Indonesian Journal of Urology
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PREDICTORS FACTORS OF BLADDER INJURY IN PLACENTA ACCRETA SPECTRUM SURGERY AT A TERTIARY HOSPITAL
Full text linkObjective: This study aims to determine the predictors factors associated to bladder injury sustained following placenta accreta spectrum surgeries. Material & Methods: This retrospective cohort study was conducted at the Saiful Anwar General Hospital from 2020-2024. Pregnant women with PAS undergoing hysterectomy or caesarean deliveries were included in the study population. Age, gestational age, number of previous cesarean deliveries, and placenta acreta index (PAI) Score were recorded. Univariate and multivariate analyses were performed to compare women with and without operative bladder injuries. Results: A total of 112 women were included in the study. The incidence of bladder injuries was 10,7%. Preoperative ultrasound examinations revealed an 84% concordance rate with surgical findings, confirming the diagnosis of placenta accreta spectrum. The average age of pregnant women with PAS was 33.71 ± 4.66 years, with the most common age range being 31-35 years (34.8%). In univariate analysis, gestational age, number of prior cesarean section, and PAI score include lacuna grade, myometrial thickness, and bridging vessel associated with risk of bladder injury. However, the number of prior cesarean sections and myometrial thickness measured by PAI showed a significant association in multivariate analysis. Conclusion: PAS condition carries a risk of bladder injury during surgery. Predictors factors associated to bladder injury of PAS cases include the number of prior cesarean section and myometrial thickness in PAI.
Keywords: Bladder injury, placenta accreta spectrum, predictors factors
COST ANALYSIS OF TRANSPERINEAL PROSTATE BIOPSY WITH VY DEVICE AND TRANSRECTAL PROSTATE BIOPSY AT HASAN SADIKIN ACADEMIC MEDICAL CENTER BANDUNG: A RETROSPECTIVE STUDY
Full text linkObjective: This study aimed to determine the analysis for the cost of Transperineal Prostate Biopsy using the VY device (VY-TPPB) and Transrectal Prostate Biopsy (TRPB). Material & Methods: This study is a retrospective descriptive study with the sample being patients who underwent TRPB or TPPB at Hasan Sadikin Academic Medical Center, Bandung for the period of January 2019 to December 2023. The total sample was 108 patients, with 53 patients having undergone TPPB and 55 patients having undergone TRPB. The cost for each procedure are then analyzed and divided into pre-procedure, intra-procedure, and post-procedure costs. Results: The average cost per patient is Rp 8.005.356 (USD 507.4) for VY-TPPB procedures and Rp 11.748.976 (USD 744.7) for TRPB procedures. Comparison of the average costs of VY-TPPB with TRPB was higher in the TRPB group (p < 0.05). Comparison of the average intra-procedure and post-procedure costs was also significantly higher in the TRPB group (p < 0.05). There was no significant difference in pre-procedure costs. Conclusion: The TPPB-VY technique is more cost-effective compared to TRPB, although further research is needed to understand the advantages of each method.
Keywords: Prostate biopsy, VY device, cost
THE PROFILE OF URINE CULTURE IN PEDIATRIC PATIENTS WITH UPPER URINARY TRACT DILATATION AT DR. SOETOMO GENERAL HOSPITAL FROM 2020-2023.
Full text linkObjective: To describe the bacteriologic profile and antimicrobial-susceptibility patterns of urine cultures from pediatric UUTD patients treated at Dr Soetomo General Hospital, Indonesia, between 2020 and 2023.
Material & Methods: This retrospective descriptive study reviewed medical records of 154 inpatients aged 0–17 years with confirmed UUTD. Demographic data, cultured species, and antibiotic susceptibilities were extracted and reported as frequencies. Results: From 154 bacterial isolates, Gram-negative bacteria dominated (78.6%) compared to Gram-positive (21.4%). The most frequent species were Escherichia coli (31.8%), Pseudomonas aeruginosa (16.9%), and Klebsiella pneumoniae (12.3%). Antibiotics with the highest sensitivity against major uropathogens were amikacin (83.7%), piperacillin-tazobactam (77.6%), and meropenem (81.6%). In contrast, gentamicin and nitrofurantoin demonstrated lower sensitivities, 61.2% and 71.4%, respectively. Severe hydronephrosis occurred in 52.6% of cases and was associated with more resistant bacterial isolates. Conclusion: Urinary tract infections in pediatric UUTD patients at Dr. Soetomo General Hospital are predominantly caused by Escherichia coli, with the highest antibiotic sensitivities observed for amikacin, meropenem, and piperacillin-tazobactam. Gentamicin and nitrofurantoin should be administered based on culture results, especially for uncomplicated cystitis. Regular antibiotic resistance surveillance is essential to ensure effective empirical treatment.
