Indonesian Journal of Urology
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THE EFFECT OF COMBINED α1-ADRENERGIC BLOCKERS AND PDE-5 INHIBITORS THERAPY ON IPSS, IIEF-5, QMAX AND PVR PATIENTS BPH WITH LUTS AND ERECTILE DYSFUNCTION
No full textPurpose: Assess the efficacy of combined α1-adrenergic blocker (tamsulosin 0,4 mg) and PDE5 inhibitor (tadalafil 5 mg) therapy compared to tadalafil or tamsulosin alone in treating patient BPH with LUTS and ED. Material and methods: A randomised, double blind experimental study assessed 36 sexually active men with ED and LUTS suggestive of BPH. All patients were randomized to 3 groups: tamsulosin 0,4 mg (n=12), tadalafil 5mg (n=12), and combination of tamsulosin 0,4 mg and tadalafil 5 mg (n= 12), once daily for 6 weeks. Changed in IPSS scores and QoL index, IIEF-5 scores, Qmax, PVR and blood pressure were assessed and compared to baseline. Complication and serious adverse event were also monitored. Outcomes were assessed using ranked analysis of variance (ANOVA) and Kruskall-Wallis depends on data distribution and homogenity.Results: Tamsulosin 0,4 mg once daily for 6 weeks were significantly improved IPSS score and QoL index and Qmax from baseline. Tadalafil 5 mg once daily for 6 weeks were significantly improved IPSS score, QoL index and IIEF-5 index from baseline. Combined tamsulosin and tadalafil therapy were significantly improved IPSS score, QoL index, IIEF-5 index and Qmax from baseline. Significantly better improvement on IIEF-5 dan Qmax from baseline were observed on the combination of tamsulosin and tadalafil compared to monotherapy with tamsulosin or tadalafil after 6 weeks in patients BPH with LUTS and erectile dysfunction. There was no significant decreased in systolic and diastolic blood pressure from combined treatment compared to single treatment.Conclusions: Combined tamsulosin and tadalafil therapy was significantly better in improving IIEF aObjective: Assess the efficacy of combined α1-adrenergic blocker (tamsulosin 0.4 mg) and PDE5 inhibitor (tadalafil 5 mg) therapy compared to tadalafil or tamsulosin alone in treating patient Benign Prostate Hyperplasia (BPH) with lower urinary tract symptom (LUTS) and erectile dysfunction (ED). Material & methods: A randomised, double blind experimental study assessed 36 sexually active men with ED and LUTS suggestive of BPH. All patients were randomized to 3 groups: tamsulosin 0.4 mg (n=12), tadalafil 5mg (n=12), and combination of tamsulosin 0.4 mg and tadalafil 5 mg (n= 12), once daily for 6 weeks. Changed in IPSS scores and QoL index, IIEF-5 scores, Qmax, PVR and blood pressure were assessed and compared to baseline. Complication and serious adverse event were also monitored. Outcomes were assessed using ranked analysis of variance (ANOVA) and Kruskall-Wallis depends on data distribution and homogenity. Results: Tamsulosin 0.4 mg once daily for 6 weeks were significantly improved IPSS score, QoL index and Qmax from baseline. Tadalafil 5 mg once daily for 6 weeks were significantly improved IPSS score, QoL index and IIEF-5 index from baseline. Combined tamsulosin and tadalafil therapy were significantly improved IPSS score, QoL index, IIEF-5 index and Qmax from baseline. Significantly better improvement on IIEF-5 dan Qmax from baseline were observed on the combination of tamsulosin and tadalafil compared to monotherapy with tamsulosin or tadalafil after 6 weeks in patients BPH with LUTS and erectile dysfunction. There was no significant decreased in systolic and diastolic blood pressure from combined treatment compared to single treatment. Conclusion: Combined tamsulosin and tadalafil therapy was significantly better in improving IIEF and Qmax, but not significantly better in improving IPSS and PVR compared to monotherapy with tamsulosin or tadalafil alone. Combined therapy was well tolerated without serious adverse effect.nd Qmax, but not significantly better in improving IPSS and PVR compared to monotherapy with tamsulosin or tadalafil alone. Combined therapy was well tolerated without serious adverse effect
PREDICTIVE FACTORS OF BLOOD TRANSFUSION AFTER TURP AT SARDJITO GENERAL HOSPITAL YOGYAKARTA
