Indonesian Journal of Urology
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THE EFFECT OF TOPICAL GENTAMYCIN APPLICATION AT THE URETHRAL STENT TO THE URETHRAL STENT’S BACTERIAL COLONY-FORMING-UNIT COUNTS IN HYPOSPADIAS PATIENTS PERFORMED URETHROPLASTY: A PRELIMINARY STUDY
No full textObjective: To determine the effect of topical gentamycin application at the urethral stent to the stent’s colony-forming-unit (CFU) in hypospadias patients. Material & methods: This study is a double blind prospective randomized controlled study, conducted from November 2016 - August 2017 in Urology Department Hasan Sadikin Hospital Bandung. We include patients with distal until penoscrotal hypospadias who underwent urethroplasty for the first time. The subjects were divided into 2 groups: Group A were patients performed urethroplasty with nasogastric tube (NGT) urethral stents only. Group B were patients performed urethroplasty with NGT urethral stents that were coated with topical gentamycin. Both group were operated by a single surgeon using either Tubularized Incised Plate (TIP) or Onlay Preputial Flap technique. Both group used supra pubic urinary diversion. Both group were given the same preoperative and postoperative intravenous antibiotics and given same dressing. At post operative day 7, the stents were removed and swabbed for bacterial culture and resistance test and colony-forming-unit (CFU) counts. Demographic data is described and, among others were analyzed statistically. Other adverse events and complications were also documented. Results: There were 25 hypospadias patients who were performed urethroplasty (12 patients in Group A and 13 patients in Group B). The median age in group A was 7 ± 2.995 (years old) and the mean age in group B was 6 ± 3.178 (years old). In group A, 1 patient (8.3%) were distal shaft type, 1 patient (8.3%) were middle shaft type, 8 patients (66.7%) were penoscrotal type, 1 patient (8.3%) were proximal shaft type, and 1 patient (8.3%) were subcoronal type. In group B, 3 patients (23.1.%) were distal shaft type, 3 patients (23.1%) were middle shaft type, 5 patients (38.5%) were penoscrotal type, and 2 patients (15.7%) were proximal shaft type. In group A, 6 patients (50%) using TIP, 6 patients (50%) using onlay preputial flap. In group B, 5 patients (38.5%) using TIP, 8 patients (61.5%) using onlay preputial flap. In Group A, Staphylococus haemoliticus was the most common bacterial found in urethral stent swabbed culture (50%), followed by Pseudomonas aeroginosa (16.7%), Acinetobacter baumannii (8.3%), Enterococcus faecalis (8.3%), Morganella morgagnii (8.3%) and sterile cultures (8.3%). In Group B, 38.5% were sterile urethral stents culture, followed by Staphylococus haemoliticus (30.8%), Enterobacter cloacae (7.7%), Staphylococus warneri (7.7%), Staphylococus epidermidis (7.7%), and Moraxella catarrhalis (7.7%). The most sensitive antibiotics in both group were Amikacin, Gentamycin, Meropenem, Cotrimoxazole, and Cefepime. In group A, 11 patients (91.7%) had >100.000 CFU counts, and 1 patient (8.3%) with no colony found. In Group B, 2 patients (15.4 %) had >100.000 CFU counts, 6 patients (46.2%) had <100.000 CFU counts, and 5 patient (38.5%) with no colony found. In group A, there were 3 patients (25%) with urethra-cutaneous fistula, 4 patients (33.3%) with hematoma, and 5 patients (38.5%) without any complications. In group B, there were 2 patients (15.4%) with urethra-cutaneous fistula, 3 patients (23.1%) with hematoma and 8 patients (61.5%) without any complication. Using Mann-Whitney U-test, we found a significant difference of CFU counts formation between the two groups (p=0.001). Statistically, the lesser CFU counts found, the lesser complication were developed (p=0.001). Conclusion: Topical gentamycin application at the urethral stents in hypospadias patients performed urethroplasty significantly reduced CFU counts found at the urethral stents and thus reduced the urethra-cutaneous fistula and hematoma formation
PRESEPSIN AND PROCALCITONIN VALUES TO DETERMINE THE PROGNOSIS OF UROSEPSIS
