The acute effects of extracorporeal Shock-wave lithotripsy (ESWL) on morphology of the renal parenchyma were evaluated by Magnetic Resonance Imaging (MRI) in 15 kidneys, before and immediately after (within 24 hours) ESWL in 11 cases. The renal parenchymal damages were observed by MRI as the changes of signal intensity of renal cortex and medulla, perirenal fluid, loss of corticomedullar differentiation, and other renal traumas. Loss of corticomedullar differentiation was seen in 9/11 cases and peripheral fluid of the kidney was seen in 4/11 cases. Irregular and edematous changes of renal capsula were seen in 5/11 cases. Obvious abnormal findings indicated renal trauma were not observed in this study. Several MRI findings may transient and reversible changes and the morpholigic changes detected by MRI may attributed to renal parenchymal obstruction and edema and decreasing of renal capillary flow, such as in renal contusion. It is concluded that MRI is very sensitive and the best technique to detect the effects and clinical trouble of ESWL.

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We started an original mass screening system of the prostatic diseases using transrectal sonography in 1976. Findings on the prostate by digital examination and transrectal sonography were compared in 1, 683 cases examined by the both methods. The results obtained were as follows:
1) The most frequent digital finding for suspected prostatic cancer was a hardness. Only 6.7% of 105 cases with a hardness in the prostate were diagnosed as prostatic cancer finally.
2) An asymmetry by digital examination was thought to be not important clinically. An unclear border on palpation was a very important finding, although it detected cancer only in 0.6% of all the cases.
3) As regards the sensitivity and specificity for prostatic cancer, palpation and sonography showed equally sufficiently high accuracy.
4) As regards the diagnosis for BPH, palpation was uncertain, with a lower sensitivity and specificity than sonography.

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Tissue polypeptide antigen (TPA) is an antigenic polypeptide occurring in the membranes of human cancer cells and can be demonstrated in serum and urine by the Prolifigen TPA (¹²⁵I) Radioimmunoassay.
Urinary TPA (U-TPA) values were measured in 170 patients with bladder cancer, 20 with renal cancer, 10 with renal pelvic & ureteral cancer, 34 with prostatic cancer, 22 with benign prostatic hypertrophy, 27 with urolithiasis, 4 with renal failure, 37 with other urological benign diseases and 54 healthy controls.
The mean values of U-TPA were 152.6U/L and 177.8U/g.Cr. with Cr. adjustment in the control group. The cut off levels of U-TPA were determined as 370.2U/L (Mean±2S. D.) and 534U/g. Cr. (Mean±2S. D.) with Cr. adjustment.
In my basic study, there was no significant difference in random urine samples and 24-h urine samples, with or without pH and/or Cr. adjustment.
The positive rate of U-TPA in 82 bladder cancer patients was 64.6% compared with 61.0% by urinary cytology, and the combination of both was elevated to 79.3%.
The determination of U-TPA seemed to be useful in the screening and the monitoring of bladder cancer.

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In an attempt to produce experimental models of congenital urinary tract obstruction, we operated on fetal rabbits.
Sixteen pregnant rabbits were operated on between 22 to 24 days of gestation under the general anesthsia with GOF and intravenous administration of ketamine. In case of ureteral ligation, one hind limb of the fetus was fixed to the uterine wall with small stay sutures to prevent excessive loss of amniotic fluid. A ureter was exposed through a flank incision, and was ligated either with a clip or with the suture material. Care was taken to keep the fetus wet and warm.
Thirty-two fetal rabbits were operated on in this experiment: urethral ligation in 14, ureteral ligation in 10, bladder neck ligation in 3, and an incision of fetal skin without any manipulation of the urinary tract (sham operation) in 5. Twenty-nine of the 32 rabbits were born alive through cesarean section after the period of ligation from 3 to 6 days. Fourteen unoperated rabbits were considered to be controls. Vesical overdistention was evident in 6 rabbits with urethral ligation and one with bladder neck ligation. The upper urinary tracts were normal in these animals. Hydronephrosis was apparent in 7 rabbits: it was marked in 3 ureters ligated with the suture material and moderate in 4 ligated with a clip.
All of the operated newborns were markedly underweight in compared with the unoperated controls. Significant decrease of lung weight/body weight was evident in rabbits with successful urethral ligation.
Microscopic findings of the kidney and the ureter were evaluated and compared with the control materials. Histologic section of the kidney from the control showed a nephrogenic zone with a few S-shaped glomeruli in the outer cortex. The specimens of the severe hydronephrosis from ureteral ligation revealed marked renal atrophy. There were remarkable dilatation of tubules and ducts in the whole parenchyma. Small glomerular cysts, in which Bowman's capsule is dilated and the glomerular tuft is compressed to the corner, were evident in the subcapsular zone. There were no striking changes of the glomeruli in the deep cortex. The kidneys of the urethral-ligation group were normal under the microscope. The ureter and renal pelvis were markedly dilated above the obstruction in the animal of urethral ligation. The epithelial layer was overstretched, and there was a slight increase in the amount of collagen fibers in the submucosal layers. Musclar hypertrophy and hyperplasia were observed in these specimens.

