Indonesian Journal of Urology
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SURVIVAL OF PATIENTS WITH BLADDER CANCER WHO HAD PARTIAL CYSTECTOMY IS BETTER THAN THOSE WHO HAD RADIOTHERAPY
No full textObjective: To evaluate the survival on patient who had muscle invasive bladder cancer that had been operated or radiotherapy at Sardjito Hospital Yogyakarta. Material & method: From the year 2004-2010, we were data the patients with muscle invasive bladder cancer that had been operated or radiotherapy at Sardjito Hospital. We studied the age when diagnosed, gender, TNM status, histophatologic finding, histophatologic grade, kinds of surgery and status when follow-up. We evaluated the survival of each patient until 5-years post-surgery. We did bivariate analyze to assess the correlation of patient survival and TNM status, histophatologic grade, clinical stadium and kinds of management. We use Kaplan Meier curve to assess the the survival of patient who had muscle invasive bladder cancer. Results: There were 37 patients with bladder cancer, 3 female patients (8.1%) and 34 male patients (91.9%). Five patients were performed radical cystectomy, 4 patients performed partial cystectomy and 28 patients performed TUR-BT and radiotherapy. There were no significant correlation on the patient survival who had muscle invasive bladder cancer with gender, age, stadium, TNM staging, histopathologic grade and kinds of management (p>0.05). From Kaplan Meier curve, we found that the patients survival was better on stadium I, staging T1, N0, M0 and histopathologic G1 grade. While based on kinds of management, patients were performed partial cystectomy had the survival rate better than the one who only performed TUR-BT and radiotherapy. Conclusion: The surgery of partial cystectomy had a better survival rate than TUR-BT and radiotherapy.
PREDICTIVE FACTORS OF POST EXTRACORPOREAL SHOCK WAVE LITHOTRIPSI COMPLICATION EVENTS
No full textObjective: To know if pre-morbid factors such as maximum power, maximum frequency, repeated extracorporeal shock wave lithotripsy (ESWL), age, hypertension, diabetic, nutrition, blood coagulation disorders, kidney function disorders, pain perception, stone burden, and stone location, can be use to predict ESWL complication. Material & methods: This study is done retrospectively. Analysis was done on 50 patients undergoing ESWL between July 2014 to December 2015. Free variables which evaluated were maximum power, maximum frequency, repeated ESWL, age, hypertension, diabetic, nutrition, blood coagulation disorders, kidney function disorders, pain perception, stone burden, and stone location. Dependent variable which evaluated was steinstrasse event, post ESWL fever, post-ESWL renal colic, post-ESWL hematuria. Age variable were distributed normally and done bivariate analysis by student T-test. Others were abnormally distributed and analyzed univariately by Mann U Whitney. Results: During study period, 50 patients were collected. Among them, 60% were men and 40% were women. Mean age of patients undergo ESWL were 50.9 +12.7 years. Mean stone size that undergo ESWL were 172.7 + 277.8 mm2. Patients with hypertension before ESWL were 9 patients. Stones were mostly located on kidney pyelum (29 patients), inferior calix (11 patients), superior calix (5 patients), middle calix (4 patients), and 1 patients has staghorn stone. After ESWL, none of the patients complaining severe pain, 35 patient complaining mild pain, and 15 patient complaining moderate pain. Repeated ESWL done in 16 patients (32%). Post-ESWL complication such as hematuria happened on 12 patients, steinstrasse on 1 patient, and colic on 6 patients. None of patients complaining fever. Repeated ESWL happened on 32% patients and have complication risk of hematuria (p=0.043). Hypertension is significantly effecting on hematuria event after ESWL (p=0.015). Conclusion: Hypertension and repeated ESWL can be used as predicting factor of hematuria complication
A 87 YEARS OLD MALE WITH GIANT PROSTATIC HYPERPLASIA AND BLADDER STONES, THE LARGEST PROSTATE REPORTED IN INDONESIA
