Indonesian Journal of Urology
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THE USE OF RIGISCAN® EXAMINATION IN DIAGNOSING PATIENTS WITH ERECTILE DYSFUNCTION IN JAKARTA
No full textObjective: The aim of this study is to describe the characteristic of patients with Erectile Dysfunction (ED) and results of Nocturnal penile tumescence and rigidity (NPTR) based on Rigiscan® examination in patients with ED in Jakarta. Material & Methods: Descriptive-prospective study of patients with ED in Cipto Mangunkusumo Referral Hospital, Bunda General Hospital Jakarta, and ASRI-Siloam Urology Hospital are recorded during 2015. Patients’ age (in years), marital status (yes/no), duration of ED (in months), and International Index of Erectile Function-5 (IIEF-5) were recorded. NPTR examination were performed while patients were sleeping. Number of events, duration of each event (in minutes) as well as the rigidity (in percentage) and tumescence (in cm) were recorded. The elevation of tip and base penile circumference (in cm) during erection were also noted. Results: There were 34 patients who agreed to perform NPTR test. Most patients were married with the average age of 40.94 ± 10.81 years old. The duration of ED were varied from 5 to 96 months with average duration of 33.7 ± 44.34 months and IIEF-5 score was 6.38 ± 5.14. In general number of erections was 4 ± 3 with 23.4% of them had normal erection. The comparison between organic and psychogenic ED showed that the increment of circumference was significantly less in organic ED patients. Other parameters showed insignificant difference in statistical results. Conclusion: NPTR examination is an objective, effective, and easy-to-use measurement in order to differentiate between organic and psychogenic ED. One third of patients who complained with ED suffered from psychogenic ED and needed referral to other specialists
TESTICULAR TUBERCULOSIS: A CASE REPORT
No full textObjective: We report a patient with unilateral testicular tuberculosis, referred to Haji Adam Malik Hospital, Medan, Indonesia. In this report we stressed on the findings in the physical examination of the patient, so it can be applied for the other case of testis tuberculosis. Case Presentation: A 3-years old boy came to the Hospital with a painless unilateral right scrotal enlargement. Based on the data from anamnesis, physical examination and laboratory testing, a diagnosis of right testicular tumor was made and the patient was planned for a right radical orchidectomy. Discussion: He was underwent of right orchidectomy and the histological findings and diagnosis was specific tuberculosis. No specific symptom of tuberculosis was found. On the physical examination, general state was normal. The local state was difficult to differentiate with testicular tumor. In the absence of a histology finding, the diagnosis of TB testis may be impossible (Shugaba et al., 2012). Patients with testicular masses should be fully investigated preoperative and post-operative in order to increase the diagnostic index of this condition. However, unilateral or bilateral Testicular Tuberculosis is uncommon and the report said that there are two patients with unilateral testicular tuberculosis referred to Sina Hospital Tehran University of Medical Science (Hassan et al., 2009). Conclusion: TB infection diagnosis might be missed when clinical findings assume a tumor (Hamm, 1997). Physical examination findings may include a non-tender or tender sensible nodule, dilation and thickening of the epididymis (Hassan et al., 2009). Testicular involvement may be either unilateral or bilateral. The clinical history of patients such as contact with lung tuberculosis patient and immune deficiency condition are not always helpful in diagnosis. Although it is a very rare disease, the clinician should consider tuberculosis of the testis as a possible differential of a scrotal mass especially in endemic area like Indonesia (Mbala et al., 1997). This will increase the possibility of early diagnosis, as well as proper and early management. And also have to remember that not testicular tuberculosis itself should be suspected, others kind of disease mimicking symptoms like hydrocele, spermatocele, epididymo-orchitis, non-hodgkin lymphoma, spleenogonadal fusion, and an adrenal rest or a second testis need to be considered
METASTASIS AND LOCAL INVASION PATTERN OF BLADDER CANCER IN HASAN SADIKIN HOSPITAL