No full textObjective: To know the factors that can predict the need for blood transfusions after transurethral resection of the prostate (TURP) at Dr. Sardjito General Hospital. Material & method: This is a retrospective study. Analysis performed on 250 patients who underwent TURP between the years 2013 to 2015. The independent variables evaluated were age, body mass index (BMI), the estimated size of the prostate by transabdominal ultrasonography (TAUS), duration of surgery, hemoglobin level (Hb), the value of international normalized ratio (INR), history of hypertension, diabetes mellitus (DM) and the use of aspirin, and leukosituria. The dependent variable evaluated was the estimated amount of bleeding which was described by the blood transfusion requirements in patients after TURP. Results: Hb levels before surgery (p=0.000), history of hypertension (p=0.001) and a history of aspirin consumption (p=0.008) had a significant association with blood transfusion after TURP. The Hb cut-off value was 12.45 g/dl. Age, BMI, the estimated size of the prostate by TAUS, duration of surgery, history of diabetes and leukosituria did not have a significant association with blood transfusion after TURP. Conclusion: The results showed that Hb levels before surgery, a history of hypertension and aspirin usage can be predictive factors for blood transfusions after TURP
CORRELATION BETWEEN PCAR WITH IPSS SCORE, QMAX, AND POST VOIDING RESIDUAL URINE AND ITS CUT-OFF VALUE IN DETERMINING BOO IN PATIENTS WITH BPH LUTS
No full textObjective: This study was conducted to determine the correlation between Presume Circle Area Ratio (PCAR) and IPSS score, Qmax, and post voiding residual urine (PVR) and to find PCAR cut-off value in determining the presence Bladder Outlet Obstruction (BOO) in Benign prostatic hyperplasia (BPH) Lower Urinary Tract Symptoms (LUTS). Materials & Methods: This study was observational analytic study with 30 BPH LUTS patients as subjects during the period September 2015 to January 2016. The determined variables were PCAR, IPSS score, Qmax, post voiding residual urine (PVR) and analyzed using the SPSS program v21. Results: There were 30 patients who met the inclusion and exclusion criteria with the mean age of 67.47 years. In the correlation test, there was insignificant correlation between PCAR with IPSS (r=0.138, p=0.467), a significant correlation between PCAR with Qmax (r=0.468, p=0.009), PCAR with PVR (r=0.399, p=0.029), PCAR with BOO (r=0.491, p=0.006) PCAR cutoff value is 0.65 with sensitivity of 69% and specificity of 71%. Conclusion: PCAR has a significant correlation with PVR, Qmax and BOO but no significant with IPSS score. PCAR value >0.65 indicating BOO in BPH LUTS. PCAR can be used as an alternative non-invasive examination in determining the existence of BOO
CHARACTERISTIC OF URINARY RETENTION IN DEPARTMENT OF UROLOGY SOETOMO GENERAL HOSPITAL SURABAYA
No full textObjectives: We analyze our data of patients with urinary retention that have been managed in Soetomo general hospital to know our prevalence, causes and its management. Material & methods: We retrospectively reviewed the medical records of the patients with urinary retention who admitted on our department between January 2011 and December 2012. Results: During 2 years between January 2011 until December 2012, a total number of urinary retention was 295 cases among 1282 urology emergency cases, with sex ratio of urinary retention in men and women was 85.7% : 14.3%. Of the study population 264 (89.5%) presented with acute urine retention while 31 (10.5%) had chronic urine retention. Most of urinary retention was caused by bladder stone (33.3%) in children, urethral stricture (26.8%) in young adult men, BPH (71.3%) in elder men and cystitis (26.3%) in women. Trial of voiding without catheter (TWOC) that performed in 60 of the BPH patients, was succeeded in 43 (71.6%) of the patients and failed in 17 (28.4%). Emergency treatment of urinary retention were urethral catheter (83.7%) and cystostomy (16.3%). Conclusion: Urinary retention is one of emergency in urology that most common occur in men. Urine retention found among the participants was mainly AUR rather than CUR. Most of urinary retention was caused by bladder stone in children, urethral stricture in young adult men, BPE in elder men and cystitis in women. The most emergency management was urethral catheter. Trial of voiding without catheter showed a high success rate, so it can be considered as definitive non-surgical therapy in selective patient
RELATIONSHIP OF PERIURETHRAL FIBROTIC IN BPH PATIENT WITH LUTS AND URINARY RETENTION