Keywords: Urine Culture, hydronephrosis, pediatrics, antibiotic, Escherichia coli
COMPARATIVE STUDY OF CLINICAL SAFETY OUTCOME OF NEOADJUVANT INTRAVESICAL MITOMYCIN-C THERAPY IMMEDIATELY BEFORE TRANSURETHRAL RESECTION OF BLADDER TUMOR VS PERIOPERATIVE INTRAVESICAL MITOMYCIN-C IN PATIENTS WITH NONMUSCLE-INVASIVE BLADDER CANCER
Full text linkObjective: This study aims to compare the outcome and complications of adjuvant vs neoadjuvant IMMC (intravesical mitomycin C) for non-muscle-invasive bladder cancer (NMIBC). Material & Methods: This prospective randomized observational study was conducted from June 2023 to December 2024. Sixty-two patients with clinico-radiological evidence of bladder growth were randomized into two arms: Neoadjuvant IMMC and Perioperative IMMC. Results: Immediate complications were more frequent in Group B, with significantly higher dysuria, suprapubic pain (74.2% vs 32.3%), and febrile UTIs (29% vs 3.2%). Haematuria was also more common in Group B (58.1%). Early complications showed similar trends: dysuria (51.6% vs 19.4%), haematuria (45.2% vs 19.4%), and bladder changes (23.3% vs 0%) were more prevalent in Group B. Allergic reactions were slightly lower in Group B (6.5%) than in Group A (9.7%). Conclusion: Pre-operative MMC instillation was more effective in reducing recurrence and improving resection ease, with fewer complications. Perioperative MMC was associated with increased inflammation and adverse events. Pre-TURBT MMC is recommended for improved clinical outcomes, while peri-operative MMC may be considered for select low-risk patients.
Keywords: Complication, IMMC, bladder cancer
MANAGEMENT OF CONSOLIDATED PYONEPHROSIS MIMICKING PYELUM STONE IN A PATIENT WITH URETEROLITHOTOMY HISTORY: A CASE REPORT
Full text linkObjective: This study presents a case of consolidated pyonephrosis mimicking a pyelum stone. Case(s) Presentation: A 34-year-old woman presented with right flank pain and intermittent fever. NCCT showed severe right hydronephrosis with a 2.5 x 2.0 x 2.8 cm pyelum stone (1300 HU). Supine PCNL was performed, revealing consolidated pus. The stone, found incidentally, was later treated with RIRS. Discussion: Consolidated pyonephrosis may mimic a stone radiologically. Prompt infection control and urinary diversion are critical to prevent sepsis. Conclusion: Multiple procedures were required in atypical stone disease to prevent systemic complications.
Keywords: Pyelum stone, consolidated pyonephrosis, infection
SYSTEMIC INFLAMMATORY RESPONSE AFTER TRANSRECTAL VS TRANSPERINEAL PROSTATE BIOPSY
Full text linkObjective: This study compares the inflammatory responses of TR and TP biopsies, using the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as biomarkers. Material & Methods: A retrospective cohort study was conducted at Dr. Saiful Anwar General Hospital, Malang, Indonesia, from January 2023 to August 2025, involving 46 patients who underwent TR or TP biopsies. Pre- and post-procedure blood samples were analyzed for NLR and PLR. Statistical analysis was performed using SPSS, employing paired t-tests and Mann-Whitney U tests. Results: NLR before the procedure was significantly higher in the TR group (p = 0.034). Post-procedure, there were no significant changes in NLR or PLR (p > 0.05). Infections and fever occurred more frequently in the TR group (12% and 24%, respectively), with no complications in the TP group. Prostate cancer detection rates were similar between both groups (p = 0.760). Discussion: Both biopsy methods induced systemic inflammation, as reflected by increased NLR and PLR post-procedure. However, TR biopsies were linked to a higher incidence of infections and febrile episodes. This aligns with prior studies indicating a greater complication rate with TR biopsies. NLR may serve as a potential biomarker for assessing tumor aggressiveness, especially in TR biopsy patients, where NLR changes were more pronounced among those diagnosed with prostate cancer. Conclusion: TP biopsies present lower infection risk and similar diagnostic accuracy compared to TR biopsies. NLR and PLR may be useful biomarkers for tracking inflammatory responses post-biopsy. Larger studies are needed to confirm these findings.