No full textObjective: To evaluate the prognostic value of presepsin and procalcitonin in patient with urosepsis. Material & Method: This is an observational prospective study. Patients who fulfilled the criteria for urosepsis at Soetomo Hospital Surabaya were enrolled. Presepsin and procalcitonin were measured at first admission. All patients were managed according to standard urosepsis therapy. At the 28th day of treatment, patients were evaluated and classified into survivor and non-survivor. The statistical analysis were tested with logistic regression test using software SPSS 23. Results: 30 urosepsis patients were included in this study with average age was 48.3 years (range 21-77 years). There were 23 survivor and 7 non-survivor. Mean presepsin values were higher in non-survivor than in survivor but the difference was not significant (4405 ± 4664 vs 4042 ± 2643, p=0.259). Mean procalcitonin value was significantly higher in non-survivor than in survivor (7.68 ± 6.81 vs 3.27 ± 2.74, p=0.013). Using the cut off value ≥2.24 ng/ml, procalcitonin can predict mortality in 28 days with sensitivity 71.4% and specificity 47.8%. Conclusion: Presepsin can not be used to determine the prognosis of urosepsis patients. Procalcitonin showed a significant correlation with outcome of urosepsis patients so it can be use to determine the prognosis of urosepsis
SUBURETERAL MUCOSA INJECTION WITH DETRANOMER/HYALURONIC ACID FOR VESICOURETERAL REFLUX TREATMENT: SYSTEMATIC REVIEW
No full textObjective: The aim of this study is to search the success rate of detranomer-hyaluronic acid (Dx/HA) used as injection through endoscopy approach and grades of vesicoureteral reflux (VUR) that could affect it success rate. Material & methods: We searched the literatures from MEDLINE database and PubMed from year 2001 until 2013. The data was analyzed using Random Effects Model with the method of Mantzel-Haenzel to analyze the success rates of dextranomer/hyaluronic acid and was determined by 95% Confidence of Interval (CI) disclosure. Meta-regression was performed to adjust the success rate compared with the grade of VUR as covariate. We assessed the heterogeneity by calculating the I2 statistic. All analyses were performed with Stata Statistical Software Version 12.0 (StataCorp). Results: We identified 9 literatures in full review. Of 1105 ureters that were injected with dextranomer/hyaluronic acid, 817 (72%; CI: 67-76%) were successfully treated according to author’s definition. The success rates of Dx/HA for pediatric with grade 1 VUR reached 80% (95% CI: 66-89%), whereas in grade 5 VUR only 50% (95% CI: 34-66%; p<0.05). Conclusion: The overall success rate of dextranomer/hyaluronic acid injection treatment was 72% after 3 months, although success rates varied widely among studies. Preoperative grade of VUR was significantly associated with treatment outcome. Increased VUR grade negatively affected success rates
CORRELATION BETWEEN S.T.O.N.E NEPHROLITHOMETRY SCORING IN PREDICTING FREE-STONE RATE AFTER PERCUTANEOUS NEPHROLITHOTOMY
No full textObjective: To investigate free-stone rate after Percutaneous Nephrolithotomy (PNL) using S.T.O.N.E nephrolitometry scoring system, with regards of stone size (S), skin-to-stone distance (T), obstruction degree (O), number of calyx involved (N), and stone density (E) in Non Contrast CT Scan (NCCT). Material & methods: This is an analytic observational study on patients with renal stones undergoing PNL. All patients underwent NCCT before and after PNL; each variables was measured and counted for a total score. Post-operative evaluation was done using NCCT. Results: Thirty patients met inclusion criteria, 19 (63.3%) were stone-free, and 11 (36.7%) were with residual stone. Among the five variables, stone size (p=0.005), number of calyx involved (p=0.002) affected the outcome of surgery, while skin-to-stone distance, obstruction degree, and stone density did not. The overall total score of S.T.O.N.E nephrolithometry is correlated with the outcome of PNL (p=0.001). Conclusion: S.T.O.N.E nephrolithometry is a simple scoring system, while it is also easy to use, and can be used to predict the free-stone rate after PNL
Patients’ Characteristics and Factors Influencing Success Rate of ESWL in Rumah Sakit Umum Daerah Kardinah, Tegal
No full textObjective: To evaluate which factors influencing success rate of extracorporeal shock wave lithotripsy (ESWL) in Kardinah Hospital Tegal. Material & methods: This was a retrospective study from secondary database of patients diagnosed with ureter or kidney stone whom underwent ESWL procedure in RSUD Kardinah Tegal from April 2012 to November 2015. Multivariate analysis and Chi-square analysis from SPSS ver. 19 were used to evaluate all the factors related to success rate of ESWL. Results: There were 314 patients included in this study with 59.5% of them were male patients. The average age of patients was 50 ± 5.5 years old. In 256 cases of kidney stones, there were 69 (26.9%) cases with