To clarify the influence of percutaneous nephroureterolithotomy (PNL) on renal function, ^99mTc-DMSA renal scintigraphy was performed preoperatively and 3, 6 and 12 months after the procedure.
In 50 stone-containing renal units, 48 patients, changes of DMSA renal uptake rate were investigated for determination of individual renal function. In 3 cases with staghorn calculi which complicated with pyelonephritis during PNL procedure, DMSA renal uptake rate was decreased after PNL. On the other hand, DMSA renal uptake rate was almost stationary after PNL in other cases.
In 21 renal units (42%), the postoperative renal scintigrams showed low uptake or cold areas at nephrostomy tracts.
These results indicate that control of infection during PNL is important to maintain renal function.

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The clinical result was studied in 56 living and 44 cadaveric renal transplantations including 4 regraftings at our department during the period from November, 1979 to August, 1987.
In living renal transplantation, the 1-year survival rate of grafts receiving steroid, cyclosporin (Cs) and preoperative lymphocytapheresis (LA) was 93.9%. On the other hand, the 1-year graft survival rate of cases treated with steroid and azathioprine (Az-patients) and that of receiving steroid, mizoribine (Mz) and LA were 55.6% and 79.2%, respectively. The graft survival rate of Cs and LA-treated patients was significantly higher than that of Az-patients.
In cadaveric renal transplantation, the 1-year survival rates of patients and grafts receiving steroid and Cs {Cs(+)} were 100% and 72.6%, respectively. Those of non-receiving Cs {Cs(-)} were 63.0% and 49.0%, respectively. The survival rates of patients between Cs(+) and Cs(-) were significantly different.
As regards post-operative serious complications, a significant decrease of liver dysfunction and a significant increase of ATN were observed in Cs(+). Bacterial pulmonary infection, leucopenia and aseptic necrosis of the head of the femur tended to be decreased in Cs(+). Although the frequency of acute rejection episodes showed no difference between Cs(+) and Cs(-), many rejection episodes in Cs(+) were milder than those in Cs(+). Also, cytomegalovirus infection decreased in Cs(+). Csnephrotoxicity was observed in 47.8% of living transplants and 47.1% of cadaveric grafts.

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We studied property of lymphokine-activated killer (LAK) cell activity and LAK generation in peripheral blood lymphocytes (PBL) isolated from patients with renal cell carcinoma. LAK cell activity was measured in a short-term ⁵¹Cr-release assay. The phenotype of the effectors and precursors of LAK cells was analyzed by serologic depletion assay with various monoclonal antibodies.
LAK cells could lyse not only fresh autologous tumor cells but also NK-resistant tumor cell lines, suggesting that LAK cells may have a rather broad specificity for tumor recognition. Treatment of LAK cells with each of monoclonal antibodies, such as OKT-3, OKT-8 or Leu-11b, could depress LAK cell activity, but its activity remained remarkably well. Patient's PBL were fractionated into low density fraction (LDF) and high density fraction (HDF) on percoll-discontinuous density gradient and each fraction was cultured with rIL-2 (2×10 lymphocytes/1000 IU·rU-2). LAK cells were generated from LDF within a day of culture. On the contrary, LAK cell activity of HDF was not significant on the first day of culture. However, it increased afterwards with incubation time till day 6. This result indicated that there was a significant time difference in kinetics of LAK generation between both fractions. Although treatment of PBL with OKT-3 or OKT-8 plus complement followed by culture with rIL-2 did not yield any suppressing effects on LAK cell generation, similar treatment with Leu-7 and Leu-11 together showed appreciable decrease in LAK cell activity.
These clinicolaboratory studies implies that LAK cells appear to be derived from phenotypically and functionally heterogeneous lymphoid cells in PBL, and the regimen of the treatment for renal cell carcinoma should be designed according to the property of LAK activity and LAK cell generation.

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To evaluate glomerular dysfunction of refluxing kidney, microalbuminuria was assessed using RIA in 84 children with primary VUR.
Albumin excretion increased in 40% of children with VUR. A remarkable increase of albumin excretion was recognized in children over 5 years old, which suggests that glomerular dysfunction of refluxing kidney progresses with aging.
Although the cases with high grade VUR and with renal cortical scar or unilateral severely impaired renal function on DMSA renoscintigraphy showed a tendency of high albumin excretion, neither grade of VUR nor severity of renal dysfunction correlates well with the degree of microalbuminuria. Even in three cases out of five that revealed high level of serum α₁-microglobulin, albumin excretion was either normal or elevated only slightly.

