Indonesian Journal of Urology
Not a member yet
480 research outputs found
Sort by
PREDICTION OF HYPOECHOIC LESIONS ON ULTRASOUND OF PROSTATE CANCER BASED ON PSA INTERVAL AND GLEASON GROUP
Get PDFObjective: To evaluate hypoechoic lesion in transrectal ultrasonography of prostate (TRUS-P) predictive value on prostate cancer based on PSA Interval and Gleason Group. Material & Methods: An observational analytic study with a cross-sectional design take place from January 2015 to December 2018 analyzing patients who had undergone TRUS-P Biopsy at Hasan Sadikin Hospital. Patients are divided into several subgroups according to different PSA levels. A p-value < 0.05 was considered statistically significant. PPV, NPV, and Youden’s index were all indexes reflecting the performance of a diagnostic test. Results: There were 35 cases (49.3%) with a visible hypoechoic lesion in TRUS and 36 cases (41.7%) without a visible hypoechoic lesion. In our study, 23.9% of the patients with hypoechoic lesions were diagnosed with prostate cancer on TRUSP-Biopsy. The results of the analysis with Youden’s index show that PSA at intervals of 10-20 is the best predictor of diagnostic values. Then we analyzed the overall detection rate based on PSA interval. Patients with PSA > 20 ng/ml, hypoechoic lesions were significantly associated with Gleason Group. Conclusion: We concluded in our study that the hypoechoic lesion in transurethral ultrasonography of prostate could improve the predictive efficacy for diagnosing prostate cancer.
 
INFILTRATING UROTHELIAL CARCINOMA ALONG THE URINARY TRACT OF A YOUNG ADULT
Get PDFObjective: To present a rare case of infiltrating urothelial carcinoma along the urinary tract on a young adult. Case(s) Presentation: A 39 year old Asian male patient with > 20 pack-year smoking history, came to the hospital with a chief complaint of hematuria and flank pain since two weeks ago. Physical examination revealed Eastern Cooperative Oncology Group (ECOG) Performance Status 1, the right kidney was palpated, no tenderness on fist percussion. Abdominal ultrasound (USG) revealed 1.5 cm and 0.5 cm masses located in the urinary bladder. The CT scan show mass in the bladder was exophytic, > 3 cm in size, and occupying lesion was located on the right posteroinferior and left lateral bladder wall accompanied with dilatation of pelvic calyces and right ureter. Histopathology of the specimen revealed low-grade infiltrating urothelial carcinoma of bladder and right ureter. The pathological stage was pT2NxMx, The patient refused neoadjuvant chemotherapy and surgery. Four months after TURBT, he came with weakness and right flank pain. The patient consent to surgery and underwent the right nephroureterectomy. Histopathology of the specimen showed infiltrating urothelial carcinoma of right kidney, ureter, Gerota fascia with lymphovascular invasion (pT3NxMx). Discussion: Urothelial carcinoma (UC) is commonly arising in the urinary bladder, but it can develop along the urinary tract. Cigarette smoke contains a lot of carcinogenic agents and stimulates DNA damage. Conclusion: Upper tract urothelial carcinoma (UTUCs) is subset of UC with a poor prognosis. Cigarette smoking is the main risk factor that induces DNA damage.
 
THE EFFICACY COMPARISON OF MIRABEGRON AS A MONOTHERAPY VERSUS ITS COMBINATION WITH SOLIFENACIN IN OVERACTIVE BLADDER: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
Get PDFObjective: This review aimed to evaluate the efficacy and safety of mirabegron as monotherapy and its combination with solifenacin for patients with overactive bladder (OAB). Material & Methods: A systematic search was conducted in PubMed, Google Scholar, and Science Direct using the keywords Overactive bladder or OAB and mirabegron or beta-3 agonist or β3 adrenoreceptor agonist and solifenacin or antimuscarinic based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guideline to include relevant randomized controlled trials (RCT)s. The included studies were assessed for their risks of bias using the Cochrane risk of bias tool for randomized controlled trials. Quantitative analysis using forest plot was performed in Review Manager 5.4. Results: A total of 4 RCTs were included from 227 studies. A fixed-effects model was chosen due to the low level of heterogeneity between the studies (I2 = 0%). The average micturition volume of patients in the combination group is higher compared to the monotherapy group (MD 17.13, 95% CI 12.78 - 21.48, p < 0.00001). The mean micturition frequency (MD - 0.54, 95% CI - 0.73 - -0.34, p < 0.00001) and incontinence incidence (MD -0.30, 95% CI -0.48 - -0.12, p = 0.001) in the combined group are significantly lower compared to the monotherapy group. Conclusion: The combination of mirabegron and solifenacin has better efficacy compared to mirabegron as monotherapy for OAB patients with a therapy duration of less than 12 weeks based on the micturition volume, micturition frequency, and incontinence incidence. The administration of combination therapy would not increase adverse event incidence compared to monotherapy