size <10mm, 160 (62.5%) cases with a size of 10-20mm, and with a size >20mm by 27 (10.5%) cases. For ureteral stones, there were 46 (79.3%) cases with size <10mm, 11 (18.9%) cases with a size of 10-20mm, and 1 (1.7%) case with size >20mm. In general there were 238 (75.7%) of patients received no additional ESWL procedure while 61 (19.4%) patients underwent 2nd ESWL procedure, 33 (10.5%) patients underwent 3rd ESWL procedure, and 11 (3.5%) patients underwent more than 4 ESWL procedures. Kidney stones with a size <10mm, ureteral stones with size <10mm got, and location of the stone had p value of p=0.0015, p=0.001, and p=0.031 respectively. Other factors such as gender, age, stone opacity, and the number of shock given did not affect the success of ESWL. Type of lithotripter were not related to SFR in patient with kidney stone but was significantly related in ureter stone with p=0.078 and p=0.04 respectively. Conclusion: Most of patients reached stone free condition after the first ESWL procedure. Factors that influence the success of ESWL were the stone size and stone location. Kidney stone size <10mm and ureter stone <10mm had the highest SFR. Types of lithotripter were not related to SFRs in patients with kidney stone but were significantly related in ureteral stone with Medispec EM1000 electromagnetic and Huikang HK-V electromagnetic had the highest SFRs
INFLUENCE OF DIABETES MELITUS, BMI, AND HBA1C IN HIGH GRADE PROSTATE CANCER
No full textObjective: This study aims to determine the effect of diabetes mellitus (DM) and body mass index (BMI) on the risk of prostate cancer and high grade prostate cancer. Materials & method: This study is a retrospective observational study with cross-sectional design, using secondary data to determine the relationship of diabetes mellitus, body mass index and HbA1c levels with the degree of differentiation histopathologic prostate cancer. Data were analyzed using Chi-Square test, T-test and Man Whitney test with a confidence level of p<0.05 and a=0.05. Results: There are 78 samples diagnosed with prostate cancer. A total of 12 (15.4%) samples are diabetes mellitus, 18 (22.9%) samples classified as body mass index more than 23.4 (5.1%) samples have elevated levels of HbA1c levels >6.5. On histopathologic examination, it was found as many as 45 (57.7%) samples with high grade prostate cancer, as much as 9 (11.5%) samples with moderate grade prostate cancer, and as many as 24 (30.8%) samples with low grade prostate cancer. In bivariate analysis diabetes mellitus, BMI>23, and HbA1c level relationship with high grade prostate cancer is not statistically significant with p>0.05. Conclusion: There were no statistically significant relationship between diabetes, BMI and increased levels of HbA1c with high grade prostate cancer
TUBULARIZED INCISED PLATE URETHROPLASTY FOR ONE-STAGE HYPOSPADIA REPAIR IN CHILDREN AT HASAN SADIKIN HOSPITAL BANDUNG
No full textObjective: To determine the outcome of tubularized incised-plate (TIP) urethroplasty for one stage hypospadia repair in children. Material & methods: A 7-year retrospective experience at Hasan General Sadikin Hospital Bandung on the outcome of tubularized incised plate for one-stage hypospadias repair in children during 2009-2015. Results: A total of 102 children was undergone one stage hypospadias repair with TIP urethroplasty. The mean age was 6.97 years old. As much as 65 (63.72%) children had distal, and 37 (36.28%) children had proximal hypospadia. The mean length of surgery was 112.56 minutes. Post operative complications was rarely found, consisting of 5 (6.32%) children had urethrocutaneus fistula formation and 11 (13.9%) children had haematoma. 4 (10.81%) children with proximal hypospdia and 1 (1.53%) children with distal hypospadia had urethrocutaneus fistula formation. 4 (6.15%) children with distal hypospadia and 7 (18.91%) children with proximal hypospadia had haematoma. Conclusion: Tubularized incised-plate (TIP) urethroplasty for one stage hypospadia repair in children was highly effective with rare complications comparable with recently published study
COMPARATION OF DIAGNOSTIC VALUE B-MODE ULTRASOUND WITH COLOR DOPPLER TWINKLING ARTIFACT FOR DETECTING RESIDUAL STONE AFTER PCNL
