Indonesian Journal of Urology
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ANGKA KEBERHASILAN DAN KOMPLIKASI PCNL PADA PASIEN BATU GINJAL DI RUMAH SAKIT CIPTO MANGUNKUSUMO TAHUN 1999 – 2006
Get PDFObjective: To study the results of renal stones treatment with PCNL in terms of complication and stone free rate in Cipto Mangunkusumo Hospital. Material & methods: Retrospective study of renal stone patients who were treated with PCNL at the Department of Urology, Cipto Mangunkusumo Hospital from January 1st 1999 until May 31st 2006. Results: There were 213 patients between 8 until 80 years old done for various stone localizations in the kidney. The overall stone free rate was 74,2%. The complication rate was 10,8%, bleeding in 15 patients (7,1%), leakage in 5 patients (2,3%), and colon perforation in 3 patients (1,4%). There was no artery + vena renalis perforation, urosepsis, hydro/pneumothorax or mortality in this group. Results are similar with experience in the literature. Conclusion: PCNL is a safe procedure for renal stones removal. It gives satisfactory results as well as a low complication rate, but if complications occur the morbidity can be severe. Hence, this procedure has to be done very meticulously
FACTORS ASSOCIATED WITH INTRACYTOPLASMIC SPERM INJECTION OUTCOME IN MEN WITH AZOOSPERMIA AND SEVERE OLIGOZOOSPERMIA
No full textObjective: This study is assigned to evaluate factors that associated with intracytoplasmic sperm injection (ICSI) outcome. Material & methods: A retrospective study design is used to evaluate couples who seeking help for infertility problems at Permata Hati Infertility Clinic, Sardjito General Hospital Yogyakarta. The outcome measures were fertilization and clinical pregnancies rates. All analyses were performed with SPSS statistical software, version 20.0. Result: Forty-five couples participated in this study with mean age 33.69 ± 5.38 years for men and 30.53 ± 4.79 years for women. Of 56 ICSI cycles, there were 43 successful fertilizations (95.6%) and 14 clinical pregnancies (31.1%). In multivariate analysis, factors associated with successful clinical pregnancies were women’s age (p = 0.034, 95% CI 0.005-0.8), number of ICSI cycle (p = 0.045, 95% CI 0.001-0.93), and sperm morphology (p = 0.019, 95% CI 1.648- 253). In bivariate analysis, only men’s age is significantly associated with successful fertilization (p = 0.006, 95% CI 7.22-16.43). Conclusion: Factors associated with outcome of ICSI are women’s age, number of ICSI cycle, and sperm morphology
TOTAL CHOLESTEROL AND C-REACTIVE PROTEIN LEVELS AS A PROGNOSTIC MARKERS OF UROSEPSIS
No full textObjective: To investigate whether total cholesterol and C-reactive protein levels could be use as a prognostic factor for outcome in patients with urosepsis. Material & Methods: An analytic observational study using 30 patients assigned for total cholesterol and CRP level at the day of admission, three days later, and on the last day of sepsis or on the dead day. All subjects were managed according to standard urosepsis therapy. At the 14th day of treatment, patients were evaluated with a clinical severity score. Then we classified the outcome as improve/good condition, worse, and died. The variables were statistically tested using Spearman’s rho test with software SPSS 20. P < 0.05 was consider significant. Result: From 30 subjects with urosepsis, we found 15 patients in septic condition, 14 patients had severe sepsis and one patient had septic shock. The mean of total cholesterol level in patient with died and worse was lower than that in patient with good outcome. Day-1 (63.25 mg/dl and 101.38 mg/dl vs 119.5 mg/dl), day-3 (56.0 mg/dl and 93.6 mg/dl vs 128.6 mg/dl) and last day/died day (51.0 mg/dl and 82.25 mg/dl vs 154.8 mg/dl). The mean of CRP level in patient with died and worse was higher than that in patient with good outcome. Day-1 (177.18 mg/l and 146.74 mg/l vs 88.1 mg/l), day 3 (127.1 mg/l and 148.8 mg/l vs 56.2 