Indonesian Journal of Urology
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THE EFFICACY AND SAFETY OF TOPICAL TRIAMCINOLONE IN REDUCING URETHRAL STRICTURE RECURRENCE FOLLOWING INTERNAL URETHROTOMY: A SYSTEMATIC REVIEW AND META-ANALYSIS
Full text linkObjective: This systematic review aims to determine the efficacy and safety of topical triamcinolone in reducing urethral stricture recurrence following internal urethrotomy procedures. Material & Methods: A systematic literature search was performed in Cochrane Library, PubMed and Google Scholar with the related keywords. The statistical analysis was conducted using a Review Manager v.5.4.1. Results: We identified 6 RCTs with a total of 316 patients diagnosed with urethral stricture undergoing internal urethrotomy. The statistical analysis appeared to lower the recurrence rate significantly in patients undergoing internal urethrotomy with the adjuvant therapy of topical triamcinolone (RR 0.55, 95% CI 0.38 – 0.78, p = 0.0008). Conclusion: Additional treatment with topical triamcinolone has the benefit of declining the recurrence rate of urethral stricture following internal urethrotomy.
Keywords: Triamcinolone, urethral stricture, internal urethrotomy
PEDIATRIC URINARY STONE PROFILE IN SAIFUL ANWAR HOSPITAL
Full text linkObjective: This study aims to provide an overview of the characteristics of age, gender, stone location, stone side, stone analysis, and management of pediatric urinary stone in the tertiary hospital. Material & Methods: This was a retrospective study done over a period of four years from January 2019 - December 2023 in our institution. The patient has undergone supporting examinations to confirm the diagnosis. Clinical data including the patient’s age, gender, stone location, stone side, stone analysis, and management were observed. Data were analyzed descriptively and using SPSS 17.0. Results: Total of 55 cases of upper and lower urinary tract stones were encountered in our study with a mean age of 11.2 years. The highest incidence was 15-18 years old (36.4%). The distribution by gender showed a higher prevalence in males (67.2%) compared female patients (32.8%). The kidney stone was the most frequent clinical presentation (36.3%). From the upper urinary tract stone, the left side becomes the predominant area (54.2%). The most common stone constituent was calcium oxalate (41.8%). The kidney stone was mostly treated with Percutaneous Nephrolithotomy (PCNL) (75.0%). Conclusion: Pediatric urinary tract stone patients in our institution are predominantly male, with a peak rate in 15- 18 years old, most commonly found in the kidney, predominantly on the left side, and the most common stone constituent was calcium oxalate. Th kidney stone is mostly treated with PCNL.
Keywords: Bladder stone, pediatric urinary stone, cystolithotripsy
CHARACTERISTICS OF PEDIATRIC NEUROGENIC BLADDER PATIENTS AT HASAN SADIKIN HOSPITAL PERIOD 2019 -2024
Full text linkObjective: The purpose of this study was to characterize pediatric neurogenic bladder patients in order to recognize, treat, and avoid the related problems. Material & Methods: a retrospective study was conducted in the urology department's at Hasan Sadikin Hospital in Bandung, Indonesia. Data from pediatric neurogenic bladder patients who had urodynamic tests performed during the study period were evaluated. Results: Participants were predominantly female with 7 subjects (58.3%) while there were 5 male subjects (41.7%). The mean age of patients was 9.2 ± 5.44 years. Conservative management was the course of treatment for 10 patients (83.3%). The majority of this patient's bladder capacity—10 participants, or 83.33% of the total—have small capacities of less than 250. Seven patients (58.33%) had normal contractility, according to the bladder contractility index (BCI) inspection. Up to 7 participants (58.3%) had detrusor sphincter dyssynergia (DSD). Conclusion: Pediatric neurogenic bladder patients typically have small bladder capacities, according to urodynamic examination results. The most common symptoms that patients experience was those related to incontinence. The fundamental principle of treatment for children with neurogenic bladder is conservative therapy. Understanding the characteristics of neurogenic bladder patients and routinely carrying out urodynamic examinations allows early detection and appropriate treatment for this condition.
Keywords: Pediatric, neurogenic bladder, urodynamic, incontinence. 
MICROSURGICAL VARICOCELECTOMY IN PRE-PUBERTAL CHILDREN: SAFETY, EFFICACY, AND REPRODUCTIVE IMPLICATIONS - A CASE REPORT AND LITERATURE REVIEW
Full text linkObjective: In this report, we aim to present a case of a prepubertal child with left varicocele who underwent successful microsurgical ligation. Case(s) Presentation: A 9-year-old boy was admitted to urology clinic due to his parents complaint about a mass in his left scrotum. We diagnosed this patient with grade III varicocele (Dubin-Amelar classification). The patient underwent microsurgical ligation surgery. After surgery, the mass such as "bag of worms" disappeared and the testicular volume increased by 53% from preoperative volume (1.8 to 2.3 cc). Discussion: The results of this case report indicate that microsurgical ligation of varicocele in children is a safe and effective therapeutic option. Conclusion: Microsurgical ligation of varicocele in pre-pubertal children represents a safe and effective therapeutic option, offering symptom relief and potential preservation of future fertility. Further studies are warranted to elucidate the long-term outcomes and reproductive implications of microsurgical varicocelectomy in this population.
