Indonesian Journal of Urology
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THE CORRELATIONS AMONG COMPONENTS OF METABOLIC SYNDROME PSA AND PROSTATE VOLUME IN BPH PATIENTS
No full textObjective: This study was to evaluate the associations among metabolic components, prostate specific antigen (PSA), and prostate volume (PV) in benign prostate hyperplasia (BPH) patients.Material & method: During the period from January 1, 2010 to August 31, 2013, 61 mens were diagnosed with BPH were enrolled. PV by transabdominal ultrasonography of the prostate, serum PSA, metabolic syndrome (MS) related parameters were investigated. MS was defined according to the modified National Cholesterol Education Program Third Adult Treatment Panel Guidelines. We evaluated the correlation between PSA, PV and MS components using Spearman’s test and Independent t test.Results: PV were not correlated with MS criteria (p=0.591) PSA total also were not correlated with MS criteria (p=0.305). PV were not correlated with each components MS; cholesterol total (p=0.593), trigliserid (p=0.479), HDL (p=0.702), LDL (p=0.512), blood glucose (p=0.317). PSA total were not correlated with each components MS; cholesterol total (p=0.255), trigliserid (p=0.543), HDL (p=0.446), LDL (p=0.615), blood glucose (p=0.987). Conclusion: There were no associations among metabolic syndrome criteria and each components, prostate volume and PSA total
INITIAL EXPERIENCES WITH THREE RENAL ARTERIES OF KIDNEY ALLOGRAFT IN KIDNEY TRANSPLANTATION: A CASE SERIES
No full textObjective: This study reported a case series of our initial experiences in kidney transplantation with three renal arteries of the kidney allograft. Material & methods: The kidney allograft from all of the four cases was harvested with laparoscopic living donor nephrectomy. End-to-side anastomosis was performed from the small artery to the larger main artery before side-to-side anastomosis was performed between the two arteries of equal size. After joining the renal arteries we performed end-to-side anastomosis from the renal vein and artery to the external iliac vein and artery respectively. Results: All of the four cases respond well to the allograft kidney. Three recipients had normal serum creatinine level before 5 days after transplantation. One recipient had undergone hemodialysis once on the third day after transplantation. All of the recipients have no vascular and urologic complications. Conclusion: Multiple renal arteries are no longer considered as a relative contraindication, especially with meticulous anastomosis technique. No vascular and urologic complication was observed from this technique
RELATION BETWEEN COMPLICATING FACTORS OF HYPOSPADIA AND COMPLICATIONS AFTER TIP: A RETROSPECTIVE STUDY
No full textObjective: This study aims to find an association between hypospadias complicating factor for complications that occurred after hypospadias reconstruction, focusing on tubularized incised plate (TIP) as reconstruction techniques are most commonly used. Material & methods: The study data was obtained from medical records of urologic hypospadias patients in Cipto Mangunkusumo General Hospital, Jakarta. Samples are those who underwent hypospadias reconstruction in Cipto Mangunkusumo General Hospital, since April 2002 until May 2014 with a total sampling method. Data were analyzed using SPSS ver 14. Results: We collected 127 patients who underwent the TIP technique with a mean patient age and treatment duration was 7.58 years and 10.95 days. Fistule is the most common complication in patients with post-TIP hypospadias accounting for as high as 32 (25.2%). Bivariate analysis showed a significant correlation between the location of the hypospadias meatus (distal) with torsion of the penis (n = 2; p 0.019). Conclusion: On the basis of the technical complications TIP, such as fistules, meatus stenosis, urethral stricture, torsion of the penis, and glans dehiscence, then the indication for TIP should be clear or selective