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The DNA content in renal cell carcinomas from 50 patients was determined retrospectively by means of flow cytometry (FCM), and related to histologic classification and prognosis of the same tumor. Paraffin-embedded materials were prepared for FCM. DNA histograms were evaluated by DNA index (DI). Aneuploid DNA histograms were found in 33 of 50 specimens (66%). The 5 year survival rate was 93 per cent for patients with diploid DNA histograms and 55 per cent for patients with aneuploid patterns (p<0.01). Aneuploid patterns were further classified into two groups. One was non tetraploid aneuploid DNA pattern and the other was tetraploid aneuploid DNA pattern. 5 year survival rate was 68 per cent for the former and 33 per cent for the latter (p<0.05). Aneuploid DNA patterns were demonstrated in 16 of 33 grade 1 tumors (52%), 15 of 16 grade 2 tumros (94%) and one grade 3 tumor (100%). The mean value of DI and 5 year survival rate were as follows: grade 1; 1.34, 86%, grade 2; 1.70, 36%, grade 3; 2.0, 0%. The difference between grade 1 and 2 tumors was statistically significant (p<0.01). But correlation between Robson's clinical staging and DNA content had no statistical significance. These results show that DNA content analyzed by FCM using paraffin-embedded materials had not only significant correlation to morphologic grading, but is one of most important indicator in the determination of prognosis for patients with renal cell carcinomas.

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In acute decerebrate cats, the pontine micturition center (PMC) was identified by electrical microstimulation, and then putative chemical transmitter agents such as carbachol, acetylcholine, noradrenaline and enkephalin were microinjected into it. The effects of each agent upon micturition reflex were studied. When the bladder was filled with subcritical volume of physiological saline, carbachol (10mM or 100mM, 0.1μl) and acetylcholine (100mM, 0.1μl) microinjections into the PMC resulted in micturition. The pattern of changes in bladder pressure and the external urethral sphincter muscle activity was almost identical to those observed during reflex micturition and electrically induced micturition. Upon reflex micturition, carbachol, acetylcholine and noradrenaline microinjections into the PMC resulted in an increase in the maximum bladder pressure and a decrease in bladder capacity, while enkephalin microinjections resulted in a decrease in the maximum bladder pressure and an increase in the bladder capacity. These results indicate that, for the neurons of the PMC, cholinergic inputs act as micturition executing ones, while noradrenergic and enkephalinergic inputs act as micturition modifying ones, exerting facilitatory and inhibitory effects to the PMC, respectively.

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Using human renal cell carcinoma heterotransplanted in nude mice (strain nomenclature, JRC 11), effects of the combined use of hyperthermia and interferon (natural human interferon-alpha; IFN-alpha, 1×10⁵, 3×10⁵ I. U., i. m., and recombinant interferon-gamma; IFN-gamma, 3×10⁵, 6×10⁵ J. R. U., i. p.) were examined. The hyperthermic device used was the Clini-Therm, Mark VII, 915MHz, microwave. IFN administration was started immediately before hyperthermia and carried out on consecutive days. Combined use of hyperthermia and IFN was compared with hyperthermia or IFN alone. Combined use of hyperthermia and IFN-alpha was shown to have significant anti-tumour effects compared with either alone. Of 10 nude mice (10 implanted tumours) used for the experiment, 5 showed complete disapperance of the implanted tumours and the others showed evident prolongation of survival. However, the combined treatment with IFN-gamma and hyperthermia showed no significant effects compared with other treatment groups. Therefore, combined treatment with local hyperthermia and IFN-alpha is suggested to be useful for clinical application to renal cell carcinoma.

