Indonesian Journal of Urology
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IMPACT OF COVID – 19 ON UROLOGICAL INTERVENTIONS AT TERTIARY REFERRAL HOSPITAL
Get PDFObjective: This study aims to identify and evaluate the impact of COVID-19 on urological interventions at Soetomo general-academic hospital as the tertiary referral center. Material & Methods: This study is a descriptive-retrospective, single-center study that included all confirmed cases of COVID-19 in urological patients from March 1, 2020 until December 31, 2021 at Soetomo general-academic hospital. We investigated these patients' characteristics, focusing on the demography, clinical data, and eventual outcome. Patient's gender, age, primary urological presentation, COVID-19-related symptom, comorbidity, chest x-ray result, and laboratory value were among the involved variables. The patient's outcome was categorized into death, delayed intervention, or intervention as scheduled. Results: Seventy-seven patients were enrolled, with a mean age of 44.2 years. Fever was found in 42 (54%) patients and respiratory symptoms in 32 (41.5%) patients. An NLR value of >6 was found in 55.8% of patients. A total of 18 patients experienced LUTS (23.4%), 33 patients presented with hematuria (42.9%), and 30 patients had urinary tract infections (39%). Nineteen out of 77 patients (27.3%) died before intervention. On the other hand, surgical intervention in 37 (66%) patients were delayed due to self-isolation, while intervention in 19 (34%) patients was performed as scheduled due to their emergency nature. Conclusion: Urological patients infected with COVID-19 were impacted by the delay of surgical procedures and mortality in the first 22 months of the pandemic.
 
THE EFFECT OF WOMEN'S AGE DURING PREGNANCY ON THE CASE OF HYPOSPADIAS IN CHILDREN
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Objective: The purpose of this study was to determine the effect of a woman’s age during pregnancy on the incidence of hypospadias in children. Material & Methods: This research is an analytic study with a case control design. The sampling technique is a non-probabilistic technique with consecutive sampling. This study was analyzed by univariate and bivariate. Results: From 62 samples, the number of hypospadias cases was 28 people (90.3%) with woman's age at pregnancy <35 years and 3 people (9.7%) with woman's age at pregnancy ≥ 35 years. While the number of controls was 29 people (93.5%) with woman's age at pregnancy <35 years and 2 people (6.5%) with woman's age at pregnancy ≥ 35 years. Conclusion: There is no significant relationship found in this research between a woman's age at pregnancy and the incidence of hypospadias in children.
Keywords: Age, hypospadias, pregnancy
5-YEAR RELATIVE SURVIVAL RATE BETWEEN SEMINOMA AND NON-SEMINOMA TESTICULAR CANCER IN SINGLE CENTER
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Objective: This study was conducted to provide data about the survival rate of testicular cancer patients with different histology in the year 2013 – 2017 in Adam Malik General Hospital and to compare these estimates with other studies conducted in another center. Material & Methods: Medical records of testicular cancer patients from 2013 to 2017 in Adam Malik General Hospital were collected. We measured 5-year relative survival between the histology group of seminoma and non-seminoma estimated using Kaplan-Meier survival analysis. Also, using Kaplan-Meier for survival analysis estimated, 5-year relative survival between metastatic and non-metastatic was estimated. Results: 63 male patients (mean age 27.5 ± 17.6 years old) were included in this study. The distribution of histology were non-seminoma (53.9%), seminoma (39.9%), non-Hodgkin lymphoma (4.7%), and gonadoblastoma (1.5%). The 5-year relative survival rate was 82.5% for the seminoma group and 80.9 % for the non-seminoma group. The 5-year survival rate in the seminoma group with metastatic was 77.8% and in the non-metastatic group was 87.3 %. The 5-year survival rate in the non-seminoma group with metastatic was 74.6 % and in the non-metastatic group was 88.9 %. Conclusion: 5-year relative survival was better for the seminoma group than the non-seminoma group. Moreover, non-metastasis seminoma was found to have a better outcome than the metastatic group. Despite that, in the non-metastatic group, it is found that non-seminoma testicular cancer has a better survival rate than seminoma testicular cancer.
