Indonesian Journal of Urology
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AN UNUSUAL CASE OF PENILE TUMOR: GIANT SIZED VERRUCIFORM XANTHOMA OF PENIS
Get PDFObjective: This study aims to present a case of Verruciform Xanthoma (VX) on penile shaft. Case(s) Presentation: A 60 years old man was admitted to our hospital with a large sized (8cm) cauliflower like tumor on his penile shaft which started to appear 2 years prior to hospital admission. The tumor was continuously getting bigger during that period. The man did not feel any other signs and symptoms. Incision biopsy sample was taken and the histopathologic result was Verruciform Xanthoma. Then the patient took excision circumcision surgery. Discussion: Penile VX is a benign, asymptomatic, warty lesion that can occur in penile shaft, glans, coronal sulcus, and preputium. Its pathological mechanism is still unclear but the most accepted theories are mucocutaneous reaction to localized trauma and chronic inflammation. Due to its atypical appearance, it can be mistaken as other lesion, even a malignant one. Histopathological examination must be done to confirm diagnosis, and to plan the right treatment. We conduct excision and circumcision to compensate a wide skin loss and achieved satisfactory result. Conclusion: Penile VX can be mistaken as a malignant lesion, thus histopathological examination must be done to avoid over radical treatment. Excision and circumcision surgery for large sized penile VX achieve satisfactory result.
Keywords: Penile, verruciform xanthoma, tumor
PRIMARY DIFFUSE LARGE B CELL LYMPHOMA OF TESTICULAR : A CASE REPORT
Get PDFObjective: To report our experience in treating a case of Testicular non-Hodgkin Lymphoma. Case(s) Presentation: A 55-year-old man came to the urology outpatient clinic with complaints of an enlarged left painless testicle that was lumpy and heavy. Urological examination found left unilateral testicle enlargement testicle, the size measured 10x7x7 cm with firm borders, solid consistency, and no tenderness. The patient then was treated with left orchiectomy. Histology and Immunohistochemical examination found non-Hodgkin B cells (CD20+) high grade, non-GCB. Discussion: In this case, the patient was treated with orchiectomy followed by a CHOP chemotherapy regimen. However, there was an unusual presentation due to the suspicion of metastases through the findings of a tender lump in the left inguinal region which was further confirmed by histological and immunohistochemical examination. Conclusion: Primary testicular lymphoma with a subtype of DLBCL (Diffuse Large B-Cell Lymphoma) is a rare disease. Orchiectomy is the initial treatment option for Testicular non-Hodgkin Lymphoma followed by combination therapy of chemotherapy to improve the prognosis.
Keywords: Orchiectomy, testicular lymphoma, testicular tumors
BLADDER EMBRYONAL RHABDOMYOSARCOMA IN AN 18-MONTHS-OLD BOY: A CASE REPORT
Get PDFObjective: This study aims to report a case of bladder embryonal rhabdomyosarcoma in an 18-months-old boy. Case(s) Presentation: An 18-months-old boy presented with complaint of difficult urinating since the last 2 months before presentation. It was accompanied with hematuria, blood clot and palpable mass in the lower abdomen. Magnetic resonance imaging (MRI) of lower abdomen showed a solid mass in the inferior bladder wall, involved bilateral ureterovesical junction (UVJ) that caused bilateral severe hydroureteronephrosis, lymphadenopathy, and multiple nodul in both lungs. Cystoscopy was performed and found intrabladder tumor near the bladder neck and trigonum. Then biopsy of the bladder tumor was performed. Pathology result of the specimens showed bladder embryonal rhabdomyosarcoma. Then immunohistochemistry examination was performed with desmin and myogenin antibody to confirm bladder embryonal rhabdomyosarcoma diagnosis. Discussion: Bladder embryonal rhabdomyosarcoma often involves the bladder neck and trigone. In general, clinical symptoms relate to mass and blockage caused by mass. Ultrasound is the first imaging examination performed. Magnetic resonance imaging (MRI) helps depict the mass, usually hyperintense on the T2 image. The immunohistochemical examination is an important examination of skeletal muscle markers. Desmin found in muscle is used to diagnose rhabdomyosarcoma. Conclusion: Bladder embryonal rhabdomyosarcoma is a diagnostic challenge as it is a rare malignant tumor. The clinician needs to be aware of this entity and performed immunohistochemistry as an important examination to accurately diagnose embryonal rhabdomyosarcoma of the bladder.