ENDOUROLOGIC MANAGEMENT IN NEGLECTED DOUBLE J STENT AT SOETOMO HOSPITAL SURABAYA RETROSPECTIVE-DESCRIPTIVE STUDY, PERIODE 2013-2016
Get PDFObjective: The use of various combinations of endourological techniques can be an effective solution in the management of neglected DJ stent. The variety of treatments that combine the extracorporeal shock wave lithotripsy (ESWL), retrograde cortolithotripsy (CLT) ureteroscopy with intracorporeal lithotripsy, percutaneous nephrolithotomy (PCNL) and open surgery have been used for the management of encrustation stent cases in a neglected DJ stent. Material & Methods: A Retrospective descriptive study by evaluating patients that have done undergoing endourological measures in the case of Neglected DJ stents in Soetomo General Hospital from January 2013 to December 2016. Data analysis based on age, gender, location of encrustation, indication of DJ stent insertion, duration of DJ stent insertion, and type of endourologic management. Results: In this study, the data of patients undergoing endourological action in Neglected DJ stent cases were 29 patients from January 2012 to December 2016. In Neglected DJ stent patients (41.4%) 12 were encrusted and (58.6%) 17 that there is no encrustation. From 29 patients neglected DJ stent, consisting of (20.7%) 6 males and (79.3%) 23 females, with ratio male to female 1:4, the incidence of DJ stent encrustation was 12 with ratio male to female 1:1, with ages ranging from 41-64 years. The most common cause of DJ stent insertion in Neglected DJ stent patients was malignancy that cause obstructive uropathy (72.4%) 2, all of them were female patients, followed by ureteral stones (24.1%) 7, where males (13.8%) 4 and women (10.3%) 3, and UPJ stenosis where there were only (3.4%) 1 men. In the neglected dentist stent there were 62 (62%) 18 unilateral stent (males (13.8%) 4 and female (48.3%) 14 while the bilateral stent were (37.9%) 11, where male (6.9%) 2 and female (31%) 9. Duration of DJ stent use in neglected DJ stent is higher in 15 weeks (20.7%) 6, followed by 17 weeks (17.2%) 5, 14 weeks (13.8%) 4, 16 weeks, 18 weeks, 20 weeks each (10.3%) 3, 13 weeks (6.9%) 2, and last order during 19 weeks, 26 weeks, 29 weeks each (3.4%) 1. Where the largest organ there is encrustation is Ureter (24.1%) 7, followed by renal with a kidney (10.3%) 3. After which the kidneys with ureter (3.4%) 1 and buli (3.4%) 1. Management of Neglected DJ stent without encrustation performed procedure of removing DJ stent 17 (58.6%), while management of Neglected DJ stent with stent encrustation. The majority procedure was URS (13.8%) 4, followed by URS + PCNL and ESWL pre op + URS respectively (6.9%) 2, and few with ESWL preoperative procedures, CLT, CLT + PCNL, and ESWL pre operation + CLT + PCNL about (3.4%) 1. Conclusion: The neglected ratio male to female 1:4, while the incidence of DJ stent encrustation was 12 with ratio male to female 1:11. The most common cause of DJ stent insertion in Neglected Dj stent patients was malignancy that cause obstructive uropathy, followed by ureteral stones and UPJ stenosis Patients with unilateral DJ stent more than those with bilateral DJ stent. Duration of DJ stent usage in Neglected DJ stent at most for 15 weeks and last order for 19-29 weeks. In Neglected DJ patients the patient incrustation ratio and no incrustation were 2:3. Management of the Neglected DJ stent without encrustation is performed by DJ stent with cystoscopy, while the management of the Neglected DJ stent with encrustation is performed with a multimodal endourology procedure, among others: a combination of URS, PCNL, ESWL pre-op and CLT. The most commonly organ that have encrustation is the ureter, the second sequence is the bladder with the kidney, and finally the kidney with the ureter and the bladder
MANAGEMENT OF BLADDER STONE WITH HOLMIUM-YAG LASER AT KARDINAH HOSPITAL TEGAL
No full textObjective: Transurethral lithotripsy using Holmium-YAG laser has been reported to be beneficial in breaking up bladder stones with large size (>4cm in diameter) with lower risk of mucosal injury and hematuria. The aim of this study is to evaluate the utilization of Holmium-YAG laser for the management of bladder stones at Kardinah General Hospital, Tegal. Material & Methods: This is a cross-sectional study conducted from January 2017 to March 2017. Patient’s demography, which included age, sex, length of surgery, stone size, and laser’s energy count were recorded. Results: We included 120 patients in this study. Mean of patients age in this study was 51.93 years old with age range were 41-85 years old. Most of the patients were male (109 vs 11) with a mean size of stone 25.09 ± 3.04 mm. Length of surgery ranges from 15 to 75 minutes and mean energy of the laser 28.99 ± 19.34 kJ. There was 100% stone’s clearance following surgery with no major complication occurred. Conclusion: Holmium-YAG laser is effective in managing bladder stones at Kardinah General Hospital particularly for large size stones. Length of surgery and energy of laser used depend on the stone size in which bigger stone size is associated with longer surgery time and bigger laser energy needed
