Indonesian Journal of Urology
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NEW BASELINE GLOMERULAR FILTRATION RATE ESTIMATION AS A GUIDANCE FOR NEPHRECTOMY STRATEGY IN LOCALIZED RENAL CELL CARCINOMA
Get PDFObjective: This literature review aims to explain the role of nephrectomy in the treatment of localized RCC and its effects on postoperative renal function, as well as the role of the new baseline glomerular filtration rate (NBGFR) estimation method in the determination of the RCC method. Material & Methods: Articles were obtained through online searches using Pubmed, ScienceDirect, Web of Science, and Wiley Online Library using keywords NBGFR, renal function, nephrectomy, or localized renal cell carcinoma. Results: The development of several diagnostic factors as well as operative factors has made partial nephrectomy (PN) replace radical nephrectomy (RN) which for decades has been the main therapy in localized RCC. Postoperative determination of renal function is a crucial factor in the selection of therapies and several methods of determining NBGFR have been proposed in several previous studies. Conclusion: The NBGFR measurement method can be an accurate guide in the determination of nephrectomy methods in the treatment of localized RCC while use of computer software can help improve accuracy in the implementation of radical nephrectomy in RCC.
 
PERCUTANEOUS DRAINAGE AS AN ALTERNATIVE OF SURGICAL MANAGEMENT IN PARARENAL ABSCESS: A CASE REPORT
Get PDFObjective: This case report will discuss the experience of using percutaneous drainage as an alternative of open surgery in pararenal abscess therapy. Case(s) Presentation: 61 years old woman complained of left flank pain 6 months before with septic condition. Physical examination revealed tenderness and mass in the left flank region with leukocytosis. Abdominal Computed Tomography (CT) Scan results showed a left lower pole pararenal abscess, severe hydropyonephrosis and ureteropelvic junction stones. Percutaneous abscess drainage and percutaneous nephrostomy was performed with an 18Fr troicart using ultrasound guidance. Discussion: The pus culture showed Escherichia coli bacteria. After three days of operation and intravenous antibiotics, the patient experienced clinical improvement. Outpatient follow-up showed decreased drain production from percutaneous abscess drainage and clear yellow liquid production from percutaneous. Percutaneous nephrolithotomy was performed for the management of stone evacuation. After going through the whole procedure, there is clinical improvement of patient. Conclusion: Percutaneous drainage is an alternative option in the management of perirenal abscesses. Compared to open surgical drainage, the percutaneous technique provides a minimally invasive process, shorter length of stay and more effective costs. This procedure has also shown good clinical improvement in patients.
Keywords: Minimal invasive, pararenal abscess, percutaneous drainage
PRIMARY SUPRARENAL GLANDULAR TUBERCULOSIS MIMICKING A MALIGNANT TUMOR
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Objective: Our case demonstrates effective tuberculosis-related Addison's disease care with laparoscopic adrenalectomy and anti-tuberculosis medication. Case(s) Presentation: A 43-year-old patient complained of left flank pain for two months before admission, unexplained weight loss, general weakness, decreased appetite, and without long-term cough. The physical examination resulted in hyperpigmentation on the fingers of both hands. MRI revealed an enlarged left adrenal gland and the blood test showed elevated cortisol to 1668 mmol/L. Three-port left laparoscopic transperitoneal adrenalectomy was used. Histopathology results showed epitheloid histiocytes that formed granulomas with caseous necrosis and Datia Langerhans cells referring to tuberculosis; no malignancy was found from the same sample. Discussion: Addison's illness is the primary cause of tuberculosis. Due to the widespread use of anti-TB medications, the incidence of adrenal tuberculosis has been on the decline recently; nonetheless, in developing nations, tuberculosis is still the predominant cause of Addison's disease. Conclusion: Surgery and standard treatment for extrapulmonary tuberculosis were adequate to diagnose and alleviate the symptoms of cortisol disturbance caused by Addison’s disease.
Keywords: Endocrine glands, adrenalectomy, tuberculosis endocrine
OUTCOME OF VESICOVAGINAL FISTULA REPAIR AT TERTIERY HOSPITAL: COHORT STUDY
Get PDFObjective: This study aims to provide an evaluation of the outcome of patients with history of vesicovaginal fistula repair by assessing the success rate and complications that occur. Material & Methods: This study was a retrospective cohort study to describe the etiology, approach, and outcome in patients undergoing vesicovagina fistula repair. We analyzed the complication with vesicovaginal fistula type, etiology and technique used. Results: There were 10 vesicovaginal fistula patients, with mean age 33.4 ± 14.5 years. Both transabdominal and transvaginal approach were equally used. Sixty percent patient was successfully treated without complication. Forty percent patient with incontinence came with mild urinary incontinence and need further repair. Conclusion: Both transvaginal and transabdominal approach were equally effective to repair fistula with relatively low complication rate and high successful rate.
