Indonesian Journal of Urology
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TESTICULAR CANCER IN SOETOMO HOSPITAL SURABAYA: RETROSPECTIVE STUDY
No full textObjective: The aim of this study was to determine the characteristics of the testicular cancer that were managed in Soetomo Hospital. Materials & Methods: This was a retrospective descriptive study. We reviewed the medical records of patient with testicular tumor admitted in Soetomo Teaching Hospital Surabaya, from January 2008 until December 2013. The data regarding demographic characteristics, clinical presentation, grading and staging based on pathological examination result, and the management of the cancer. Data was presented in tabular and narrative in order to know the number and percentage of testicular cancer in Surabaya. Results: There were 46 patients with testicular cancer with mean age of 27.1 ± 7.9 years. Peak incidence was 15–35 years old (54%). Testicular mass was the most frequent clinical presentation in 42 patients (91%), abdominal mass and other complaints in 4 patients (9%). Most of the patients live outside Surabaya in 34 patients (72%). Location of the tumor was more frequently in scrotum, which occured in 42 patients (91%). A total of 4 patients (9%) were found to have a history of UDT. Based on the TNM staging, patients with stage pT3 were as many as 20 patients (43%), pT4 11 patients (24%), pT2 7 patients (15%) and pT1 4 patients (9%). In regional lymph nodes staging (N) N3 were as many as 26 patients (57%), N0 9 patients (20%), N2 5 patients (11%) and N1 2 patients (4%). Metastase staging (M) M0 was found in 27 patients (58%) and M1 tumor was found 42%. The major pathological finding was seminoma in 37 patients (80%), Yolk sac tumor in 4 patients (9%), Embryonal Ca in 1 patient (2%), Teratoma in 1 patient (2%) and mixed germ cell tumor in 3 patients (7%). The most widely theraphy was underwent orchidectomy followed by PEB chemotheraphy in 29 patients (64%), 3 patients (6%) underwent EBRT and PEB chemotheraphy, 5 patients (11%) underwent PEB chemotheraphy, There were 9 patients (19%) underwent orchidectomy alone. Group of seminoma tumor show normal limit of tumor marker α-FP and β-HCG and increased in non seminoma. Conclusion: Testicular cancer mostly appears in younger males. Most of testicular cancer was seminoma, diagnosed in advanced stage with metastase 42% of the patient. Most of the patients received orchidectomy followed by PEB chemotheraphy
PHENOTYPE-GENOTYPE AND PEDIGREE ANALYSIS OF ISOLATED HYPOSPADIAS PATIENTS
No full textObjective: Hypospadias is a malformation in urethra which has many range of severity. A patient with Isolated hypospadias (IH), a mild disorder of sex development (DSD) has a hypospadias phenotype only. Hypospadias is considered as multifactorial disease in which genetic factors contribute to its development. Chromosome analysis in DSD including hypospadias is conducted for gender assignment and other possible genetic contributions. This analysis solely could not elucidate all genetic causes of hypospadias. Polymorphism of V89L in SRD5A2 is suggested as one of genetic risk factors of hypospadias. To determine the genetic risk factor and pattern of inheritance, a good pedigree construction is required. Material & methods: 35 eligible subjects with IH admitted to Center for Biomedical Research (CEBIOR) during 2012-2015 were randomly selected. 35 normal male as control were included in this study. Data on three generation pedigrees were collected from medical records in 35 affected subjects. Chromosome analyses were done by using G-banding technique. Polymorphism analysis of V89L in SRD5A2 gene was done using PCR-RFLP technique in all samples. Results: From the 35 affected subjects, the most frequent phenotype was penile hypospadias (47%), a pair of twins were monozygotic and one had a cousin diagnosed with urogenital abnormalities (i.e micropenis and chordae). All subjects had 46,XY chromosome. No chromosomal aberration was found. No positive correlation between polymorphism of V89L in SRD5A2 and risk of hypospadias (PR of CC+CG vs GG=1.0, 95% CI: 0.342−2.921, p value=1.0). Conclusion: The pedigree data from our study implies tendency of genetic involvement in hypospadias cases. There were no chromosomal aberrations in hypospadias cases. The finding on polymorphism of V89L in SRD5A2 gene does not support that of previous studies