THE QUALITY OF SPERM AND FEMALE AGE AS FACTORS INFLUENCING PREGNANCY IN INTRACYTOPLASMIC SPERM INJECTION (ICSI)
No full textObjective: To evaluate the quality of sperm and the female age influence on fertilization and pregnancy rate after Intracytoplasmic Sperm Injection (ICSI) procedure. Material & Methods: This study was an observational analytic study with a retrospective cohort design. The data of infertile and subfertile male undergoing ICSI for five years were analyzed and evaluated to determine factors influencing pregnancy post-ICSI in Central General Hospital Dr. Sardjito. The Data were analyzed by using Chi-squared test, Kolmogorov-Smirnov test, and Mann-Whitney U test with the confidence level of p<0.05 and α=0.05. Results: There was 52 male included in this study. A total of 52 males were infertile, with azoospermia, oligozoospermia, and oligoasthenoteratozoospermia. 2 patients (3.8%) were patients with oligozoospermia, 32 patients (61.5%) were patients with azoospermia and 18 patients (34.6%) were patients with oligoasthenoteratozoospermia. We evaluated 52 ICSI cycle, the percentage of fertilization and pregnancy are 84.6% and 36.5%, respectively. Bivariate analysis showed a significant relationship between wife under 37 years old variable and pregnancy post ICSI procedure with p=0.021 and OR 9.0 (95% CI 1.05-76.4). There was no significant difference between azoospermia, oligozoospermia, and oligoasthenoteratozoospermia and the occurrence of pregnancy post ICSI procedure, p=0.986. Conclusion: The percentage of fertilization and pregnancy post ICSI procedure were 84.6% and 36.5%. Azoospermia, oligozoospermia, and oligoasthenoteratozoospermia variables were not significantly associated with pregnancy post ICSI procedure. ICSI procedure must be carried out immediately before the age of the wife 37 years because of the high success rate
EFFECTS OF TAMSULOSIN 0.2 MILIGRAM AND TAMSULOSIN 0.4 MILIGRAM ON LOWER URINARY TRACT SYMPTOM SCORE OF USSQ IN PATIENTS WITH INDWELLING DJ STENTS
Get PDFObjective: To assess the difference in the administration of 0.2 mg and 0.4 mg tamsulosin to the patient's complaint with DJ stent based on USSQ parameters. Material & Methods: This was a prospective study conducted in Hasan Sadikin Hospital Bandung from October to December 2017. A total of 60 patients with indwelling DJ stents randomly divided into 2 groups (n=30). The first group was given tamsulosin 0.2mg daily and the second group was given tamsulosin 0.4 mg daily. LUTSs before and after tamsulosin administration for a week were evaluated in both groups using USSQ. Percentage decreases in USSQ score in both groups were then compared using Mann Whitney Test. Results: In group I, USSQ score means were 31.9 (20.0-40.0; SD 31.9) before tamsulosin 0.2 mg administration and 26.1 (15.0-35.0; SD 5.6) after tamsulosin 0.2 mg administration. Comparison test before and after tamsulosin 0.2 mg administration showed significant decrease in USSQ score. In group II, USSQ score means were 38.9 (31.0-44.0; SD 2.9) before tamsulosin 0.4 mg administration and 16.7 (13.0-21.0; SD 1.8) after tamsulosin 0.4 mg administration. Comparison test before and after tamsulosin 0.4 mg administration showed significant decrease in USSQ score. The percentage decreases in USSQ score were 18.7% in group I and 56.9% in group II. Different test score before and after treatment for both groups showed p-value<0.05. Scoring results after treatment showed the effectiveness of tamsulosin 0.4 mg was better than tamsulosin 0.2 mg. Conclusion: LUTS is the most common stent-associated symptom (SAS) in patients with indwelling DJ stent. Independent administration of tamsulosin 0.2 mg and 0.4 mg significantly alleviated SAS. Tamsulosin 0.4 mg had better effectiveness in alleviating SAS compared to tamsulosin 0.2 mg
PROSPECTIVE STUDY: COMPARISON OF PRONE AND SUPINE POSITION IN PERCUTANEOUS NEPHROLITHOTOMY (PCNL) AT ADAM MALIK HOSPITAL MEDAN