Keywords: 5-year relative survival rate, seminoma, non-seminoma, testicular cancer
A HIGH PREOPERATIVE NEUTROPHIL-LYMPHOCYTE RATIO AS AN INDICATOR OF EARLY RESPONSE OF KIDNEY TRANSPLANT
Get PDFObjective: This study aims to evaluate the association of the preoperative Neutrophil-lymphocyte ratio (NLR) and postoperative creatinine levels after kidney transplantation, which is a predictor factor for determining early postoperative transplantation complications. Material & Methods: We conducted a retrospective study of 33 patients enrolled in Sardjito General Hospital in Yogyakarta between 2017 and 2020. In this study, we observed the preoperative NLR and compared it with the postoperative creatinine level. The data were compared and analyzed. Results: This study showed that preoperative NLR in these 33 patients was 4.17 + 2.82. Postoperative creatinine levels were 2.38 + 1.75 mg/dL. Postoperative creatinine levels were higher in patients with low preoperative NLR (p=0.00). Besides, the correlation is weak and had a positive correlation direction (r=0.379). Conclusion: This study showed preoperative NLR and the postoperative serum creatinine level is correlated even weakly. NLR could be considered a predictor factor for determining postoperative transplantation complications, and even it still needs further research
EARLY-STAGE TESTICULAR CANCER MANAGEMENT REFERRING TO EUROPEAN ASSOCIATION OF UROLOGY (EAU) GUIDELINES: A SURVEY IN INDONESIA
Get PDFObjective: This study aimed to determine the management of early-stage testicular cancer among urologists in Indonesia by using a survey. Material & Methods: This research was a descriptive-analytic study using a survey method through a Google-forms questionnaire distributed to urologists throughout Indonesia who were willing to participate. Data were collected from September 1 to 30, 2021. Results: Of the total respondents, 15 (14.2%) respondents were consultant urologic oncologists, and 90 (85.71%) respondents were non-consultant urologists or consultant urologists non-oncology. There was no difference in the treatment given by consultant uro-oncologists and non-consultant urologists/consultant urologists non-oncology in the management of surveillance of stage IA-IB seminoma (66.7% vs. 55.6%, p-value = 0.207), chemotherapy of stage IIA-IIB seminoma (100.0% vs. 90.0%, p-value = 0.080), surveillance of stage I non-seminoma cancers (46.7% vs. 41.1%, p-value = 0.304), and chemotherapy of stage IIA and IIB non-seminoma cancers (80% vs. 91.1%, p-value = 0.193). Conclusion: In general, as many as 84.4% of oncology consultant urologists and 83.7% of non-consultant urologists/consultant urologists non-oncology have performed initial diagnostic examinations, treatment, and follow-up following testicular cancer management guidelines according to the European Association of Urology 2021
COMPARISON OF ANDROGEN AND ESTROGEN RECEPTORS’ EXPRESSION IN DARTOS TISSUE OF BOYS WITH AND WITHOUT HYPOSPADIAS
Get PDFObjective: This study aims to investigate the characteristics of androgen receptors (AR), estrogen receptor 1 (ER1) and estrogen receptor 2 (ER2) expression in dartos tissue of patients with congenital hypospadias, compared to normal penis. Material & Methods: We harvested 63 dartos tissue consisting of 53 congenital hypospadias that underwent urethroplasty (20 distal and 33 proximal) and 10 normal penis that underwent circumcision as controls from September 2017 to September 2018. The expressions of AR, ER1, and ER2 were measured using Quantitative Real-Time PCR (qPCR). All data were analyzed by Prism 7, and one-way ANOVA tests were used to compare gene expressions between the groups. Results: The mean age was 68.99 (± 45.5) and 65.6 (± 25.8) months in boys with and without hypospadias, respectively. The expression of mRNA AR was decreased in proximal (6.26 ± 2.30) and distal hypospadias (6.43 ± 2.22) compared to controls (9.69 ± 1.10), which were statistically significant (p=0.0001 and p<0.0001, respectively). We found a statistically significant difference of ER1 expression compared to controls (p=0.0064). The expression of ER2 was significantly increased in distal (21.03 ± 5.00) and proximal hypospadias (25.21 ± 8.06) groups compared to controls (11.80 ± 2.49) (p<0.0001). There was no statistically significant mean difference in mRNA ER1 expression (p=0.65). Conclusion: The repressed AR and elevated ER mRNA as shown in our study may suggest that defects in those receptors’ interaction and/or balance may contribute to hypospadias and penile curvature condition. Further studies are needed to evaluate any gene-related problems in hypospadias.
Keywords: Hypospadias, androgen receptor, estrogen receptor, dartos tissue.
 
NECROTIZING FASCIITIS OF THE RIGHT FLANK MIMICKING A XANTHOGRANULOMATOUS PYELONEPHRITIS
Get PDFObjective: Xanthogranulomatous pyelonephritis (XGP) is a rare and serious chronic inflammation of the kidney, manifesting as a granulomatous inflammation of the kidney tissue. It can be life-threatening if not recognized and managed appropriately with antibiotics and surgery. Since there are no single pathognomonic clinical or radiological features, diagnosis requires combining the results of several clinical signs and imaging characteristics. However, determining the disease is oftentimes difficult as other conditions may mimic its characteristics, such as renal cancer, mesoblastic nephroma, renal abscess, and necrotizing fasciitis. Case(s) Presentation: A 45-year-old man was admitted to the emergency department of Soetomo General-Academic Hospital with right flank gangrene and fever for one week. Discussion: The patient was admitted to the hospital with sepsis and poor laboratory result. Computed Tomography (CT) scan results showed nephrolithiasis. The patient was diagnosed with Xanthogranulomatous pyelonephritis and underwent necrotomy in the Emergency Operating theatre. Conclusion: During the operation, necrotizing fasciitis was found in the right flank region instead. The external oblique muscle was intact without any tunneling into the retroperitoneal space. The postoperative care was joined by the Plastic Surgery department.  
