Indonesian Journal of Urology
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PROSTATE SPECIFIC ANTIGEN LEVEL FOLLOWING TRANSURETHRAL RESECTION OF THE PROSTATE
No full textObjective: To evaluate the correlation of the weight of the resected prostate with the reduction of the PSA level. Material & methods: This is a prospective study of all BPH patients undergoing TURP procedure in Kardinah Hospital, Tegal, with a timeframe of April–June 2018. Patients consumed α-blocker and 5-α reductase inhibitor medication before the procedure were eliminated from the study. The data collected were the estimated prostate weight calculated using transabdominal ultrasonography (TAUS) of the prostate, PSA level before and after the procedure, and the calculated weight of the resected prostate. The resected tissues of the prostate were examined by an anatomy pathologist and the PSA level will be examined at 1, 14, and 30 days after the surgery. Data was analyzed using repeated measure ANOVA with SPSS version 23.0. Results: We included 35 cases of prostate enlargement in our center. 2.8% of the patients didn’t undergo definitive surgical procedure due to be postponed with various reasons. The patients mean age is 64.2 ± 8.26 with average BMI is 21.8 ± 3.56kg/m2. The median value of the prostate volume is 43.8 mL. The median preoperative PSA level was 8.7 ng/dL, while the median value of the 1st day, 14th days, and 30th days post-operative PSA level were17.67 ng/dL, 6.93 ng/dL, and 3.2 ng/dL, respectively, with significant reduction of PSA level (p<0.001). Conclusion: PSA level post-TURP shows a significant decrease. Every milliliters (mL) prostatic tissue resected could reduce the PSA level for 0.11 ng/mL. This calculation could further be used to predict how much tissue needed to resect, to treat the symptoms, and obtain normal PSA level. In addition, further research is needed, especially with larger sample size and longer follow up period to confirm these findings
PARTIAL VERSUS TOTAL UROGENITAL MOBILIZATION IN UROGENITAL RECONSTRUCTION: A META-ANALYSIS
No full textObjective: Urogenital sinus, cloacal malformation and congenital adrenal hyperplasia are some of the congenital anomalies which comprehensive management should be done to achieve better outcomes. Total Urogenital Mobilization (TUM) and Partial Urogenital Mobilization (PUM) are the most widely used in term of surgical management. However, many researches showed different outcomes of those procedures. This meta-analysis aims to compare the outcome of TUM and PUM in urogenital reconstruction. Material & Methods: Studies were collected from five different search engines (PubMed, EBSCO, ProQuest, Science Direct, Google Scholar) with keyword as mentioned in the methods section of this paper. All full text articles were included. Critical appraisal for each study was done using the Oxford Center of Evidence Based Medicine Worksheet for therapy. Data were analyzed by Cochrane's Review Manager 5.3 for charts and plots builder. Results: Three studies were found with 81 participants divided into PUM or TUM group. All studies were analyzed by using the Mantel-Haenszel test to produce Forest plot. Overall, urinary incontinence event was more common found in patient who underwent TUM compare with PUM (OR 8.21; 95%CI: 1.1-61.11; p=0.04). Conclusion: PUM has a better urinary outcome in comparison with TUM. Further study with a better study design, follow-up and standardized evaluation is needed to achieve a better understanding on urogenital reconstruction and management
COMPARISON OF BLADDER CANCER CELLS APOPTOSIS INDUCED BY METFORMIN, CISPLATIN, AND COMBINATION OF METFORMIN-CISPLATIN: IN VITRO STUDY
