Indonesian Journal of Urology
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SURVIVAL ANALYSIS OF PEDIATRIC WILMS TUMOR BASED ON RISK STRATIFICATION
Get PDFObjective: This study aims to determine prognostic factors of WT patient in Adam Malik Hospital, Medan. Material & Methods: at Adam Malik Hospital, Medan. Univariate and multivariate Cox regression analyses were performed to determine independent prognostic factors for WT. The primary endpoint of this study were patients’ overall survival (OS) obtained by performing Kaplan-Meier analysis on significant variables. Results: From the univariate Cox regression analysis, gender was found to be the sole significant factor (HR = 0.218, p = 0.005) with males have a higher hazard ratio. The multivariate Cox regression analysis yielded age of diagnosis (HR = 13.860, p = 0.014) and incomplete tumor removals (HR = 0.056, p = 0.008). Kaplan-Meier analysis were performed on three significant variables mentioned before. Only gender yielded a significant Mantel-Cox log-rank score (p = 0.002) with male patients were found to have better survivability (which median survival 476 days compared to females’ 11 days). The survival of the boys was 45.45% while all of the girls did not survive until the cut-off. Conclusion: Three prognostic factors, including children’s gender, age of diagnosis, and tumor removal status, were confirmed to be prognostic factors for the overall survival of children with WT. Further studies covering broader demographic areas were suggested to confirm significant results.
 
PERCUTANEOUS CYSTOLITHOLAPAXY AS AN ALTERNATIVE APPROACH FOR GIANT BLADDER STONES: A CASE SERIES OF PATIENTS WITH SIGNIFICANT COMORBIDITIES
Get PDFObjective: We reported two giant bladder stones cases, with significant comorbidities and mentally impaired patients, treated with PCCL. Case(s) Presentation: We report two cases of giant cystolithiasis (sized 8.8 cm x 7.2 cm and 7.0 cm x 5.8 cm) in male patients with impaired renal functions and mental illness. We performed PCCL on both patients with cystoscopy-guided bladder puncture and dilation, under spinal anesthesia. Stone fragmentation through transurethral (pneumatic) and percutaneous (suprapubic amplatz ultrasound) lithotriptors was performed simultaneously. Discussion: Stone fragments were evacuated through the nephroscope. These fluoroscopy-free procedures were performed under one hour. The patients were discharged on day three post-operatively without indwelling catheter. Conclusion: We performed PCCL with simultaneous transurethral fragmentation in giant bladder stone cases presenting with impaired renal functions and mental illness. We faced no significant post-operative issue. This technique, or its modified approach, is safe and applicabl
URETHRAL INJURY AS A RARE COMPLICATION OF CIRCUMCISION: A CASE REPORT AND LITERATURE REVIEW
Get PDFObjective: In this report, we describe the case of urethral injuries after circumcision. Case(s) Presentation: A 5-year-old male came to the urology clinic complaining of urine seeping through the gauze-covered wound. The patient had undergone circumcision. Before the procedure, the patient could generally urinate through the external urethral orifice. His parent realized that the urine was flowing out through the circumcision scar instead of the external orifice. Even though the wound was open and wet, he felt painless when urinating. After cleaning the wound, it appeared that there was a sizeable chromic catgut thread knotted on the right corpus cavernosum. The pendular urethra was cut widely; therefore, the urine came out of this spot. A six French Foley catheter was inserted over the external urethral orifice, the cut urethra towards the bladder. The injured urethra was expected to be attached to simplify the next six-month operation by inserting this urinary catheter. Discussion: Urethral injury post circumcision is rarely reported, but this complication is dangerous due to its morbidity and long-term impact. The paradigm shift from two-stage repair to one-stage repair has developed. Mathieu’s modified technique and the Snodgrass technique are recommended. Conclusion: Urethral injury during circumcision can be devastating. The repair technique for urethral trauma depends on the involvement and condition of the surrounding soft tissue, also the size of the tissue damage
RISK FACTORS OF BLADDER CANCER PATIENTS IN ARIFIN ACHMAD REGIONAL GENERAL HOSPITAL, RIAU PROVINCE, INDONESIA
Get PDFObjective: This study aims to describe the risk factors of bladder cancer patients in Arifin Achmad Regional General Hospital, Riau Province, Indonesia. Material & Methods: We reviewed the medical records of bladder cancer patients managed in Arifin Achmad Regional General Hospital from January 2013 - December 2017. The data collected were sex, age, histopathology types, staging, smoking history, occupation, ethnic/tribes, and city/district origine. Statistical analysis of univariate was used. Approval on the study was obtained from the Ethical Review Board for Medicine and Health Research, Medical Faculty, University of Riau. Results: There were 101 bladder cancer patients consisting of 83.2% patients with transitional cell carcinoma and 65.3% with advanced stage. The result showed the most common (82.2%) patients were males and 35.6% of patients were in age 51-60 year old group, with the youngest was in 9 year old group and the oldest is 85 years. The most common risk factors of bladder cancer patient were farmers in 29.7% and the non-smoking patients were in 52.5%, Malay ethnic in 30.7% and Pekanbaru origin in 30.7% of patients. Conclusion: Bladder cancer risk factors in Arifin Achmad Regional General Hospital were males, farmers, Malay ethnic, and Pekanbaru origin
