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公立豊岡病院において1991～1993年の上部尿路結石患者について集計した. 1)年間有病率は人口10万あたり125人(1991年), 156人(1992年), 141人(1993年)で, 年齢別有病率(1991年～1993年平均)は60歳代が最も高く245人, ついで50歳代235人, 40歳代205人であった. 2)年間罹患率は84人(1991年), 113人(1992年), 94人(1993年)で, 50歳代が最も高く169人であった. 3)男女比は有病率で2.0:1, 罹患率で2.2:1であった.男女別の罹患率をみると50歳代, 40歳代の男性が最も高く200人以上であった. 4)結石除去の治療は殆どがESWLであり, 有病者の23.4%であった.結石自排の患者は23.1%で, ESWL施行患者の平均年齢は52.5歳, 自排結石患者の年齢は47.0歳であった. 5)結石成分では蓚酸カルシウムが最も多く76%を占め, ついで尿酸16.4%, リン酸マグネシウムアンモニウム, リン酸カルシウム炭酸塩5.6%であった, Toyooka Hospital is a central hospital in Tajima, a rural area in the northern part of Hyogo Prefecture. Because we possess the sole lithotripter in this area, almost all urolithiasis patients requiring treatment have been referred to our department. Based on the number of urolithiasis patients treated in our institution, we estimated the annual prevalence and incidence of upper urinary tract stones in the Tajima area. The mean annual prevalence of urolithiasis and incidence during the 1991-1993 period were 141 and 93 per 100, 000, respectively. The male to female ratio was 2.0 to 1 in prevalence and 2.2 to 1.0 in incidence. Prevalence was highest in the sixties (245) and fifties (235), followed by the forties (205), seventies (162) and thirties (160). The incidence was highest in the fifties (169), followed by the forties (147), sixties (145) and thirties (118). In consideration of sex, the incidence was highest in males in the fifties and the forties. Of the patients with upper urinary calculi, 23.1% were treated by extracorporeal shock wave lithotripsy, while in 23.8% stones passed spontaneously and 50.9% were followed up without treatment. On stone analysis, calcium oxalate and/or calcium phosphate was present in 75.6%, uric acid in 16.4%, struvite and/or carbonate apatite in 5.6% and cystine in 1.4%. In summary, the prevalence and incidence of upper urinary tract calculi in the Tajima area were considerably higher than those in the nationwide survey on urolithiasis in Japan conducted in 1985.

1993年7月より1994年3月までの9ヵ月間に, 新ESWL機器エダップLT-02(R)を用いて上部尿路結石症246例(277腎単位)に対しESWLを行い, 良好な成績がえられたので, 3ヵ月経過観察可能な224腎単位のESWL単独療法の治療成績を報告した, From July 1993 through March 1994, 512 ESWL therapy was performed on upper urinary tract calculi in 277 renoureteral units using an EDAP LT-02 Lithotripter. Of these cases, 244 renoureteral units which were followed up for more than 3 months after ESWL were examined. These included 124 renal stones and 100 ureteral stones. Complete removal or sufficient stone disintegration was obtained in 66.7, 98.0 and 94.1% in the R1, R2 and R3 groups of renal stones, respectively, and in 92.4, 87.5 and 100% in the U1, U2 and U3 groups of ureteral stones, respectively. The over-all stone-free and success rates were 78.2 and 95.2%, respectively for renal stones and 93.0% and 94.0% respectively for ureteral stones. These results were better than those obtained by LT-01 in our experiences. The newly built-in coaxial X-ray system greatly contributed to these high success rates. As side effects, there were no serious complications. It is concluded that ESWL using an EDAP LT-02 is safer and more effective for the treatment of upper urinary tract calculi.

