized provided following efferent projections from the spinal nuclei.
Sympathetic pathways from the thoracolumbar IML and IMM coursed through the hypogastric, pelvic and pudendal nerves, and projected to the bladder and urethra including the external urethral sphincter muscles. Sympathetic pathways via the hypogastric nerve changed the fibers from preganglionic to postganglionic ones at certain levels of the L1-6 SCG, GG, IMG and pelvic ganglia (PG), and crossed partially at the IMG and bilateral sympathetic chains. Other sympathetic pathways via the pelvic and pudendal nerves changed the fibers at certain levels of the L5-S3, SCG and crossed partially at bilateral sympathetic chains. Parasympathetic pathways from the sacral IML and IMM changed the fibers at the PG through the pelvic nerve, and projected to the bladder and urethra. Somatic pathways from the Onuf's nucleus projected to the external urethral sphincter muscles, mainly via the pudendal nerve and partially via the pelvic nerve.

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Primary afferent neural pathways from the lower urinary tract were examined in the cat. To do this, horseradish peroxidase (HRP) was applied to the following 9 sites; bladder wall, bladder trigone, proximal urethra, external urethral sphincter muscle, vesical branch of the pelvic nerve, urethral branch of the pudendal nerve, hypogastric nerve, central and lateral fibers projecting to the inferior mesenteric ganglion (IMG).
The primary afferent pathway via the hypogastric nerve entered the spinal cord via the L1-5 dorsal root ganglia (DRG). This pathway crossed partially at the IMG and bilateral sympathetic chains. Other pathways via the vesical branch of the pelvic nerve and the urethral branch of the pudendal nerve entered the spinal cord mainly via the S1-3 DRG and partially via the L1-5 DRG. This pathway via the L1-5 DRG also crossed partially at the bilateral sympathetic chains.
Transganglionic fibers from the L1-5 DRG were found to project to the laminae I, IV-VII and X at the levels of caudal thoracic, lumbar and rostral sacral cord segments, and the lateral portion of the gracile nucleus in the medulla. Other fibers from the S1-3 DRG were found to project to the laminae I, IV-VII and X at the levels of middle and caudal lumbar sacral and rostral coccygeal cord segments, and the medial portion of the gracile nucleus.
These widespread rostrocaudal extents of the hypogastric, pelvic and pudendal primary afferent projections are consistent with the spinal and supraspinal integration of the sympathetic, parasympathetic and somatic elements for micturition reflexes.

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The frequency of the employed microwave was 2, 450MHz. We were interested in evaluating the thermal effect of microwave radiation on the prostate.
A new transuretheral applicator for microwave radiation of the prostate has been developed. As a preliminary experiment sliced ham was radiated with microwave using this applicator in order to investigate the extent of thermal effect. Using 40 mongrel dogs, microwave coagulation of the prostate was examined.
Oval shaped thermal distribution was produced around the antenna on sliced ham by microwave radiation and the size of thermal distribution was regulated easily by varing the length of the antenna and microwave energy.
Blood circulation in the prostatic tissue was shut off after microwave radaition with a microwave energy of 100W for 30 seconds.
On histologic examination, an extensive necrotic region with hemorrhage was noted immediately after microwave radiation. Fourteen days after radiation, cavitation of the prostatic urethra was noted in 7 of 12 dogs. Twelve weeks after radiation, epithelization of the cavity was noted in 4 of 5 dogs.
Prostatic tissue was not carbonized by microwave radiation. No complication was observed in animal experiments.
Experimental studies indicate that microwave coagulation can be a safe therapeutic procedure for patients with prostatic hypertrophy or prostatic cancer.

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Microwave surgery as a tool for better prostatic electroresection was introduced. The prostate was radiated with 2, 450MHz microwave from the monopolar electrode of a specially designed applicator prior to electroresection. We did comparative study in 25 patients with benign prostatic hypertrophy between microwave coagulation group followed by transurethral resection and conventional transurethral resection group with respect to blood loss, irrigant absorption and frequency of complication. During and after operation, the former group has significant reduction of blood loss, and had no complications. We concluded that the combination procedure of microwave coagulation and transurethral resection could minimize the disadvantages of formal transurethral resection, and might be of value in patients with bladder neck obstraction due to prostatic hypertrophy in the presence of hemorrhagic diathesis or in poor risk patients.

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A procedure has been newly developed, with which urinary oxalate may be determined through an electroconductivity detector, whenerver sample urine is transfused into the high performance liquid chromatography through a dispo-typed column. The procedure features a measuring range from 1 to 100mg/l; a variation factor as reproducibility determinant of 2.0±0.9% on the basis of triplicate assay; and a recovery rate of 102.3±3 9%. The mean urinary oxalate excretion of normal subjects (n=10) was 25.6±4.7mg/day.