No full textObjective: The aim of this study is to provide database about local invasion and metastasis pattern, as well as the disease characteristics of bladder cancer in Hasan Sadikin Hospital, Bandung. Material & Methods: Between January 2011 and December 2016 there were 321 cases of bladder cancer recorded in our hospital. Of all cases, 106 patients included in this study, with evident of local invasion or distant metastasis either radiologically (contrast abdominal pelvic CT scan) or pathologically. Results: The study group consist of 106 patients (86 men [81.7%], 20 women [28.3%]); with mean age of 56.78 ± 13.19 (4-76) years old. Histopathology findings of transitional cell carcinoma (TCC) consist of 82 (77.3%) patients and the atypical histology features group of 24 (22.7%) patients. Local invasion was found in 99 patients of 321 (30.8%), with the most common organ invasion to the prostate in male (n=38 [35.8%]). Lymph node metastasis were found in 47 patients (44.3%), with the most common nodal metastasis to obturator lymph nodes (n=21 [19.8%]). Distant metastasis was found in 24 patients (22.6%) with the most common site for distant metastasis was the liver (n=12 [11.3%]). In TCC group, 12 patients (63.1%) had a distant organ metastasis with nodal metastasis, whereas in atypical group, majority of the patients with distant organ metastasis (n=5 [83.3%]) had no lymph node involvement. Moreover, in transitional cell group, not all patient (n=17 [73.1%]) had local invasion of the tumor, while all patients with distant organ metastasis in atypical group (n=6 [100%]) had abdominal or pelvic wall invasion (cT4b). Conclusion: TCC is the most common pathology findings and with Prostate is the most common site for local tumor invasion. Obturator lymph nodes is the most common nodal metastasis and liver is the most common site for distant metastasis in bladder cancer.
COMPARISON OF PERITUBAL INFILTRATION OF ROPIVACAIN AND PLACEBO IN PERCUTANEOUS NEPHROLITHOLAPAXY FOR POST OPERATIVE ANALGESIA AT SOETOMO HOSPITAL SURABAYA
No full textObjective: To observe the effects of ropivacain peritubal infiltration in reducing postoperative pain and analgesic requirements postoperatively in patients underwent percutaneous nephrolithotomy (PNL). Material & method: Double blind randomized controlled trial on 32 patients with renal stone who underwent PNL at Soetomo General Hospital Surabaya from February until August 2017, divided into 2 groups. Experimental group (A) who received peritubal infiltration of ropivacain pre-operative, and control (placebo) group (B) Evaluation using Wong Baker pain score 2 hour post operation, time from operation until first rescue analgesia, and total analgesia given in first 24 hours. Result: Mean age was 51.81 ± 9.13 and 49.31 ± 10.53 years in group A and B respectively. Mean operation time 49.31 ± 10.53 and 89.69 ± 17.74 hours in group A and B respectively. There was no significant difference in stone complexity, nephrostomy placement and stenting between two groups. There was no significant difference of Wong Baker pain score 2 hours post operation between group A and B (p 0.72). There was no significant difference in total analgesia in the first 24 hours between group A and B (p 0.48). The time of first rescue analgesia demand was significantly longer in the experimental group (p 0.00). Conclusion: Peritubal infiltration of ropivacain in percutaneous nephrolitholapaxy is safe and effective to prolong the need of first rescue analgesia in post operative pain management which result in patients convenience
EFFECT OF PURWOCENG EXTRACT ON THE EXPRESSION OF NITRIC OXIDE NEURONAL SYNTHASE IN PENILE TISSUE OF WHITE MALE RATTUS NOVERGICUS
No full textObjective: To know the effect of purwoceng extract (Pimpinella alpine) on the expression of neuronal nitric oxide synthase (nNOS) in the penile tissue of white male rats (Rattus novergicus) through immunohistochemical examination. Material & Methods: Animal experiments consisted of 27 male rats, three months of age with a mean body weight of approximately 200 grams were divided into three groups randomly, one group consisted of 10 rats. Treatment 1 rats receive Pimpinella alpina extract with 50 mg/ml, Treatment 2 rats receive Pimpinella alpina extract with 100 mg/ml. In the control group rats receive aquadest as much as 1 ml. Results: In the control group the average is 75.67, in the treatment group 1 is 113, and in group 2 is 181.44. The difference in treatment between groups was performed using one-way ANOVA test. Between control and treatment groups 1 the different is significant with p value of 0.013 (p<0.05). The mean expression of nNOS between treatment groups 1 and 2 differ significantly with p=0.00 (p<0.05). Conclusion: Purwoceng extract (Pimpinella alpine) can increase the expression of nNOS on NANC nerve fibers (nonadrenergic noncholinergic) in the corpora cavernosa of the penis that causes smooth muscle relaxation in penile erection