1)1992年7月までの14ヵ月間に, 115例の上部尿路結石に対しTherasonicによる破砕治療を行った。2)術後1ヵ月目の観察で, 腎盂腎杯内54結石中48結石, 腎盂尿管移行部8結石中7結石, 上部尿管30結石中27結石, 下部尿管結石23例全例で完全排石をえた。3)2例に腎周囲血腫を認めたが, 保存的療法で軽快した。他の症例には重篤な合併症は見られなかった, A third generation lithotripter (THERASONIC Lithotripsy Treatment System) was used for disintegration of upper urinary tract calculi. A total of 115 patients was treated at Miki Municipal Hospital, 54 with renal calculi, 8 with UPJ calculi, 30 with upper and 23 with lower ureter calculi. The stone-free rate one month after treatment was 89%, 88%, 90% and 100% for renal, UPJ, upper ureter and lower ureter calculi, respectively. As for side effects, we experienced two cases of perinephric hematoma which were treated conservatively. However, we encountered no other severe complications. These findings clearly indicated that the THERASONIC lithotripter is highly useful for disintegration of calculi of the upper urinary tract.

1)難治性の膀胱炎とアルカリ尿, struvite結石形成を示し, のちに膀胱直腸瘻をきたしたCorynebacteriumによる尿路感染症の1例を報告した.2)臨床分離株のCorynebacterium renaleを用い, in vitro, in vivoの尿アルカリ化作用, ラットstruvite結石形成実験を行い, C. renaleがP. mirabilisと同じように強力なウレアーゼ活性があり, 結石形成作用があることを確認した.3) Corynebacteriumには多剤耐性で難治性の菌種があり, 本菌による院内感染の可能性もあり, 注意を喚起した.また感染結石の原因菌としての重要性を指摘した, We repose of chronic cystitis associated with alkali urine, struvite stones and a subsequent vesicorectal fistula caused by Corynebacterium sp, probably Corynebacterium group D2. We also studied in vitro and in vivo stone formation caused by Corynebacterium renale isolated clinically. C. renale inoculated into normal human urine increased urine pH and formed struvite crystals after a 24-hr incubation. Bladder stones were also formed in rats experimentally infected by C. renale as well as P. mirabilis. Some urea splitting species of Corynebacterium such as C. group D2 and C. renale may play a role in the formation of human struvite stone.

薄切標本および走査電顕にて, 結石内の真菌の観察を2症例の結石について行った.1)症例1は結石内の一部の層に菌糸および胞子などの菌要素がみられ, 過去に真菌性尿路感染症があったものと推察され, 症例2は黒色真菌が結石表層にみとめられ, 結石摘出後付着し, 結石内に侵入したものと推察された.2)結石内には, 真菌が増殖する結晶間隙が十分にあり, また結石表面より内部にも侵入する事ができるものと思われ, 侵入増殖は丁度組織内での侵入と同じようであった, We examined the fungi within the urinary stones of two cases by light microscopy and scanning electron microscopy. In one case, fungal elements, hyphae and spores, were found in some layers within a bladder stone. This patient probably had a history of fungal urinary infection. In another case brown hyphae suggesting dematiaceous fungi were found in the surface and peripheral layers of a kidney stone. This maybe due to contamination of the fungi after removal of the stones. These fungi invaded into interstices of the apatite crystals within the stone as in the tissue.

当科において1974年より1981年までの7年4ヵ月, 富山県立中央病院泌尿器科において1961年より1981年までの20年11ヵ時間と経験した尿路結石のうち, 赤外線分光分析が行なわれた1514結石についてマイクロコンピューターを用いて臨床的分析を試みた.男子930例, 女子344例, 年齢は1歳より90歳に及び平均は男子44.7歳, 女子41.6歳であった.結石成分分析には日立赤外線分光光度計EPI-G3型を, マイクロコンピューターとしてはSHARP MZ-80Cを用い, 年齢, 性別, 発生部位, 内層成分, 外層成分, 血清電解質, 尿中電解質などを入力し, color display, green display, printer, X-Y plotterに出力, 表示させた.4年前に報告した300個の結石における成績と比較すると, 若干の変化が見られ, 年齢分布において腎結石, 膀胱結石含有患者の老齢化の傾向が認められた, In our laboratories, more than 1, 500 urinary calculi have been analyzed by infrared spectroscopy. These data were statistically analyzed by microcomputer. The most frequent type was calcium oxalate combined with calcium phosphate, followed by pure calcium oxalate and magnesium ammonium phosphate combined with calcium phosphate. In particular, the composition of magnesium ammonium phosphate combined with calcium phosphate increased as compared with that four years earlier. Four years ago, we spent one month to statistically analyze 300 urinary calculi. But in this study, only sixteen days was required to analyze 1, 500 urinary calculi by using a microcomputer.