mg/l) and last day/died day (141.88 mg/l and 88.71 mg/l vs 31.58 mg/l). These were statistically significant between total cholesterol and CRP levels in determining the outcome of urosepsis patient. Day-1 (p 0.000 vs 0.011), day-3 (p 0.000 vs 0.002), and last day/died day (p 0.000 vs 0.000). The coefficient correlation total cholesterol was better than CRP in day-1 (rho -0.633 vs 0.459), day-3 (rho -0.755 vs 0.543), and last day/died day (rho -0.874 vs 0.686). Conclusion: Low total cholesterol and high C-reactive protein levels can be used as poor prognostic in urosepsis patients. Total cholesterol level was better than CRP as a prognostic marker
DELAYED GRAFT FUNCTION FOLLOWING LAPAROSCOPIC LIVE DONOR NEPHRECTOMY: A MULTIVARIATE ANALYSIS
No full textObjective: This study was performed to define and investigate the incidence, risk factors, and clinical characteristics of delayed graft function (DGF) in laparoscopic live donor nephrectomy (LDN). Material & methods: We retrospectively analyzed the medical records of donor and recipient from our first 100 cases of laparoscopic LDN in Cipto Mangunkusumo General Hospital Jakarta, from November 2011 to February 2014. The criteria used to define DGF were the requirement for dialysis in postoperative week 1 and/or serum creatinine greater than 2.5 mg/dl at postoperative day 7. Patients who did not match any of these criteria were define as having normal renal allograft function. Results: The overall prevalence of DGF was 14%. Recipients body mass index, cold ischemia time, vascular anastomosis time, and total ischemia time were higher among the delayed graft function group, but no risk factors for DGF were significantly associated after multivariate analysis. Conclusion: The incidence of DGF in our study was in the range of that observed in previous studies. The factors that previously reported and believed as risk factors of DGF in laparoscopic LDN were not significantly associated with the development of DGF in our study
CONGENITAL HYDRONEPHROSIS: PROBLEMS IN DIAGNOSIS AND MANAGEMENT
Get PDFObjective: To evaluate problems in diagnosis and management of congenital hydronephrosis. Material & methods: This study was retrospective. Data was collected from medical records of patients with congenital hydronephrosis, which were hospitalized or went to urologic outpatient clinic at Ciptomangunkusumo Hospital from January 1999 to December 2008 and Harapan Kita Maternal and Pediatric Hospital from January 2004 to December 2008. Data was analyzed with SPSS programme version 13.0. Statistical analysis was performed to find the relationship between age at diagnosis and kidney function (Mann-Whitney test) and between age at diagnosis and nephrectomy rate (Chi-Square test). Results: There were 15 patients who presented because of antenatal diagnosis. Of the 145 patients, we could collect antenatal history only from 63 patients. Obstetricians provided antenatal care in 56 out of 63 patients. Antenatal ultrasound was performed in only 59 out of 63 patients and only 44,07% (26 patients) with hydronephrosis was detected antenatally. Eleven out of 26 antenatally diagnosed patients came to our clinic at a later age. Three standard studies (postnatal ultrasound, voiding cystourethrogram, and renal scintigraphy) were performed only in 12 out of 145 patients (8,27%). Ultrasound was performed in 108 patients (74,5%), voiding cystourethrogram in 79 patients (54,5%), and renal scintigraphy in only 26 ptients (17,9%). The suggested management was conducted in 115 patients; operative management in 95 patients (82,61%) and conservative treatment in 20 patients (17,39%). The most common operative procedures were ureteroneocystostomy, pyeloplasty, nephrectomy, and posterior urethral valveablation. Mean serum creatinine in below 12 months old group and above 12 months old group was 0,78±0,93mg/dl dan 1,03±0,88 mg/dl respectively(p<0,05). There was no significant difference in nephrectomy rate in both