Indonesian Journal of Urology
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DIAGNOSTIC VALUE OF NON-CONTRAST HELICAL CT-SCAN AND INTRAVENOUS UROGRAPHY IN UROLITHIASIS EVALUATION
No full textObjective: To evaluate the diagnostic value of Non Contrast Helical Computed Tomography (NCHCT) scanning as the first choice diagnostic modality for detecting urolithiasis cases in Soetomo General Hospital Surabaya and evaluate the feasibility as alternative to Intravenous Urography (IVU). Material & Methods: Seventeen patients with clinical manifestation of suspected urolithiasis underwent NCHCT and IVU to evaluate suspected urolithiasis. Reformatted three-dimensional CT was performed in all patients. The images were correlated with findings from surgical procedure (ureteroscopy, percutaneous nephrolithotomy, and open surgery). Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were determined for NCHCT and IVU. Results: The diagnosis of urolithiasis was defined as unequivocal evidence of urolithiasis on either NCHCT or IVU. Sixteen of seventeen patients evaluated were diagnosed with urolithiasis. NCHCT established the diagnosis in 16 of 17 patients while IVU was positive in 11 of 17 patients. IVU was negative in 6 of the 17 cases. The sensitivity, specificity and accuracy of NCHCT was 100%, 100%, and 100% respectively (p = 0.05) and the sensitivity, specificity, and accuracy of IVU was 68%, 100% and 70% respectively (p = 0.35). There was no statistically significant difference between IVU and NCHCT using Fisher’s exact test. Conclusions: NCHCT accurately diagnosed urolithiasis in patients with suspected urolithiasis. Considering that NCHCT is more effective and efficient than IVU as diagnostic modality in determining the presence of urolithiasis, it may be considered to replace IVU as the first line diagnostic tool for urolithiasis in Soetomo General Hospital Surabaya.
Keywords: Non Contrast Helical CT Scan, Intravenous Urography, Urolithiasis
EXPERIENCE ON TRANSPERITONEAL LAPAROSCOPIC DIVERTICULECTOMY IN UROLOGY DEPARTMENT HASAN SADIKIN HOSPITAL BANDUNG
No full textObjective: To described our experiences in treating large bladder diverticulum using transperitoneal laparoscopic techniques in Urology Department Hasan Sadikin Hospital, Bandung. Material & method: There were 3 patients with bladder diverticulum due to bladder outlet obstruction. There are 2 males and 1 female patients. The bladder outlet obstruction was caused by BPH in both male patients and urethral stenosis in female patient. The bladder diverticles were located in left lateral bladder wall in 2 patients and right lateral bladder wall in 1 patient. All the patients underwent two stages procedure. Initially, we perform correction of the obstruction. Next stages were transperitoneal laparoscopic diverticulectomy. Result: The operating time was improving in each procedure, with average time was 180 minutes. Drain was removed in 3 days in one patient and 2 days in 2 patients. Cystostomy was removed in POD 14 in all patients. One month post operatively, we performed cystography and all of the patients had a normal result without any extravasation. The patients was discharge on day 7 in one patient and day 4 in 2 patients post operatively, with minimal pain. Until now, patient was still under follow up and no major complication was found. Conclusion: Transperitoneal laparoscopic diverticulectomy is a save alternative for the management of bladder diverticulum with minimal post-operative pain and length of stay
RISK FACTORS IN SEVERE ERECTILE DYSFUNCTION POPULATION
No full textObjective: To find the risk factors of severe erectile dysfunction. Material & methods: This Cross sectional study subjects completed the questionnare at the time of diagnosing Erectile Dysfunction (ED). Amount of 297 ED patients with mean age of 49.08 ± 13.69 years were enrolled consecutively at Urology Outpatient Clinic from 2005 to 2012. The questionnaire consisted of marital status, educational status, and occupation, comorbidities, habits, and International Index of Erectile Dysfunction-5 (IIEF-5) questionnare. We compared population proportion of ED severity (severe vs not severe) between sociodemographic, comorbidities and habits group and we also compared the mean of ED onset age and ED duration between those groups. Results: Of the patients, 29.3% were classified as severe ED, and 70.7% were classified other than severe ED (mild, mild-moderate, etc). The median of ED onset age was 47 years (46.64 ± 13.77 years) and the median of ED duration was 52 weeks (126.75 ± 167.69 weeks) ranged from 1 to 1040 weeks. We found status of low education level, unemployed, not married and having diabetes mellitus could increase the risk of having severe ED in ED population with each prevalence ratio was 1.44 (1.12-1.87), 2.02 (1.20-3.42), 1.91 (1.10-3.30), 2.01 (1.30-3.12). Not married group was also found have an earlier mean of ED age onset (mean difference 6.78 (2.37-11.19) years. Conclusion: We found that education level, occupation status, marital status and diabetes mellitus contributes in determining ED severity
LAPAROSCOPIC LEFT HEMINEPHRECTOMY IN COMPLETE DOUBLE COLLECTING SYSTEM WITH MULTIPLE UPPER MOEITY KIDNEY STONE
No full textObjective: Laparoscopic heminephrectomy was firstly reported by Jordan and Winslow in 1993. Laparoscopic heminephrectomy has recently been described as a feasible procedure for the treatment of poorly functioning renal moiety in the duplex kidney. However, this minimally invasive technique is a complex procedure that has remained confined to the hands of experienced teams, with a limited number of reports of relatively few cases. In Indonesia, it has rarely been done. Material & method: A 49-year-old male with chief complaint of pain at the left flank for 2 months. From IVU, we found double collecting system with left upper moiety kidney stone. Then we performed laparoscopic left heminephrectomy. Result: Operative time was 2 hours 30 minutes with bleeding < 100 mL. Post operative VAS was 3 with paracetamol analgetic. Patient was discharged 5 days after operation without any complaint. Conclusion: Laparoscopic heminephrectomy is safe to treat patient with complete double collecting system with multiple upper moeity kidney stone