No full textObjective: To compare the accuracy of B-Mode US and color Doppler twinkling artifact for detecting residual stone after Percutaneous Nephrolithotomy (PCNL) with Non-contrast CT (NCCT) as the standard diagnostic. Material & methods: In this prospective study, 30 patients who underwent Percutaneous Nephrolithotomy (PCNL) were examined with US and NCCT. In US, echogenicity and posterior-shadow (PS) parameters were evaluated and compared with color-Doppler ultrasonography (CDUS) twinkling artifact and NCCT signs. The results then analyzed statistically with Kappa and McNemar tests. Results: More positive residual stone results with color Doppler twinkling artifact in 14 patients than B-Mode US in 11. NCCT detected 17 residual stone with the most location in inferior calyx. (n=10, 58.8%). The sensitivity, specificity and difference positive-negative likehood ratio of B-Mode US were 64.7%, 92.3% and 8.02, both Kappa test was significant (p=0.125) and McNemar tests was significant (p=0.002). The color Doppler twinkling artifact has 82.3%, 92.3%, and 10.5 for sensitivity, specificity and difference positive-negative likehood ratio, the Kappa test was significant (p=0.00), McNemar test was not significant (p=1.00). Conclusion: Color Doppler twinkling artifact was valid, highly sensitive and accuracy better than B-mode US in detecting residual stone after PCNL procedure
THE EFFICACY OF DUTASTERIDE AND GREEN TEA TOWARDS BLEEDING ON BPH AFTER TURP: STUDY THEIR EFFECT ON HIF-1α EXPRESSION & HEMATOCRIT
No full textObjective: This study proves differentiation of the combination of dutasteride and green tea, dutasteride, green tea, and placebo alone and their association with differences in hematocrit levels and the expression of hypoxia induced factor-1 alpha (HIF-1α) in patients with Benign Prostate Hyperplasia (BPH) were performed Trans urethral resection of the prostate (TURP) surgery. Material & method: Experimental study with the draft "randomized control trial". Comparing angiogenesis changes between groups of BPH patients who underwent TURP surgery to assess the expression of HIF-1α and Δ Ht (Hematocrit) after administration of dutasteride, green tea with combination of dutasteride and green tea for 14 days. Results: The combination of dutasteride and green tea was not significant in reducing the expression of HIF-1α. Mean P1 group (59.32 ± 14.69); P2 group (59.11 ± 20.73); P3 group (64.21 ± 14.95); K group (58.16 ± 16.00). Kruskal test results obtained p=0.491 walis which means the difference percentage of HIF-1α among the 4 groups was not significant. The mean Δ Ht P1 group (0.61 ± 0.204); P2 group (0.54 ± 0.250); P3 group (0.41 ± 0.275); group K (0.41 ± 0.275). In statistical test with Mann Whitney test comparing the percentage reduction obtained Ht levels dutasteride group against group of green tea obtained p=0.213 means that there is no significant difference. Where a significant difference to the other groups. Conclusion: The combination of dutasteride and green tea for 14 days before TURP surgery does not reduce the expression of HIF-1α in BPH patients who underwent TURP surgery. Δ Ht significant decline in the combination group compared with other groups and might be influenced by several factors during TURP surgery
RETROPERITONEAL LAPAROSCOPIC DISMEMBERED PYELOPLASTY FOR URETEROPELVIC JUNCTION OBSTRUCTION (UPJO)
No full textObjective: To share our experience of retroperitoneal laparoscopic dismembered pyeloplasty as the treatment of Ureteropelvic Junction Obstruction (UPJO) in Department of Urology, Hasan Sadikin Hospital Bandung. Material & Methods: Boy 8 years old came for a chance to relieve mass at both flank region especially at left flank region. From the ultrasonography there were bilateral hydronephrosis. We decided to urethrocystoscopy, bilateral ureteral catether insertion, bilateral retrograd pyelography guided with c-arm and left retroperitoneal laparoscopic dismembered pyeloplasty. Results: Operative time was 240 minutes and blood loss was about 200cc. Double J Stent was used for ureteral stenting. Parenteral ketorolac was given as needed to control the pain. The Visual Analogue Scale (VAS) post operative day 1 until 4 were6, 4,, 2, 2 respectively. Urethral catheter was removed at post operative day 2 and drain was removed at post operative day 3. Operating wound was good. Patient was hospitalization until post operative day 4. Left nephrostomy was removed at postoperative day 7 after there was no leakage, confirmed with left antegrad pyelography. From post operative ultrasonography we found that hydronephrosis at left kidney became almost normal. Conclusion: In our opinion that the retroperitoneal laparoscopic dismembered pyeloplasty is an alternative treatment for UPJO. This procedure depends on experience and pristine surgical tehnique from the surgeo