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.

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.

We investigated the outcomes of nephron-sparing surgery in patients with small renal cell carcinomas by retrospectively reviewing the records of 20 elective cases of nephron-sparing surgery performed from 1994 to 2003. All patients had low pathologic stage, localized, unilateral tumors smaller than 4 cm and sporadic renal cell carcinomas. There were no significant differences between mean preoperative serum creatinine levels and postoperative levels. Nephron-sparing surgery may be safe and curative treatment for low pathologic stage, localized, unilateral tumors smaller than 4 cm and sporadic renal cell carcinomas.

During the past 5 year period, oral morphine hydrochloride was administered to 31 cases with end-stage urologic cancer to eliminate their intractable pain. Initial dose, usually 20-30mg/day, was augmented every 2 days and given in divided dosis 6 times a day.Twenty-two cases (71%) were relived of their pain. The average dosis and administered period were 53mg/day and 74 days, respectively. Excluding 4 cases who were administered for more than 200 days, 51 days was the mean period when opium was nesessary.Although mild, constipation, vomiting, somnolency and illusion were noted as the side effects of opium.After achieving analgesia by this therapy, discontinuation or reduction of morphine hydrochloride was possible without any withdrawal symptom.There is no optimum dose of opium for cancer pain. Therefore, use of enough opium should not be hesitated. It is advisable to use sufficient opium to eradicate intractable pain due to end-stage urological cancer during the final 50 days of their life and let the patient die in peace.

Lower urinary tract symptoms are widespread in elderly men and often suggestive of benign prostatic hyperplasia (LUTS/BPH). A randomized, prospective, and open-labeled trial directly comparing the effects of tadalafil (a phosphodiesterase 5 inhibitor) 5 mg once daily and tamsulosin (an α1-blocker) 0.2 mg once daily for 12 weeks in LUTS/BPH patients was conducted. Data were recorded before randomization as well as at 4, 8, and 12 weeks after medication. Fifteen patients allocated tadalafil and 20 allocated tamsulosin completed 12 weeks of medication. Total IPSS, IPSS voiding, and IPSS-QOL scores declined with medication, but there was no difference between drugs. IPSS storage scores reduced more in the tamsulosin group than tadalafil group. OABSS did not decline significantly with medication. IIEF5 was maintained in the tadalafil group, but declined in the tamsulosin group. The maximum flow rate and post-void residual urine volume did not significantly change with medication. Daytime, night-time, and 24-hour urinary frequencies as well as the mean and largest daytime, night-time, and 24-hour voiding volumes per void did not significantly change with medication. In conclusion, tamsulosin was more effective to reduce storage symptoms than tadalafil. Tadalafil had the advantage of maintaining the erectile function.