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Imperforate anus is often accompanied by considerable abnormalities of the urinary tract. Apart from rectourinary fistula, vesicoureteral reflux (VUR) is the most common abnormality. We made a retrospective review of the clinical courses and the management of VUR in 43 children with anorectal deformity.
1) Urinary retention and urinary tract infection were two most common signs and symptoms which had led to urological examinations.
2) There was an increased incidence of moderate to severe grades (grade IV and V) of reflux with the higher type of rectal anomalies. Of 46 ureters in patients with supralevator lesions, 27 (59%) showed moderate to severe refluxes.
3) Scarring of the renal parenchyma was evident in 35% of the kidneys. There was a tendency for the renal scarring to increase with more severe reflux.
4) Spontaneous cessation of the reflux was radiologically comfirmed in 9 ureters (14%). Ureterovesical junction stenosis progressed after the reflux had stopped in 2 cases.
5) The antireflux operation was performed on 36 ureters of 15 patients (35%), and nephrectomy on 3 kidney of 3 patients. In 4 severely dilated ureters, temporary upper tract diversion was performed before the antireflux operation.
In the management of VUR in patients with imperforate anus, we should examine first the lower urinary tract in order to find out whether or not there is functional or mechanical obstructions. As far as the result of the evaluation remains unclear, the decision of antireflux operation should be made with caution. Because the rectal pull-through may alter the anatomy around the ureterovesical junction, we recommend to postpone the antireflux operation for at least 6 months to 1 year after anorectoplasty. One must be most careful to avoid the complication in cases with thick bladder wall or in cases with severe adhersion of the lower ureters.

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We experienced 3 cases with characteristic findings of the vesiculograms, which were regarded as the anomalies different from so-called seminal vesicle cysts, and designated as “cystic dilatation of the seminal vesicles”, Its definition was demonstrated by the classification of the cystic lesions of the seminal vesicles.
These 3 patients with complaint of childlessness, whose semen analyses showed no or few sperms and whose histological findings of the testes showed normal spermatogenesis, were diagnosed to have obstructive azoospermia. In these 3 patients, epididynovasostomy, implantation of artificial spermatocele and retrograde dilatation of the ejaculatory duct were performed as the treatment, respectively.
Conception was successfully obtained in the patients who was treated with retrograde dilatation of the ejaculatory duct.
Finally, it was suggested that “cystic dilation of the seminal vesicles” should be classified as unique disorder based on the findings of the vesiculograms and its characteristics besides the following two characteristics which were (1) involvement of bilateral sides of the seminal vesicles and (2) complication with polycystic kidney.

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To investigate the role of microhematuria for the diagnosis of urological neoplasma, the retrospective study of 251 patients including 33 with renal cell carcinoma, 25 with upper urotherial tumor, 140 with bladder tumor and 55 with prostatic cancer was done. Among the 251 cases, asymptomatic microhematuria was observed in 17 cases (7%) as an initial sign of the disease. According to the process to the final diagnosis, these 17 cases were classified into 4 groups; the Group 1 with 2 patients who consulted the urologist just after the health examinaiton; the Group 2 with 8 patients who consulted the urologist by the introduction of the general practitioner; the Group 3 with 2 patients who disregarded the sign and consulted the urologist after the appearance of symptoms, the Group 4 with 5 patients whose general practitioner overlooked the sign and who consulted the urologist after the appearance of the symptoms. The mean duration between the initial sign and the final diagnosis of each group was 2, 2, 8 and 65 months, respectively. In 10 patients with bladder tumor, high grade tumor was observed more frequently in groups 3 and 4 than in groups 1 and 2. Four of 6 patients (67%) in groups 3 and 4 were treated by total cystectomy, while 2 of 4 patients (50%) in groups 1 and 2 were. In 3 renal cell carcinomas, there was no correlation between the duration until the final diagnosis and the grade or the stage of the tumor.

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In 37 cases of prostate cancer treated by endocrine therapy, grade was compared between the specimen obtained at the start of treatment and that at autopsy.
Nine cases of 23 of moderately differentiated cancers as the start of the treatment progressed to poorly differentiated cancers and the other showed no change during the courses. There were similar grades during whole courses in cases showing poorly differentiated cancers at the start of treatment.
Seven cases of 16 of poorly differentiated cancers at the start showed unresponsiveness to endocrine therapy.
At autopsy, the same grade was observed between the prostate and the sites of metastases.