1)腎結石40例のうち27例は核部も外層部と同じリン酸塩であったが, 13例は蓚酸カルシウムを核部成分としていた.膀胱結石にも核部成分の異なるものがみられた.2)核部が同一成分の感染結石では, 構築は外層部とほぼ同一で核内に多数の細菌がみられ, 細菌自体も核形成に重要な役割を演じていると考えられた.3)蓚酸カルシウムを核部成分とする感染結石では核部内に細菌は認められず, 核部外側の移行部に細菌が認められ, 蓚酸カルシウム結石に感染が加わり感染結石に変化したものと考えられた.4)同一成分の感染結石をprimary infection stoneとすれば, 成分の異なる感染結石はsecondary infection stoneと呼ぶべきもので, 再発予防にはそれに応じた原因を探しこれを除去すべきである, The composition and structure of nuclei of infection stones were investigated. Twenty seven out of 40 renal stones were found to contain struvite and/or carbonate apatite in the nuclei as well as peripheral layers, and 13 contained calcium oxalate. Some bladder stones also contained different substances in the nuclei. In some infection stones whose architecture was studied in thin section and with scanning electron microscopy, we found large numbers of bacteria in the nuclei composed of struvite and/or apatite. Though we could find no bacteria within the nuclear parts composed of oxalate, we found them in apatite layers outside the nuclei. Urea-splitting bacteria are suggested to participate both in the initial formation of struvite stones and in the diversion of oxalate stones into phosphate stones. Such bacteria may play important roles in stone formation, not only as promotors of crystallization of struvite and apatite but also as a component such as of an organic matrix.

薄切標本の偏光顕微鏡的観察によって検討した.1)尿酸と蓚酸カルシウムの混合結石には, 蓚酸カルシウム結石を核とするもの, 蓚酸カルシウムの結晶群が核部に混在するもの, 内部に含むもの, 外層を覆うものなど多彩であった.2)尿酸と蓚酸の混合結石では粒状の蓚酸カルシウム1水化物の結晶は粒状の尿酸結晶と混在し, 菱形の2水化物の結晶は核部および外層の尿酸の層を溶蝕して混在する傾向がみられた.以上より蓚酸カルシウム1水化物は尿酸とほぼ同じ条件で析出し, 2水化物は異なる条件で析出し易い, The architecture of mixed uric acid and calcium oxalate stones was studied by polarized light microscopy. Some uric acid stones contained calcium oxalate stones (whewellite or weddellite) as a nucleus. Other uric acid stones contained calcium oxalate crystals in the nucleus or inner portion. A uric acid stone covered with layers of calcium oxalate was also found. In the mixed stones, nuclei of randomly mixed fine grained whewellite and uric acid were seen and both crystals appeared in alternating sequence in the outer layers. Weddellite crystals dissolved layers of uric acid and invaded into them in the nuclear or peripheral zones. Whewellite may precipitate in the same or a similar condition as uric acid precipitates, whereas weddellite may precipitate in a different condition. We discussed the pathogenesis of mixed uric acid and calcium oxalate stones, heterogeneous nucleation and epitaxial growth based on a morphologic study of the mixed stones.

The following tables show statistics on the patients, diseas e s, operations and main urological examinations in our department during the period of January to December, 1962.

Autonomic instability was suggested to be one of the f actors of pathogenesis of urolithiasis based on methacholine chloride test and total or separated renal clearance studies. 1) In patient with urolithiasis the sympathetic hyperreactive type was dominan t . 2) Changes of CPAH and CSTS under administration of methacholine ch l oride were more remarkable in patients with urolithiasis than in others. 3) Under unstable condition of the autonomi c nervous system CPAHa nd CSTS were markedly fractuated. 4) It is supposed that the enlarging and prognosis of renal calculus depend upon not instability of autonomic nervous system but renal secondary parenchymal changes.

