Objective To evaluate the impact of maintenance haemodialysis and live‐related renal transplantation on the reproductive potential of men with end‐stage renal disease. Patients and methods The plasma levels of testosterone, follicle‐stimulating hormone (FSH) and luteinizing hormone (LH) were determined, and semen analysed, in 19 men (22–41 years old) with advanced uraemia after 6 months of dialysis and again 6 months after renal transplantation. Eight patients who had azoospermia or severe oligospermia underwent testicular biopsy after 6 months of dialysis and again 6 months after the transplant. Results Following dialysis, levels of testosterone were low in 17 patients and levels of LH and FSH were elevated in 15 and eight patients, respectively. Four patients each had azoospermia and severe oligospermia. The testicular tissue was hypospermatogenic in three patients, showed late‐maturation arrest in four and germ cell aplasia in one. After renal transplantation, testosterone and LH levels returned to normal in 15 and 13 patients, respectively, while FSH levels became normal in only two patients. The recovery of testosterone and LH levels after transplantation was statistically significant. Semen quality improved in 13 patients, with the improvement in sperm density and motility being statistically significant. Testicular histology revealed normal spermatogenesis in four patients, while three continued to show late‐maturation arrest. The wives of five of the transplanted patients conceived. Conclusions The impairment of testicular function seen in advanced uraemia is not reversible by maintenance haemodialysis. In contrast, after successful transplantation, steroidogenic function became almost normal while spermatogenic function showed a striking if incomplete recovery.

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Many paediatric problems can present to medical professionals. This article covers some of the common ones including phimosis, undescended testis, retractile testis, vesicoureteric junction reflex, hypospadias, neonatal hydronephrosis, obstruction of the pelviureteric junction, and some types of tumour. Phimosis Phimosis is the most common reason for circumcision, although recurrent balanitis is also an indication. Circumcision may also be performed for religious or social reasons. At birth, adhesions are present between the glans penis and foreskin, but separation begins to occur immediately and continues thereafter. The prepuce normally becomes retractile after the age of two years, but many adolescent boys retain some adhesions. Preputial adhesions are a common reason for referral to a urologist, but adhesions are normal and should be treated only if "physiological phimosis" persists into adolescence and causes problems with masturbation or sexual intercourse. A non-retractile foreskin is free of symptoms and self limiting, and circumcision is not needed. Parents often say that the prepuce "balloons" when the child urinates, but this is a sign of a non-retractile foreskin rather than phimosis. Careful examination will show that the urethral meatus is visible through the narrowed preputial opening, and, with time, this opening widens to allow the foreskin to retract normally. True or "pathological phimosis" is rare, but it may cause appreciable problems in childhood or adolescence. Treatment is usually circumcision, whereas alternative treatments are preputioplasty or application of steroid creams.

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