Keywords: Bladder, immunohistochemistry, rhabdomyosarcoma
URETHRAL INJURY IN REGIONAL HOSPITAL IN THE BPJS ERA: A CASE REPORT
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Objective: To present a case of urethral injury treated in a male adult. Case(s) Presentation: A 48 year old Asian male patient previously involved in a motor vehicle accident presented to the hospital with a chief complaint of pain and bleeding from the genitalia. On examination, it is revealed bleeding from the urethral meatus, pain in touch, palpable bladder, high riding prostate, and a butterfly-shaped bruising on the perineum. X-ray examination demonstrated soft tissue mass in the right scrotal region. The patient is diagnosed with urethral rupture with urinary retention and then underwent ultrasonography-guided cystostomy and perineal hematoma evacuation. The patient is followed-up 1 month later with a complaint of difficulty in voiding and erectile dysfunction. The patient is then diagnosed with urethral stricture and underwent direct vision urethrotomy. Discussion: Urethral injury is a rare type of injury of genitourinary trauma that may cause long term morbidity such as strictures, incontinence, impotence, and infertility. Urethral injury can be classified into posterior urethral injury which is associated with pelvic fracture and anterior urethral injury which is associated with blunt trauma. The gold standard of radiographic examination in urethral injury is dynamic retrograde urethrography. Prompt diagnosis, staging, and selecting intervention must be done for minimalizing complications. Sequelae may also develop which also affects quality of life. The usage of universal health coverage such as BPJS in In Indonesia can increase the accessibility of medical treatment. Conclusion: Urethral injury is a rare injury that requires prompt and careful management to minimize complications and increase the patient’s quality of life.
Keywords: Urethral Injury, urethrotomy, urethral stricture
URINARY BLADDER FOREIGN BODY: A CASE REPORT
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Objective: This study aims to knowing the causes and symptoms is very important in determining the management. Case(s) presentation: A 44-year-old man came to the urology clinic with the chief complaint of painful urination after inserting an electric cable 1 meter long and 1 cm in diameter through the urethra 2 days earlier. The patient was then subjected to cystoscopy and removal of the cable using grasping forceps. Discussion: Urinary system foreign bodies can be caused by stimulation when the patient is conscious or under the influence of alcohol, mental disorder, curiosity to medical procedure (iatrogenic). Diagnosis of foreign bodies is based on history, physical examination and supporting examinations in the form of plain abdominal x-rays, ultrasound to CT-Scan. Removal of foreign bodies is adjusted to the type, size and location of foreign bodies in the urinary tract. Conclusion: Recognition of urinary system foreign bodies is very important. The various types of foreign bodies are a challenge for urologists. The selection of an appropriate operative intervention with low complications gives a good prognosis.
Keywords: Foreign body, electrical wire, bladder, cystoscopy
CONSERVATIVE MANAGEMENT PELVIC FRACTURE URETHRAL INJURY (PFUI) IN A GIRL: A CASE REPORT
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Objective: This case report aims to describe a different approach of PFUI by conservative management that resulted in good outcome. Case(s) Presentation: A 7-year-old girl patient was brought to the emergency department after falling from public transportation diagnosed with suspicious urethral rupture, perineal rupture grade III, vertical-shear type pelvic-ring injury, laceration wound on the right lower leg, abrasion on the medial side left lower leg and urinary retention. The patient underwent percutaneous cystostomy, pelvic bandage, a perineal debridement and repair, a cystography, percutaneous vesicolithotripsy, cystostomy and synechiae incision. One year after the first admission it was planned for urethroplasty due to completely obliterated from antegrade and retrograde panendoscopy. Discussion: 8 months later urethroplasty was aborted because of an open bladder neck, a fistula at the anterior connected to the distal of the bladder neck with size of 3 mm. The patient was performed a silicon cystostomy catheter insertion for 6 weeks. At the time of evaluation, the fistula was closed, it was proven by Qmax uroflowmetry was 18ml/s with average flow: 9.8 ml/s, voiding volume: 90ml, flow time: 9s, voiding time: 9s, hesistance:1.5, and PVR:5.35 cc. Conclusion: In this case, it showed that conservative management could improve PFUI with satisfactory result, proved by good result of uroflowmetry. However, periodic evaluations must be carried out to follow the progress of the disease and the possibility of future complications including sexual function.