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Fourteen patients with advanced urothelial cancer (11 bladder tumors, 2 renal pelvic tumors and 1 ureter and bladder tumors) were treated with M-VAC (monthly cycles of methotrexate, 30mg/m², followed 24hr later by vinblastine, 3mg/m², adriamycin, 30mg/m², cisplatin, 70mg/m², with vinblastine and methotrexate repeated on days 15 and 22).
The objective response rate was 43% (6 of 14 patients), with 2 patients achieving a complete remission (CR). In 1 patient who had a partial remission (PR), CR was achieved with surgery. The overall CR was 21% (3 of 14 patients).
All metastatic sites responded, including primary lesion (5 of 6), lymph node (3 of 7), lung (3 of 8), liver (1 of 3), bone (1 of 3) and brain (1 of 2). As side effects, nausea or vomiting (78.6%), nephrotoxicity (21.4%), anemia (RBC<250×10⁴ cells per mm³) (21.4%), leucopenia (<1000 cells per mm³) (42.9%), thrombocytopenia (<10⁵ cells per mm³) (57.1%) and alopecia (85.7%) were noticed. Severe toxicity did not occur. M-VAC therapy was effective against advanced urothelial cancer with satisfactory results.

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Combination chemotherapy with CDDP, vinblastine and bleomycin (PVB) has improved the prognosis of patietns with advanced testicular cancer. Recent efforts have been focused on the treatment for the patients with refractory testicular cancer who fail to achieve complete response (CR) or for those patients who have once achieved CR but subsequently have a recurrence of disease.
In this study, we presented our clinical results of the induction PVB therapy in 22 patients with advanced testicular cancer and of the surgical treatment for the residual metastasis following chemotherapy in 16, who failed to achieve CR, of the 22 patients.
With induction chemotherapy, 4 (18.2%) and 11 patients (50.0%) achieved CR and PR, respectively, resulting in a 68.2% response rate. The low CR rate may contribute, in part, to several “poor prognostic features”, such as the bulky metastasis, found in most of these patients.
The surgical treatment for 16 patients consisted of retroperitoneal lymph node dissection in 12 patients, partial resectin of the lung in 5, supraclavicular lymph node dissection in 1 and resection of a brain lesion in 1.
The histopathological study revealed that 3 patients (18.8%) had granulation or fibrosis, 3 (18.8%) mature teratoma and 10 (62.4%) cancer cells in the surgically removed residual metastasis following chemotherapy. In all of the patients without cancer cells in the residual metastasis, AFP and hCG-β had normalizd at the time of surgery by the induction PVB chemotherapy. However, in the patients with cancer cells found in the residual metastsis, most had shown either one or two persistently elevated markers.
With surgical treatment, 6 (37.5%) out of 16 patients with residual metastasis following chemotherapy have been free of disease for more than 36 months.
The post surgical course was influenced by the status of AFP and hCG-β prior to surgery following chemotherapy, since the patients having a normalized status of these markers experienced a good clinical course, while those with the persistently elevated status died of cancer, postoperatively, within 12 months. This result has indicated that surgical treatment for residual metastasis following chemotherapy should be determined by the status of the tumor markers.
The histological features of residual metastasis following chemotherapy were also reflected in the post surgical course. All long term survivors had granulation or fibrosis, or mature teratoma in the histology of their residual metastasis. In contrast, the patients who died of cancer revealed to have cancer cells in the histology of metastasis.