CORRELATION BETWEEN MATERNAL AGE, LOW BIRTH WEIGHT, PREMATURITY AND HORMONAL DRUGS USING WITH THE OCCURRENCE OF HYPOSPADIAS (CASE STUDY AT BINA SEHAT JEMBER HOSPITAL, PARU JEMBER HOSPITAL, AND BHAYANGKARA BONDOWOSO HOSPITAL)
Get PDFObjective: This research aims to determine the correlation between maternal age during pregnancy, low birth weight (LBW), prematurity, and history of hormonal drugs used in the first trimester of pregnancy with the occurrence of hypospadias. Material & Methods: This research is an observational analytic research with case control design. The sample in this study were 50 samples that consisting of 25 patients with hypospadias and 25 patients without hypospadias at Bina Sehat Jember Hospital, Paru Jember Hospital, and Bhayangkara Bondowoso Hospital. After determined every case and control group, data acquired retrospectively by traced the hypospadias risk factors (maternal age at pregnancy, LBW, prematurity, and history of hormonal drugs using in the first trimester of pregnancy) by interviewing the patient's mother. The data of this research were analyzed by bivariate and multivariate using SPSS 16.0. Bivariate analysis in this study used chi-square Yates correction (chi-square with continuity correction) and fisher's exact test, whereas multivariate analysis used logistic regression techniques with significance p-value<0.05. Results: The result of bivariate analysis in this study showed that variable maternal age during pregnancy more than 35 years (p = 0.667) has no correlation with occurrence of hypospadias, while variable of LBW (p = 0.027), prematurity (p = 0.041), and the history of hormonal drug use in the first trimester of pregnancy (p = 0.049) have a correlation with the occurrence of hypospadias. Conclusion: In this study, there was a significant correlation between LBW, prematurity, and history of hormonal drugs using in the first trimester of pregnancy with the occurrence of hypospadias. This study did not show a significant correlation between maternal age during pregnancy with the occurrence of hypospadias.
 
LAPAROSCOPIC PYELOLITHOTOMY AND Y-V PYELOPLASTY IN PATIENT WITH LARGE PYELUM CALCULI AND UPJO
Get PDFObjective: We report our experience in laparoscopic pyelolithotomy with Y-V pyeloplasty. Case(s) Presentation: A 35 years old man with a chief complained of right flank pain since 1 year ago and worsened since 3 months before admission. KUB-IVU showed right hydronephrosis, pyelum calculi, and UPJO. We performed Laparoscopic Pyelolithotomy and Y-V Pyeloplasty. Operative time was 180 minutes and blood loss was about 50 cc. Drain was removed at post-operative day 4. Operating wound was good, maximum VAS score was 3. Patient was discharged at post-operative day 4.Discussion: Y-V plasty technique significantly reduces surgery time and has lower risk of devascularization of the UPJ. The success of the Y-V plasty depends on proper placement of the incision ensuring a broad-based flap of pelvis. Following incision the apex of the flap is advanced and secured with an interrupted suture ensuring no tension. The remaining gaps are then closed in an interrupted fashion. Conclusion: Laparoscopic Pyelolithotomy for large stone with Y-V Pyeloplasty was safe and effective alternative treatment of large pyelum calculi and UPJO
MANAGEMENT OF ADRENO CORTICAL CARCINOMA: CASE REPORT
Get PDFObjective: Adreno cortical carcinoma (ACC) is a rare malignancy. Currently, surgical resection offers the best chance of cure with localized tumor. Multimodal therapy including systemic chemotherapy and radiation therapy are often required for locally advanced and metastatic disease aims to decrease these high recurrence rates. Case(s) presentation: A 42-year-old male patient was referred from internist due to mass in left adrenal. Solid mass with calcification on left adrenal gland within size 9 x 11.8 x 11.5 cm was found in MSCT. We performed complete surgical resection (adrenalectomy), and results from pathology anatomy was ACC functional T2N1M0 (stage 3). The patient was planned eight times chemotherapy with etoposide and carboplatin, but he decided to stop the treatment after six times due to no constitutional complaint. We found no residual mass on follow up six months after operation and patient demonstrated a good clinical outcome after one year. Discussion: We perform open adrenalectomy and after surgery mitotane plus etoposide, cisplatin, doxorubicin (EDP) administered as first-line therapy but we only did chemotherapy with etoposide and carboplatin because mitotane was not covered by patient insurance. We chose to not perform radiation therapy due to lesser benefit of adjuvant radiotherapy as evidenced by many studies in term of recurrence-free survival and overall survival. Conclusion: In our case, adreno cortical carcinoma treated with open adrenalectomy combined with 6 times chemotherapy used etoposide and carboplatin demonstrated a good clinical outcome after 1 year