Indonesian Journal of Urology
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CLINICAL EVALUATION OF TENCKHOFF CATHETER INSERTION IN PAEDIATRIC PERITONEAL DIALYSIS : A SINGLE CENTER STUDY
Get PDFObjective: This study aimed to evaluate the clinical outcome of Tenckhoff catheter insertion at Sardjito General Hospital for pediatric renal failure. Material & Methods: Data were collected from January 2014 to December 2018 at Sardjito General Hospital. All patient records were collected retrospectively such as patient characteristics, underlying diseases of kidney failure, congenital abnormalities, surgical technique, complications that occur after Tenckhoff catheter insertion. Results: 45 patients meet the inclusion criteria. A total of 7 patients with acute kidney failure (15.5%) and 38 patients with chronic kidney failure (84.5%). Glomerulonephritis is the most common cause of kidney failure (21 patients, 46.7%). The insertion technique used was open surgery in 34 patients (76%) and laparoscopic insertion in 11 patients (24%). Complications reported were catheter dysfunction, leakage of dialysate, surgical site infection, and peritonitis. Conclusion: Tenckhoff catheter insertion for peritoneal dialysis (PD) in pediatric patients with acute and chronic renal failure performed in our center is effective and safe. The most common cause of renal failure in pediatric is glomerulonephritis. Open surgery and laparoscopic insertion of Tenckhoff catheter both have a low complication rate. Catheter dysfunction due to mechanical catheter obstruction is one of the main problems in the placement of Tenckhoff catheter
MALE URETHRAL STRICTURE CHARACTERISTIC IN DR KARIADI GENERAL HOSPITAL SEMARANG: A DESCRIPTIVE STUDY
Get PDFObjective: This research was conducted to describe male urethral stricture characteristic in Kariadi General Hospital Semarang. Material & Methods: The data is collected retrospectively from the male urethral stricture patient medical records Kariadi General Hospital Semarang between January 2013 until December 2017. The data is analyzed descriptively to describe the characteristics of male urethral stricture patients, patient age, etiology, site, definitive surgery, and complications. Results: Within the period, 171 patients with male urethral stricture. The mean age was 52.11 years (range 9-86). The causes of stricture were trauma in 145 patients (84.8%), infection in 25 patients (14.6%) and iatrogenic in 1 patients (0.06%). Strictures site were posterior in 146 patients (85.4%) and anterior in 25 patients (14.6%). The definitive surgery for strictures were from DVIU in 132 patients (77.2%) and urethroplasty in 39 patients (22.8%). Complications rate were recurrence of stricture 56 patients (32.74%), bleeding 6 patients (3.05%), extravasation 14 patients (8.18%), erectile dysfunction 4 patients (2.34%). Conclusion: Trauma is the leading cause of urethral stricture in Kariadi General Hospital. The most common definitive therapy for urethral stricture in Kariadi General Hospital was still DVIU, but there has been an increase for urethroplasty and we still get the learning curve for it
THE EFFECTIVENESS OF TNF-Α INHIBITOR THERAPY IN BLADDER PAIN SYNDROME/INTERSTITIAL CYSTITIS PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Get PDFObjective: To evaluate the effectiveness of TNF-α inhibitor therapy in Bladder Pain Syndrome/Interstitial Cystitis (BPS/IC) patients compared to placebo, assessed using Global Response Assessment (GRA). Material & Methods: A systematic review and meta-analysis. Subjects were patients with moderate to severe diagnosis of BPS/IC who were given TNF-α inhibitor versus placebo, with the Global Response Assessment (GRA) (patient-reported self-reported BPS/IC treatment response scale). A systematic literature search was carried out on the English databases PubMed/MEDLINE and Science Direct, published until September 2020. Data were extracted independently and assessed the bias and quality of each selected article. Results: Initially there were 124 studies. After further selection, 2 RCT studies were included in the criteria for this study. The number of samples obtained was 85 patients. There is 1 study that used 400 mg of certolizumab pegol subcutaneously and 1 study used adalimumab 80 mg subcutaneously and followed by 40 mg subcutaneously for 2 weeks. Both studies had statistically low heterogeneity with I2 = 0% (P = 0.34), so fixed effect statistical model was used to determine the result. Furthermore, there was no significant difference (P = 0.32) between the number of GRA responders from the TNF-α inhibitor and placebo therapy groups, with odds ratio of 1.61 (CI = 0.65-4.00). Conclusion: TNF-α inhibitor therapy did not increase GRA responders when compared to placebo