During the past five years, 342 cases of urolithiasis were found among the 3, 821 cases of urological patients who visited the Toho University medical school clinic. Clinical statistical analysis of these 342 cases gave the following results. Thirty-nine cases of them showed double location of stones in the urinary tracts. (1) The occurrence of urolithiasis during the past five years was 8.95 p e r cent of the whole cases. (2) They consisted of 78 cases (20.5%) of renal, 234 (61.4%) of ureteral, 35 (9.2%) of vesical, 13 (3.4%) of urethral and 21 (5.5%) of prostatic calculi. The number of the patients with calculus in the up p er urinary tracts was much more than that of the patients with calculus in lower urinary tracts. So-called "Stone wave" was revealed. (3) As to sex, the condition w as found to occur for more frequently in males (280 cases : 81, 87%) than in females (62 cases : 18, 13%). The ratio was 4.5 to 1. (4) Age distribution of the cases showed 152 occurred in the third decade and 90 in the fourth decade. (5) As to seasonal variation, the results were reported previously. (6) As to occupations of the patients, the results of a nalysis shound higher incidence among office workers. (7) The r ecurrence was 20 cases (5.25%). (8) As the initial symptoms and th e chief complaints pain and haematuria were observed most frequently.(9) Treatment of the upper urinary tract calculi was surgical operation in about a half of cases while the other half received conservative therapy. For cases of vesical and urethral calculi, endosc o pic treatment was commonly used, and for cases of prostatic calculus, the treatment was conservative in all of them. It should be noted that cases of spontaneous discharge or chemical dissolution of stones have been increasing.

1) Renal clearance study was performed in 109 patients w ith various urological diseases, 20 patients who had undergone upper urinary tract surgery and in 35 with spinal cord injury . In some of them split renal clearance test was also studied. Clearance test values were compared with other renal function tests values and also grouped according to diseases. 2) Renal tuberculosis . GFR, RPF and RBF were low in parallel with ea c h other. In tuberculosis of both kidneys and solitary kidney after nephrectomy these clearance test values were markedly lowered. 3) Upper urinary c a lculus . In general, RPF and RBF were low, whereas GFR was not so much affected. Many of cases showed elevated FF. In nephrolithiasis group, clearance test values were diminished more remarkably than in ureteral stone group. Site of stone, period since onset of disease, presence or absence of associated infection : - those are probably determinative factors of clearance test values. 4) Prostatic enlargement . No mark e d change was observed. RPF and RBF were slightly dropped probably due to the senile change of kidney in this aged group. 5) Ureterovaginal fistula (4 cases) . Split renal clearance w as studied with the result of remarkable drop on the diseased side and compensatory increase on the healthy side. On the diseased side RPF and RBF were diminished more than GFR. 6) In comparison with PSP and Indigocarmin test, renal clearance test was proved to be quite sensitive and accurate. Simultaneous and parallel decrease in diluting power and clearance values, especially GFR, suggested the correlation between glomerular and tubular function. 7) After surgical invasion upon the upper urinary tract, such as nephrectomy and nephro-or ureterolithotomy, renal clearance .values became lowest within 3 to 7 postoperative days and returned normal or more than it in 3 to 4 weeks. 8) Clearance values in patients with cord inju r y were not low as expected. Some of them actually showed diminished values probably as a result of ureteral reflux, urinary infection, or urinary calculus. Site of cord injury, grade of paralysis, period since trauma : those seem to have less to do with renal function. 9) Renal clearance tests were prove d to be useful to establish the clinical judgment if performed together with other renal function examinations.