Laparoscopic transperitoneal approach for vesicovaginal repair : The first experience in Hasan Sadikin Hospital
No full textIntroduction : Obstetric fistula is a severe and debilitating condition occurring throughout the developing world. Although there are no accurate data on the incidence and prevalence of the condition, the majority of vesicovaginal fistulas develop after gynaecologic surgery, with transperitoneal hysterectomy accounting for 90% of cases. Several techniques are available for repairing the fistulas. Transperitoneal approaches give good results even for difficult posterior located fistulas, but are associated with increased morbidity compared with the transvaginal approach. We performed a laparoscopic repair and omentum interposition. Objective : To report our first experience in transperitoneal laparoscopic repair of vesicovaginal fistula in Hasan Sadikin Hospital. Patient and Method : A 31-year-old female presented with vesicovaginal fistula after sectio caersaeran. After a failed trial of conservative treatment with catheter drainage, a transperitoneal laparoscopic repair was performed. Cystoscopy was performed initially to confirm the fistula location and for bilateral ureteric catheterization. A 4-port technique was performed with the patient in the position with her legs in lithotomy position. Without opening the bladder, the fistula tract was excised with separation of the bladder from the anterior vagina wall. Both the bladder and vagina walls were then closed separately using intracorporeal suturing with an interpositional omentum. Result : Total operative time was 270 min. Normal diet was resumed on day 1, drain was removed on post operatif day 1 and patient was discharged on the second day with an indwelling catheter. Good cosmetic result on wound operation and no leakage under cystogram after 2 weeks. The catheter was removed after 2 weeks. Conclusion : Laparoscopic transperitoneal repair of vesicovaginal fistula with omentum inteposition is feasible in Hasan Sadikin Hospital with good outcomes, short hospital days, and good cosmetics result. Keywords : Fistula vesico vaginal, laparoscopic.
Early detection of Prostate Cancer with Prostate Specific Antigen > 4 ng/ml : A Multivariate Logistic Regression
No full textBackground:Early detection of prostate cancer is a possible means of decreasing the mortality and increasing the quality of life. Objective :To determine whether the prostate specific antigen (PSA), abnormal DRE, family history, age, and prostate volume could increase the specificity and sensitivity of screening for prostate cancer. Methods :We included 92 patients with PSA > 4 ng/ml between January and December 2011 in Sardjito Hospital. Patients received prostate biopsy due to having abnormal serum prostate specific antigen (PSA) level. The relationship between the possibility of prostate cancer and the following variables were evaluated including: age; PSA level, prostate volume, DRE finding and family history. By using chi-square analysis, multiple logistic regression and receiver operating characteristic (ROC) curve were drawn based on the predictive scoring equation to predict the possibility of prostate cancer. All analyses were performed with SPSS, version 18.0. Results:We analyzed 92 patients with PSA > 4 ng/ml. It showed the relationship between the possibility of prostate cancer and the following variables, including : age (p < 0.001), PSA level (p < 0,001), DRE finding (p < 0.001) family history (p < 0,001) except prostate volume (p = 0.398). Using a predictive equation, P = 1/(1-e-X), where X= -3,821 +1.846 (if DRE positive) + 2,488 ( if family history positive ) + 1.718 ( when PSA > 10 ) + 1.414 ( when age > 68), followed by receiver-operating characteristic curve analysis, it showed the sensitivity 90,4% and specificity 85 % in predicting the possibility of prostate cancer. Conclusion: Age, DRE finding, PSA and family history are factors associated prostate cancer. They can be used as independent predictor to predict prostate cancer. Key words: Logistic regression, early detection,prostate cance
URINARY CONTINENCE DIVERSION IN CHILDREN WITH NEUROGENIC BLADDER
No full textObjective: We evaluate the initial experience of the implementation of the urinary diversion procedure in patients with neurogenic bladder continence in children. Material & method: The study was conducted retrospectively by collecting data contained in patient medical records of patients who come for treatment to Cipto Mangunkusumo Hospital Jakarta, from 2003 to 2012, and by interviews with parents of patients over the phone or when the patients control to the clinic. The patient is a child (age 0-18 years), diagnosed with congenital neurogenic bladder, and had urinary diversion continence procedure. Results: There are eight cases with urinary diversion continence undertaken in Cipto Mangunkusumo Hospital and found only 7 cases met the inclusion criteria with more girls than boys. Common etiology was spina bifida (57%). Most of the patients complained of recurrent UTI, and the most techniques used are Mitrofanoff (72%) with complications 33%. Conclusion: Urinary diversion continence procedure that has been done in Urology of Cipto Mangunkusumo Hospital is Mitrofanoff-Monti. Of the total of seven cases performed, the initial evaluation gives good results after urinary diversion continence procedure. Improved quality of life of patients with the achievement continence, overcome recurrent UTI problems and kidney function can be retained.