Get PDFObjective: To evaluate the effect of metformin, cisplatin, and their combination on apoptosis of bladder cancer cells. Material & Methods: Urothelial cell lines 5637 were cultured until 80% confluence. Cells were exposed to metformin and cisplatin at certain doses for 24 and 48 hours. Cytotoxicity test was carried out by calculating the viability of bladder cancer cells using the MTT assay until IC50 of each drug was obtained. IC50 Metformin and Cisplatin obtained from the cytotoxicity test were used to induce apoptosis in bladder cancer cells using TUNEL assay. Additional combination doses of Metformin and cisplatin used to induce apoptosis were ¼ IC50 (metformin + cisplatin), ½ IC50 (metformin + cisplatin), and IC50 (metformin + cisplatin). Results: IC50 of metformin was 15 uM while cisplatin was 18 uM with a 48-hour exposure. There was a difference in the mean value of the apoptosis index in all treatment groups compared to control except for the group exposed to IC50 metformin and ¼ IC50 (metformin + cisplatin). Conclusion: Metformin administration solely is not able to increase bladder cancer cell apoptosis. Conversely, the administration of Cisplatin can significantly increase bladder cancer cell apoptosis. The combination of Metformin and Cisplatin can significantly increase bladder cancer cell apoptosis. The rate of apoptosis in line with an increase dose of the combination of these two drugs
THE IMMUNOEXPRESSION PROFILE OF FGFR3 AND P53 IN PUNLMP AND UROTHELIAL BLADDER CARCINOMA AT HASAN SADIKIN GENERAL HOSPITAL
No full textObjective: To obtain FGFR3 and p53 immunohistochemistry of PUNLM and UBC basic data profile. Material & Methods: This retrospective observational analytic study used a cross-sectional design on formalin-fixed paraffin-embedded (FFPE) from patients diagnosed as PUNLMP and UBC then performed FGFR3 and p53 immunohistochemical staining. Statistical analysis of immunoexpression data using SPSS 24.0. Results: There are three main immunohistochemistry pattern profiles of PUNLMP and UBC in this research data, i.e. FGFR3+ p53+, FGFR+ p53- and FGFR3- p53+. There were no Cis sample obtained. FGFR+ was showed in PUNLMP, LG-PUC, HG-PUC, IUBC (pT1, pT2, pT3, pT4) with decreased percentage sequentially. As many as 51 of 54(94.44%) IUBC samples showed combination pattern with p53+ while 3 other samples were p53-. Conclusion: The FGFR3 and p53 immunohistochemistry profile, separately or as a pattern of combination, is in accordance with the oncogenesis molecular pathway of UBC
DIFFERENCES OF TESTOSTERONE LEVELS TO THE DURATION OF INHALED NICOTINE EXPOSURE IN SPRAGUE-DAWLEY MALE WHITE RATS
No full textObjective: To analyze the differences in testosterone level in young Sprague-Dawley white rats after exposure of inhaled nicotine and the recovery effect that occurs when nicotine exposure is stopped. Material & Methods: This is an experimental study, which variable measurements were taken after the experimental animals were treated. The experimental grouping process was carried out randomly, with repetitions of 12 experimental animals in each group and the control group as a comparison (negative control). This study using male Sprague-Dawley white rats as samples. Nicotine administration was carried out by inhalation using pure nicotine (C10H14N2), which was diluted using distilled water. Treatment group 1 (P1) was given nicotine exposure for 30 days, treatment group 2 (P2) for 15 days, and treatment group 3 (P3) for 15 days and then stopped for 15 days compared to the control group. Testosterone levels are measured using the ELISA (Enzyme-Linked Immunosorbent Assay) method in the morning. Results: The lowest testosterone levels were found in the P1 and significantly different from the P2 (p=0.029) and P3 (p=0.001). The results of the analysis show that a decrease in testosterone levels in mice is related to the duration of nicotine exposure. Conclusion: Testosterone levels in the control group were significantly higher compared to the treatment group that exposed by nicotine inhalation with a dose of 4 mg/kgBW/day for 15 days, and also there is a significant recovery effect on testosterone levels after the treatment was halted for 15 days
EFFECTS OF X-RAY RADIATION EXPOSURE ON SPERM MOTILITY AND MORPHOLOGY CHANGES OF WISTAR STRAIN RATS