Keywords: Microsurgical ligation, varicocele, children
COMPARISON OF CONTINUOUS AMBULATORY PERITONEAL DIALYSIS TENCKHOFF CATHETER INSERTION (OPEN SURGERY VS LAPAROSCOPIC) – A CASE CONTROL STUDY
Full text linkObjective: This study aims to investigate post-operative complication rate of Tenckhoff catheter placement methods between open surgery and laparoscopic. Material & Methods: This is a case control comparative study reviewed from the medical records of patients who required insertion, removal, or repairment of Tenckhoff catheter for the provision of CAPD at Hasan Sadikin Bandung general hospital between January 2015 to December 2020. Clinical outcome and complication were compared between the open surgery and laparoscopic group. Results: We obtained 30 patients who required insertion of a Tenckhoff catheter for the provision of CAPD, 15 patients by open surgery and 15 patients by laparoscopic technique. Insertion of Tenckhoff catheter using open surgery have a higher risk of catheter migration (p=0.049; O R=3.25) and infection (p=0.014; OR=12.25) compared to laparoscopic. Discussion: Laparoscopic technique facilitates omentectomy, allows better fixation under direct visualisation, and for lysis of adhesions to increase peritoneal surface. Conclusion: Tenckhoff catheter insertion by using laparoscopic surgery tend to have better outcome compared to open surgery, with lower risk of catheter migration and infection.
Keywords: Tenckhoff catheter, laparoscopic, CAPD
PSA LEVEL AND ADVERSE EVENTS IN SIXTH AND TENTH SERIES DOCETAXEL CHEMOTHERAPY IN CASTRATE-RESISTANT PROSTATE CANCER (CRPC) PATIENTS
Full text linkObjective: This study aims to compare the efficacy of docetaxel on PSA levels and to analyze the adverse events caused by docetaxel. Material & Methods: The study design was retrospective cohort. Participants were prostate cancer patients at Saiful Anwar Hospital who received androgen deprivation therapy with increased PSA level 3 times the nadir or 2 bone lesions or soft tissue lesions > 2cm. PSA levels were assessed monthly. Participants were grouped into 6 and 10 series regimens. Adverse events of nausea, diarrhea, alopecia, SGOT SGPT abnormailties, creatinine abnormalities, anemia, and neutropenia were observed. Statistical analysis was performed using a differential T-test. Results: A total of 32 participants were involved. The PSA levels between 6 and 10 series groups were as follows: 1st month (142.2 vs 28.24 ng/mL,p=0.000), 2nd month (101.78 vs 16.98 ng/mL,p=0.001), 3rd month (472.35 vs 13.95 ng/mL,p=0.439), 4th month (120.64 vs 4.0 ng/mL,p=0.180), 5th month (64.325 vs 24.6 ng/mL, p=0.015), 6th month (41.915 vs 20.7 ng/mL,p=0.497). Adverse events in the 6 and 10 series regimens were nausea (25% vs 81.25%), diarrhea (37.5% vs 50%), alopecia (6.25% vs 43.75%), SGOT SGPT abnormalities (25% vs 56.25%), creatinine abnormalities (6.25% vs 37.5%), anemia (18.75% vs 31.25%), leukocytosis (6.25% vs 0%), and neutropenia (25% vs 12.5%). Adverse events in 6 series regimen began to occur in 3rd series with 1 participant experiencing nausea, and the most were 3 participants experiencing diarrhea in 6th series. Adverse events in 10 series regimen began to occur in 4th series with 1 participant experiencing nausea, 1 participant experiencing SGOT SGPT abnormalities, 1 participant experiencing diarrhea, and the most were 4 participants experiencing nausea in the 9th series. Conclusion: The 10 series of docetaxel chemotherapy is not superior to 6 series. Adverse events are more prominent in the 10 series.
Keywords: Docetaxel, PSA, adverse events
CLINICAL PROFILE OF PATIENTS WITH UNDESCENDED TESTIS IN TERTIARY HOSPITAL
Full text linkObjective: The objective of this study is to present the clinical profile of patients with UDT in tertiary hospital. Material & Methods: This study used a descriptive retrospective approached with approved ethical number 400/019/K.3/102.7/2024. Collecting identification was done by tracing UDT case-patient documents from January 2015 to December 2023. The characteristics observed were age, location of UDT, unpalpable or palpable, patient's address, and antenatal care examination. Results:
From 107 UDT patients, 16 patients (24.31%) was diagnosed at the age 19 until 24 months old and decreased in puberty ages. 74 cases of UDT (69.16%) are unilateral UDT with almost the same distribution between left and right. In 75 cases of unpalpable UDT (70.09%), it was found that the testis were still viable in 57 cases during diagnostic laparoscopic. On average, there are 63 patients (58.87%) coming from the Malang area. The average number of patients receiving antenatal care from midwives is 61 cases (62.61%). Conclusion: In all, many cases of UDT under 12 years old were found, with the majority is Unpalpable Unilateral UDT, patient come from the Malang area and have received antenatal care from midwives. The data obtained can be used as a database for enhancing the standard of care.
