Indonesian Journal of Urology
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ADIPOSE-DERIVED STEM CELL TRANSPLANTATION ON URETHRAL MICROVESSEL AND VOIDING FUNCTION
No full textObjective: To examine the effects of adipose-derived stem cell (ADSC) transplantation on urethral tissue microvessel and voiding function on artificial stress urinary incontinence (SUI) in rats. Material & methods: 25 of 32 female wistar rats underwent vaginal distension as animal-SUI model. ADSCs were isolated from the peri-ovary fat, examined for stem cell properties, and labeled with PKH-2. Seven rats without vaginal distension and periurethral ADSCs injection as control. Twelve rats received periurethral injection of phosphate buffer saline as plasebo and 13 rats received periurethral injection of ADSCs. 14 and 28 days later, voided volume was meassured with voided stained on paper and microvessel density was meassured with immunohistochemical analysis (factor VIII R-Ag). Results: Voided volume analysis showed that rats in the plasebo group had abnormal voided volume compare to normal rats in day 14 (168.5 ± 119.05l vs 621.21 ± 283.85l; p 0.05). While in the ADSCs group only showed significant improvement of voided volume compare to abnormal rats in days 14 (379.35 ± 191.74l vs 228.18 ± 56.26l; p < 0.05). Immunohistochemical analysis showed that microvessel density higher in the ADSCs group compare to plasebo group in days 28 (12.86 ± 2.5 vs 9.50 ± 1.64; p < 0.05). Conclusion: ADSCs transplantation promotes improvements voided volume and urethral microvessel in the rat-SUI model.
Keywords: Adipose-derived stem cell, vaginal distension, voided stained on paper, microvessel density
EFFICACY OF SURGICAL SPERM RETRIEVAL IN AZOOSPERMIC PATIENT AND ITS CONTRIBUTION TO IN VITRO RERTILIZATION PROGRAM
No full textObjective: This study was made to evaluate efficacy and success rate of Percutaneous Epididymal Sperm Aspiration (PESA), Microsurgical Epididymal Sperm Aspiration (MESA), or Testicular Sperm Extraction (TESE) in azoopsermic patients, and evaluate IVF program’s pregnancy rate by comparing methods of sperm retrieval. Material & method: A descriptive retrospective study to azoospermic patients undergone PESA, MESA or TESE and IVF program in Bunda Hospital Jakarta and Cipto Mangunkusumo Hospital Jakarta in 2011–2012. The data were collected from patients’ medical records and IVF program’s database. Results: There were 146 azoospermic patients with mean age 38.97 ± 7.35 years. Viable sperm was found in 46 patients (31.5%) by PESA and 47 patients (32.2%) by MESA and TESE. The IVF program was followed by 72 patients. Sperm was retrieved by PESA in 43 patients (59.7%) and TESE in 29 patients (40.3%). Pregnancy was achieved in 18 patients in PESA group (25%) and 15 patients (20.8%) in TESE group. Conclusion: Sperm can be retrieved from azoospermic patients by PESA, MESA or TESE, and there was good success rate in pregnancy rate of IVF program by using surgically retrieved sperm
RETROPERITONEOSCOPIC HEMINEPHRECTOMY: INITIAL EXPERIENCE IN CIPTO MANGUNKUSUMO HOSPITAL JAKARTA
No full textObjective: To explain efficacy and feasibility of heminephrectomy laparoscopic with retroperitoneal approach in double collecting system patients with non-functional upper moiety. Material & methods: Three cases in Cipto Mangunkusumo Hospital’s urology outpatient clinic from July 2013 - January 2014 with double collecting system and non-functional upper moiety. Laparoscopic heminephrectomy with retroperitoneal approach were done to these patients. Results: Surgery was done within 200 - 240 minutes with minimal bleeding and no significant complication. There was no significant hemodynamic disturbance observed during surgery. Patients were able to mobilize and to get immediate oral intake. Pains were minimal and can be treated with first-line analgesics. The patients were discharged on the fourth and fifth day of hospitalization. Conclusion: We are reporting our initial experience doing retroperitoneoscopic heminephrectomy in double collecting system patient. This procedure was feasible and produced good outcomes for the patients
RETROPERITONEAL VS TRANSPERITONEAL LAPAROSCOPIC URETEROLITHOTOMY
No full textObjective: To compare retroperitoneal versus transperitoneal laparoscopic ureterolithotomy in effectivity, pain scale and early complications. Material & methods: In this prospective comparison study from January 2013 to June 2014, 32 patients with proximal and mid ureteral stones underwent retroperitoneal laparoscopic ureterolithotomy or transperitoneal laparoscopic ureterolithotomy. The randomization occured on consecutive sampling on a 1 : 1 basis. Group 1 and 2 consisted of patients who underwent retroperitoneal laparoscopic ureterolithotomy and transperitoneal laparoscopic ureterolithotomy, respectively. Demographic and clinical variable, operative time, length of stay, ureteral suturing, pain scale according to visual analog scale (VAS) and early complications data were collected and analyzed. Statistical analysis was performed with SPSS® version 17.0 using student T-test and Mann-Whitney U tests with p value < 0.05 considered statistically significant. Results:VAS on day 1 between the 2 groups was statistically significant, and was higher in group 2 (p < 0.05). According to the Clavien-Dindo classification of surgical complication all the patients were in grade 1 classification. The differences in operative time, length of stay, ureteral suturing, visual pain analog score on day 3, and early complications between the 2 groups were not statistically significant.Conclusion: Transperitoneal laparoscopic ureterolithotomy is significantly associated with pain than retroperitoneal laparoscopic ureterolithotomy in first day after surgery. Successful stone removal remains the same in both groups