PERCUTANEUS NEPHROSTOMY IN PATIENTS WITH OBSTRUCTIVE UROPATHY DUE TO MALIGNANCY: A SURVIVAL ANALYSIS
No full textObjective:To find out effectiveness of percutaneous nephrostomy (PCN) and patient survival rate as palliative decompression of the obstructed urinary system due to malignancy (urogenital neoplasias). Materials & Methods: A cohort retrospective study was performed with 76 patients (58 female and 18 male) with malignancy process who were undergoing percutaneous nephrostomy during January 2009 – December 2012, in Sardjito General Hospital Yogyakarta. Survival analysis was done by Kaplan-Meier method and differences were assessed using the log-rank test. Results:There was no procedure-related mortality. The mean of age was 49.14 years. The primary tumoral site was the uterine cervix in 56.6 %, the bladder in 17.1 %, the prostate in 2.6% and other sites (intestinal, ovarium and other malignancies caused obstructive uropathy) in 23.7%. The patients died during the hospitalization period due to advanced neoplasia are 17.1%. The mortality rate was higher in patients with interval between diagnose of obstructive uropathy and nephrostomy > 7 days (HR=5.7; 95%CI 4.5-6.9; p = 0.001) and in those who required hemodialysis before the procedure (HR=6.1; 95%CI 4.7-7.4; p = 0.001). The survival rate was 55.2% (42/76) at 6 months and 32.9% (25/76) at 12 months. The percentage of the lifetime spent in hospitalization was 17.1% (13/76). There are no differences on survival rate in that patients based on neoplasias type and age.Conclusion: The urinary obstruction must be immediately relieved. The percutaneous nephrostomy is a safe and effective method for relief the obstruction. Patient with hemodialysis before the procedure had a poor prognosis
PERBEDAAN KADAR PSA DAN TGF-β1 TERHADAP PEMBERIAN KOMBINASI INHIBITOR 5α-REDUKTASE (DUTASTERIDE) DAN ANTI ESTROGEN (TAMOXIFEN) PADA PASIEN BPH LUTS
Get PDFObjective: To compare the PSA and TGF-β1 plasma level before and after administration of a 5α-reductase inhibitor (dutasteride) and an anti estrogen (tamoxifen) in nonobstructive patients with BPH. Material and Method: We enrolled 40 patients with a diagnosis of BPH without urinary retention. Patients were allocated into 4 groups of 10 patients and were given tamoxifen, dutasteride, a combination of tamoxifen and dutasteride, or placebo. We measured PSA and TGF-β1 plasma levels at study entry and 3 months after administration. Data were analysed using SPSS 12. Results: Increase of TGF-β1, as high as 54% (2,18 ± 0,88 to 3,36 ± 1,06) in the tamoxifen group, 26% (2,75 ± 0,62 to 3,47 ± 0,82) in the dutasteride group, and 92% (2,37 ± 0,75 to 4,56 ± 1,98) in the combination group, was significant (p < 0,05). PSA was not significantly decreased in all groups (p > 0,05). PSA decreased 28% (4,25 ± 3,28 to 3,06 ± 3,08) in the tamoxifen group, 27% (2,20 ± 2,17 to 1,60 ± 0, 982) in the dutasteride group, and 19% (2,95 ± 1,22 to 2,40 ± 1,78) in the combination group. In the placebo group was no significant difference of both parameters. Conclusion: TGF-β1 was significantly increased in all groups except in placebo. PSA was decreased in all groups but not significant statistically. We concluded that TGF-β1 may better be used as a biomarker in the evaluation and management of BPH than PSA
THE ROLE OF BEDSIDE BLADDER SONOGRAPHY FOR DETECTION OF BLADDER TRAUMA
No full textObjective: To evaluate the role of bedside bladder sonography along with retrograde instilation of saline as a novel diagnostic procedure for suspected bladder trauma. Material & methods: Prospective evaluation of all patients with suspected bladder injuries admitted to the Emergency Department of Hasan Sadikin General Hospital, Bandung, Indonesia, from 2010–2013. Suspected urethral injury patients were excluded. Along with routine Focused Assessment Sonography for Trauma (FAST) procedure, bedside bladder sonography was performed concurrently with retrograde instillation of normal saline 350cc through a Foley catheter. The objective of