[Clinical study on renal trauma].

A total of 64 patients with renal trauma were treated at the Department of Urology, St. Marianna University School of Medicine, from January 1988 to December 1996. Patients were between 3 and 66 years old (mean 28.2); 56 (87.5%) of them were male and 8 (12.5%) were female. The main cause of injury was a traffic accident in 33 cases (51.6%). According to the Classification of Renal Injury by the Japanese Association for the Surgery of Trauma in Japan, there were 27 cases (42.2%) of Type I (subcapsular injury), 12 cases (18.8%) of Type II (superficial injury), 16 cases (25.0%) of Type III (Deep injury), 6 cases (9.4%) of Type IV (Pedicle injury). Surgical treatment was performed in 6 cases (9.3%). The major associated injuries were bone fracture in 33 cases (51.6%), lung injury in 20 cases (31.3%) and liver injury in 16 cases (25.0%). The literature is also reviewed briefly.

Conservative treatment of childhood phimosis with topical conjugated equine estrogen ointment.

PURPOSE: To assess the application of topical conjugated equine estrogen for the treatment of boys with phimosis. METHODS: Fifteen boys with phimosis were included in the study. Conjugated equine estrogen (Premarin) 0.1% ointment was applied on the prepuce once daily. The treatment was continued until the prepuce was fully retractable. The patient was examined each second week up to a maximum treatment of 8 weeks. Retractability and the appearance of the foreskin were graded before and after treatment. RESULTS: Thirteen of 15 boys (87%) referred with phimosis were successfully treated with conjugated equine estrogen ointment. An adverse effect of gynecomastia was seen in one boy (7%). CONCLUSION: Conjugated equine estrogen ointment application for phimosis may be an alternative to surgery.

[Fertility in patients after surgical repair of membranous urethral strictures associated with pelvic fractures].

We evaluated fertility in fourteen patients after surgical repair of membranous urethral strictures associated with pelvic fractures. Eight patients were operated on using Badenoch's method (pull through) and six patients by end-to-end anastomosis of the urethra. All of them have maintained libido and potency after urethroplasty. No ejaculatory disturbance had ever occurred since surgery. Semen analysis was evaluated three months to four years after urethroplasty and serum hormone levels were measured in four patients. The results were as follows: 1) All except 2 patients had normal semen volume (more than 2 ml). 2) Nine patients (64%) had a sperm density of more than 40 x 10(6)/ml. Two patients had a sperm density of 20 to 40 x 10(6)/ml and three patients less than 20 x 10(6)/ml. 3) Nine patients (64%) had a sperm motility of more than 50%, three 30-50% and two less than 30%. 4) Seven patients (50%) had normal semen findings with a sperm density of more than 20 x 10(6)/ml and a sperm motility of more than 50% according to the WHO laboratory manual. 5) Pyospermia (WBC greater than or equal to 10/hpf) was observed in three patients. However, they never had subjective symptoms or objective findings of inflammation. 6) Serum LH, FSH, testosterone and PRL levels were within normal limits. 7) After urethroplasty, two patients married and their wives became pregnant. In conclusion, these results indicate that surgical repair of membranous urethral strictures associated with pelvic fractures has little effect on fertility.

[Chlamydia trachomatis infection among sexual partners of the patients with non-gonococcal urethritis].

During the past 3 years, 30 sexual partners including 18 married couples and 12 extramarital sexual pairs whose male partners were diagnosed as having non-gonococcal urethritis were examined for Chlamydia trachomatis infection. Twenty-three of the 30 couples (76.7%) had identical results either positive or negative for Chlamydia trachomatis infection. All 3 male partners of the 3 pairs who had the non-identical results for Chlamydia trachomatis infection, male negative and female positive, had history of urethritis or prostatitis. Fourteen of the 17 female partners (82.4%) who were positive for Chlamydia trachomatis, had no subjective complaints. The above findings suggest the necessity of treating the female sexual partners of the non-gonococcal urethritis patients irrespective of their symptom.

[Clinical studies on doxycycline in male nongonococcal urethritis].

Doxycycline (DOXY) was administered to 45 male patients with nongonococcal urethritis. The dose was 200 mg b.i.d. and the duration of administration was 14 consecutive days in principle. The results were as follows: C. trachomatis was detected from urethral swab by culture confirmation test and/or direct specimen test. Of 45 patients with nongonococcal urethritis, 25 were positive with C. trachomatis. The positive rate was 56%. In the C. trachomatis positive group, the clinical efficacy was excellent in 15 patients, and fair in 4 out of 19 patients which could be studied about the clinical effect after administration. The total efficacy rate was 79%. The efficacy in 11 patients of the C. trachomatis negative group was excellent in 7 patients and fair in 4, the total efficacy rate being 64%. Microbiologically, inclusion bodies disappeared in 7 days of administration in all 9 patients which were positive with C. trachomatis by culture confirmation test. In 19 patients which were positive by direct specimen test, elementary bodies of C. trachomatis disappeared within 7 days in 13 patients (76%) and within 14 days in all patients. As to side effect, mild epigastralgia was observed in 1 patient, but medication could be continued when the dose of DOXY was reduced by half. Clinical laboratory tests were investigated in 15 patients before and after administration and no abnormal alteration was observed.