Keywords: PFUI, girl, urethral ruptur
PENIS GROWTH RESPONSE TO HORMONAL THERAPY IN CHILDREN WITH MICROPENIS AT HASAN SADIKIN HOSPITAL
Get PDFObjective: This study aims to determine the response of penis growth to testosterone injection. Material & Methods: The study was conducted on all cases of micropenis from January 2016 to December 2020. Each subject who met the criteria for micropenis received 25 mg of intramuscular testosterone ester injection, in 4 doses with an interval of 1 week. Evaluation is done at the beginning, before administration of testosterone, then an evaluation is carried out for each patient before testosterone injection until 1 week after the 4th injection. Penis measurement is done by fully stretched length measurement. Results: There were 62 patients who met the criteria for micropenis. The average age of patients with micropenis when they first came was 5.9 years. The patient's mean initial penile length was 2.13 cm. There was an increase in penis length of 32% in the first injection, 28% after the second injection, 18% after the third injection and 14% after the fourth injection. The average length of the penis at the first, second, third and fourth injections was 2.53 cm, 3.24 cm, 3.65 cm and 4.01 cm, respectively. At the end of treatment, there was an average increase in penile length of 75.8% compared to the beginning of treatment. Conclusion: In conclusion, it can be said that testosterone therapy in micropenis patients gave a good response in terms of increasing penile length by 75.8% and increasing the average from 2.13 cm to 4.01 cm
HYPERTENSION IS ASSOCIATED WITH BIGGER PROSTATE VOLUME AMONG BPH PATIENTS AT dr. SOEBANDI GENERAL HOSPITAL, JEMBER
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Objective: Hypertension is one of BPH (Benign Prostate Hyperplasia) risk factors. This study was to compare the prostate volume of hypertensive-BPH patient and normotensive-BPH patient at Soebandi General Hospital Jember. Material & Methods: This is an observational analytic study with cross-sectional design conducted at Soebandi General Hospital, Jember. The data (blood pressure and prostate volume) were obtained from the medical records of BPH patients visiting the Urology Department during December 2021 until January 2022. They were analyzed with Independent T-test. Result: The results showed that there was a significant difference in prostate volume between hypertensive-BPH patients and normotensive BPH patients (p-value: 0.013). Among the BPH patients, the hypertensive groups had a bigger prostate volume than the normotensive groups. Conclusion: This study proves that hypertension is associated with bigger prostate volume among BPH patients at Soebandi General Hospital, Jember.
Keywords: Independent T-test, prostate volume, blood pressure
RISK FACTORS ASSOCIATED WITH FEMALE SEXUAL DYSFUNCTION IN MARRIED WOMEN WORKING IN HEALTH CARE SYSTEM
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Objective: In this study, we want to evaluate the risk factors associated with sexual dysfunction in married women working in health care system. Material & Methods: The sexual function was assessed in the questionnaire using Female Sexual Function Index (FSFI). The analysis was conducted using chi-square test or Fisher Exact Test. Results: All participants who were overweight/obese had highest pain problem (p-value 0.034). Women with diabetes mellitus had higher satisfaction problems (p=0.002, OR 13.13, CI 1.73-99.91). The females who used contraception had significantly lower orgasm problems (p<0.004, OR 0.33, CI 0.15-0.72. Participants who worked as medical staff such as nurse/midwife, pharmacist, radiographer had higher pain problems (71.43%) compared to medical staff (administration staff) (OR 27.47, CI 3.73-202). Conclusion: The BMI (overweight/obesity), diabetes mellitus, the use of contraception, and the medical occupation were the significant risk factors to sexual dysfunction problem in women working in the hospital.
Keywords: Female sexual dysfunction, working women, hospital.
 
CARCINOMA TESTIS PROFILE IN TERTIARY HOSPITAL
Get PDFObjective: This study was undertaken to estimate the epidemiological characteristics, histological types, and subtypes of testicular neoplasm according to the WHO classification in our patient group. Material & Methods: This was a retrospective study done over a period of ten years from January 2010 - December 2020 in our institution. Histopathological slides were retrieved and reviewed for tumour. Testicular Neoplasm patients who underwent orchidectomy and chemotherapy clinical data including the patient’s age, tumor location, tumor side, pathological finding, tumor marker, chemotherapy regiment, prognosis, chemotherapy response, and side effect were observed. All the data were analyzed descriptively and using SPSS 17.0. Results: A total of 31 cases of testicular and paratesticular neoplasm were encountered in our study with a mean age of 32.516.2 years. The highest incidence was 15-35 years old (48.3). Scrotum mass was the most frequent clinical presentation (70.96%) and left side became the predominant area (52%). Most of the patients come in late stage T3 (51.61%) and N3 (67.74%) with no metastatic process (70.96). The major pathological finding was Seminoma (64.51%), Teratoma (16.12), Yolk Sac (12.9%), Embryonal, and Mixed (3.22%). AFP, B-HCG, and LDH were elevated in some Seminoma, Teratoma, and Yolk Sac groups. The most wide chemotherapy used was 4 series BEP (87.09%). Patient prognosis highest incidence were Intermediate (70.96%). Most of the patients showed complete response (67.74) of chemotherapy. Nausea, vomiting, alopecia, and mucositis were observed as chemotherapy side effect in all patients. Conclusion: Testicular neoplasm peak incidence appears in young male. Most patients come to health care service in late stage. Seminoma become the highest testicular neoplasm incidence in our study. Elevated tumor markers were found in some patients. Four cycle BEP chemotherapy regiment showed great outcome for these patients.
Keywords: Epidemiological, histological, testicular neoplasm