Keywords : Clinical profile, UDT, Malan
THE RELATIONSHIP OF NEUTROPHIL-TO-LYMPHOCYTE RATIO (NLR) WITH LOCALIZED AND NON-LOCALIZED TESTICULAR GERM CELL TUMORS
Full text linkObjective: This study aim to reveal the relationship preoperative neutrophil-to-lymphocyte ratio (NLR) with testicular germ cell tumors (GCT). Material & Methods: A total of twenty-six patients diagnosed with TGCT from 2017 to 2022 in Saiful Anwar Hospital, Malang were included in this retrospective study. Patients were grouped as localized and non-localized. Hematological and biochemical blood measured the days before radical orchiectomy. Results: Eleven patients (42.3%) had seminomas and fifteen patients (57.7%) had non-seminomatous testicular cancer. Six patients (23.1%) had localized and twenty patients (76.9%) had non-localized testicular cancer. There was a statistically significant difference between mean NLR of the localized patients and non-localized patients (localized NLR: 1.7±0.84, non-localized: 3.65±0.97, p=0.000). The optimal cut-off value for localized and non-localized TGCT was 3.05 with sensitivity 83.33% and specificity 75%. That was statistically significant between cut-off value NLR with localized and non-localized TGCT (correlation coefficient 0.505, p=0.008). Conclusion: NLR appears to be a useful marker for TGCT. It is successful in predicting localized and non-localized disease in early preoperative period.
Keywords: Neutrophil-to-lymphocyte ratio, testicular cancer, testicular germ cell tumors
CLINICAL PROFILE OF PATIENTS WITH HYPOSPADIAS IN SAIFUL ANWAR GENERAL HOSPITAL, MALANG
Full text linkObjective: This study aims to present the clinical profile of hypospadias patients in the Urology Department of Saiful Anwar Hospital. Material & Methods: This retrospective study analysed the characteristics of delayed hypospadias cases at Saiful Anwar General Hospital in Malang. The study utilized a descriptive design with a quantitative approach, conducted from January 2019 to February 2024. All patients with hypospadias who visited were included in this study. Data were presented in percentage format to illustrate the distribution of cases. Results: Among the 250 patients, 242 (97%) were classified as having a delayed diagnosis. Of all the cases, 141 (56%) were located in Malang. Proximal hypospadias was the most prevalent anomaly, affecting 131 (52%) of the patients. Additionally, there were 88 cases (35% of the total) of mid-shaft hypospadias and 31 cases (13% of the total) of distal hypospadias. Out of the total, 39 patients (16%) had undescended testis (UDT), while 53 patients (22%) had bifid scrotum as an additional condition. Of the 46 patients, 18.4% experienced preterm labor, and approximately 78% of the newborns, specifically 194 of them, had a birth weight over 2500 grams. The healthcare provider participated in 226 out of 232 births, accounting for 97% of the total. The condition was primarily diagnosed by obstetricians, who identified 42% of cases, while midwives identified 58% of the cases. Conclusion: Most hypospadias patients presenting at Saiful Anwar Hospital are diagnosed late, with proximal hypospadias being the most prevalent type. Accompanying conditions include bifid scrotum, occurring in 22%, and undescended testes, present in 16% of cases. This finding presents a potential opportunity to enhance the standard of care.
Keywords: Hypospadias, UDT, bifid scrotum
FROM DIAGNOSIS TO RECOVERY: A CASE REPORT OF AN INFECTED URACHAL CYST IN AN ELDERLY MALE
Full text linkObjective: This case report was aimed to present an infected urachal cysts in an elderly male. Case(s) Presentation: We are presenting a case of an infected urachal cyst actively draining pus through the umbilicus in a 72-year-old male. He was managed by surgical excision of that urachal cyst completely along with omphalectomy after initial intravenous antibiotics and investigations. Discussion: In this instance, the patient complained of suprapubic discomfort, exudation of pus from the umbilical cord, and fever. Due to the variety of manifestations, the urachal cyst can frequently be interpreted as Meckel diverticulitis, pelvic inflammatory disorder, appendicitis, or infection of the urinary system. The probability of cancer ought to be weighed up while addressing an elderly with a urachal cyst. Urachal malignant tumor, which develops from the remaining epithelia of the urachal abnormalities, has an awful prognosis. The most typical presentation is hematuria. Conclusion: This case emphasizes the need for the inclusion of urachal anomalies in the differential diagnosis of abdominal discomfort with umbilical discharge even in the elderly patients.
Keywords: Urachal cyst, elderly male, excision