Get PDFObjective: To analyze the differences of sperm motility and viability changes in Wistar Rats that exposed to X-ray radiation compared to Wistar Rats that were not exposed to X-ray radiation. Material and Methods: Experimental laboratory research within vivo design using Wistar strain rats as subjects. There are three treatment groups in this study: rats exposed to 50 mGy X-ray radiation, 100 mGy, and 200 mGy and one untreated control group. Radiation exposure was calibrated using the RTI Piranha dosimetry. After radiation exposure, at week 4, orchidectomy was performed in rats. Sperm analysis was carried out to determine sperm motility by direct observation and sperm viability by Hematoxylin Eosin (HE) staining observations using a light microscope. One Way ANOVA was used to compare motility and viability of rats spermatozoa in the treatment group compared to control group with a significant value of p<0.05. The analysis was continued with a Post Hoc test to determine the differences in each group. Results: The percentage of motile sperm decreased in all treatment groups compared to control group (p<0.05). There was no significant difference in mean sperm motility on rats exposed to 200 mGy X-ray radiation compared to 100 mGy X-ray radiation (p>0.05). Viability counts decreased in all treatment groups compared to control group (p<0.05) and the spermatozoa viability in 200 mGy radiation group was not significantly different from 100 mGy group (p>0.05). Conclusion: X-ray radiation exposure decreases sperm motility and viability in Wistar rats with the optimum doses 100 mGy
CHARACTERISTIC AND MANAGEMENT FOURNIER’S GANGRENE IN ARIFIN ACHMAD REGIONAL GENERAL HOSPITAL OF RIAU PROVINCE
No full textObjective: To evaluate the characteristic and the management of Fournier’s gangrene. Material & Methods: We reviewed medical records of Fournier’s gangrene patients including age, etiology, invasion of bacteria, underlying disorders, clinical symptom, radiology and laboratory findings, management, and complication in Arifin Achmad General Hospital, Pekanbaru, Riau Province, in January 2012–December 2017. Statistical analysis of univariate was used. Approval of the study was obtained from the Ethical Review Board for Medicine and Health Research, Medical Faculty, University of Riau. Results: There were 19 patients in the study. The result showed that Fournier’s gangrene cases occurred mostly in age 56-65 year old age group in 8 (42.1%) patients. The etiology was from urogenital cause in 15 (78.9%) patients. Most invasion bacteria was Acinetobacter baumannii in 5 (26.3% ) patients. The most underlying disorder was elderly age in 10 (5.6%) patients. The most frequent symptom was puss on the scrotal in 10 (52.6%)patients. The most laboratory examination was puss bacterial culture in 14 (73.7%) patients. The most frequent treatment for Fournier’s gangrene was initial and preoperative management in 19 (100%) patients. The acute complication of Fournier’s gangrene was sepsis in 5 (26.3%) patients. Conclusion: Fournier’s gangrene occurred mostly in elderly age in which Acinetobacter baumannii was the most invasion bacteria and sepsis was the most complication
LATERAL PERCUTANEOUS NEPHROLITHOTOMY: A CASE SERIES
Get PDFObjective: To report our experience on lateral PCNL in the management of complex kidney stone in patients with many morbidities. Case(s) Presentation: In our hospital, there were 2 cases of incomplete stone clearance after PCNL which underwent lateral PCNL. The first case was a 47 years old woman who was morbidly obese and some cardiac problems such as coronary artery disease (CAD) and arrhythmia. Her intravenous pyelography shows that she has incomplete double collecting system with kidney stone in her upper moiety. She underwent PCNL in supine position which was halted due to arrhythmia with rest stone on her upper moiety system. The second case was a 57 years old male with multiple right kidney stone with hydronephrosis in his upper calyceal system. He has some comorbidities such as obese and CAD. He had history of open kidney surgery and right PCNL. Due to incomplete stone clearance after first procedure and some morbidities of those patients, we decided to perform PCNL on lateral position of both cases. The surgery went successfully with duration of 100 minutes in average with less than 100cc of blood loss. Both of the patients were discharged on second operation day without any complication. Discussion: Positioning for the patient who undergo PCNL is important. The lateral position of PCNL is useful in morbid obesity and have least effect on cardiac and respiratory function. This technique proved to increase patient comfort and safety. Conclusion: Lateral PCNL is safe and effective procedure to treat kidney stone in patients with history of incomplete stone clearance after supine or prone PCNL. It also can be performed safely in patients with comorbidities