In vitro at 37°C, extracted urinary calculi were continuou s ly irrigated at 5-10 drops per minute for 72 hours with 10% and 15% renacidin solutions, as control distilled water and titriplex III (E.D.T.A.) solution. The examined calculi weighed every 6 hours. As the result, phosphate and carbonate stones were markedly disolved with renacidin solutions, whereas oxalate and urate obtained no result. 15% solution was about twice as effective as 10%. Four cases with renal stones were treated with the continuous irrigation of 15% r e nacidin solution at 10-40 drops per minute for 82-218 hours, one of whom had good result. The huge staghorn calculus was dissolved and reduced to finger-tip and pea in size on radiographic appearance. One patient passed majority of small stones after removal of catheters. One of two failures were assigned to the unsatisfactory location of pyelostomy tube. In the other, the stone was urate and in vitro insoluble. As undesirable side effects, th r e e cases suffered from febrile attacks, pain and macroscopic hematuria. Only one patient was free from any complications. The fluctuations in serum phosphorus, N.P.N ., 'electrolytes and PSP test were observed before, during and after the irrigation. We recognized the moderate elevation of N.P.N., the slight of serum P and K and the lowering of PSP test.

Transurethral resection was performed with use of URIGA L in nine cases and 4% of glucose in D/W in seven cases as an irrigating fluid, and it was impressed that the former was more excellent than the latter in the isotonic fluids. URIGAL was also applied for bladder irrigation in ten cases with postoperative hematuria, and it was found that blood clots were less formed and more easily evacuated when URIGAL was used than RIVANOL. No side effect was encountered.

The statistical study on urolithiasis in Hiroshima Ken fro m 1959 to 1961 was reported. The ratio of the number of the patients with urinary calculus (1963 cases) t o the total number of the outpatients (16153 cases) in those clinics were 12.15 per cent, and the number of the patients with calculus in upper urinary tracts was much increased than that of the patients with calculus in lower urinary tracts. Several studies were reported in t h is paper regarding the location of calculi, multiple stone, sex, age, distribution chart in Hiroshima Ken, symptoms, complications, therapy, and relationship to urolithiasis and cholelithiasis.

1) The patient was a 44-year-old man who had a la r g e physique and was markedty obese. He had no family history of gout. 2) For the past 6 years, he ex p erienced recurrent attack of gout and showed gouty nodules (tophi) in the left ear, left elbow, both insteps, and inner aspect of the left foot. Since about a month ago, be has had severe attack a pain in the left flank abdomen and discharged a stone of azuki bean large. 3) Serum uric acid was 8.5 6 mg/dI (Folins method). Urate was demonstrated in the gouty nodules and the discharged stone (the murexid reaction was+ + +). 4) With administration of phenylbutazone, an improvement of the s y mptoms and lowering of the serum uric acid level were achieved.

A new hemostatic agent "Dicynone" was administe r ed to a total of 21 patients with urological diseases, including 11 cases of postoperative use. Marked effective, effective, slight effective and ine f f ective responses were observed in 3, 12, 3 and 3 cases respectively, making 80% of effetiveness. In cases of refractory ideopathic renal bleeding, a particularly beneficial result was obtained when it was given accompanied with other hemostatics haing blood clotting functions. No side effect was seen in all cases treated.

This report deals with a case of urethral divcrticulum with stone arising in the anterior urethra at peno-scrotal junction in a 67 years old Japanese male. Considering the clinical history and histological findings, this diverticulum was assumed to be a congenital one. The stone weighed 19 gm (2.5 x3.9 x 2.0cm) of which main component was phosphatic calculus. The domestic literatures were reviewed and seventy-nine cases of diverticu l u m of the male urethra so far reported have been tabulated by location and etiology. Forty of them were found to be congenital and twenty-four were found to be acquired diverticula. Thirtyseven out of the eighty-two diverticula were associated with stone.