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^99mTc-dimercaptosuccinic acid renal uptake (DMSA uptake) was measured in patients with hydronephrosis and we obtained the following conclusions.
1. Grades of hydronephrosis on IVP according to Oka's classification were compared with DMSA uptake. In 73 adult patients, the grade of hydronephrosis paralleled DMSA uptake well, but in 20 children it did not.
2. The changes of DMSA uptake pre- and post-nephrostomy were measured in 21 kidneys in 19 cases with congenital hydronephrosis. DMSA uptake of 7 infantile kidneys significantly increased post-nephrostomy, but in the cases over 1 year old significantly decreased after nephrostomy. DMSA uptake of the contralateral kidney significantly increased after nephrostomy in infants, but it did not change in the group over 1 year old.
3. In 15 kidneys of 13 cases with nephrostomy, DMSA uptake during closure and after opening of the nephrostomy catheter and DMSA uptake due to the radioisotope (RI) accumulated in the renal collecting system were measured. In the group over 1 year old, DMSA uptake decreased after opening nephrostomy nearly all and the extent of the decrease almost agreed with DMSA uptake due to RI accumulated in the renal collecting system. But in infants, DMSA uptake increased after opening nephrostomy in most cases and the extent of the change in DMSA uptake did not agree with DMSA uptake due to RI accumulated in the renal collecting system.

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Flow cytometric DNA analysis (FCM) of bladder irrigation specimens was studied to evaluate whether FCM is a useful examination for screening and monitoring of patients with bladder cancers.
Seventy-three point four percent of 218 FCMs performed in 115 patients with histologically proved bladder cancers showed positive FCMs. When bladder cancers were classified according to the tumor grade, positive rates obtained by FCM were 56.8% for grade-I, 67.9% for grade-II and 90.3% for grade-III. Thus, high grade bladder cancers tended to have more positive FCM results. A total of 666 FCMs including 488 FCMs which was obtained from patients with positive history of bladder cancers treated by bladder preserving procedures, could be analyzed regarding their FCM fingings and histologically presence or absence of bladder cancers. Seventy-six point five percent (235/307 FCMs) with the presence of bladder cancers revealed positive FCM findings, while, 23.5% of them were negative. Therefore, false negative rate of FCM method was thought to be 23.5%. On the other hand, 20.3% of FCMs (60/295 FCMs) showed no evidence of bladder cancers confirmed by biopsy, thus false positive rate of FCM method was considered to be 20.3%. These results indicate that FCM examinations of bladder washings in patients with bladder cancers are valuable armament not only for the detection of bladder cancers but also for the monitoring of the treatment of bladder cancers.

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We report on creation of the colonic continent urinary reservoir for supravesical diversion. The right colon (cecum, ascending colon and the right third of transverse colon) along with a 15-18cm segment of the terminal ileum is isolated. The colonic segment is split open at the anterior taenia. The ileal mesentery is stripped for 8cm proximal to the ileocecal valve and the denuded ileum was intussuscepted into the cecum. The intussuscepted ileal nipple is stabilized by using a Dacron mesh collar at the base of the intussusception and by making a 2-3cm longitudinal full-layer incision through the outer layer of the ileal nipple and the opposite colonic wall and sewing the ileal edges to the colonic edges. Following an antirefluxing ureterocolonic anastomosis using the submucosal tunnel method, the colonic segment is closed transversely (Heineke-Mikulicz type closure) to disrupt the tubular nature of the colon. A flush stoma is created in the right lower quadrant so that the ileal limb can reach the skin as short as possible. The Dacron mesh collar is fixed securely to the anterior rectus sheath opening. To date we performed this procedure in 7 patients. All patients remained dry day and night with easy intermittent self-catheterization during 3 to 17 months (average 11 months) of followup. Pouchmetry revealed low pressure reservoirs with capacities of more than 500ml. All patients had stable upper tracts without reflux. No early postoperative complications were encountered. No electrolyte disturbance or malabsorption syndrome was observed.