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The levels of serum γ-seminoprotein (γ-Sm) and prostatic acid phosphatase (PAP) were determined by enzyme immunoassay using an EIA γ-Sm test kit and radiommunoassay using a RIA PAP test kit in 205 patients with clinically diagnosed benign prostate hypertrophy (BPH).
A γ-Sm level of over 4.0ng/ml and a PAP level of over 3.0ng/ml were considered to be high.
A high level rate of γ-Sm was seen in 12.2% of the BPH patients (25 out of 205 patients), and 15 of these patients were histopathologically diagnosed BPH.
20 of the remaining 180 patients whose γ-Sm level was normal received transurethral resection of the prostatic gland (TUR-P), and incidental prostatic carcinoma was found in 3 patients. Transrectal prostatic longitudinal ultrasonography by linear array was performed in 25 γ-Sm positive patients (A group) and in 20 γ-Sm negative patients who who had received TUR-P (B group).
As a result, prostatic stones were found in 60% in A group and 35% in B group, and prostatic abscess was observed in 32% in A group and 10% in B group. When the weight of the prostate was computed using ultrasonography, the mean prostatic weight was 30.8g in A group and 23.9g in B group.
The γ-Sm level tended to be high in patients with large BPH and BPH patients with prostatic stones and/or prostatic abscess. These data suggested that transrectal prostatic sonography was useful for γ-Sm positive patients.

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We examined operated prostate tissues from 573 patients who were diagnosed as having clinical benign prostatic hyperplasia and urinary bladder cancers.
1. 25 of the 573 patients (4.4%) were diagnosed as having incidental carcinoma. The patients with incidental carcinoma were an average of 73.8 years old, and the patients of BPH were an average of 69.5 years old. The former was significantly older than the latter (p<0.05). Incidental carcinoma did not increase in recent years.
2. By means of the step-section technique and examination of all TUR chips, the frequency of incidental carcinoma increased from 5.6% to 7.4%.
3. The tumor size was closely assosiated with the histological grade. Most large tumors were moderately or poorly differentiated adenocarcinoma. Well differentiated adenocarcinomas which were over 5mm in diameter, were mixed with moderately or poorly differentiated adenocarcinoma. More than 5 chips in TUR-P patients were diagnosed as moderately or poorly differentiated.
From the above results, we propose that stage A1 is the tumor size of less than 5mm and well differentiated adenocarcinoma, or less than 3 chips and well differentiated adenocarcinoma.

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The usefulness of transurethral resection or incision (TUR) of ureteroceles exprienced in these 16 years was evaluated.
In 12 cases (15 ureters) of simple ureteroceles without collapse and eversion, TUR (distal incision) was performed for better drainage of the ureter. Though mild VUR appeared in 3 ureters, one disappeared spontaneously. In all cases clinical symptoms such as pain and urinary infection disappeared. Stone extraction was also successful in 3 patients.
In 8 cases (8 ureters) of ectopic ureteroceles, TUR was performed for various reasons such as bladder outlet obstruction (5 ureters), drainage (2) and prolapse (1). In the former, bladder outlet obstruction was resolved in all without postoperative problems such as urinary incontinence. In particular, cecoureterocele was thought the best indication. In the latter two, TUR was also useful in 2 of 3, including one case which was thought cured only by TUR. TUR was also useful for the assessment of renal function.
Thus TUR of ureterocles was thought one of the quite useful treatments both in simple and ectopic ones when the indication was strictly selected.

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Surgical enucleation for renal malignant tumors has a fundamental problem of leaving residual malignancy. We reviewed the results of enucleation in six patients treated from January 1980 to December 1987. Of them four had renal cell carcinoma alone unilaterally or bilaterally, one had renal cell carcinoma associated with angiomyolipoma in the same side, and one had renal oncocytoma. Of the 5 patients with renal cell carcinoma, 4 remained free of cancer in the follow-up period, while one with pathological stage II tumor in the nephrectomized contralateral kidney died of recurrent disease. Three patients presently are free of disease 2 to 31 months postoperatively. Although some authors point out the malignant potential of renal oncocytoma, the patient with oncocytoma has not evidence of recurrence 8 months after enucleation.
We consider that surgical enucleation for renal cell carcinoma as well as oncocytoma and angiomyolipoma may have a curative efficacy in selected patients, especially for so called “small incidental cancer”.