Laparoscopic Live Donor Nephrectomy: Comparison of Left-sided and Right-sided Approach in Our First 50 Cases
No full textObjectives: To compare the operative results and outcomes between right and left laparoscopic live donor nephrectomy (LLDN). Methods: We retrospectively analyzed the first 50 consecutive LLDN in Indonesia performed between November 2011 and February 2013. Of these patients, 6 underwent right LLDNs and 44 left LLDNs. All patients underwent LLDNs in Cipto Mangunkusumo Hospital. All LLDNs were done by the same surgical teams. Intraoperative, post-operative donor and recipient data results were compared.Results: There were no significant differences of intraoperative, post-operative and recipient data results in both groups. The first warm ischemic time (mean±SD, 6min 55sec±145sec vs 7min 37sec±177 sec, p>0.05), the second warm ischemic time (41min 35sec ± 7min 45sec vs 48min 36sec ± 8min 41sec, p>0.05), and the operative time (4hour 41min ± 31min vs 4hour 32min ± 49 min, p>0.05) showed similar results in the right and left LLDN, respectively. Active mobilization on 72-hour post-operation was found in 83,3% in the right LLDN compared to 95,5% (p>0.05). There were no delayed graft function and post-operative hemodialysis within one week in the recipients of right LLDN group. Conclusion: Right LLDN has equal operative results and outcomes compared to left LLDN. Right-sided LLDN may be a judicious approach for donors with unfavorable characteristics of the left kidney
Diagnostic Value of Ureteric Jet Frequency Examination using Color Doppler Ultrasonography to Predict Success of Retrograde DJ Stent Insertion in Uterine Cervicis Carcinoma patients with Hydronephrosis
No full textAbstractObjective: To prove that ureteric jet examination using Color Doppler Ultrasonography (CDU) can be used as a diagnostic tool to predict success of retrograde Double J Stent insertion in uterine cervicis carcinoma patients with hydronephrosis.Materials and Methods: This observational analytic study took 32 samples since May until October 2013. Before, the ureteric jet were counted for 5 minutes using CDU, then continued on the same day with cystoscopy and retrograde DJ Stent insertion. The analysis was using Chi-Square and also Coefficient Contingency test.Results: In both Chi-Square and Coefficient Contingency test, it is proven a significant correlation between success of retrograde DJ Stent insertion and Blood Urea Nitrogen (BUN), creatinine value, grade of hydronephrosis and also ureteric jet examination using CDU, with probability value (p < 0,005). The normal of BUN, creatinine level and the lower grading of hydronephrosis, the more likely successful DJ Stent insertion. Successfulness of DJ Stent insertion is also greater in a positive ureteric jet samples on examination using CDU, with sensitivity value 90,9% and specificity 89,5%, positive predictor value 83,3%, negative predictor value 95% and accuracy value 0,9.Conclusion: Ureteric jet frequency examination using CDU can be used as a success predictor of retrograde DJ Stent insertion in hydronephrosis uterine cervicis carcinoma patients with sensitivity value 90,9% and specificity 89,5%.Keywords: Ureteric jet, Color Doppler Ultrasonography, Double J Stent, Uterine Cervicis Carcinom
URINARY RETENTION EFFECT IN THE INCREASED OF PSA EXPRESSION WITHIN PROSTATIC TISSUE
No full textObjective: To determine whether the increased of PSA expression within prostatic tissue and subsequent systemic blood circulation in acute urinary retention cases of nonmalignant origin were caused by acute inflammation on the prostatic gland. Following this inflammation, PSA willincrease, producing byacinar epitelial cells in the gland and continue to capillary vessels before entering the blood circulation. Material & method: Thirty male Rattus Norvegicus were randomly allocated into 3 groups. A control group underwent urethral manipulation, treatment-1 group and -2 group underwent proximal urethral ligation. Prostatectomy was performed after 24 hours in the control and treatment-1 group. Ligation was removed after 24 hours in treatment-2 group, and prostatectomy performed after 4x24 hours. Each prostate specimen was examined for PSA expression by immunohistochemistry methods in the prostatic gland. Statistical analysis of study data was analyzed by descriptive statistics and performed ANOVA with level of significance α = 0.01.Results: Study results showed an increase PSA expression significantly after urinary retention and returned to normal values four days later after relief of retention.Conclusion: Urinary retention caused acute inflammation on the prostatic gland and increased PSA expression within prostatic tissue. Entry of PSA into stroma and subsequent systemic blood circulation occur through significant increase in PSA production by acinar epithelial cells