CHARACTERISTICS OF RENAL CANCER PATIENTS IN HAJI ADAM MALIK GENERAL HOSPITAL MEDAN IN THE YEAR 2011 -2015
No full textObjective: The aim of this study is to identity the characteristics of kidney cancer patients at Haji Adam Malik Hospital between 2011 and 2015. Material & methods: This is a retrospective descriptive study of all kidney cancer patients treated at Haji Adam Malik Hospital between 2011 and 2015. Individual patient data was collected from medical record and compiled. Results: Between 2011 and 2015, there were 38 patients diagnosed with kidney cancer treated at Haji Adam Malik Hospital. The patients mean age is 48.26 ± 14.68 years, with a male to female ratio 1.7:1. Histological type found in the study was RCC (57.15%), urothelium based (19.05%), sarcoma variant (14.28%) and benign kidney tumor (9.52%). Clear cell RCC (58.3%) is the most common type of RCC. Based on the TNM classification, patients with kidney tumor of stage II, stage III and stage IV are 15.8%, 10.5% and 73.7% respectively. The treatment modalities for kidney cancer are nephrectomy (44.7%), nephroureterectomy (2.6%), biopsy (8.0%) and inoperable patients or treatment refusal (44.7%). The mortality rate of kidney cancer patients was 81.5%. Conclusion: Mean age of kidney cancer patients at Haji Adam Malik Hospital was lower than that reported in literature. Gender ratio was found similar as seen in literature. The ratio of histological type was differ, but we still found RCC as the most common type of kidney malignancies. Higher number of patients presented at advance stage at diagnosis and refusal to treatment may contribute to the high mortality rate in this study
ROBOTIC-ASSISTED KIDNEY TRANSPLANTATION: A REVIEW
No full textObjective: To discuss about kidney transplantation (KT), primarily on robotic-assisted kidney transplantation (RAKT) and to present the current updates on RAKT techniques performed by different centres worldwide. Material & methods: We searched and compiled various literatures on RAKT, focussing on different techniques used to perform the procedure. All the references cited in this review are indexed in PubMed or Scopus. Results: Since the first successful kidney allograft transplantation in human was performed in 1954, KT has become the preferred treatment modality for patients with end-stage renal disease (ESRD) seeking a more definitive outcome and better quality of life. Over the years, newer techniques of KT have been introduced, including minimally-invasive laparoscopic KT. However, laparoscopic KT has its own limitations, which include loss of hand-eye coordination and poor ergonomics for the surgeon. RAKT offers the same benefits as laparoscopic KT without its limitations. There are several transplantation centres worldwide performing RAKT regularly. The differences in RAKT technique between these centres are regarding patient’s position during surgery, location of incision for graft placement, use of regional hypothermia, and techniques of graft placement and ureteric reimplantation. Conclusion: The invention of RAKT as a minimally-invasive KT technique has enabled surgeon to perform surgeries when the operative field is deep and narrow and when fine dissection and microsuturing are required
PREDICTIVE FACTOR OF METASTATIC RENAL CELL CARCINOMA PATIENT IN SARDJITO HOSPITAL PERIOD 2010 - 2015
No full textObjective: To analyze the association between various prognostic factors and the incidence of renal cell carcinoma (RCC) metastatic. Material & methods: This is a descriptive retrospective study. In this research, the dependent variable is metastatic RCC while the predictor factor as independent variable influencing renal cell carcinoma metastasis. The study population were all patients with renal cell carcinoma that were diagnose in Sardjito Hospital from period 2010 to 2015. Results: In this study there were 34 patients who became the object of research. Consisting of men as many as 20 people (58.8%) while women as many as 14 people (41.2%), while for the age category <51 years as many as 16 people (47.1%) while RCC patients aged > 51 years old 18 People (52.9%). In this study, patients with RCC mostly found in stage 2 were 15 people (44.1%), stage 3 of 6 people (17.6%), stage 4 were 13 people (38.2%). These results are consistent with previous studies which suggest that RCC is found most frequently in stage 2 (Soblin et al, 1997). The p value = < 0.038 indicates that there is a significant correlation between tumor staging and metastatic occurrence in RCC, the result of this study is similar to the previous study which stated that the higher the staging of the tumor the greater the risk of metastasis with p value = 0.001 (Vina et al., 2016). Conclusion: There was a significant association between staging of renal cancer and metastatic events