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Bactericidal activity of the complement and its synergistic effects with cephem antibiotics against Serratia marcescens as a pathogenic organism in complicated urinary tract infections were investigated.
The sensitivity of each strain of the bacteria was determined from the survival rate of the strain after 1 hour of incubation with pooled serum obtained from 10 healthy adult male subjects. As a result, 24 strains (63% of total) demonstrated high sensitivity to the complement with a survival rate of -2log₁₀ or less, 8 strains (21%) showed low sensitivity with a survival rate of -1 log₁₀ or more, while 6 other strains (16%) showed moderate sensitivity to the complement. A strain with high sensitivity to the complement and another with low sensitivity were selected from the tested strains, and the presence or absence of synergistic effect of the complement with cephem antibiotics was investigated. Changes in the number of viable bacteria of these two strains with time upon exposure to ceftizoxime, ceftazidime or cefotaxime in 50% growth inhibitory concentrations in the presence of guinea pig complement were compared. The ratio of the two strains were -2 log₁₀ or less, suggesting additive effects between the complement and cephem antibiotics against S. marcescens.

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Six cases of retroperitoneal tumor experienced by us during the 5 years from 1982 to 1986 are reported, and 243 cases of this disease reported in Japanese journals of urology during the same period are reviewed.
The six cases were two rhabdomyosarcomas and each one malignant fibrous histiocytoma, leiomyosarcoma, hemangiopericytoma and mesenchymoma. The patients, when first seen, ranged from 21 to 76 in age. The chief complaints were abdominal or low backpain in four patients, palpation of mass in one and hematuria in one.
Operation for removal was performed in three patients, and radiation therapy and/or chemotherapy were administered to two patients. In one case who had been operated on, liver metastasis was found soon after operation, and partial hepatectomy was performed after chemotherapy. Only the three patients who could be operated on are still alive.
Retroperitoneal tumor is equivocal in the manifestation of symptoms, and are already inoperable when first seen. Few cases respond to radiation therapy or chemotherapy. And for these reasons, the prognosis of this disease is poor.
In future, multidisciplinary treatment including surgery, radiation therapy and chemotherapy to this disease is expected to improve the prognosis.

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Brain metastasis was removed surgically in two patients with renal cell carcinoma. The first case was a 53-year-old man who underwent right radical nephrectomy (pT3N0M0V1) on December 7, 1980. He suffered from an attack of convulsive seizure soon after the surgery. Solitary metastasis was found in the left occipital lobe and excised on January 27, 1981. Multiple pulmonary metastases apperaed and the right middle lobe was resected. Brain metastases recurred and the whole brain was irradiated. He died of cancer on July 8, 1981, 5 months after the brain surgey. The second case was a 70-year-old man who received left radical nephrectomy (pT2N0M0V0) on December 8, 1978. Diplopia, dysgrahia, walk disturbance, and Gerstmann's syndrome appeard 4 years later. A metastasic lesion was found in his left occipital lobe and removed on January 25, 1983. Neurological symptoms disappeared completely after surgery. Lung and vertebral bone (Th11) metastases developed and the spinal column was fixed by metal plates on March 21, 1984 for compression fracture. He was working for 3 years and 5 months. The patient became paraplegic due to the progression of the vertebral metastasis and died of cancer 4 years after the brain surgery.
In the Japanese literature, we have collected 65 cases of brain metastasis (cerebral 24, cerebellar 5, both 6, unknown 30) of renal cell carcinoma including our two cases. Sex ratio remarkably predominates in the male. Their ages ranged from 20 to 74 years and 55.8 in average. The frequent clinical signs of brain metastasis were headache, hemiplegia, and gait disturbances. 21 of 35 cases (60%) manifested neurological symptoms after nephrectomy and the interval between nephrectomy and brain metastasis was 34 months in average. Brain metastasis are solitary in 20 cases, two in 8 cases and more than three in 3 cases. 33 of 65 cases were subjected to brain surgery and survived for 18.1 months in average (in 24 cases) from onset of brain metastasis. On the contrary, the mean survival time of the unoperated cases (32/65) was 6.7 months in average (in 12 cases). The sites of brain metastasis of the 33 operated cases were cerebral in 11, cerebellar in 5, both in 3 and unknown in 14. Of 14 cases with cerebral metastasis, 11 cases were single organ metastasis and 8 of them (73%) survived more than 1 year, while 3 cases of multiple organs metastases did not survived more than 1 year. Of 8 cases with cerebellar metastasis. single organ metastasis was found in one patient who survived more than 1 year.
These data as well as our experiences indicated that surgical removal of brain metastasis would prolong the survival time of patients with renal cell carcinoma provided that the brain is the single organ of metastasis.

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