CHARACTERISTIC CHEMOTHERAPY RESPONSE OF TESTICULAR CANCER PATIENTS IN TERTIARY HOSPITAL
Get PDFObjective: The purpose of this study was to determine the correlation of testicular tumor markers on the success of chemotherapy in my institution. Material & Methods: This research is a retrospective study single center using the medical record database at the span of the research period. The patient with testicular carcinoma who underwent complete chemotherapy between 2017 until 2022 was included. The data collected and analyzed by descriptive data and analytical correlation using SPSS Ver. 25. The comparation test using T-test and Anova. Results: A total of 31 testicular cancer patients were enrolled in the study. Fifteen patients were seminoma and 16 patients were non-seminoma. The mean age of patient at presentation of seminoma and non seminoma were 38.3 ± 17.03 and 30.74 ± 13.01. Most patients presented a karnofsky score about 79 ± 15. There was a negative correlation (r=-0.492) with a significant correlation between the types of testicular carcinoma cases and the response to chemotherapy (p=0.027). There was a significant difference in cases of seminoma and non-seminoma to the success of the chemotherapy response (p=0.024). There was a positive correlation between serum β-HCG, AFP, LDH with serial chemotherapy result with a no significant correlation (p=0.879; p=0.242; and p=0.277). Conclusion: Most types of the testicular carcinoma responses to chemotherapy. Patients with seminoma pathology have better response to chemotherapy compared to non-seminoma
ROLE OF MAGNETIC RESONANCE IMAGING IN NODAL AND METASTATIC STAGING OF PROSTATE CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS
Get PDFObjective: To evaluate the usage of MRI in prostate cancer staging, especially in nodal involvement (N-staging) and metastasis (M-staging) of prostate cancer. Methods: This is a systematic review and meta-analysis assessing role of MRI in nodal and metastasis staging of prostate cancer. Search of studies were done through search engine using Pubmed, Cochrane, and EBSCO Host and manual searching. Quality of eligible studies were assessed using a revised version of Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) and analyzed in pooled analysis according to nodal involvement or metastasis staging, modality of diagnosis used as the index test and gold standard used using STATA version 13. Results: Total 26 studies corresponding with study’s eligibility criteria were found. Overall, usage of MRI has a sensitivity of 47% (95% CI 35% - 60%; I2 83.08%) and a specificity of 93% (95% CI 89% - 96%, I2 82.21%) in nodal involvement staging of prostate cancer, while using of MRI in M-staging of prostate cancer shows a sensitivity of 94% (95% CI 86% - 97%) and a specificity of 99% (95% CI 97% - 99%). Using lymphotrophic superparamagnetic nanoparticle (LSN) - enhanced MRI gives higher sensitivity than using MRI without LSN for N-staging of prostate cancer. Conclusion: The usage of MRI in prostate cancer staging has a moderate sensitivity and relatively high specificity in detecting lymph node. Moreover, it plays an important role and even can be used as a modality of choice in assisting bone metastatic prostate cancer detection
GIGANTIC ADRENAL CYST MIMICKING MESENTERIAL TUMOR: A CASE REPORT
Get PDFObjective: This study aims to know the effects of giant adrenal cysts and their challenges for surgeons. Case(s) Presentation: A 41 years old female was referred with a chief complaint of growing palpable mass on the left side of the abdomen since five months ago. During the past five months, the patient has also had complaints of hard narrow-caliber stools. The general conditions and vital signs have been within normal limits. Discussion: Complete resection of the tissue remains the current best treatment of choice. When available, laparoscopic adrenalectomy is the gold standard for treating giant adrenal cysts. Open adrenalectomy is an alternative when laparoscopic adrenalectomy is not available, or when there is not enough diagnostic information preoperatively. For large cysts with a size of >6cm, open surgery is the favorable treatment, because it is difficult to control the mass via the laparoscopic approach. Conclusion: The giant adrenal cyst is a rare condition that, due to its size, it could lead to moderate-severe abdominal symptoms. Localizing the origin of the cysts preoperatively poses a challenge for surgeons and diagnosticians. Intraoperative diagnostic and therapeutic with laparoscopy or open surgery is recommended for these cases.