No full textObjective: The aim of this article is to report a case of Giant Prostatic Hyperplasia and see the correlation between volume of prostate and benign prostate hyperplasia (BPH) symptoms. Giant BPH is defined as a prostate weight over 200 g or 500 g; the lower threshold was suggested by Japanese authors. It’s extremely rare, with only 16 cases exceeding 500 g till 2013. Case presentation: Patient was an 87-year-old male with chief complaint of haematuria. We performed Transabdominal Ultra Sonography (USG) on the patient. Discussion: Transabdominal USG showed enlarged prostate with median lobe protruding into the bladder measuring 86 x 102 x 76 mm and 348 cc in volume. We performed transvesical prostatectomy. The large prostate was enucleated completely in one piece with 23 stones measuring about 1 cm in size. Grossly, the mass measured 12 x 8 cm and weighed 300 g. Histopathology evaluation revealed BPH. Conclusion: To our knowledge, this is the first giant BPH case being reported in Indonesia. We would like to emphasize that severity of BPH symptoms does not correlate with volume of the prostate. Unfortunately, we can not conclude that there were correlation between body mass index (BMI) and volume due to lack of BMI data from the literature
EXTRAPERITONEAL LAPAROSCOPIC RADICAL PROSTATECTOMY: INITIAL EXPERIENCE AND LEARNING CURVE OF A VERY LOW VOLUME CENTER
No full textObjective: This study is aimed to report and evaluate the experience and learning curve of extraperitoneal Laparoscopic Radical Prostatectomy (LRP) performed in Cipto Mangunkusumo General Hospital Jakarta. Material & method: We collected all data of patients that had been performed extraperitoneal LRP from June 2013 until February 2016, retrospectively. We divided those data into 3 groups with equal number in each group. We compared the preoperative (age, prostate volume, PSA level and prostate cancer staging), intraoperative (surgery time, total blood loss, conversion to open surgery and other organ injury), and postoperative (postoperative length of stay) variables between those 3 groups using ANOVA and Kruskal-Wallis test. Results: We performed 15 extraperitoneal LRP from June 2013 until February 2016 with patient’s mean age was 64.40 (SD ± 5.30) years old and mean prostate volume was 42.39 (SD ± 29.21). In this study, we found significant differences in surgery time, total blood loss, and postoperative length of stay (LOS) in all group with decrease on each intraoperative and postoperative variables. We also found no conversion to open surgery or other organ injury in all patients. Conclusion: The increase of surgeon’s experience and the number of surgery, and the consistency undergo the procedure of LRP demonstrate a decrease in surgery time, intraoperative blood loss and LOS in LRP patients
PROSTATE CANCER RISK CALCULATOR COMPARISON: IPCRC vs KPCRC vs PCPT-RC vs ERSPC-RC IN PREDICTING PROSTATE CANCER AT HASAN SADIKIN HOSPITAL
No full textObjective: To compare the validated calculators of Indonesian Prostate Cancer Risk Calculator (IPCRC) vs Korean Prostate Cancer Risk Calculator (KPCRC) vs Prostate Cancer Prevention Trial Risk Calculator (PCPT-RC) vs European Randomized Study of Screening for Prostate Cancer Risk Calculator (ERSPC-RC) in predicting prostate cancer in our patients at Hasan Sadikin Hospital Bandung. Material & methods: This study is a prospective study conducted from August 2014 – December 2015 at Urology Clinic at Hasan Sadikin Hospital that included all patients with BPH or suspected PCa who have been undergoing prostate biopsy. Variables such as age, PSA level, prostate volume (transabdominal or transrectal ultrasound) and digital rectal examination (DRE) finding were recorded. Risk calculation was generated using each risk calculator. Data were analyzed using Chi-square analysis, Kolmogorov-Smirnov, and finally receiver operating characterisitic (ROC) curve. All statistical analyses were performed with SPSS version 20. Results: There were 89 BPH and 43 PCa patients between August 2014 – December 2015. The mean age, PSA and prostate volume are 65.78 ± 8.33 years; 121.16 ± 375.76ng/ml; 55.86 ± 31.9ml respectively. Abnormal DRE was found in 27 PCas and 4 BPHs. Receiver operator curve analysis of IPCRC showed AUC 0.861 vs KPCRC (AUC=0.779) vs ERSPC-RC (AUC=0.745) vs PCPT-RC (AUC=0.794) vs PSA (AUC 0.794), sensitivity 81.4% and specificity 71.9% with cut-off point 19.67 for the IPCRC in predicting the prostate cancer in our center. Conclusion: IPCRC is better than KPCRC, PCPT-RC and ERSPC-RC in predicting prostate cancer in our center