No full textObjective: Analyzing the differences between collagen thicknesses in periurethral region from transurethral resection of the prostate (TURP) specimens of Benign Prostate Hyperplasia (BPH) patients with lower urinary tract symptoms (LUTS) and of those with urinary retention. Material & methods: This was an observation analytic study on 30 patients who underwent TURP. Patients who met the inclusion criteria were divided into 2 groups: BPH patients with LUTS and those with urinary retention. Each group consisted of 15 people. The first TURP specimen of proximal verumontanum resection were examined in anatomic pathology using mass on strichrome staining as an examination of periurethral collagen thickness. Collagen will be stained as blue. Periurethral collagen thickness was measured from the basal membrane of transitional epithelium to fibromuscle tissue. Data were then statistically analyzed using independent t-test. Results: The average patient age was 66 ± 7 years old and there was no significant difference between age and periurethral collagen thickness with p=0.175 (p>0.05). The mean prostate volume was 47.19 ± 13.2 ml and there was no significant difference between prostate volume and periurethral collagen thickness with p=0.148 (p>0.05). Average periurethral collagen thickness in BPH patients with urinary retention was 146.67 ± 39.80 micrometers and while in those with LUTS was 205.33 ± 85.6 micrometers. There were no significant differences between periurethral collagen thickness and the occurrence urinary retention with retention of urine with p=0.063 (p>0.05). Conclusion: There were no significant differences between periurethral collagen thickness patients in BPH patients with LUTS and in those with urinary retention. This suggests that periurethral collagen thickness is not associated with the occurrence of urinary retention or LUTS in BPH patients
NORMATIVE DATA OF PENILE LENGTH ON CHILDREN AGE GROUPS WITH TANNER CLASSIFICATION IN HASAN SADIKIN HOSPITAL
No full textObjective: It has been reported that normal value of penile length were varied among countries. Difference in race, ethnicity, genetics and nutrition plays a factor in penile length. Micropenis is an abnormality in which penile length were considered smaller in comparison of a ‘normal penile length’. There are published article in Asia and Europe in terms of local penile length figures unfortunately none in West Java. This study was aim to establish local data as a reference in order to define micropenis. Material & method: All subjects in pediatric outpatient clinics were collected with cross sectional method. Exclusion criteria includes: congenital penile disease (hypospadias, burried penis, chordee, fistulas, webbed, etc), history of hormonal therapy, malnourished, and congenital syndromes. Subjects will undergone examination of stretched penile length. Results: A total of 276 children were included in the study with 23 subjects in each Tanner groups. The average penile length in Hasan Sadikin Hospital were inferior in all groups in contrast with the Tanner age groups as cited in table 1. Conclusion: Normative local data of penile length is necessary. Not using the local reference may result in underestimation and overdiagnosis
THE EFFECT OF PERIOPERATIVE AND PROPHYLACTIC ANTIBIOTICS AGAINST THE INCIDENCE OF UTI AND SURGICAL SITE INFECTIONS AFTER HYPOSPADIAS SURGERY
No full textObjective: The aim of this study is to analyze the effect of perioperative and prophylactic antibiotics against the incidence of urinary tract infections (UTI) and surgical site infections (SSI) after hypospadias surgery (hypospadias repair operation). Materials & Methods: This study is an observational study of explanation with 24 hypospadias patients (2 groups) during the period of October 2015 to February 2016. Samples were divided into two groups, 12 patients received prophylactic antibiotics and 12 patients received perioperative antibiotics (random sampling). Inclusion criteria included patients with glandular hypospadias to proximal penile hypospadias, aged 6 months until 15 years and underwent hypospadias surgery with one surgical technique namely Tubularized Incised Plate (TIP). The examination of urine culture and evaluation of the wounds were performed on day 4, 10, and 20 day after surgery to determine the incidence of urinary tract infections and surgical site infections. Results: There is no significant difference in the incidence of UTI on on day 4, 10 and 20 in perioperative group and prophylaxis group with p=0.282 and p=0.500 at day 4 and 10 (p>0.05). There is no significant difference in the incidence of SSI on day 4, 10 and 20 in the group of perioperative antibiotic and prophylactic antibiotic with p=0.680 and p=0.217 at day 4 and 10 (p>0.05). Conclusion: There is no effect of the prophylactic antibiotic as well as perioperative antibiotic treatment on the incidence of UTI and SS