The effects of various vegetative nervous drugs upon in t ravenous excretory urograms were observed in experimental animals, rabbits. In few minutes or at the same time w ith the injection of contrast media, certain kinds of such drugs were given intramusculary or intravenously. Roentgenographies were undertaken (at 3, 15 and 30 min. thereafter). Immediately after the last one, urine excreted into the bladder during the examination was catheterized in every rabbit for measurements of volume and amount of excreted contrast media. The grades of sharpness, or visibility of urograms were rated in accordance with certain criteria. The cerrelations between the grades of visibility and the conditions of renal excretions of contrast media were analysed stochastically. The various experimental groups were compared on the grades of sharpness of urograms as well as the shapes of pyeloureterograms. For clinical application of such drugs, they were tried for improvement of excretory urograms, and for interpretation of the autonomic nervous conditions of the. urinary tracts. Histological examinations of renal parenchyma of the rabbits were performed to study a possibility of any pathological changes due to the large amount of contrast media given with autonomic nervous. drugs. A series of 154 patients with neurosis were subjected to search complicated urol o gical diseases, especially, urolithiasis. The main points o f the results are as follows : 1) Rating the grades of sharpness of urograms based on accurately defined criteria, it is possible to prove stochastically the correlation between the visibility and the condition of renal excretions of contrast media. 2) It is suggested that ce rtain kinds of autonomic nervous drugs, such as pilocarpine mecholyl and triomin-finalin, are able to imorove the sharpness of excretory pyelograms in rabbits when a sufficient dose of contrast media is given to exceed the maximal tubular secretory capacity(Tm), although the mechanism of them is widely varied according to the sort of drug. 3) A s a rule, visibility of excretory urograms depends on the concentration of excreted contrast media, and therefore, a positive correlative coefficient is calculated between them. However, especially in the upper urinary tracts, the visibility may be influenced more remarkablly by the activity of the ureter, because the value of the coefficient is somew hat too small to be said "strictly significant" On the contrary, if given with diuretic, neophyllin, the visibility is completely dependent upon the excreted amount of contrast media. Hence, a positive, strictly significant coefficient is calculated between them in the neophyllingroups. 4) Comparing the results presented in mecholyl-group and neophyllin-groups, it is assumed that there are at least two types of mechanism to promote tubular excretion of contrast media, and that it is not always necessary to have innervation of tubular excretion as the mechanism considering on dynamic aspects of biochemistry. 5) The most promising drugs to improve urograms of r abbits are pilocarpine, mecholyl and atropine ; however, atropine must be given with neophyllin, and it may distort the shape of pyelogram causing dilatation. 6) Performing pilocarpine- or mechlyl-test simultaneously with I. V. P., correlations between the conditions of the vegetative nerves localized in the urinary tract and of systemic ones are obviously recognized to some extent. But in these cases, organ-specificities are also recognized ; namely, when pilocarpine is used both salivary hypersecretion and hypertonic state of the ureters are observed, and when mecholyl is given both salivary hypersecretion and higher concentration of excreted contrast media appear . 7) No neurotic patient subjected here has ever suffered from urolithiasis . However, of course, it is entirely unreasonable to decide that neurotic patients are not apt to urolithiasis, because the number of the patients inquired is too small , and more extensive investigations are necessary. 8) Histological findings of renal parenchyma are almost essentially normal , and there are not found any irreversible changes .

The following tables show statistical observation s on the in-patients in our urological clinic from 1955 to 1962. During the eight years, the total number of in-patients were 2, 531, and these were classified by the urological diseases.

During the eight years from 1955 to 1962, ther e were seen 1, 1 64 cases of urolithiasis among 12, 648 cases of total out-patients in our urological clinic. The ratio of these patients to the total patients was 9.27 per cent, and the patients with calculus in upper urinary tracts were on the increase, but these with calculus in lower urinary tracts were not so. The following tables show s everal and statistical observations regarding the location and multilocation of calculi, sex, age, occupations, family history, previous history, recurrence, chief complaints, urinary pH, chemical analysis, complications and therapy on urolithiasis.

1) Chemical resolution of urinary calculi was experime n tally studied with RENACIDIN. Among phosphate, urate and oxalate, phosphate calculi were most remarkably dissolved. 2) Calculi of the kidney with cutaneous uraterostomy were destroyed a n d dissolved under renal pelvic irrigation with 10% and 20% RENACIDIN solution.