EFFICACY OF BLADDER TRAINING PROCEDURE IN PATIENTS UNDERGOING TURP
No full textObjective: Catheter management is conducted to the patients undergoing transurethral resection of the prostate (TURP). There were many arguments between clinical practitioners about bladder training procedure after TURP procedure. This study aims to determine whether there is a relationship between bladder training action and success of spontaneous micturition in post TURP procedure in patients with urinary retention caused by prostate enlargement. Material & methods: Randomized clinical trial was conducted at Kardinah General Hospital, Tegal from October 2015 to February 2016. 44 study participants who underwent TURP were randomly allocated into two groups. In Group I, patient’s Folley catheter was clamped prior to its removal (bladder training group); and in Group II was not clamped (control group). Results: Mean age of patients was 64.48 ± 8.1 years old. There were 23 patients (52.3%) have had history of recurrent urinary retention and 21 patients (47.7%) have had not (p=0.560). There were 4 patients (17.4%) in Group I and 1 patient (4.7%) in Group II who required re-catheterization and discharge with catheter. There was no statistically significant difference in spontaneous micturition rate between bladder training group and control group (p=0.187). Conclusion: The result of the current study identified that bladder training to patients undergoing TURP procedure had no significant impact in spontaneous micturition
PATIENT PERCEPTION RELATED TO URODYNAMIC TESTING: A QUESTIONNAIRE BASED STUDY
No full textObjective: Urodynamic test is a series of test to evaluate the bladder function including voiding and storage physiology. Several previous studies have found that urodynamic testing had association with physical and emotional discomfort. The primary goal of this study was to determine the parameters of anxiety, pain, and shame related to urodynamic testing. Material & Method: From June 2014 to June 2015, a total of 57 consecutive patients who underwent urodynamic study were included in the present study, consisting of 20 men and 37 women. They have completed the questionnaire before and after urodynamic study. Patients were requested to answer four questions related to pain, embarrassment, anxiety, and knowledge related to urodynamic test. Results: Overall, most of the patients felt not at all and nearly not anxious before urodynamic study. Thirty percent of patient thought that there would be moderate pain when the urodynamic test is performed. Majority of patients (68% of patients) felt no embarrassment prior to the test. Overall, patients felt better after urodynamic study in terms of anxiety and pain. Parameter of embarrassment significantly increased after the test. Patient perception of anxiety and pain before urodynamic test are not significantly different with perception after urodynamic test. Conclusion: Urodynamic tests are very well tolerated by men and women. Majority of patients felt better after urodynamic test according to pain and anxiety score. No statistical difference in level of pain and anxiety between before and after the procedure, while parameter of embarrassment was significantly higher after the test was done
SUCCESS RATES OF TAMSULOSIN AND DUTASTERIDE AS MEDICAL THERAPY BASED ON IPSS IN SYMPTOMATIC BPH PATIENTS IN ARIFIN ACHMAD HOSPITAL PEKANBARU RIAU
No full textObjective: To evaluate the success rates of tamsulosin and dutasteride as medical therapy based on international prostate symptom score (IPSS) in symptomatic benign prostatic hyperplasia (BPH) patients. Materials & Methods: We reviewed medical records of the symptomatic BPH patients in Arifin Achmad Regional General Hospital, Pekanbaru, Riau Province, Indonesia in 2011-2016. The previous and after IPSS of administering tamsulosin 0.2 mg or 0.4 mg or dutasteride 0.5 mg as a single therapy and tamsulosin 0.4 mg with dutasteride 0.5 mg as a combination therapy were assessed. Wilcoxon 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: 100 patients fulfilled the inclusion criteria. The results showed 50% patients with mild IPSS and 50% patients with severe IPSS before the medication. 70% patients administered tamsulosin 0.2 mg as first-line therapy, 35% patients administered medication for 6 months-1 year, and 3% patients with mild IPSS, 44% with moderate IPSS and 53% with severe IPSS after the medication. The Wilcoxon test showed there was a significant different (p<0.005) between IPSS levels before and after the medication with success rate 18%. Conclusion: There were good success rate of tamsulosin 0.2 mg, tamsulosin 0.4 mg, dutasteride 0.5 mg as single therapy and tamsulosin 0.4 mg with dutasteride 0.5 mg as combination therapy in symptomatic BPH patients based on IPSS, and the medical therapy are still recommended