EFFICACY AND SAFETY OF LUBRICATING JELLY INSTILLATION TO PREVENT RETROPULSION DURING URETEROLITHOTRIPSY FOR URETERAL STONES
No full textObjective: We studied the efficacy and safety of lubricating jelly instillation before ureterolithotripsy for prevention of retropulsion and improvement in stone-free rate. Material & methods: We enrolled 22 subjects with ureteral stone in this prospective, randomized, single-blind and controlled clinical trial. Each subject was randomly assigned to the lubricating jelly instillation group (n=11) and control group (n=11). Ureteroscopy and lithotripsy was performed according the standard protocol, using 9.8 F semirigid ureteroscope and pneumatic lithotripter. A 6 F ureteral catheter was advanced beyond the stone, and lubricating jelly was instilled through the catheter lumen. Retropulsion and the presence of residual fragments were evaluated with plain kidneys, ureters and bladder x-ray and ultrasonography, or Non Contrast-enhanced Computed Tomography. Any complication was reported and graded using the Modified Clavien Classification System.Results: The 2 groups had comparable preoperative characteristics. There were no statistically significant difference between the lubricating jelly instillation group and control group regarding the retropulsion rate (54.5% vs 72.7%, ρ=0.375), the stone-free rate (54.5% vs 36.4%, ρ=0.392), and the complication rate (45.5% vs 54.5%, ρ=0.670). Conclusion: Lubricating jelly instillation during ureterolithotripsy has limited value for prevention of retropulsion and improvement in stone-free rate
ESTROGEN EFFECT ON WISTAR'S VAGINAL EPITHELIUM
No full textObjective: To evaluate the effect of estrogen on wistar’s vaginal epithelium. Material & method: We divided 30 female wistars into three groups, ten wistars underwent bilateral ovariectomy, 10 wistars underwent bilateral ovariectomy, and estrogen replacement and 10 wistars as control. The second group received estradiol 1 mg/kg/day, directly after ovariectomy. After 4 weeks the vagina was then harvested and stained with hematoxylin-eosin to evaluate the thickness of epithelial layer of vagina. A pair T-test was use for statistical analysis. Results: Estrogen ablation decreased the thickness of epithelial layer in wistar’s vagina. The mean thickness of epithelial layer in vagina were 3, 5, and 10 for each group respectively. The mean epithelial layer of the first group as well as the second group showed significant difference compared to control group (p>0,05), while the first group showed insignificant difference compared to the second group. Conclusion: Estrogen ablation seems to decrease the thickness of vaginal epithelium, while estrogen replacement revealed insignificant effect
THE VALUE OF URINARY CYTOLOGY AND HYDRONEPHROSIS TO PREDICT MUSCLE INVASIVE BLADDER CANCER
No full textObjective: We evaluated the value of urinary cytology, and presence of hydronephrosis to predict muscle invasive bladder cancer. Material & methods: We retrospectively analyzed data of 167 patients that diagnosed bladder cancer from medical record at Sardjito General Hospital Yogyakarta, between 2004-2011. Preoperative parameters were evaluated including age, gender, number and location of bladder cancer, urinary cytology, as well as presence of hydronephrosis. The outcome was muscle invasive bladder cancer. Results: A total of 96 (57.5%) patients had positive urinary cytology, 80 (47.9%) had hydronephrosis, most location of tumor were in trigone 43 (25.7%). The youngest patient was 26 years and the oldest was 84 years old, male was most affected in 145 (86.8%). On bivariate analysis, positive urinary cytology and hydronephrosis were associated with muscle invasive bladder cancer (OR 0.08 CI 0.038–0.167; OR 30.24 CI 12.72–71.89, respectively, each p < 0.05). Combination urinary cytology and hydronephrosis incrementally improved prediction of muscle invasive bladder cancer with positive and negative predictive value were 93.9% and 71.4%, respectively. Presence of hydronephrosis was associated with tumor location in trigone (p < 0.05). Conclusion: Urinary cytology and hydronephrosis were associated with muscle invasive bladder cancer, and can be used to predict muscle invasive bladder cancer