age groups (p>0,05). Nephrectomy was performed in 16 patients, with the most common indication was grade IV hydronephrosis with thin parenchyma in 11 patients (68,75%) and the most common etiology was UPJ obstruction in 10 patients (62,5%). We can only collect follow up data from 73 out of 115 managed patients (63,48%). Urinalysis, ultrasound/voiding cystourethrogram, and renal function studies were not routinely conducted during follow up. Conclusion: The management of congenital hydronephrosis in Indonesia needs improvements in antenatal care standards, particularly obstetric ultrasound, to improve early detection of congenital hydronephrosis. Better education for parents about the importance of follow up is needed, especially for antenatally diagnosed patients. A consensus regarding diagnostic tools used in managing congenital hydronephrosis must be established among urologists, pediatricians, and radiologists
PERBANDINGAN DAN PENYEBARAN ESCHERICHIA COLI DAN KLEBSIELLA PNEUMONIAE PENGHASIL EXTENDED SPECTRUM BETA-LAKTAMASE PADA ISOLAT URINE PASIEN PRIA DENGAN KATETER DAN TANPA KATETER
Get PDFObjective: membandingkan dan menelaah penyebaran bakteri Eschericchia coli dan Klebsiella pneumoniae penghasil ESBL pada pasien dengan kateter dan tanpa kateter. Material & methods: Sampel dalam penelitian ini adalah 194 orang pasien di bagian urologi RSU Dr. Soetomo Surabaya Yang memenuhi criteria inklusi, yang dibagi dalam 2 kelompok secara random. Sembilan puluh tujuh orang pasien dipasang kateter dan 97 orang yang lain tidak dipasang kateter. Bakteri yang diteliti adalah Eschericchia coli dan Klebsiella pneumoniae yang menjadi resisten akibat peran ESBL. Semua hasil kultur urine diperiksa dan dicatat. Results: Didapatkan Persentase kejadian E. coli pada pasien yang dipasang kateter lebih tinggi dibandingkan yang tidak dipasang kateter, yaitu 51,2% : 48,8%, sedangkan persentase kejadian K pneumonia pada pasien yang dipasang kateter lebih rendah dibandingkan yang tidak dipasang kateter, yaitu 45,5% : 54,5%. Persentase ESBL negatif pada pasien yang dipasang kateter lebih rendah dibandingkan yang tidak dipasang kateter, yaitu 38,9% : 61,1%, sedangkan persentase ESBL positif pada pasien yang dipasang kateter lebih tinggi dibandingkan yang tidak dipasang kateter, yaitu 72,2% : 27,8%. Persentase penyebaran E. coli dibandingkan K. pneumonia lebih tinggi pada E. coli, yaitu 34,9% : 27,3%. Conclusion: Tidak ada perbedaan penyebab kejadian infeksi oleh kuman E. Coli dan K. Pneumoniae pada pasien dengan kateter dan tanpa kateter. Angka kejadian E. coli dan K. pneumoniae penghasil ESBL pada pasien pemakai kateter lebih tinggi daripada pasien pria tanpa kateter di bagian urologi. Adanya penyebaran klonal E. coli dan K. pneumoniae penghasil ESBL dari pasien satu ke pasien urologi lain.
TRANSPERITONEAL LAPAROSCOPIC URETEROLITHOTOMY FOR LARGE DISTAL URETERIC STONE
Get PDFObjective: This study is aim to share our experience (in videos) in Laparoscopic ureterolithotomy for large distal ureteric stone with transperitoneal approach. Material & methods: A 37 years old male has been diagnosed with a right hydronephrosis due to proximal ureterolithiasis and stone at left calyx inferior, first and stone migrated to right distal ureter on 12 hours prior surgery, in Hasan Sadikin Hospital Bandung. He underwent laparoscopic ureterolithotomy with transperitoneal approach. Results: We successfully perform laparoscopic ureterolithotomy with transperitoneal approach on a 37 years old male patient who diagnosed with a right hydronephrosis due to distal ureterolithiasis and stone at left calyx inferior. Duration of operation was 45 minutes. Patient was discharged at 2nd postoperative day without any complications. Conclusion: A transperitoneal laparoscopic ureterolithotomy for distal ureteric stone is a safe and feasible technique that should be an options on every patients who is planning to undergo distal ureterolithotomy especially large stone.