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Natural killer (NK) cell and lymphokine-activated killer (LAK) cell activity of peripheral blood lymphocytes (PBL) were measured in patients with bladder tumors by using ⁵¹Cr release cytotoxicity assay.
K562, HT1197 (bladder tumor) and fresh bladder tumor cells were used as target cells. LAK activity of 25.5% was observed in PBL cultured with IL2 for 4 days. The activity was IL2 dose-dependent and was also induced from PBL of patients with high stage tumors (T₄). This activity was detectable in macrophage-depleted PBL and also induced in PBL stimulated with OK432. The significant change of lymphocyte subsets was not found in PBL cultured with IL2 fro 4 days. IL2 also induced the augmented cytotoxity against autologous and allogenic fresh bladder tumors. A similar cytotoxity was observed in regard to K562 cell lysis and IL2 induced a remarkable augmentation of NK activity even in patients with end stage tumors.
Although further studies are required for the assessment of host immune response, these findings may give a useful information for the immunotherapy against bladder tumors.

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We performed retrospective surveys on 131 boys with cryptorchidism and 33 with hypospadias to determine what other congenital anomalies were present. Other congenital anomalies were apparant in 46 cases (35.1%) with cryptorchidism and 17 (51.5%) with hypospadias. Urogenital anomalies were apparent in 18 cases (13.7%) with cryptorchidism and 15 (45.5%) with hypospadias. Associated urogenital anomalies in cryptorchidism were hydrocele testis or of cord (5.3%), hypospadias (4.6%), and so on. That in hypospadias were undescending testis (21.2%), migratory testis (12.1%), and so on. Anomalies except for urogenital systems were apparent in 38 cases (29.0%) with cryptorchidism and 10 cases (30.3%) with hypospadias. Associated anomalies except for urogenital systems in cryptorchidism were inguinal hernia (11.5%), congenital cardiac anomalies (5.3%), and so on. That in hypospadias were inguinal hernia (9.1%), congenital cardiac anomalies (9.1%), and so on.
Nine patients with cryptorchidism were diagnosed in Multi-Congenital Anomaly Syndrome. The patients with multi-congenital anomalies associated with cryptorchidism had frequently both growth retardation and mental retardation. Among 61 patients with cryptorchidism and 20 patients with hypospadias, chromosome aberration was demonstrated in 3 cases (4.9%) with cryptorchidism and in 2 cases (10.0%) with hypospadias.

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For the assessment of the pathogenetic role of Chlamydia trachomatis (C. trachomatis) in prostatitis, we surveyed 128 patients with prostatitis. Chlamydial organisms were examined by the direct immunofluorescence antibody technique (DIF) using Micro Trak and isolation in cell cultures. Serum antibodies were also examined by means of the microplate immunofluorescence antibody technique using L2/434/Bu as antigen.
The results are summarized as follows:
1) C. trachomatis was detected in 7 cases (22.6%) out of 31 cases with prostatitis, and all cases proved antigen were chronic nonbacterial prostatitis. Positive rates of serum antibodies were 8.6% for IgM, 14.0% for IgA and 46.9% for IgG in all cases, and 8.6% for IgM, 13.3% for IgA and 46.7% for IgG in 105 cases with chronic nonbacterial prostatitis, respectively.
2) Changes of antibody titers in pair sera examined in 10 cases with chronic nonbacterial prostatitis till 5 months (at the longest). The number of the cases that range of antibodies indicated changes over than 4 times as much were IgM in 2 cases, IgA in 2 cases and IgG in 4 cases. Of five cases in 10 cases, antibody titers in the paired sera changed more than 4 times.
3) In 7 patients with positive antigen, the average age was 43.1 years (the range was 29-54). The serum antibody were positive in 2 cases of IgM, one case of IgA and 4 cases of IgG. Pyuria was recoginized in 3 cases, and the bacteria to cause prostatitis were not proved in all cases.
4) The proportion between C. trachomatis infections and chronic nonbacterial prostatitis was examined. The cases showing positive antigen, IgM antibody and/or IgA antibody were diagnosed as overt C. trachomatis infection. Of 36 cases (34.3%) in 105 cases with chronic nonbacterial prostatitis seemed to have C. trachomatis infection. It was thought that C. trachomatis was one of the predominant pathogens for chronic nonbacterial prostatitis.