GIANT CLEAR CELL RENAL CARCINOMA: A CASE REPORT
No full textObjective: This article is aimed to report an unusual presentation of renal cancer T4N0M0 in which the tumor weighed about 5 kilograms in a patient admitted to Urology Department of Hasan Sadikin Hospital in Bandung, Indonesia, in August 2016. Case presentation: We report a case 62 year old male with history of growing mass in his left abdominal. There are also painless hematuria and weight loss of approximately 10 kg over the past 2 years. Discussion: Physical examination found a significant palpable, immobile and mild tender mass in the left upper quadrant of the abdomen. Abdominal Pelvic Computed Tomography (CT) scan revealed inhomogenous hypodens mass in the left kidney. Resection of the tumor revealed a 5 kg (22 x 25 x 18 cm, with total volume of 9.900 cm3) encapsulated neoplasm. Histophatological examination revealed a clear cell type renal cell carcinoma (RCC) with positive margin and Fuhrmann grade 2. In Asia, a giant chromophobe RCC exceeding 10 kg in weight was reported in 2009. As for previously reported giant clear cell RCC, we found out the data to be very limited. Conclusion: Giant RCC is rare, especially clear cell type in histophatological result. The size of the tumor reported in this article is considered as the largest-sized giant clear cell RCC ever reported in Asia. The size of the tumor in this case presented several challenges in the operative settings. However, the outcome and six months post-operative follow-up of the patient was satisfying in which there was no presence of single symptom within the six-month follow-up period
STONE FREE RATES OF KIDNEY STONE WAS LOWER THAN THE ONE OF URETER STONE PATIENTS MANAGED BY ESWL AND THE ONE OF URETER STONE MANAGED BY URETEROLITHOTRIPSY
No full textObjective: To evaluate the stone free rates of kidney and ureter stone patients managed by Extracorporeal Shockwave Lithotripsy (ESWL), and the ureter stone free rate managed by ureterolithotripsy. Material & method: We reviewed the medical records of kidney and ureter stone patients managed by ESWL and ureter stone patients managed by ureterolithotripsy in Arifin Achmad Regional General Hospital Pekanbaru Riau Province, Indonesia, from January 2010 - December 2016. ESWL and ureterolithotripsy stone free rates were examined by the control of KUB röngents. Results: There were 891 kidney and ureter stone patients consisting of 325 (36.5%) were kidney stone patients and 566 (63.5%) were ureter stone patients. The pyelum stones were the most (78.2%) in kidney stones and the lower ureter stones were the most (57.2%) in ureter stones. There were more male patients than the female ones in which most of the patients were in the group age of 49-59 years. The amount of patients increased each year. The kidney stone free rate managed by ESWL was lower (71.7%) than ureter stone free rate (84.1%) by ESWL, while the stone free rate of ureter stone patients managed by ureterolithotripsy was 100%. Conclusion: The ESWL stone free rate of the kidney stone patients was lower than the one in ureter stone patients while the ureterolithotripsy stone free rate was 100%
THE EFFECT OF DEXAMETHASONE ON SPERMATOGONIUM AND SERTOLI CELL OF IPSILATERAL TESTIS IN UNILATERAL TESTICULAR TORSION WISTAR RAT