Keywords: Neurogenic bladder, Mitrofanoff techniques, Yang-Monti
URINARY STONE RISK PROFILE IN STONE FORMER PATIENT
No full textObjective: We were comparing the urinary stone risk profiles in stone former subjects group with normal population (non stone-former) group. Material & method: In this study, each group consist of 10 subjects. Urine samples used was a 24-hour-urine. All subjects in this study were previously informed and voluntarily participating. Inclusion criteria in this study were adult, stone free, residing in Jakarta. Measurement was performed in Department of Molecular Biology and Biochemistry Faculty of Medicine Indonesia University. Statistical analysis was performed using SPSS 20 (Chicago, USA) with Student’s t-test or Mann-Whitney (p 0.05) in sodium, creatinine, calcium, magnesium, oxalate, and citrate levels. Conclusion: There were no significant differences in urinary stone promoting and inhibiting factors between two groups. Bigger number of sample size with better sampling method must be conducted for future studies
UNPALPABLE UNDESCENDANT TESTES MANAGEMENT EVALUATION IN CIPTO MANGUNKUSUMO HOSPITAL
No full textObjective: This study is to evaluate imaging modalities used in unpalpable undescended testes (UDT) patient at our centre. We evaluate the data descriptively. Material & methods: This is a descriptive and retrospective study. Data was taken from medical record in Cipto Mangunkusumo Hospital from January 2010 until June 2014. Sampling method is total sampling. Inclusion criteria for this study was unpalpable UDT patients at Urology Department Cipto Mangunkusumo Hospital, whereas patients with incomplete data and have XX chromosomes were excluded. Results: Mean ages in this study was 9.35 years old (7 month to 41 year old). Diagnostic tools was not performed in half of the patients. Abdominal ultrasound was performed in 9 patients (34.6%), and 4 patients with CT-Scan. We found that most of patients were unilateral UDT (57.7%). Bilateral UDT was found in 11 patients (42.3%). Twenty one patients undergo laparoscopic orchidopexy (80.8%). There were 7 patients undergo full laparoscopy orchidopexy. Fowler Stephen technique applied to 4 patients, and eleven patients underwent inguinal exploration and orchidopexy. Laparoscopic biopsy was performed in 4 patients and agenesis of the testis was found in one patient. There are 13 cases with other abnormalities; hypospadias (38.5%), DSD 46 XY (53.8%), and testicular tumor (7.7%). Conclusion: Unpalpable UDT is adequately diagnosed by history and physical examination. Half of our patient in this study were not performed additional examination such as ultrasound, CT-Scan, and MRI for diagnostic tools and directly underwent laparoscopic orchidopexy. The best management of unpalpable UDT is laparoscopic orchidopexy
CORRELATION BETWEEN ALDEHYDE DEHYDROGENASE 1A1 LEVEL AND BONE METASTASIS IN PROSTATE CANCER
No full textObjective: To determine the association between Aldehyde Dehydrogenase 1A1 (ALDH1) expression and metastasis in prostate cancer. Material & methods: This study was a prospectivestudy in 45 patients diagnosed with prostate cancer in Sardjito General hospital. Patient characteristics and patient clinical data were recorded. Paraffin blocks of 45 patient surgery results were performed with immunohistochemical staining with monoclonal antibody of anti ALDH1A1 (EP1933Y, Biocare, dilution 1: 200). ALDH1 expression differences between prostate cancer without metastases and prostate cancer with metastasis was compared and analyzed with Chi-square. Results: This study involved 45 prostate cancer patients with median of age of 74 years. A high Gleason scores was found in 25 (55.6%) patients with prostate cancer and 24 (53.3%) patients had metastasis to the bone. The high expression of ALDH1 was found in 30 (66.7%) patients. The incidence of bone metastasis in patients with prostate cancer was associated with high levels of ALDH1 (p < 0.001, OR, 95% CI 17.88 (3.28-97.83) and was not associated with Gleason score (p = 0.316). Conclusion: Prostate cancer cells with high ALDH1A1 level increased the risk of the incidence of bone metastasis. ALDH1A1 level in prostate cancer cells can be considered as a predictor factor of the bone metastasis in prostate cancer