ORAL PHENAZOPYRIDINE HCL FOR URETER ORIFICE IDENTIFICATION AND RETROGRADE STENTING
No full textObjective: To compare the successful of the identification of the ureteral orifice at cervical cancer patients who received phenazopyridine orally and to analyze the correlation between hydronephrosis and successful rate for retrograde stenting. Material & Method: This was a comparative experimental study, using phenazopyridine hcl orally prior to cystoscopy to identify the ureteral orifice on cervical cancer patients and to perform retrograde stenting on spotted ureteral orifice. Forty samples provided consent to enroll in this study. Mean age was 49.2 ± 5.16 years. Thirty-four out of 40 samples was confirmed as squamous cell carcinoma type. Results: Chi-square test demonstrated no significant differentiation in finding ureteral orifice between treatment and control group on stage 3B (p = 0.408). However, result shown conversely on stage 4A (p = 0.046). There was no significant disparity in conducting retrograde stenting between treatment and control group on stage 2B and 3B (p = 0.221 and p = 0.197). There was no significant correlation between hydronephrosis gradation and retrograde stenting on control group (p = 0.144). Conclusion: Administration of phenazopyridine HCL orally in cervical cancer patients increase success for ureteral orifice identification and retrograde stenting, but not statistically significant. There is no correlation between hydronephrosis with a success retrograde stenting.Keywords: Cervical cancer, hydronephrosis, phenazopyridine hcl, ureteral orifice, retrograde stenting
CORRELATION OF PROSTATIC VOLUME MEASUREMENT BETWEEN TRANSABDOMINAL ULTRASOUND AND CT SCAN
No full textObjective: This study aims to determine correlation between measurement of prostatic volume and dimensions using transabdominal ultrasound (TAUS) and Computed Tomographic scan (CT scan) in male population ages 50 years and above. Material & method: Research was conducted at Radiology Department, Cipto Mangunkusumo Hospital, Jakarta. Twenty two patients who underwent whole abdominal CT from Desember 2013 to January 2014, were enrolled and examined using TAUS. Results: The calculation shows there is strong correlation between volume measurement, width, and height dimensions between TAUS and CT scan, where the Spearman correlation indicates r = 0.80 with p = 0.000 for volume measurement and r = 0.81 with p = 0.000 for width dimension and r = 0.64 with p = 0.001 for height dimension. There are also regression formula for estimating volume and dimensions measurements using TAUS. Conclusion: This study show strong correlation between volume and dimensions measurement using TAUS and CT scan
EFFICACY OF INTRAVESICAL INSTILLATION OF NETILMICIN ON MANAGING UTI
No full textINTRODUCTION Urinary tract infections (UTIs) are common, affect men and women of all ages, and vary dramatically in their presentation and sequelae. They are a common cause of morbidity and can lead to significant mortality. New antimicrobial agents that achieve high urinary and tissue levels, that can be administered orally, and that are not nephrotoxic have significantly reduced the need for hospitalization for severe infection. Shorter-course therapy and prophylactic antimicrobial agents have reduced the morbidity and cost associated with recurrent cystitis in women. Intravesical instillation of aminoglycoside has been used empirically as prophylaxis and to treat bacilluria in spinal-cord-injured patients undergoing clean intermittent catheterization.METHODS In a prospective clinical trial performed in the urologic ward of Dr. Sardjito Hospital, yogyakarta, Indonesia, we studied 56 patients who has indwelling urethral catheter more than 4 days. Patients were divided into two groups. In group 1 (28 patients) one-time intravesical instillation of Netilmicin 25 mg was administred, and in group 2 (28 patients) none were given any treatment. Urinalysis was evaluated before and after instillation of Netilmicin. Statistical data and results were studied using descriptive statistics as median (minimum and maximum). To compare the response to treatment, Chi-Square test was used in two groups. Consequently, the data were analyzed using the SPSS 17 software.RESULTS Urinalysis were evaluated in two groups 4 days after intravesical instillation of 50 mg netilmicin. The patients we studied, the median age 59 years old (min. 29; max. 81). In the first group we found 22 (78,5 %) patients still without UTI, 6 (21,5 %) patients with UTI, in the second group we found 4 (14,3 %) still without UTI, 24 (85,7 %) patients with UTI. The difference was statistically significant (p=0.0001)CONCLUSIONS Intravesical instillation of netilmicin on patients with indwelliing urethral catheter were effective on preventing catheter-related UTI.Keywords : UTI, indwelling catheter, netilmicin, intravesical antibiotic instillation