Keywords: Vesicovaginal fistula, retrospective, transabdominal and transvaginal.
 
ANALYSIS OF THE EFFECT OF EXPOSURE TO CHLORPYRYPHOS, CARBOFURAN, AND CYPERMETHRIN ON SPERMATOGENESIS IN ADOLESCENT RAT
Get PDFObjective: To investigate the effect of exposure to chlorpyryphos, carbofuran, and cypermethrin on spermatogenesis in adolescent rat. Material & Methods: This study is an experimental study with a post-test only control group design. In this study, 30 adolescent rats aged 30-45 days were randomly divided into 5 groups. Group I was a normal control or without treatment for 21 days (K0), group II was a solvent control group, namely DMSO 5% which was administered subcutaneously for 21 days (KI), group III was a group that received chlorpyrifos 20 mg/kgBW dissolved with DMSO 5% subcutaneously for 21 days (P1), group IV was the group that received carbofuran 0.2 mg/kgBW dissolved with DMSO 5% subcutaneously for 21 days (P2), group V was the group that received cypermethrin 20 mg/kg. kgBW dissolved with 5% DMSO subcutaneously for 21 days (P3). Ipsilateral testicular orchidectomy was performed on all rats to remove the left testicular organ for preparation with Haematoxylin Eosin staining. The spermatogenesis score was calculated based on the Johnsen score in 5 seminiferous tubule visual fields. Data were analyzed using Kruskal Wallis followed by Mann Mitney test. The difference was considered significant at p<0.05. Results: There was a significant decrease in spermatogenesis scores between P1, P2, and P3 against K0 and K1 (p<0.05). On the other hand, there was no significant difference in the decrease in spermatogenesis scores between P1 and P2, P1 and P3, P2 and P3 and K0 and K1 (p>0.05). Conclusion: Exposure to chlorpyrifos, carbofuran, and cypermethrin had an effect on reducing spermatogenesis scores in adolescent rats
RELATIONSHIP BETWEEN OVERWEIGHT AND OBESITY WITH LOWER URINARY TRACT SYMPTOMS (LUTS) DUE TO BENIGN PROSTATIC HYPERLASIA IN PRE-ELDERLY A PRELIMINARY STUDY
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Objective: The purpose of this study is to find the relation between overweight and obesity with lower urinary tract symptoms due to benign prostatic hyperplasia in pre-elderly. Material & Methods: This analytical study was conducted in a cross sectional manner to 113 respondents. LUTS assessment uses the International Prostate Symptoms Score questionnaire. Measurements for overweight and obesity, this study uses the BMI and waist circumference methods. Fisher's exact test with SPSS v.25 was used for data analysis. Results: Results from data analysis showed that there was no significant relationship between overweight and obesity based on the BMI method on LUTS, p = 0.122. The results also showed a significant relationship between central obesity and LUTS, p = 0.003. Conclusion: Central obesity can be identified as a risk factor for LUTS while overweight and obesity based on the BMI method cannot be considered as a risk factor. These results can be used as education for pre-elderly to reduce the risk of LUTS due to BPH.
Keywords: Overweight, obesity, lower urinary tract symptoms, benign prostatic hyperplasia, pre-elderly
SURGICAL OUTCOMES IN SECONDARY HYPOSPADIAS PATIENTS IN A TERTIARY CARE CENTRE – OVER A DECADE EXPERIENCE
Get PDFObjective: The objective of this study is to analyze the surgical outcomes in secondary hypospadias patients over 10 years in a tertiary care center. Material & Methods: From January 2010 – December 2019, 68 patients with secondary hypospadias were managed in our department. The age at surgery, location of meatus at presentation, associated chordee, meatal stenosis, and fistula were noted. Techniques used for correction and postoperative complications with overall success rate were studied. Primary hypospadias cases (n=303) were excluded from this study. Results: Age varied from 6 months to 32 years (mean - 11.06 years). The most common presentation was dehiscence of repair with resultant hypospadias (n=43) and their meatal position was distal 44.1% (n=30) followed by middle in 14.7 % (n=10) & proximal in 4.4% (n=3) patients after orthoplasty. Chordee was present in 67.64% (n=46) cases. (<30o in 50%, n=34; 30-600 in 14.7%, n=10; >60o in 2.9%, n=2). Also, 17.6% (n=12) patients had urethrocutaneous fistula(UCF) and 19.1% (n=13) patients had meatal stenosis. Urethral closure was done using tubularized incise plate (TIP) alone in 4.4% (n=3) cases, TIP and spongioplasty in 48.5% (n=33) cases. The urethral plate was augmented (Snodgraft) in 26 cases (inner prepuce, n=5 and BMG, n=21). Urethral reconstruction was staged in 10.3% (n=7) cases. Meatoplasty was done in 19.1 (n=13) cases and fistula closure was done in 17.6% (n=12) cases. The success rate in secondary cases was 79.2% in our series. Fourteen patients required revision surgeries of which 7 had UCF (Fistula repair), meatal stenosis (n=1, meatoplasty), Glanular dehiscence (n=5, Glanuloplasty and Meatoplasty), stricture (n=1, urethroplasty). Conclusion: Hypospadias surgery in secondary cases is difficult owing to fibrosis, loss of local tissue, and difficult dissection. Glanular dehiscence was most common followed by fistula in our series. We also reported the effectiveness of buffering layers and urethral augmentation in secondary cases but without statistical significance.
