Indonesian Journal of Urology
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CORRELATION BETWEEN BLOOD SERUM PSA LEVEL AND MMP-2 IN PROSTATE ADENOCARCINOMA
No full textObjective: This study aims to prove the correlation between Prostate Specific Antigen (PSA) blood level and Matrix Metalloproteinase-2 (MMP-2) expression in patients with prostate adenocarcinoma. Material & method: Prostate cancer patients’ data from January 2009 to May 2012 were collected at the Department of Pathology, Soetomo General Hospital Surabaya. Data collected included patient medical documents, PSA blood examination, and histopathological examination. Histopathology slides and paraffin blocks of needle biopsies, Transurethral Resection of Prostate (TURP) and radical prostatectomy of prostate cancer patients werere-read, then the samples that met the inclusion criteria were stained by immunohistochemistry using antibodies MMP-2. Results: Data collection was done to obtain data samples of prostate cancer patients in 2009 to 2012 comprising as many as 22 patients between the ages of 52-91 years. Prostate adenocarcinoma in age of 70-79 was found in 8 patients, with a mean age of 68 years. PSA values obtained from medical documents were between 8.6-594.41 ng/ml. Spearman's test performed in this study showed a positive correlation (one-tailed) (correlation coefficient (r) 0431, p < 0.05) between blood PSA level and MMP-2 expression in patients with prostate adenocarcinoma. Conclusion: Blood PSA level correlates positively with MMP-2 expression in prostate adenocarcinoma
PENGETAHUAN, TINGKAH LAKU, DAN TINDAKAN KLINIS DOKTER UMUM PADA PENATALAKSANAAN BPH
Get PDFObjective: To evaluate the Primary Care Physician’s (PCPs) knowledge, attitude and clinical behavior in managing patients with BPH, as an input in the review of BPH guideline of Indonesian Urology Association. Material & method: The mailing included a cover letter, questioner consist of 10 questions survey, survey instrument and a post-paid envelope. A 10-questions survey were validated according to BPH guideline by Indonesian Urology Association (IUA). PCPs who work in district health offices and registered in district health office of Indonesian Health Ministry in Bandung, were selected as respondents. Results: 75% of sampled primary care physician working in 71 district health offices responded. 83% of respondent did not know the BPH guideline that had been published by Indonesian Urology Association. Although 88% of PCP’s knew about the symptoms of BPH, only 32% heard about of International Prostate Symptoms score. However, only 13 % were reported applying the symptoms score. Regarding to mandatory examination by the guideline, 64% of PCPs reported performing digital rectal examination, and 47% reported ordering urinalysis test. The recommended test such as PSA and serum creatinine level only asked 24% and 60% by PCPs. Only 21% of PCPs knew about the uroflowmetry but never ordering the test. 47% of PCPs reported using α blockers and 2% using finasteride for treating BPH. The referral was conducted by PCPs mostly due to urinary retention and hematuria. 70% of PCPs would refer the patients to urologist and the others to general surgeon and general internist. Conclusion: Although PCPs play role up to certain extent in diagnosing and managing of BPH, most of them are not interested in looking for reference
UROLOGY RETROPERITONEOSCOPY: INITIAL EXPERIENCE IN CIPTO MANGUNKUSUMO HOSPITAL