THE CHARACTERISTIC OF ERECTILE DYSFUNCTION AMONG TYPE 2 DIABETES MELLITUS MALE IN EASTERN INDONESIA
Get PDFObjective: To determine Type-2 diabetic patients and its characteristics to determined risk of Erectile dysfunction (ED) and the role of EHS score as more practical tools to screening ED among T2DM patients. Material & Methods: The cross-sectional observational study was carried out at the Internal medicine Unit of Manambai Abdulkadir and Dompu district Hospital, out of 45 patients were included on this study. The data were collected from June 01 – August 01 2017. A structural questioner was used to collect the data and was analyzed using SPSS 2.0. person analysis correlation and logistic regression were used to find the Odds Ratio (OR). Results: We found that 38 out of 45 (84.4%) patients (mean age 57.2 ± 7.1) have Erectile dysfunction, 26 patients uncontrolled diabetes, 5 (11.1%) treated as CHF, 4 (8.9%) CKD, and 7 (15.6%) neuropathy diabetic. There is high correlation between random glucose level and IIEF-5 score (r=0.5, p=0.01). The overall odd ratio of ED in this studies was 4.3 (95% CI: 0.73 to 25.1) for uncontrolled diabetes, 2.5 (95% CI: 0.1 to 51.1) for Treated CHF, 2 (95% CI: 0.01 to 41.6) for CKD, and it was 1.2 (95% CI: 0.1 to 11.5) for neuropathy diabetics. Conclusion: From this study, we found that most diabetic patients have ED, and there is high correlation between random glucose level and simplified IIEF-5 score, EHS performed similar result on diagnoses ED compared to IIEF-5
EFFECTS OF COCONUT WATER (COCOS NUCIFERA SP.) ADMINISTRATION AS PREVENTION OF UROLITHIASIS IN CALCIUM OXALATE INDUCED - WHITE RAT WISTAR STRAINS
Get PDFObjective: To analyze the effect of coconut water administration on the occurrence of urolithiasis in calcium oxalate-induced Wistar rats. Material & Methods: Laboratory experimental study with post-test only control group design, using experimental model of male Rattus norwegicus-Wistar strains. The treatment given is ad libitum administration coconut water to observe its effect on renal histopathological changes, microscopic analysis, and renal function markers. Urolithiasis induction uses exposure of 0.75% ethylene glycol (EG), and 2% Ammonium chloride (AC) in drinking water. Results: Descriptive analysis showed the tendency of decreasing in mean of renal function markers, and histopathological nephron damage in the treatment group versus control group: BUN (11.22 versus 14.29); Creatinine Serum (0.5308 versus 0.5714); degree of nephron damage (5.22 versus 10.36). In microscopic analysis, there were calcium deposits in the kidney tubules in the control group, which were not found in the treatment group. Based on the ANOVA test, obtained significant difference in BUN levels with p value=0.023 (p<0.05), and the degree of nephron damage between study groups with p value= 0.000 (p<0.05). There was no significant difference in serum creatinine with p value= 0.23 (p>0.05). Conclusion: Coconut water is potential modality in inhibiting the deposition of calcium oxalate crystals, and protecting from impaired kidney function against urolithiasis in animal-model of calcium oxalate-induced Wistar rats
EFFECT OF PERIURETHRAL INJECTION ADIPOSE-DERIVED STEM CELLS IN NERVE HEALING AND VOIDING BEHAVIOR FOR THE TREATMENT OF STRESS URINARY INCONTINENCE IN A RAT MODEL
Get PDFObjective: To investigate whether ADSCs are capable of nerve repair in stress urinary incontinence. Material & Methods: Thirty rats were allocated to five groups for receiving a periurethral injection with Phosphate Buffer Saline (PBS) (B1,B2) and Adipose-derived Stem Cells (C1, C2). Functional assessments with Voided Stain on Paper (VSOP) Method were reassessed at 2 and 4 weeks after injection. The rat SUI model was generated by Vaginal Distention (VD). The regeneration of peripheral nerve was evaluated by PGP 9.5 immunohistochemical staining. Results: Results revealed significant peripheral nerve differences between ADSC group and other groups in 28 days using PGP 9.5 staining. Our functional assessment, Voided Stain on Paper (VSOP), showed that ADSC group had significant improvement in 14 days; unfortunately, our 28 days improvement was not substantial. Conclusion: Periurethral injection of ADSCs improves urine pattern in SUI-induced rats and increase the amount of peripheral nerve. This method may be a potential strategy for SUI treatment.