HAEMATURIA AND COLIC CORRELATION AS CLINICAL PREDICTORS IN URETERAL STONES PATIENTS AT UROLOGY OUTPATIENT UNIT SOETOMO HOSPITAL WITHIN JANUARY 2011 - DECEMBER 2015 PERIOD
No full textObjective: Determine the relationship between clinical symptoms of colic pain and haematuria as a predictor of ureteral stones incident at Dr Soetomo Hospital within a period of five years. Material & methods: This study is a descriptive analytic study using the sensitivity-specificity test with retrospective design. Data were collected from patient's medical records with a ureteral stone diagnosis at outpatient unit Dr Soetomo Hospital within 2011-2015. Results: Renal colic or ureter colic without haematuria had 88.32% specificity and 53.07% sensitivity in the incidence of ureteral stones at Urology Outpatient Unit Dr Soetomo Hospital within 2011-2015 period. Haematuria without colic complaint had 29.37% sensitivity and 90.17% specificity in the incidence of ureteral stones. Colic and haematuria compared with colic had 55.76% sensitivity for the incidence of ureteral stones and 70.09% specificity. While colic and haematuria compared with haematuria had a sensitivity of 77.41% for the incidence of ureteral stones and 65.92% specificity. Colic and haematuria compared to other complaints has a 58.77% sensitivity for ureteral stones incidence and 94.66% specificity. Conclusion: Colic and haematuria are clinical predictors that have a better value than the complaints of colic without haematuria and haematuria without colic, in the ureteral stones incident at Urology Outpatient Unit Dr Soetomo Hospital within 2011-2015 period. This is consistent with the literature that mentions prominent complaint in the incidence of ureteral stones is their colic pain caused by the stone through the ureteral passage, and followed by haematuria for their mucosal surface injury
THE EFFECT OF ANDROGEN DEPRIVATION THERAPY ON THE LIPID PROFILE AND BLOOD GLUCOSE LEVEL IN PROSTATE CANCER PATIENTS IN ADAM MALIK GENERAL HOSPITAL MEDAN
No full textObjective: The aim of this study is to observe the effect of Androgen Deprivation Therapy (ADT) on patients with advanced stage of prostate cancer on the lipid profile and blood glucose level. Material & Methods: This is a descriptive cross-sectional study and include the prostate cancer patients which were admitted to Urology Policlinic in Haji Adam Malik General Hospital, Medan from June 2014 – June 2015 and also received ADT. Results: From June 2014 – June 2015, a total of 25 prostate cancer patients receiving ADT was included in this study with an average age of 67.08 ± 7.48 years old. The median prostate specific antigen (PSA) level of this group of patients is 19.6 ng/mL and the lowest and highest value of 3.4 and 278 ng/mL respectively. ADT administration is found to cause a significant elevation of 2-hour postprandial blood glucose (121.12 ± 21 mg/mL vs 134.64 ± 33.35 mg/mL, p-value=0.011) and Glycosylated hemoglobin (5 ± 0.5% vs 5.5 ± 0.79%, p-value=0.000) (HbA1c) after 6 months of therapy. Additionally, ADT administration within 3 and 6 months of duration had also significantly increased triglyceride (TG) level when compared to before treatment (104.4 ± 38.67 vs 131.2 ± 32.27 vs 127 ± 33.43 respectively, p-value=0.005). Conclusion: ADT treatment in prostate cancer patients increase triglyceride levels after 3 and 6 months of treatment followed by 2-hour postprandial blood glucose and HbA1C levels after 6 months of the treatment
PERCUTANEOUS NEPHROSTOMY FOR RELIEF OBSTRUCTIVE UROPATHY: BENIGN VERSUS MALIGNANT DISEASE