No full textObjective: This study was conducted to evaluate the initial experience of retroperitoneoscopy surgery. Material & method: This is a descriptive study with cross-sectional design. Data was collected from medical records of Urology Department in Cipto Mangunkusumo General Hospital Jakarta, from March 2013 until February 2014. Subjects were all patients who performed retroperitoneoscopic surgery between the time periods. Results: Patients consisted of 9 males (42.85%) and 11 females (57.14%). Mean age was 38.95 + 21.88 years old. Proportion based on diagnosis were 5 renal failures (23.8%), 5 ureteral stones (23.8%), 3 renal cysts (14.3%), 2 PUJOs (9.5%), double 3 collecting systems (14.3%), 1 tumor (4.8%), 1 ureteral tumor (4.8%), and 1 renal diverticle (4.8%). Proportion based on kind of retroperitoneoscopy were ureterolithotomy (23.8%), nephrectomy 3 (14.3%), nephroureterectomy 3 (14.3%), renal cyst unroofing 3 (14.3%), heminephrectomy 3 (14.3%), pyeloplasty 2 (9.5%), partial nephrectomy 1 (4.8%), and diverticle coagulation 1 (4.8%). Mean operating time was 178.81 + 55.72 minutes with mean length hospitalization 8.05 + 4.4 days. Mean amount of bleeding was 98 + 69.47 cc, wound operation infection 0 (0%), peritoneal perforation 1 (4.76%), open surgery conversion 2 (9.52%), and transperitoneal laparoscopy conversion 1 (4.76%). Conclusion: In this study, total number of retroperitoneoscopy surgery cases still less than others abroad. Demographic characteristic showed variety than other study. Compared to other studies, the operating time was comparable but the length of stay was longer. We had higher open surgery conversion rate, while another complication was relatively the same
BODY MASS INDEX RELATIONS WITH THE DIFFICULTIES AND COMPLICATIONS OF PERCUTANEOUS NEPHROLITHOTOMY
No full textObjective: To identified outcomes and complications of percutaneous nephrolithotomy (PCNL) in patients of various body mass indices (BMI) to determine the safety of this procedure in patients with elevated BMI.Material & methods: The analytic observational prospective study of patients who underwent PCNL between February to July 2015 in the operating room Soetomo General Hospital Surabaya. Specifically, BMI, stone-free rates, difficulties duringsurgery, complications, and Clavien score were assessed. We evaluate the independent contribution of BMI as a predictor of outcomes. Results: There were 35 selected patients with kidney stone and planned to PCNL, 20 patients were included and 15 patients were excluded from this study. The patients consisted of 10 men (50%) and 10 women (50%). Mean age was 47.55 years (range 33-75). There were 4 patients with diabetes (20%), and 10 patients with hypertension (50%). Mean stone size was 23.30 mm. Stone location was 11 patients (55%) in the right kidney, and 9 patients (45%) in the left. There were 12 patients (60%) with a single stone, and 8 patients (40%) with multiple stones. BMI values were distributed as follows,underweight 1 patient (5%), normoweight 7 patients (35%), overweight 6 patients (30%), obesity 6 patients (30%). Mean skin to stone distance (SSD) was 87.56 mm. Stone free rate was 55%, and difficulties during surgery only seen in 1 patient (5%) bleeding profusely and open surgery was performed. Clavien score in these patients were grade I in 11 patients (55%), grade II in 7 patients (35%), and grade IIIB in 2 patients (10%). The BMI had no significant effect with Intra operative and postoperative difficulties (0.390. p <0.05. CI 95%). However the lower stone free rate had significant effect (0.040. p <0.05. CI 95%).Conclusion: BMI had no significant effect with Intraoperative and postoperative difficulties in PCNL.However, the lower stone-free rate risk associated with elevated BMI was significant
PERBEDAAN IPSS, Q MAX, DAN VOLUME PROSTAT PADA PEMBERIAN KOMBINASI INHIBITOR 5α-REDUKTASE (DUTASTERIDE) DAN ANTI ESTROGEN (TAMOXIFEN) PADA PASIEN BPH YANG MENGALAMI LUTS TANPA KOMPLIKASI
Get PDFObjective: To compare the IPSS, Q max, and volume of the prostate pre and post treatment of 5α-reductase inhibitor and tamoxyfen in patients with BPH. Material and Methods: We collected 40 patients who had been diagnosed as BPH without urine retention. They were classified in to 4 groups, each group contained of 10 patients who were given tamoxifen, dutasteride, combination tamoxyfen with dutasteride, or placebo. We recorded IPSS, uroflow, and volume of the prostate before and after 3 months of medication. Data were analyzed by the SPSS 12 program. Results: Q max (7,75 + 3,5538 to 9,15 + 2,9448) and IPSS (z score –1,633) after treatment with tamoxyfen (p > 0,05) was not improved. We found significant decrease of the prostate volume (40,124 + 7,9129 to 36,323 + 8,2573) after treatment with tamoxifen (p < 0,05). There is significant improvement of Q max (9,55 + 3,2793 to 15,12 + 4,3522), IPSS (z score –2,887), and significant decrease of the prostate volume (30,93 + 9,0031 to 24,506 + 7,3267) after treatment with dutasteride (p < 0,05). There was also significant improvement of Q max (6,55 + 2,5435 to 8,86 + 4,4475), IPSS (z score –2,449), and decrease of prostate volume (31,403 + 9,0031 to 26,78 + 7,3267) after treatment with the combination dutasteride and tamoxifen (p < 0,05). None of those parameters were improved in placebo group. Conclusion: Q max and IPSS improve significantly in the dutasteride and the combination group. There was a significant decrease of the prostate volume in all groups except the placebo group
LITOTRIPSI LASER HOLMIUM YAG UNTUK TERAPI BATU URETER
Get PDFObjective: To assess the efficacy of pulsed holmium:YAG laser lithotripsy for ureteral stone therapy. Material and method: Ninety-one patients (70 males and 21 females) with age range 20 – 76 years underwent 93 ureteroscopic procedures for 101 ureteral stones. A preoperative diagnosis was established by ultrasound scanning and intravenous urography. An 8 F rigid Karl-Storz ureteroscope was used for a holmium:YAG laser (OmniPulse MaxTM 80 watt Holmium Laser System Model 1210-VHP, Trimedyne,Inc. Irvine CA, USA) as energy source for laser lithotripsy. The stone localization was mostly at the lower third of the ureter. The mean stone size was 9,6 mm, mean duration of procedure was 48,1 minutes, and the mean hospital stay was 2,1 days. Results: The overall stone clearance rate was 95,6% with the best results for stones in the middle third of the ureter (100%). At follow up we noted two patients with residual stones and two patients with a perforation of the ureteral wall. Conclusion: The Holmium:YAG laser is effective for ureteral stone treatment with a high success rate. Special attention and care should be afforded in impacted ureteral stones.
URODYNAMICS UTILITY PATTERN AMONG INDONESIAN UROLOGISTS
No full textObjective: Aim of this study was to describe urodynamic utility pattern among Urologists in Indonesia especially in treating lower urinary tract symptoms (LUTS), urinary retention, overactive bladder (OAB), stress urinary incontinence (SUI) and urologic pediatric cases. Materials & methods: Subjects were Indonesian Urologists who attended urological scientific meetings or workshop in Jakarta between February-July2014. They were given questionnaires about urodynamics and its indications. Results: One hundred and eight Urologists completed and returned the questionnaires out of 303 Urologists in Indonesia. Thirty eight Urologists worked at hospitals where urodynamic machine is available, the rest sent their urodynamic cases elsewhere. Most of Urologists ordered urodynamics for LUTS patients with neurological deficit (84.3%) and weak anal sphincter tone/bulbocavernosus reflex (62.0%). In OAB cases, urodynamics was used in cases with failure of medical therapy (70.4%) and neurological deficit (68.5%). Two most common indication criterias in SUI cases were failure of conservative therapy (70.4%) and mixed incontinence cases (SUI with OAB) (60.2%). Neurological deficit (66.7%) and urinary incontinence (26.9%) were the most frequent urodynamic indications applied in children. Conclusion: We described the urodynamic utility pattern among Indonesian Urologists. Availability of urodynamic machine, patient economic capabilities, guideline availability on urodynamics could be the factors affecting this pattern
COMPARISON OF APOPTOSIS IN CONTRALATERAL RENAL TUBULAR CELLS IN ORYCTALAGUS CUNICULUS DUE TO ARTIFICIAL UNILATERAL URETERAL OBSTRUCTION, WITH AND WITHOUT VERAPAMIL