CHARACTERISTIC OF IATROGENIC BLADDER TRAUMA PATIENT IN HASAN SADIKIN GENERAL HOSPITAL FROM JANUARY 2013 - JANUARY 2018
Get PDFObjective: This study was conducted to determine the characteristics of iatrogenic bladder trauma in Hasan Sadikin General Hospital from January 2013 – January 2018. Material & Methods: The study was conducted by retrospective descriptive methods. We reviewed iatrogenic bladder trauma from medical record at Hasan Sadikin General Hospital from January 2013 to January 2018. The data obtained is subsequently recapitulated and processed using a spreadsheet. Results: Most of the cases were found in female patients. There were 30 cases (73.17%) are recorded. Whilst on male patients, there were only 11 cases (26.83%). The average age was 42.35±2.35 years old. According to AAST grading, a total of 2 patients (4.88%) experienced AAST grade V, 28 patients (68.29%) experienced AAST grade IV, 8 patients (19.51%) experienced AAST grade III, and 3 patients (7.31%) experienced AAST grade I. In addition, there were 31 (75.61%) iatrogenic injuries due to gynecologic surgery, 6 (14.63%) iatrogenic injuries due to digestive surgery, and 4 (9.76%) iatrogenic injuries due to endourology surgery. Of all cases, 30 patients (73.17%) underwent immediate intraoperative reconstruction surgery, whilst the other 11 (26.83%) underwent delayed reconstruction surgery. As for the management, 33 (80.49%) patients underwent bladder repair, 1 (2.44%) patients underwent palliative cystectomy, 2 (4.88%) patients underwent damage control surgery, 3 (7.32%) patients underwent bladder exploration, and 2 (4.88%) patients underwent urethral catheter insertion. From all of 41 cases of patients with iatrogenic bladder injury, there were 3 (7.32%) mortality cases due to prolonged bleeding and sepsis. Conclusion: In this study, iatrogenic bladder trauma mostly affected female patients that underwent gynecologic surgery on the age group of 41-50 years old. Almost all of the cases were treated by bladder repair. By knowing the epidemiology of iatrogenic bladder injury and perform prompt treatment then we can take precautions to reduce the level of morbidity and mortality
PROFILE OF URINALYSIS IN KIDNEY, URETER AND BLADDER STONE PATIENTS
No full textObjective: To evaluate the profiles of urinalysis in kidney, ureter, and bladder stone patients. Material & Methods: We reviewed the medical records of kidney, ureter and bladder stone patients proved underwent operative managements and urinalysis in Arifin Achmad Regional General Hospital Pekanbaru Riau Province, Indonesia in 2011-2015. The sampling technique in this study was minimum sampling that meets the inclusion criteria. Univariate test was used for statistical analysis. Approval on the study was obtained from the Ethical Review Board for Medicine and Health Research, Medical Faculty, University of Riau. Results: There were 226 patients fulfilled the inclusion criteria. This study showed that in macroscopic urinalysis the mostly (94.7%) urine density was 1.003-1.030, urine color mostly (46%) was turbid yellow, all (100%) urine acidity showed normal results with mean acidity was 6, most (95.1%) erythrocytes >1 in urine sediment, most (66.2%) leukocytes was >5 hpf, mostly (99.1%) crystal was absent and most urinary epithelium <15 (63.1%). In microscopic urinalysis showed mostly protein in urine was absent (56.4%), and mostly ketone (98.7%) was absent in urine and mostly (56.2%) was absent protein in urine. Conclusion: Urinalysis findings could be normal or abnormal in kidney, ureter and bladder stone patients