Keywords: Prostate cancer, prostate biopsy, transrectal biopsy, transperineal biopsy, NLR, PLR, inflammatory response, infection
TEKNO KLEM: NEW DISPOSABLE DEVICE FOR PEDIATRIC CIRCUMCISION–A CASE REPORT
Full text linkObjective: This case report aimed to present the use of Tekno Klem, a novel disposable circumcision device. Unlike existing devices, Tekno Klem allows immediate clamp removal, potentially reducing the risk of postoperative complications. Case(s) Presentation: A 6-year-old boy presented to the Urology Outpatient Clinic with difficulty in retracting the foreskin of the penis. Physical examination revealed a non-retractable foreskin with a constrictive ring, classified as grade 3 phimosis. Elective dorsal slit surgery using Tekno Klem device was scheduled. The circumcision procedure using the Tekno Klem device began with measuring the glans size to ensure appropriate device selection. The appropriate Tekno Klem clamp size was selected from the available options: 12 mm, 14 mm, 16 mm, 18 mm, 22 mm, and 27 mm. The preputial skin was marked to define the excision area. The safety tube was then carefully positioned around the glans. Subsequently, the clamp frame was inserted. Once the desired positioning was confirmed, the screw cap was applied, locking the clamp securely in place through its serrated and threaded mechanism. The preputial skin was excised using thermal cautery. After clamp removal, N-butyl cyanoacrylate ointment was applied to protect the wound. The procedure lasted 15 minutes. Discussion: Postoperative pediatric penile perception scored 10, indicating improved penile appearance, while voiding satisfaction scored 5, reflecting favorable functional outcomes. No complications, including bleeding, hematoma, infection, glans injury, meatal stenosis, or delayed healing, were observed. The circumcision site healed properly with satisfactory cosmetic and functional results. Conclusion: Tekno Klem offers enhanced precision, safety, and ease of use over conventional devices, with the potential to reduce complications and optimize outcomes, particularly in settings prioritizing surgical accuracy and patient safety.
Keywords: Tekno Klem, circumcision, disposable, pediatric, clamp
THE EFFECT OF HIGH-INTENSITY FOCUSED ELECTROMAGNETIC (HIFEM) THERAPY ON PATIENTS WITH URGE URINARY INCONTINENCE
Full text linkObjective: This study aims to determine the effect of HIFEM on OABSS and pad usage through the Voiding Diary. Material & Methods: An experimental study with pre and post-test. Patients will be given a questionnaire before and after undergoing HIFEM therapy for six sessions, and be followed for one month. Data analysis was carried out using SPSS software. Paired T-test was used for data with normal distribution, while the Wilcoxon Non-parametric test was used for data which is not normally distributed. Data are considered statistically significant if the p-value <0.05. Results: Twenty-eight patients completed the study. After six HIFEM sessions, the mean OABSS significantly decreased from 12.89 ± 1.03 to 11.61 ± 1.59 (p < 0.001), and pad usage reduced from 8.39 ± 1.20 to 2.82 ± 1.56 (p < 0.001). Conclusion: Six sessions of HIFEM therapy were associated with a decrease in OABSS and pad use in patients with urinary incontinence. But OABSS did not significantly reduce in patient with DM and HT.
Keywords: HIFEM, urinary incontinence, OABSS
CHARACTERISTICS OF IATROGENIC URETERAL TRAUMA IN TERTIARY HOSPITAL IN WEST JAVA FROM JANUARY 2019 - DECEMBER 2023
Full text linkObjective: This study aims to identify the characteristics of iatrogenic ureteral trauma in patients at Dr. Hasan Sadikin General Hospital, Bandung, during the period from January 2019 to December 2023. Material & Methods: This study used a retrospective descriptive study method by collecting secondary data from the medical records of inpatients, outpatients, and emergency room installations at Dr. Hasan Sadikin General Hospital, Bandung. The characteristics of iatrogenic ureteral trauma data were manually processed and presented in the form of frequency distribution tables for analysis. Results: This study involved 58 cases of ureteral trauma over the past 5 years. The respondents were predominantly over 40 years old (55.1%) and mostly female (94.8%). The main cause of ureteral trauma was gynecological surgery (94.8%). The most common site of injury was the right ureter (58.6%), with right distal ureter injuries accounting for 34.4% of the cases. Based on the provided data, bladder involvement in ureteral trauma occurred on both the right side (13.7%) and the left side (10.27%). Early diagnosis (75.8%) is crucial to reduce the risk of serious complications, while selecting the appropriate management method is essential for the success of the intervention and patient recovery. In this study, ureteral re-implantation had the highest rate of success at 50%. Conclusion: Most cases of iatrogenic ureteral trauma are experienced by women, predominantly caused by gynecological procedures.
Keywords: Iatrogenic ureteral trauma, characteristic, ureteral re-implantation
TESTICULAR TORSION INDUCED BY EPIDIDYMO-ORCHITIS: A RARE CASE REPORT
Full text linkObjective: We report a case of an episode of acute scrotum within 4 days. To our knowledge, this is a rare case of epididymo-orchitis predisposing to testicular torsion. This paper has been reported in line with the SCARE 2023 criteria. Case(s) Presentation: This case involves a 17-year-old male with worsening scrotal pain and swelling following minor trauma, accompanied by intermittent fever. Physical examination revealed left testicular enlargement and tenderness, with a negative Prehn’s test. Doppler ultrasound indicated decreased blood flow and a whirlpool sign, suggesting torsion. Discussion: Emergency scrotal exploration confirmed a 180-degree spermatic cord torsion with partial testicular necrosis, necessitating orchiectomy and orchidopexy. The patient had a smooth recovery. Conclusion: Testicular torsion requires prompt diagnosis and intervention for optimal outcomes.
Keywords: Testicular torsion, epididymo-orchitis, case report