Keywords: Transperitoneal, laparoscopy, distal ureterolithotomy
THE INSIDENCE OF BLADDER SQUAMOUS CELL CARCINOMA IN LARGE BLADDER STONE CASES
No full textObjective: To determine the incidence of squamous cell carcinoma (SCC) in patients with large bladder stone (> 40 mm). Material & method: This is a descriptive retrospective cross-sectional study, data was collected from medical record on patients with a diagnosis of large bladder stone (> 40 mm) that have been performed surgical removal of stone (vesicolithotomy) and bladder mucosa biopsy in Hasan Sadikin Hospital Bandung during 2006-2010. Furthermore, the data are classified according to pathology. Results: This study found cases of large bladder stone (> 40 mm) of 47 cases during the period 2006-2010, and of these 47 cases, there were 76.7% and 23.3% non-malignancy of a malignancy in 2 cases (4.3%) with anatomical pathology picture of SCC. Based on the age group of patients aged 31-40 years obtained 25.5%, 41-50 years 21.3%, 51-60 years 21.3% and > 60 years 23.4%, whereas for ages below 30 years 8.5%. Based on sex, male 95.7% and 4.3% of women. Based on the size, found a stone the size of 40 mm (48.9%), stone size of 50 mm (10.6%), stone size 60 mm and 70 mm respectively (8.5%), stone size 80 mm (12.8%), stone size > 80 mm (4.3%) and 6.4% with multiple bladder stones. Conclusion: There were only two cases of bladder SCC from 47 cases patients with large bladder stone (> 40 mm) in Hasan Sadikin Hospital Bandung during 2006-2010.
Keywords: Bladder Stone, bladder carcinoma, squamous cell carcinoma
LAPAROSCOPIC RADICAL CYSTECTOMY WITH ILEAL CONDUIT URINARY DIVERSION, FIRST EXPERIENCE IN BANDUNG
No full textObjective: To report our experience in performing laparoscopic radical cystectomy with ileal conduit urinary diversion (extracorporeal reconstruction). Material & method: This study was take place in Hasan Sadikin Hospital Bandung. A 54-year-old male with histologically proven transitional cell carcinoma of the bladder cT2bN0M0 underwent a laparoscopic radical cystoprostatectomy and ileum dissection was performed under laparoscopy. Ileal conduit and stoma reconstruction performed extracorporeal through small incision between ports (about 4cm). Results: The surgical margins were free of disease. The operative time was 360 minutes. Estimated blood loss was 600cc. Hospital stay was 5 days. Patient was discharge with no complication of post-op wound, and urine production about 1500cc/24hrs via stoma. Conclusion: Laparoscopic radical cystectomy with ileal conduit extracorporeal reconstructive urinary diversion could be the preferred means in managing bladder tumor on selective case
COMPARISON OF FOSFOMYCIN TROMETAMOL WITH CIPROFLOXACIN FOR UNCOMPLICATED UTI DUE TO E.COLI IN WOMEN
No full textObjective: To compare clinical therapeutic effects (frequency, dysuria, and pyuria), microbiology, pharmacokinetics index Cmax/MIC Fosfomycin Trometamol 3 gr single dose with Ciprofloxacin 2 x 500 mg/12 hours for 5 days in the treatment of uncomplicated UTI in women due to Escherichia coli (E.Coli). Materials & Methods: Experimental observational design from February until July 2013. Twenty two women with uncomplicated UTI due to E.Coli performed clinical and microbiological examination. Pharmacokinetics index (Cmax/MIC) is looked for. Patients are divided 2 group, Ciprofloxacin 500 mg/12 hours 5 days and Fosfomycin Trometamol single dose. Repeat clinical and microbiological evaluation is performed in 7 days after therapy. Statistic analysis use Chi Square test, Paired T test, and Independent T test. Results: In the treatment of uncomplicated UTI in women, Fosfomycin Trometamol single dose therapy provides clinical cure (dysuria 81.2%, p = 0.338, frequency 90.9%, p = 0.004, pyuria 90.9%, p = 0.009) much better than Ciprofloxacin 500 mg/12 hours 5 days. Fosfomycin Trometamol single dose therapy also provides bacteriological eradication (100%) better than Ciprofloxacin 500 mg/12 hours 5 days (p = 0.035). Fosfomycin Trometamol single dose had a higher pharmacokinetics index (Cmax/MIC) compared to Ciprofloxacin 500 mg/12 hours (p = 0.035). Conclusion: Fosfomycin Trometamol single dose therapy is superior to Ciprofloxacin 500 mg/12 hours 5 days in the treatment of uncomplicated UTI in women. Keywords: Therapeutic effect, fosfomycin trometamol, ciprofloxacin, uncomplicated UTI, Escherichia coli