THE EFFECT OF POVIDONE IODINE INTRARECTAL TO REDUCE BACTERIURIA, BACTEREMIA, AND SIRS AFTER TRUS PROSTATE BIOPSY
No full textObjective: To compare the incidence of bacteruria, bacteremia, and Systemic Inflammatory Response Syndrome (SIRS) after Transrectal Ultrasound (TRUS) of prostate biopsy for the patients whom given intrarectal povidone iodine, enema, prophylactic antibiotic with given enema and prophylactic antibiotic. Material & Methods: A Randomised, experimental study, 20 samples of men with suspicious of prostate cancer were divided into two groups, first group (control) were given enema (dulcolax supp 10 mg) and prophylactic antibiotic (ciprofloxacin 1000 mg), second group (treatment) were given enema (dulcolax supp 10 mg) prophylactic antibiotic (ciprofloxacin 1000 mg), and intrarectal povidone iodine befotre TRUS of prostate biopsy. Urine and rectal swab culture examination were performed before biopsy then urine, blood culture, and blood leucocyte 2 days after biopsy. To assess any bacterial translocation from rectum to urinary tract, we match the post biopsy urine culture antibiogram and rectal swab culture antibiogram before biopsy. Complications and serious adverse effects were also monitored. Outcomes were assessed using Unpaired T Test and Mann Whitney depends on the data distribution and homogeneity. Results: There was no significant difference bacteriuria between groups (p=0.26). Bacteremia and SIRS were not found within two groups 2 days after prostate biopsy. Post biopsy bacteriuria positive patients antibiogram were compared with pre biopsy swab rectal culture antibiogram, there was no significant difference between two groups. But, significant correlation of pre biopsy rectal swab culture with post biopsy urine culture (p=0.04) were noted. Conclusion: Intrarectal povidone iodine before TRUS of prostate biopsy were not needed as part of rectal preparation, since enema and prophylactic antibiotic was proven to decrease the incidence of bacteriuria, bacteremia, and SIRS after TRUS of prostate biopsy. The occurrance of bacteriuria were caused by bacterial translocation from rectum to urinary tract
COMPARISON OF EFFECTIVENESS OF MELOXICAM 15 MG ONLY, COMBINATION OF MELOXICAM 15 MG AND TAMSULOSIN 0.4 MG, AND TAMSULOSIN 0.4 MG ONLY FOR SUCCESS OF TWOC IN BPH PATIENTS WITH FIRST EPISODE OF ACUTE URINARY RETENTION
No full textObjective: To prove that Meloxicam 15 mg only, combination of Meloxicam 15 mg and Tamsulosin 0.4 mg were more effective for the success of Trial Without Catheter (TWOC) in BPH patients with first episode of urinary retention compared to Tamsulosin 0.4 mg only. Material & methods: Benign Prostatic Hyperplasia (BPH) patients with first episode of urinary retention that met the inclusion criteria and did not fulfill the exclusion criteria were randomized to form 3 treatment groups, n=11 for each group. Group I was given Meloxicam 15 mg only, group II was given a combination of Meloxicam 15 mg and Tamsulosin 0.4 mg, and group III was given Tamsulosin 0.4 mg only. For each group the drug given once orally for 7 days. The success of TWOC assessed by an ability to spontaneous micturition after that each treatment in the first 24 hours after urethral catheter removal, accompanied by Qmax in uroflowmetry ≥ 5 cc/sec and PVR ≤ 100 cc. Results: All Meloxicam 15 mg only group samples have recurred urinary retention (100%). The success rate of TWOC for combination of Meloxicam 15 mg and Tamsulosin 0.4 mg group was 72.7%; while for the Tamsulosin 0.4 mg only one was 63.6%. The success rate of TWOC for combination of Meloxicam 15 mg and Tamsulosin 0.4 mg group was higher than Tamsulosin 0.4 mg only one (p=0.003). Conclusion: The combination of Meloxicam 15 mg and Tamsulosin 0.4 mg orally once daily for 7 days was more effective in the success of TWOC in BPH patients with first episode of urinary retention compared to Tamsulosin 0.4 mg only orally once daily for 7 days