Get PDFObjective: To compare the effects of verapamil on the contralateral kidney affected by unilateral ureter obstruction. Material & method: The right ureter of oryctalagus cuniculus rabbits, were obstructed surgically with silk suture material, and kept alive for 14 days. One group was obstructed without other treatment, one group was given verapamil from day 7 until day 14 of the obstruction. One group was obstructed and given verapamil from day 0 through day 14. One group was given a sham operation as a control group. The contralateral kidney of all groups were harvested and processed with ApopTag. The increase of apoptotic tubular cells compared to the control group was then analyzed between each group. Results: The highest increase in apoptotic cells was in the obstructed group without verapamil, but increased significantly compared to control (p<0,001). The groups which received verapamil had lower increase of apoptotic tubular cells, in the group given verapamil for 14 days lower than the group which received verapamil only for 7 days. Both the 7 to 14 and the 0 to 14 groups were significantly lower than the group without verapamil (p=0,035 and p<0,001 respectively). Conclusion: verapamil has a protective effect on the contralateral kidney by inhibiting apoptosis caused by unilateral ureter obstruction. While the definitive treatment for urinary obstruction is to relieve it, verapamil can protect the kidney in the mean time
ULTRASONOGRAFI UNTUK PREDIKSI LASERASI PARENKIM GINJAL DAN HEMATOMA PERIRENAL PADA PASIEN TRAUMA TUMPUL ABDOMEN DENGAN KECURIGAAN TRAUMA GINJAL
Get PDFObjective: To evaluate the sensitivity and the specificity of the ultrasound in predicting renal parenchyma laceration and perirenal hematoma in patients with abdominal blunt trauma with suspicion of renal trauma, as confirmed by operative findings in the explorative laparotomy. Material & methods: From March 2005 to March 2006, we found 28 patients admitted to the emergency department with abdominal blunt trauma with suspicion of renal trauma. Every patient was scanned sonografically to detect the presence of the renal parenchyma laceration and perirenal hematoma. All those patients underwent laparotomy for any certain indication, but not because of ultrasound findings. The ultrasound findings then were checked with the operative findings. Results: The sensitivity of the ultrasound in predicting renal parenchyma laceration is 53.8%, while its sensitivity in predicting perirenal hematoma is 75%. The specificity of ultrasound in predicting both renal parenchyma laceration and perirenal hematoma is 100%. Conclusion: Ultrasound for kidney trauma is sensitive in predicting the presence of perirenal hematoma, but not sensitive in predicting the presence of a renal parenchyma laceration. Ultrasound is very specific in predicting if both perirenal hematoma and renal parenchyma laceration are present
EVALUATION OF TENCKHOFF CATHETER INSERTION USING OPEN SURGERY IN CHRONIC RENAL FAILURE PATIENTS
No full textObjective: To evaluate the dysfunction rate of Tenckhoff catheter insertion for end stage renal disease patients at Sardjito General Hospital Yogyakarta. Material & method: Data were collected from medical record retrospectively for all chronic kidney disease (CKD) patients underwent continuous ambulatory peritoneal dialysis (CAPD), by open surgery at Sardjito General Hospital Yogyakarta, from January 2010 until Desember 2013. The cause of CKD and dysfunction rate was studied. Data was analyzed using SPSS ver 18.0 (IBM corp, USA). Results: There were 43 CKD patients underwent Tenckhoff cateter placement using open surgery. Tenckhoff catheter dysfunction was found in 11.7% patients. Disfunction was caused by blockage of the catheter by omentum (6.9%) and catheter migration (4.8%). Peritonitis complication was found in 2.3% patients. The cause of CKD at Sardjito General Hospital Yogyakarta was diabetes mellitus (53.5%), hypertension (44.2%), and glomerulonefritis (2.3%). There were no correlation of dysfunction rate with gender and the cause of CKD. Conclusion: Tenckhoff catheter placement by open surgery at Sardjito General Hospital Yogyakarta have good outcome