Three cases of primary hyperparathyroidism with pancreatitis or peptic ulcer were reported. All of them had history of urolithiasis or nephrolithiasis and were admitted to our hospital with complaints of midepigastric pain or general fatigue . Further biochemical studies substantiated the impression of primary hyperparathyroidism . Two of them who had attacks of pancreatitis or peptic ulcer prior to surgery experienced no such attacks after successfull removal of parathyroid adenoma. As reported in literatures, it ap p ears that hyperparathyroidism precedes pancreatic disease or gastric complaints.

The following tables show statistical observation s on the out-patients in our urological clinic from 1955 to 1962. During the eight years, the total number of out-patients were 12, 648, and these were classified by the urological diseases. There was seen the ten d ency of increase on urolithiasis, male sterility, diseases of internal glands and urogenital tumors. On the contrary, there was seen the tendency of decrease on urogenital tuberculosis and venereal diseases.

L'urolithiased ans notre clinique urologiqued u mois de ma i 1960 au mois de l'avril 1963e st 162, et son pourcentage est 18.0% dans tous les malades urologiques. La frequenced e l'urolithiase est plus haute dans les mois d'aoCit, de mai et d'avril ; et sur le sexe, le male est 3 fois plus nombreus que la femelle ; sur l'age, la deux decade est la plus nombreuse (29.6%), et la trois decade est seconde (19.1%). Sur la siege des calculs, ceux ureteriques sont 66.4% , et renals sont 33.6%, et sur la grandeur, de petits calculs moins des grains de riz sont le plus nombreux.

During these seven years, there were seen 248 cases o f urolithiasis amongt he 5, 775c ases of urological patients who visited the Iwate Medical College, which is located in the eastnorthern part (Tohoku District) of Japan. Clinical statistical observations of the 248 cases gave the following results : 1) The occurrencei nc i d enceo f urolithiasisd uringt hese seven years was 4 .3%/4.8%"-3.9% (Occurrencei ncidence/confidencleim it : upper l imit—lowerl imit). 2) As to sex, the conditionw as noted to occurs ignifican t ly( P < 0 .001)f ar more frequently in male (192 c ases: 77.4%/81.9%"-72.0%t)h an in female (56 cases : 22.6%/27.5%018.5%). 3) As to age, it was noted to be seen most frequently in the th i r d decade (78 cases: 31.5%/37.3%, --26.2%t)h, ereafter gradually decreasing in number with age. Around half of the patients were in the age group between 21 and 40 years of age (142 cases : 57.3%/68.4% —47.6%). 4)C oncerningi ts occurrence sites, ureter occupiedt he greatest proportion (119 cases: 46.7%/52.7%, --40.8%fo), l lowedb y bladder (57 c ases : 2 2.4%/27.3%-18.3%).D ividingt he case s into urolithiasis of the upper urinary tract and that of the lower urinary tract, it was revealed that the occurrence incidence of the former was significantly( P < 0.001) greater than that of the latter, making us recognizet hat the so-called- Steinwelle" has become finally observed also in this part of Japan. 5) As to occup a tiono f the patients, it was found that the condition in this part of Japan occurred highly in office workers (94 case 37.9%/43.7%, -32.8%), and then in farmers (70 cases : 28.2%/33.8%, -23.5%). Further, it was noted that in these office workers the occurrence incidence of urolithiasis of the upper urinary tract was significantly (p

The following tables show statistics on the patients, diseases , and main operations in our department during the period of January to December, 1962.

1) Rowatin was used in 35 patients with urolithia s is in accordance with the .folltwing standards, and the results were obtained as being effective in 23 cases, of no influence in 3, and 3 cases are now under observation. a) Patients selected : 35 cases of urolithiasis (2 cases of nephrolithiasis and 33 cases of ureterolithiasis). b) Administration : Each 4 gtt. 3 times daily. c) Evaluation of medication effect : On t h ose who have passed the calculi spontaneously it was considered to be effective, and all of others were regarded as not influenced. 2) Rowatin is recommended for ureterolithiasis or comparatively small nephrolithiasis. But when there are signs of impaired renal function or uremia, the calculi should be removed by surgical operation without delay.