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In order to evaluate the long-term integrity of adrenocortical function, a study has been carried out in nine renal transplant recipients followed for 5 to 17 years after surgery. Their age was 24.3 years (range 10 to 32 years). Conventional immunosuppression with steroids and azathioprine was applied in all instances. At the end of the 2nd year, steroids were completely stopped if renal funciton was normal and if no alterations were seen on renal biopsy. Adrenocortical function tests were repeated serially at 1-year intervals after transplantation. The mean serum 11-hydroxycorticosteroid (11-OHCS) was 23.0±2.3μg/dl in 3 patients without steroids and 6.3±1.8μg/dl in 6 patients on steroids (p<0.003). A positive increase in serum 11-OHCS was produced by a standard 8 hour intravenous corticotropin (ACTH) test in 2 out of 3 patients without steroids and in 3 out of 6 patients with steroids. In all 3 patients with normal graft function (GFR>70ml/min) serum cortisol and 11-OHCS, and urinary 17-hydroxycorticosteroid and 17-ketosteroid (17-KS) were within normal limits. However, only 1 out of 6 patients with renal dysfunction (GFR<70ml/min) had normal serum 11-OHCS and urinary 17-KS. The results observed in this clinical study indicate that adrenocortical function was significantly suppressed in the patients on long-term steroid therapy.

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Our experience with surgical treatment of chordee without hypospadias (CWH) performed in 11 boys (ages ranged from 2 to 11 year-old) was reported. As done by Devine and Horton, meticulous dissection enabled us to devide CWH into three types depending on the deficiency of periurethral layers. Eight of them were classified as type I as all periurethral layers (corpus spongiosum, dartos and Buck's fasciae) were deficient. Chordee deformity was corrected by further urethral mobilization in 5 (type Ia) and by urethral transection for dysplastic urethra (type Ib) in other 2. A case of type Ib who did not undergo urethral transection still remained in a state of “short urethra”. Three of type II in which the urethra was surrounded by normal corpus spongiosum but deficient in dartos and Buck's fasciae were successfully corrected by dartos mobilization alone. Type III deformity, characterized as the limited abnormality of dartos fascia, was not experienced. The total success rate was 10/11 (90%).

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We evaluated the usefulness of endocrine therapy combined with chemotherapy as an initial treatment in comparison with endocrine therapy alone in 100 patients with prostatic cancer treated at the Department of Urology, Kurume University between 1978 and 1987.
The 5-year and 8-year survival rates in all patients were 46.4 and 24.1%, respectively.
The response rates (partial response and stable in NPCP criteria) 3 months after the initiation of the therapy were 93.3% in the group receiving endocrine therapy combined with chemotherapy and 92. 6% in the group receiving endocrine therapy.
Though the survival rates within 3 and a half years were slightly higher in the group treated with endocrine therapy combined with chemotherapy, no significant difference was observed between the two groups during the entire period. However, the outcome was significantly better in the groups showing partial response 3 months after the initiation of the therapy (p<0.01) and showing stable condition (p<0.05) than in the group showing progression. These results suggest that the proximity effects affect the prognosis.
In the group treated by endocrine therapy combined with chemotherapy, cisdichlorodiammine platinum, cyclophosphamide, or adriamycin, as the drug combined with diethylstilbestrol diphosphate, tended to produce better results than estracyt 1-3 years after the treatment.

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In this study, we examined whether urinary components in hydronephrosis could predict functional recovery after release of obstruction.
The subjects were 128 patients with hydronephrosis, these included 118 with unilateral hydronephrosis, 7 with bilateral hydronephrosis and 3 single kidney.
Intravenous pyelography (IVP) was initially performed and the function of hydronephrotic kidney was evaluated according to the appearance state of the pelviocalyceal system on the film made 15 minutes after the onset of contrast medium injection. The urine specimens in the hydronephrotic kidneys were then collected, and the levels of K, Cr and urea-N and activities of NAG and β₂-MG were determined. The levels of K, Cr and urea-N tended to decrease with a reduction in the function of the hydronephrotic kidney. On the other hands, NAG and β₂-MG activities tended to increase with decreased function of the hydronephrotic kidney.
After the obstruction had been removed, IVP was repeated to determine the presence or absence of the functional recovery of the hydronephrotic kidney. Patients in whom calices had been visualized in 15 minutes of the IVP prior to removal of the obstruction, exhibited an earlier appearance of the pelviocalyceal system on the IVP after removal of the obstruction. So functional recovery of the these hydronephrotic kidneys was confirmed.
Among patients with so-called non visualizing kidney, in whom no calices had been visualized in 15 minutes of the IVP before release of the obstruciton, some showed caliceal appearance on the IVP after removal of the obstruction, while others did not. There were significant differences in the levels of K, Cr and urea-N between the patients with and without appearance of calices after release of the obstruciton. These levels were higher in those with appearance of calices than in those without. In the patients without appearance, the upper limits of the critical region (p<0.05) was 11.9mEq/L for K, 21.3mg/dl for Cr and 81.9mg/dl for urea-N. Therefore, levels of urinary components exceeding these figures are considered to predict future functional recovery of hydronephrotic kidney.
Thus, the levels of K, Cr and urea-N seem to be very useful for judging the possibility of functional recovery in non visualizing kidneys.