No full textObjective: To investigate the effect of dexamethasone on spermatogonium and sertoli cell of ipsilateral testis in unilateral testicular torsion strain wistar rat. Material & Method: Experimental study with post-test only control group design. The present study was conducted on 30 Wistar male rats aged 10 – 12 weeks grouped into 5 groups. Group I was the normal/sham operation group (KN), group II was left testicular torsion for 4 hours group and followed by manual detorsion (K1), group III was left testicular torsion for 10 hours group and followed by manual detorsion (K2), group IV was left testicular torsion for 4 hours group and given dexamethasone 10 mg/kg body weight subcutaneously 30 minutes before manual etorsion (D1), and group V was left testicular torsion for 10 hours group and given dexamethasone 10 mg/kg body weight subcutaneously 30 minutes before manual detorsion. All rats had left orchidectomy 4 hours after detorsion. The number of spermatogonium and sertoli cells were counted in histological seminiferous tubular testis that have obtained Haematoxylin Eosin staining. Data were analyzed by ANNOVA followed by Post Hoc Tukey for spermatogonium and Kruskal Wallis followed by Mann Whitney test for sertoli cell. Differences were considered significant at p <0.05. Results: There was significant difference in the mean number of spermatogonium between K1 & D1 group. Otherwise, there was no significant difference in the mean number of spermatogonium between K2 & D2. There was significant difference in the mean number of Sertoli cells between K1 & D1 group, likewise that between K2 & D2 group. Conclusion: These results suggest that dexamethasone has protective effect in spermatogonium and sertoli cell in testicular torsion for 4 hours
SURVIVAL ANALYSIS OF CONTINUOUS AMBULATORY PERITONEAL DIALYSIS ON PATIENTS WITH END STAGE RENAL DISEASE IN SARDJITO HOSPITAL PERIOD 2007-2011
No full textObjective: This study was aimed to analyze the survival rate on End Stage Renal Disease (ESRD) patients and underwent Continuous Ambulatory Peritoneal Dialysis (CAPD) insertion surgery. Materials & Methods: The subjects of this study were 58 people diagnosed as chronic renal failure and underwent CAPD insertion surgery. This type of research is retrospective, using medical record data in Sardjito Hospital, and then we performed patient survival analysis with CAPD procedure performed on end stage renal disease patient. Results: In survival test performed on patients who underwent CAPD insertion without considering other factors, the mean survival rate was 40.26 months. Kaplan Meier curve obtained 3 and 5 years survival rate of 62% and 45% respectively. Furthermore, the survival test is done by dividing into two group diabetes mellitus (DM) and non-diabetes mellitus (non-DM). In CAPD-attached patients with DM, has a lower mean survival time compared to non-DM. Mean survival time of CAPD patients with comorbid of DM 36.05 months while non-DM 43.43 months. In this study, the Hazard Ratio was 1.44 (0.69-2.99) DM: Non DM. In the survival test by dividing into two age groups, age group ≥ 55 years and <55 years. The results obtained mean survival time for age group ≥ 55 years 36.02 months and for age group <55 years 43.08 months. Conclusion: Patients with kidney failure who underwent CAPD with comorbid DM had lower survival compared with non-DM. The younger the age of the patient that underwent CAPD insertion, the survival rate increase
URINARY STONE COMPOSITION ANALYSIS IN INDONESIAN POPULATION: A SINGLE MAJOR CENTRE ANALYSIS
No full textObjective: To evaluate the urinary stone composition of Indonesian population. Material & Methods: This is a retrospective study analyzing total 277 urinary stone, obtained from urinary stone patient that underwent treatment in Cipto Mangunkusumo Hospital Jakarta in period 2000-2013. Results: Urinary stone disease is more common in male, with male : female ratio 1.8 : 1, with both in male and female patient, the incidence are highest at 51-60 years old. Calcium containing stone is predominant in this study with calcium oxalate as the most frequent stone with 61% overall, 43.7% in male and 17.3% in female and founded most frequent in 51-60 years old. Uric acid become the second most common stone after calcium containing stone with 9.0% overall, 6.5% in male and 2.5% in female. Infection associated stone such as struvite is 5.8% and Amonium urate 0.7%. In our study, struvite is founded more in male 3.6% than in female 2.2%. Cystine is a rare stone which is only founded 0.7%, in young age at 21-30 years old. Conclusion: Calcium oxalate is the most frequently stone type in our country as it is worldwide. This study revealed information of stone composition in Indonesian population, that could be beneficial for strategies and management to prevent urinary stone disease and recurrence.