Keywords: Secondary hypospadias, urethrocutaneous fistula, chordee.
 
CHARACTERISTICS OF PATIENTS WITH URINARY TRACT STONES AND PROFILE OF URIC ACID AND CHOLESTEROL AT KUSTATI ISLAMIC GENERAL HOSPITAL SURAKARTA IN THE PERIOD OF OCTOBER 2020 TO MARCH 2022
Get PDFObjective: This study aims to research the characteristic of patients with urinary tract stones and the profiles of uric acid and cholesterol at the Kustati Islamic General Hospital (RSUI) in the period from October 2020 to March 2022. Material & Methods: This research uses the cross-sectional retrospective approach with the descriptive method. The research subjects are the patients with urinary tract stones that have undergone operations in Kustati Islamic General Hospital in the period between October 2020 and March 2022 as well as patients that have had their level of uric acid and cholesterol examined in the laboratory of Kustati Islamic General Hospital in the period from October 2020 to March 2022. Results: Urinary tract stones occur the most in men (70.3%) and in the age group 46-59 years old with a percentage nearing 50%. Urinary tract stones occur the most in the upper section of the urinary tract, mainly in the kidneys (67.2%). Hyperuricemia occur mostly in men while hypercholesterolemia occur mostly in women. Conclusion: The location of stone is mostly found in the kidneys. Patients with hyperuricemia are mostly men, while patients with hypercholesterolemia are mostly women
LONG URETERIC STRICTURES MANAGED BY USING BUCCAL MUCOSAL GRAFTS
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Objective: This study aims to describe the reconstruction of long ureteric strictures using buccal mucosal patch grafts and to report the short term outcome. Material & Methods: We retrospectively looked at our hospital inpatient and outpatient records of all patients who underwent surgical treatment for benign ureteric strictures. Imaging records and films, histopathological reports were reanalysed. The short term outcomes were also noted. Results: During this 10 years’ study period 8 patients (six Males and two Females) underwent 10 buccal mucosal grafts procedures. The mean age of the patients was 36.25 years and the mean length of the stricture was 7.13.41 cm. There were intraoperative complications noted and none of the patients needed either intra or post-operative blood transfusions. Serum creatinine remained stable at 6 and 12 weeks after surgery. Radioisotope renograms done 12-16 weeks after surgery showed improvement in function on the affected sides in all patients with adequate drainage. Conclusions: Buccal mucosal patch grafting and omental wrapping is feasible, effective, less complicated and associated with good outcomes at short term follow-up.
Keywords: Reconstruction, ureteric stricture, buccal mucosa
HIGH FLOW PRIAPISM IN 7 YEARS-OLD BOY AFTER ACCIDENTALLY CONSUMING APHRODISIAC CHOCOLATE: A CASE REPORT
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Objective: This case report aimed to present our experience of conservative treatments for High Flow Priapism in children. Case(s) Report: A 7 years old boy presented with persistent and painless erections without sexual stimulation for 24 hours, the erection was first noticed when he woke up in the morning after accidentally consuming aphrodisiac chocolate 2 days before admitted to the hospital. There was no previous history of priapism and trauma or other risk factors. Discussion: Laboratory studies were within normal limits. Physical examination revealed a fully erect, nontender penile with rigid corpora cavernosa, soft glans, and erection hardness scale (EHS) 3. A cavernosal blood gas analysis was collected with the following values PH 7.41, pO2 117,7 mmHg, and pCO2 24, 8 mmHg. With diagnosis of High Flow Priapism, he was observed and got conservative treatments; ice and site-specific compression and after that EHS become 1. On follow-up after 2 months reported that patient had normal erections with no further episodes of priapism. Conclusion: High flow priapism in old boy after accidentally consuming aphrodisiac chocolate can managed by conservative therapy with favourable outcome.
Keywords: Aphrodisiac chocolate, penile erection, priapism.