real-time bladder sonogram was to examine the presence of peri-vesical free fluid turbulence and accumulation during saline instillation, which subsequently indicated a suspected bladder perforation. The accuracy of sonographic results were compared with computerized tomography (CT), cystogram or intraoperative findings. Time to diagnosis was recorded. Statistical analysis was performed to evaluate the sensitivity, specificity, positive predictive value (PPV), negative predictive value(NPV) and diagnostic accuracy. Results: 23 patients met the inclusion criteria. The mean age was 27.21 years old, 87% were males. Based on cystogram or intraoperative finding there are 21 patients have bladder rupture. Among these patients, 14 patients had positive result onbladder sonogram, and all confirmed positive on cystogram and operative finding. Nine patients had negative result on bladder sonogram. While 7 among them have positive result on cystogram or intraoperative finding. Analysis revealed 67% sensitivity, 100% specificity, 100% PPV, and 22.2% NPV. Overall diagnostic accuracy of bladder sonogram was 83.5%. Time to diagnosis were significantly shorter in bedside bladder sonogram compared to CT or cystogram (11.82 ± 2.99 min vs 181.30 ± 88.89 min; p < 0.05). Conclusion: Bedside bladder sonogram is a useful adjunct procedure for diagnosis of bladder trauma. It is time and cost effective, and can be performed in bed-side emergency setting with acceptable accuracy
CUT-OFF POINT OF PSA AND PSA DENSITY IN PROSTATE CANCER SUSPECTED PATIENTS
No full textObjective: In Hasan Sadikin General Hospital Bandung prostate biopsy is recommended for patients with prostate specific antigen (PSA) levels above 10 ng/mL or PSA density (PSAD) above 0.15 if PSA in between 4–10 ng/mL. However, there were other factors beside of prostate cancer (PCa) that could influence PSA value, such as racial differences and prostatitis. Thus, the optimal cut-off point for PSA is still debatable in national level. This research aimed to determine PSA and PSAD cut-off point for patient suspected of PCa in Hasan Sadikin Hospital Bandung. Material & Methods: A total of 502 patients underwent prostate biopsy for suspicion PCa from 2010–2014. The cut-off point of PSA and PSAD is generated from receiver operating characteristic (ROC) curve. Results: The cut-off point for PSA was 14.6 ng/mL (sensitivity 81.4%, specificity 29.8%). The cut-off point for PSAD was 0.23 (sensitivity 81.4%, specificity 34.8%). Positive predictive value (PPV) for this new cut-off point of PSA and PSAD were 41.1% and 37.6% respectively. Conclusion: PSA and PSAD cut-off point for patients in our center was 14.6 ng/mL and 0.23 respectively. This value is relatively higher compared to the Indonesian consensus. The difference might occur due to high rate of urinary tract infection in patients attending Hasan Sadikin General Hospital Bandung
INITIAL EXPERIENCE OF LAPAROSCOPIC PARTIAL NEPHRECTOMY IN HASAN SADIKIN GENERAL HOSPITAL BANDUNG
No full textObjective: To describe our experience about laparoscopic partial nephrectomy to treat localized renal tumour patients in Urology Department Hasan Sadikin General Hospital Bandung. Material & method: In 2014, there were 6 female patients that underwent laparoscopic partial nephrectomy in Hasan Sadikin General Hospital Bandung. In one case, there were tumours on both kidneys. Five patients were underwent transperitoneal approach and 1 patient were undergo retroperitoneal approach. All patients were examined with ultrasonography and Abdominal CT scan with contrast. We also calculate RENAL nephrometry score. Results: There were 6 female patients with left flank pain that undergo laparoscopic partial nephrectomy. In one case, there are tumours on both kidneys. In RENAL nephrometry score calculation, there were 3 patients with 10x score, 1 patient with 11x score, 1 patient with 7x score, and 1 patient with 6p score. From all of them, 4 patients were successfully performed laparoscopic partial