 
CATALASE 1 GENE EXPRESSION (CAT-1) IN HYPERGLICEMIA INDUCED TESTIS, AS AN ANTIOXIDANT THERAPY INDICATORS
Get PDFObjective: This study aims to analyze the effects of hyperglycemia status on the function of testicular spermatology, especially CAT-1. Material & Methods: This study was an experimental pre-clinical study. Twenty-seven rats were divided into 3 groups: normal, 2 weeks, and 4 weeks hyperglycemia. The hyperglycemic state in the Wistar rats was induced by Streptozotocin (STZ). All data were collected and analyzed with SPSS 20.0. At two and four weeks, testicular tissue was extracted and it will be processed using the Total RNA Mini Kit FavorPrepTM then quantitative PCR was performed using the SYBR® Fast qPCR Kit. Results: CAT-1 gene expression in the hyperglycemia induction group increased when induced for 2 weeks and again after 4 weeks compared to controls (18.88 ± 4.7 and 21.45 ± 5.52 vs 10.83 ± 3.4). However only induction after 2 weeks was statistically significant (p= 0.021). Conclusion: CAT-1 (Catalase) gene expression has increased in testicular tissue under conditions of hyperglycemia
FRESH GRADUATE UROLOGIST IN EASTERN INDONESIA: FIRST YEAR SURGERY EXPERIENCE
Get PDFObjective: In present days, endourology is the hallmark of urology, including in developing countries. This study reviews the surgical experiences of a urology practitioner in the first year of his practice in the underdeveloped province in Indonesia. Material & Methods: This research is a descriptive study that retrieval patients data from the medical record during June 2018 - May 2019. Results: Total of 401 operations were obtained. There were 328 male (81.8%) and 73 female (18.2%) with the average of patients age were 52+17.77 years old. The most common diagnoses were BPH 113 cases (28.2%). bladder stone 83 cases (20.7%), and ureteral stone 52 cases (13%). The most common surgical procedures performed were TURP 120 operations (29.9%), Ureterorenoscopy (URS) 64 operations (16%), and Vesicolithotripsy 58 operations (14.5%). The upper tract procedures were 84 operations (20.9%), mainly URS 64 operations (16%). Whereas the lower procedures were 317 operations (79.1%) mainly TURP 120 operations (29.9%). The complications were bleeding post-TURP 5 cases which require blood clot evacuation (1.2%), bleeding post open nephrolithotomy 1 case which requires blood transfusion (0.2%), and TURP syndrome 1 case (0.2%) with mortality 2 patient (0.4%). All kidney stones were handled by open surgery due to lack of PCNL and ESWL set devices. Conclusion: First year urologist who are interested in serving in such areas may benefit from prioritizing the availability of upper and lower set to performed basic standard care for surgical urology without leaving the hallmark of urology
RELATION OF TOTAL CHOLESTEROL TO PROSTATE VOLUME AND INTRAVESICAL PROSTATIC PROTRUSION IN BENIGN PROSTATIC HYPERPLASIA PATIENTS
Get PDFObjective: To determine the relationship between total cholesterol, prostate volume, and intravesical prostatic protrusion in patients with benign prostatic hyperplasia. Material & Methods: This study used a cross-sectional method, carried out at the Paru and Bina Sehat Hospital in Jember. The sample in this study was BPH patients who met the inclusion criteria taken through medical record data from October 2019 to January 2020 Results: Samples on this study amounted to 33 patients. In this study, there was a difference between normal and high cholesterol with prostate volume in BPH patients (p = 0.00) and there was a significant relationship between cholesterol and prostate volume with strong correlation strength (p = 0.00 and r = 0.751) while the difference between high and normal cholesterol with IPP obtained insignificant results (p = 0.211) and the correlation between cholesterol and IPP obtained an insignificant relation with weak correlation strength (p = 0.217 and r = 0.221). Conclusion: There is a significant relationship between total cholesterol and prostate volume and a significant difference in prostate volume between normal and high total cholesterol in BPH patients, while there is no significant result between total cholesterol and intravesical prostatic protrusion in BPH patients