No full textObjective: This study aimed to find out the effectiveness of percutaneous nephrostomy (PCN) as palliative decompression of the obstructed urinary system. Materials & Methods: A case control study was performed with 118 patients (69 female and 49 male) with obstructive uropathy who were undergoing PCN during 2009 until 2012, retrospectively. The mean of age was 50.03 years. The PCN technique involves an ultrasound-guided puncture of the dilated collecting system with nephrostomy trocar than insert an 8 Fr nasogastric tube as nephrostomy catheter. Differences of renal function between benign and malignancy were assessed using Independent t-test. Changes in renal function after procedure were expressed as mean ± SD and analyzed using Pair t-test. Results: There was no procedure-related mortality. The most cause of malignancy was cervix cancer (36.4%) while the result of a benign process was 28.8% of urinary tract stones. Dialysis before procedure were performed in 43 (36.4%) consisting of 42 malignancies and 1 benign process. Improvement in renal function were statistically significant both benign and malignant groups seen in the levels of creatinine and blood urea nitrogen (BUN) before and after procedure (p<0.001). The mean differences were also statistically significant at the preoperative creatinine values between benign and malignant processes (p=0.019) but BUN levels before and after as well as postoperative creatinine levels showed no significant difference. Conclusion: PCN is a widely used technique, with a high technical success rate and low rate of complications. Obstructive uropathy due to benign processes had a better prognosis than malignancy after PCN treatment. Hemodialysis was mainly performed in patients with malignancy prior to PCN
RELATIONSHIP BETWEEN RENAL STONE LOCATION WITH STONE-FREE RATE AFTER ESWL
No full textObjective: This study aims to evaluate the relationship between stone location and stone location in kidney stone to the stone-free rate after Extracorporeal Shock Wave Lithotripsy (ESWL) procedure. Material & method: This is a non-experimental research using descriptive analytic method with retrospective study design that takes data from patient medical record diagnosis of urinary tract stones and ESWL action from January 2011 until December 2013 in the Department of Surgery Division of Urology General Hospital H. Adam Malik, Medan. Results: It was found that if the size of the stone only is the only factor that counts in patients who get a urinary tract stones ESWL therapy, it is not found a statistically significant relationship. Stone location plays an important role in the incidence of stone-free patients with urinary tract stones ESWL therapy. Conclusion: ESWL therapeutic efficacy in the treatment of patients with kidney stones is not only determined by the size and location of the stone, but is also determined by the number of stones, stone composition, frequency ESWL is used, and the thickness of the skin of the patient
PROGNOSTIC FACTORS OF RENAL CANCER
No full textObjective: Course of the disease of kidney cancer may be unpredictable. For example, between 4.2–7.1% of patients with tumours ≤4 cm that are usually slow-growing may have metastases at diagnostic and are at an elevated risk of disease-specific mortality. Conversely, as many as 40% of patients with lymph node metastases were diagnosed at nephrectomy are alive 5 year after surgery. Several approaches have been proposed to help predict the course of disease of kidney cancer and to distinguish between poor and favourable risk patients. In this study, we review the existing prognostic factors and compared with established prognostic models. Material & methods: This is an analytic 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: The number of samples analyzed in this study were 38 patients. We found seven patients remain alive of the entire sample. From the results of the univariate test, the factors that have a significant relationship with the mortality rate were low KPS (<80), weight loss, and nephrectomy. From the results of multivariate analysis, nephrectomy is the only prognostic factor in patients with kidney cancer. Mortality rate was 0.056x lower in patients who underwent nephrectomy compared with patients who did not underwent nephrectomy. Conclusion: Despite the high mortality rate that is found in this study, nephrectomy still has a place in kidney cancer management, even in patients with advanced stage