nephrectomy, 1 patients was undergo laparoscopic nephrectomyand 1 patient is converted to open partial nephrectomy. Five patients were undergo transperitoneal approach and 1 patient was undergo retroperitoneal approach. Surgery ranged from 180-240 minutes. Intra operative bleeding was ranged from 50-200 cc. Tramadol intravenous was used for post operative pain control. With VAS score in first post operative day was 6, and 2 at the time of discharge. Hospitalized time was ranged from 4-6 days. Conclusion: Laparoscopic partial nephrectomy is an alternative treatment that safe for localized renal tumour. This procedure is depend on the technique and approach from each Urologist. Our limitations are we didn’t have laparoscopic ultrasonography and the tumour close to pelvocalyces system
THE EFFICACY OF NASOGASTRIC TUBE IN A LARGE BLOOD CLOT EVACUATION DURING CYSTOSCOPY
No full textObjective: In this study we introduce using nasogatric tube as an alternative to procure a safe and efficient way to remove large troublesome blood clots during cystoscopy procedure. Material & methods: We prospectively perform blood clot evacuation using nasogastric tube suction (NGT) on 21 patients in Hasan Sadikin GeneralHospital Bandung,within 6 months period. A 24 fr sheath and 16 fr NGT connected to suction unit with a 300 mmhg negative pressure was set. A repetitive back and forth technique was set in motion during the procedure. Cystoscopy time and NGT suction time was documented. Results: All patients were successfully managed with this method without complication during the procedure. The average time for clot removal was 5 minutes 8 seconds with average cystoscopy time was 20 minutes 12 seconds and average estimated blood clots volume was 483 grams. Conclusion: Evacuation using NGT suction is effective, safe and an efficient way to remove a large bothersome clots
RELATION BETWEEN AGING MALE SYMPTOM SCORE (AMS SCORE) AND AGE
No full textObjective: To study the relation of the Aging Male Symptom Score (AMS score) with age groups, and to find the age when the AMS score increases. Material & method: In all, 347 patients with age beginning at 50 years underwent an interview with the AMS Score questionnaire, then they were divided according to age in groups, less than or equal to 50 years, 51 – 55 years, 56 – 60 years, and more than 60 years. Results: In the age group less than or equal to 50 years, there were 26 men (7,5%). With an abnormal AMS psychology, there were 18 men, with abnormal AMS somatovegetative score there were 20 men, with an abnormal AMS sexual score 20 men, and with abnormal total AMS Score 14 men. In the age group 51 – 55 years, there were 146 men (42,07%), with an abnormal AMS psychology in 75 men, with abnormal AMS somatovegetative score 114 men, abnormal AMS sexual in 123 men, and abnormal total AMS Score in 71 men. In age group 56 - 60 years there were 48 men (13,83%), abnormal AMS psychology in 35 men, abnormal AMS somatovegetative score in 44 men, abnormal AMS sexual in 45 men, and abnormal total AMS Score in 35 men. In the age group of more than 60 years, there were 127 men (36,6%), abnormal AMS psychology was found in 87 men, abnormal AMS somatovegetative score in 112 men, abnormal AMS total sexual score 122 men, and abnormal total AMS score was in 96 men. All of the AMS score values significantly increased after 55 years old, p value at AMS psychology was 0,005, AMS somatovegetative was 0,000, AMS sexual was 0,000, and at total AMS Score was 0,000. To define the age when AMS score increases. The conclusion was that AMS psychology values begin to increase after 55 years (sensitivity 69,71, specificity 45,93), AMS somatovegetative values increase after 55 years (sensitivity 89,14, specificity 22,09), and total AMS score value begins to increase at 55 years (sensitivity 74,86, specificity 50,58). However, AMS sexual value increase at 50 years (sensitivity 90,34, specificity 23,08). Conclusion: All of the AMS score values increase significantly at 55 years