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Serum levels of IAP (immunosuppressive acidic protein), CEA (carcinoembryonic antigen) and CA19-9 were measured in 64 male patients with urological malignant diseases and 16 with urological benign diseases. Positive rates of IAP, CEA and CA19-9 were 59.4%, 12.5% and 12.5% in malignant diseases and 18.8%, 12.5% and 6.3% in benign diseases, respectively. Only with regard to IAP there is a significant difference between the malignant group and the benign group. IAP also seemed to be useful to know the extent of the malignant diseases. From these results, it is considered that IAP is a good marker for urological malignancies which have no specific marker but that CEA and CA19-9 are not suitable for screening. In a few patients, however, CEA and CA19-9 were better markers for monitoring the clinical courses compared with IAP.

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Ten patients with penile carcinoma were treated between 1976 and 1987 at Kinki University Hospital. The average age was 60.6 years old, ranged from 42 to 87 years old. The mean interval between the onset of symptoms and the first visit was 17.6 months.
The number of patients combined with phimosis was 80%. The tumors were classified according to the Jackson's staging system and TNM classification. With the Jackson's system, 4 patients were in Stage I, 1 Stage II, 2 Stage III and 3 Stage IV. With the TNM classification, 2 patients had T_is, 1 T₁, 5 T₂, 1 T₃, and 1 T₄. Histopathologically 9 patients were with squamous cell carcinoma and 1 Erythroplasia of Queyrat. Treatment consisted of surgery (8), irradiation (3), and chemotherapy (10). Teatment was done mainly by combination of surgery and chemotherapy with Bleomycin.
In survival rates calculated with Kaplan-Meier's method, the patients with low stage tumors had significantly higher survival rates than those with high stage tumors. Death from cancer was observed in 5 cases, the detailed reports of cancer patients were also discussed.

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Anatomic variations of the renal veins were studied retrospectively in 97 living donors for renal transplantation (47 right kidneys, 50 left kidneys). The results were as follows:
Multiple renal veins were observed in 18 of 47 right kidneys (38%), while only in 1 of 50 left kidneys (2%).
Small accessory veins connected to the main renal vein were observed in 13 of 47 right kidneys (28%) and in all of the left kidneys (range, 1-5 accessory veins).
The adrenal vein was connected to the right renal vein in 2% of cases (1/47) and to the left renal vein in 70% of cases (35/50).
The gonadal vein was connected to the renal vein in 17% of cases (8/47) on the right side and in 90% of cases (45/50) on the left side. During nephrectomy, particular attention should be paid to the possibility of multiple renal veins draining the right kidney and to small accessory veins connected to the main left vein. The left renal vein may be retro or cirucmaortic.

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Cushing's syndrome caused by bilateral adrenal adenomas is very rare in Japan.
We have reported the 7th case of Cushing's syndrome due to bilateral adrenal adenomas. The patient was a 37-year-old woman. Her complaint was extreme obesity. Among the physical findings were central obesity, moon face and facial edema. Stria cutis, hypertrichosis, muscle atrophy and dysmennorhea were not observed. Endocrinological examinations revealed low serum ACTH (below 10pg/ml) and high serum cortisol (19.6ng/ml). Adrenogenital hormone was within a normal range. Therefore, hyperfunction in the adrenal glands was supposed. Taking into consideration the findings of the abdominal CT scanning, ¹³¹I adrenal scintigraphy, venography and high cortisol level in adrenal veins, we diagnosed her Cushing's syndrome as that due to the functining bilateral adrenal adenomas.
Right subtotal and left total adrenalectomy were carried out. The tumors were microscopically confirmed as adenomas. After operation, her obesity improved in a few months and an administration of corticosteroid hormone was stopped 6 months later.
In the 7 cases of Cushing's syndrome caused by bilateral adrenal adenomas reportd in Japan so far, the symptoms, diagnostic methods and therapies were almost the same as that of a single adenoma.
Differential diagnosis between bilateral adenomas and adrenal nodular hyperplasia is difficult. The latter is defined as the entity that a part of diffuse hyperplasia has become to have an autonomic function with persistent stimulus caused by the pituitary adenoma. Generally, in venography, an adenoma shows tumor stain, while a dnodular hyperplasia shows extension of its surrounding vessels. But morphological examinations are difficult when the tumor is smaller than 2cm in diameter. Therefore, we think that a final diagnosis should be reached from many aspects.

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