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Fifteen patients who had received reanl transplantation were examined as to intrarenal hemodynamics by color Doppler echography composed of ultrasonic duplex scanning and color flow imaging. The equipment used was a prototype scanner for color Doppler echograph SSD-350 (ALOKACo.)
Renal hilar vessel's flow could be visualized in 14 of 15 patients and intrarenal branch vessel's flow could be evaluated in all patients. Peak flow velocities of either the renal hilar artery or the segmental artery were 30.3±12.3cm/sec in the group with well functioning graft and 16.5±6.3cm/sec in the group with a poor functioning graft due to ATN or rejection. There was significant difference in values between these two groups; and arterial blood flow velocity in the transplant may be a possible indicator of graft function. The density of dotty red and blue color in the renal parenchymal echo also correlated with the graft function.
This technique might be a diagnostic tool of new generation for the intratransplant hemodynamics and has a practical usef ullness in managing cadaver renal transplant patients under ATN.

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One hundred and sixty strains of Escherichia coli isolated from the urine of patients with urogenital infections were assayed for pilus type, in vitro capability of agglutination for guinea pig red blood cells and hemolysin production. Of the 160 strains, 151 manifested type 1 pili and 47 did P pili or mannose-resistant pili. Strains that manifested P pili were dominantly collected from the urine of patients with acute uncomplicated pyelonephritis or bacterial prostatitis. Hemagglutination titers were higher in strains isolated from the urine of patients with acute uncomplicated cystitis or bacterial prostatitis than in strains from chronic complicated cystitis or pyelonephritis. Hemolysin production seemed to correlate with manifestation of P pili. These data suggest the significance of P pili and hemolysin production in the pathogenesis of acute uncomplicated pyelonephritis and bacterial prostatitis.

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Metal staples have been used for stabilization of an intussuscepted nipple valve in creation of a continent urinay reservoir (CUR) such as Kock pouch or Mainz pouch. We report successful stabilization of the intussuscepted nipple valve in creation of the ileal and colonic CURs without using metal staples which are expensive and may act as a nidus for stone formation. Our technique for stabilization of the nipple valve included complete mesenteric exclusion from the nipple valve, use of a Dacron mesh collar at the base of intussusception, and fixation of the nipple valve to the pouch wall by making a 2-3cm longitudinal full-layer incision through the outer layer of the nipple valve and the opposite pouch wall and sewing the edges of nipple valve incision to the edges of pouch wall incision. Using this technique the intussuscepted nipple valve was successfully stabilized without extussusception or prolapse for 6 to 20 months (average 12 months) of followup in 11 patients who underwent creation of the ileal or colonic CUR. All of these patients are continent day and night with easy intermittent self-catheterization.

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Reported is a case of extramedullary hematopoiesis in the nonfunctioning adrenocortical adenoma. This patient was a 64-year-old woman who was found to be with a right adrenal mass with calcification by CT scan incidentally. The labolatory data including ACTH and adrenal endocrine studies were all within normal limits. Under US guidance, needle biopsy of the right adrenal mass was performed and the specimens revealed adrenocortical adenoma. A right adrenalectomy was performed under diagnosis of nonf unctioing adrenocortical adenoma. Pathologically, there were two distinct histological components, a large adrenocortical adenoma with calcification and a smaller extramedullary hematopoiesis.
Nonfunctioning adenocortical adenoma found incidentally is increasing, but we have found no reports of its association with extramedullary hematopoiesis or myelolipoma.

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