Get PDFObjective: This prospective study aims to compare the outcomes of PCNL with prone position compared to the supine position. Material & Methods: A total of 57 patients treated with PCNL from January 2017-December 2017 were included in the study. Inclusion criteria include patients with kidney stones greater than 20 mm in size measured with KUB imaging (Kidney-Ureter-Bladder) or abdominal NCCT (Non Contrast Computed Tomography) who were willing to be treated with PCNL. The exclusion criteria were patients younger than 17 years of age, patients who refused to surgery, patients with history of PCNL on the same side, patients with blood clotting disorders, pregnancy, and kidney stone in patients with congenital kidney disorders. Patients were randomized to undergo PCNL with prone or supine position. A total of 29 patients were treated with PCNL in prone position and 28 patients were treated in supine position. Data on patient characteristics, puncture location, number of puncture, use of post PCNL nephrostomy, duration of surgery, presence or absence of residual stones measuring ≥5 mm in size, total complications, postoperative fever, sepsis, bleeding requiring transfusion, retroperitoneal hematoma, pleural effusion, intestinal injury, and the difference between hemoglobin count before and after surgery was compared between the two groups. Results: There were no significant differences observed in terms of number, sex, age, BMI, stone size, hydronephrosis, and comorbidities in patients of both groups. Stone free rate in PCNL with prone position and supine position is 82.8% and 92.9% respectively. Significant comparisons were observed on differences in the mean duration of surgery in which PCNL duration of surgery with the prone position was 150 minutes whereas the supine position took 130 minutes (p=0.003). There were no significant differences between successful puncture, total complications, postoperative fever, sepsis, and bleeding requiring transfusion. There were no patients who had pleural effusion, intestinal injury, or death in this study. Conclusion: PCNL in supine position has the same effectiveness and safety as PCNL in prone position. The Stone free rate is higher in PCNL performed in supine position. The duration of PCNL surgery in supine position is significantly shorter than the PCNL prone position
SURVIVAL OF PROSTATE CANCER PATIENTS WITH COMBINATION HORMONAL-RADIOTHERAPY BETTER THAN HORMONAL THERAPY
Get PDFObjective: This study aims to determine the survival of prostate cancer (PCa) patients who did not undergo radical prostatectomy, but received hormonal therapy or a combination of radiotherapy and hormonal therapy. Material & Methods: This study was an observational analytic study with a retrospective cohort design, using secondary data to determine baseline data and diagnosis of patients, and using primary data to determine the survival of prostate cancer patients who received combination hormonal and radiotherapy therapy compared with hormonal therapy alone. The analysis was performed using chi-square and contingency coefficients to assess the relationship between survival with factors such as age, stage T, N, M, clinical stage, type of therapy, and prognosis. It also used the Kaplan Maeier curve to assess the survival picture of prostate cancer patients at Sardjito General Hospital. Results: 79 patients met the inclusion criteria. The mean age of the patients was 68 ± 8.4 years. A total of 52 (65.8%) patients received hormonal therapy, and 27 (34.2%) patients received combination hormonal and radiotherapy. There were 41 (51.9%) patients remain life, while 38 (48.1%) of patients died during the monitoring. We found that the Gleason score, PSA level, and clinical stage were significantly associated with patient survival with p <0.005. The 5 years survival rate patient with local, locally advanced clinical stage and PSA level ≤20 ng/ml who received combination hormonal and radiotherapy achieved 100%. Conclusion: Combination of hormonal and radiotherapy was more improving patient survival compared with hormonal therapy only in patient with locally advanced clinical stage, PSA level ≤20 ng/ml and Gleason score ≤7
DIFFERENCES IN THE EFFECTIVENESS OF SELECTIVE ALPHA BLOCKER THERAPY COMBINED WITH 5-ALPHA REDUCTASE INHIBITOR ON IPSS VALUE OF BPH LUTS PATIENTS
Get PDFObjective: The purpose of this study is to know the differences in effectiveness between SAB administration with combination 5-ARI administration assessed by IPSS evaluation in BPH LUTS patients. Material & Methods: This observational analytic with a cross-sectional design study had been done to 50 BPH LUTS patients that obtained at Paru Jember, Bina Sehat Jember, and Bhayangkara Bondowoso Hospital. These samples had got by simple random sampling method and include in inclusion with exclusion criteria freely. Results: This comparison study between the type of medical therapy administration and total IPSS decrease, IPSS-voiding decrease, IPSS-storage decrease, IPSS-QoL, and prostate volume give significancies as follows: p=0.002; p<0.001; p<0.001; p<0.05; p<0.001. Conclusion: There are significant differences between the type of medical therapy (SAB or 5-ARI combination) and total IPSS decrease, IPSS-voiding decrease, IPSS-storage decrease, IPSS-QoL, and prostate volume