 
PROGNOSTIC FACTORS TOWARD BLADDER CANCER PATIENT RECOVERY AFTER RADICAL CYSTECTOMY SURGERY
Get PDFObjective: This study aimed to know independent prognostic factors to predict the recovery time of bladder cancer patients after radical cystectomy. So that it would be a consideration to determine patient feasibility before surgery and after surgery management. Material & Methods: This study was an observational analytical study with a retrospective approach to examine the relationship between pre-surgery variables of the bladder cancer patients and the duration of treatment post radical cystectomy. Results: From the results of this study, it is known that the average length of postoperative care for older patients (above 65 years) was lower when compared to patients under 65 years with averages of 17.08 and 18.03 days respectively p-value of this analysis was 0.781. Patients with low hemoglobin, albumin, and HALP scores had longer postoperative hospitalization periods but with P values of 0.384, 0.276, and 0.603, the ileal conduit has the longest hospitalization treatment period between the two other procedures, with a P-value of 0.904. It was found that the average length of postoperative care for underweight patients was 16.5 days and for patients with normal BMI was 19.59 days. The difference between these averages showed a p-value of 0.396 it is known that the average length of postoperative care for older patients (above 65 years) was lower when compared to patients under 65 years with averages of 17.08 and 18.03 days respectively. The p-value of this analysis was 0.781 it was found that patients with low hemoglobin, albumin, and HALP scores had longer postoperative treatment periods, p-value 0.384, 0.276, and 0.603. The average duration of postoperative care for patients who applied the ERAS protocol tended to be faster (15.67 days) compared to patients who did not apply the ERAS protocol (18.16 days). Nevertheless, the p-value of this difference was 0.518. Conclusion: This study concludes that there is no prognostic factor that can independently predict the duration of treatment of bladder cancer patients post-radical cystectomy. Therefore in-depth assessment of various factors is required before performing radical cystectomy to achieve the best postoperative recovery rates
THE EFFECTIVENESS OF ULTRASONIC LITHOTRIPTOR COMPARED TO COMBINED ULTRASONIC AND PNEUMATIC LITHOTRIPTOR IN PERCUTANEOUS NEPHROLITHOTOMY (PCNL) SURGERY: A SYSTEMATIC REVIEW AND META-ANALYSIS
Get PDFObjective: To evaluate the effectiveness of the ultrasonic lithotriptor compared to the combined ultrasonic-pneumatic lithotriptor in percutaneous nephrolithotomy (PCNL). Material & Methods: A systematic search was conducted focusing on studies evaluating nephrolithiasis patients who underwent PCNL using pneumatic, ultrasonic, ultrasonic-pneumatic, or laser lithotriptor. The search was conducted in the PUBMED and Science-direct databases from early to September 2020. Results: There were 406 journals in the initial search. On further selection, 3 randomized controlled trials (RCT) were obtained, with a total of 251 patients. The stone-free rate of three studies had low heterogeneity, I2=0% (P=0.34), so a fixed effect statistical model was used. There was no significant difference (P=0.44) between the stone-free rates from the ultrasonic lithotriptor group and the combination with an odds ratio of 1.26 (95% CI = 0.70-2.26). High heterogeneity was obtained with I2=71% (P=0.03) for the mean fragmentation time, so random effect statistical model was used. There was no significant difference (P=0.56) between the mean fragmentation time of the ultrasonic lithotriptor and combination group with a mean difference of -3.69 (95% CI = -16.09-8.71). Conclusion: The ultrasonic lithotriptor did not have a significant difference in stone-free rate, and mean fragmentation time compared to the combined ultrasonic-pneumatic lithotriptor in PCNL. More RCT studies are needed.
 
TRANSITION FROM PRONE TO SUPINE PERCUTANEOUS NEPHROLITOTOMY: EVALUATING THE LEARNING CURVE FROM THE SINGLE SURGEON EXPERIENCE
Get PDFObjective: This study aims to evaluate the learning curve of the urologist to perform supine PCNL and the perioperative outcome of patients based on a single surgeon’s experience. Material & Methods: 60 consecutive patients who underwent modified supine PCNL for renal stone were analyzed. A single experienced urological surgeon performed the supine PCNL. Mean operative time, drop in hemoglobin level, stone-free rate, complications, and length of hospital stay were analyzed to evaluate the learning curve of the surgeon. All parameters were compared among all six groups obtained from the 60 cases in chronological order. Besides, the outcomes of supine PCNL were also compared to prone PCNL. Results: Mean operative time from 60 cases of supine PCNL was 100 ± 27 minutes. The mean operative time was decreased over time, particularly after 20 cases. Significantly different mean operative times (89 ± 14 minutes vs. 126 ± 21 minutes, p < 0.001) in the groups of cases 21-60 compared to the group of 1–20 cases were observed. The total stone-free rate for supine PCNL from all cases was 68%. There was no difference regarding the reduction of hemoglobin level, stone-free rate, hospital stay, and complication rate. No major complication was found among study subjects. Supine PCNL showed similar outcome parameters compared to prone PCNL. Conclusion: The surgeon acquired the surgical competencies to perform supine PCNL after 20 cases. The supine PCNL could remove the kidney stone as effective and safe as prone PCNL
mRNA EXPRESSION OF PD-1, PD-L1, AND IMMUNOTHERAPY IN BLADDER CANCER
Get PDFObjective: This study aims to investigate mRNA expression of PD-1 and PD-L1 in patients with bladder cancer. Material & Methods: In this study, we examined 30 samples from paraffin embedded tissue blocks, samples were divided into two groups, 15 were NIMBC, and 15 were MIBC according to their histopathological result. mRNA expression of PD-1 and PD-L1 were conducted using Real Time-Polymerase Chain Reaction (qRT-PCR) and statistical significance was set at a p-value < 0.05. Results: Statistical analysis using the Mann-Whitney test found a significant difference in mRNA expression of PD-1 and PD-L1 in NMIBC compared to MIBC groups. Conclusion: mRNA expression of PD-1 and PD-L1 were higher in MIBC compared to NMIBC. PD-1 and PD-L1 as immune checkpoints are potential immunotherapy for patients with advance stage bladder cancer. Immunotherapy could be a substitute or combined with other treatments such as chemotherapy or radiotherapy