Indonesian Journal of Urology
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Prognosis of obstructive nephropathy patients after percutaneous nephrostomy
No full textBackground: Percutaneous nephrostomy is a life-saving procedure for the treatment of obstructive uropathy associated with septicaemia and uraemia. It is regarded as a temporary interventional procedure before definitive treatment. Several factors can affect recovery of renal function after nephrostomy, such as patient age, duration of obstruction, function of the contralateral kidney, pyelolymphatic backflow and compliance of the ureter and renal pelvis.Objective: To determine factors that can predict the decrease in creatinine levels after percutaneous nephrostomy (< 2mg/dl).Methods: This is a retrospective analysis descriptive study. All patients previously performed nephrostomy at Sardjito General Hospital Yogyakarta, from January 2009 to December 2012 were identified. The data were analyzed to evaluate the relationship between reduction of serum creatinine level and following variables including: etiology, nephrostomy (unilateral or bilateral), symptom duration (≤14 days or >14 days), comorbid disease (hypertension, diabetes melitus, heart disease) and degree of hydronephrosis (mild, moderate and severe). The data were analyzed with Chi-Square test and multiple logistic regression to obtain predictive factor and predictive scoring equation to measure the possibility of recoverability of renal function after nephrostomy.Results: We analyzed 117 patients that previously treated by percutaneous nephrostomy. It showed the relationship between reduction of serum creatinine level and the following variables: nephrostomy (unilateral or bilateral) (p=0,000), symptom duration (p=0,000), hypertension (p=0,004) and degree of hydronephrosis (p=0,000). Whereas etiology of urinary obstruction and other comorbid diseases showed no relationship. Predictive equation result: P= 1/(1+ey), where y= -0,271 + 1,636 (degree of hydronephrosis) + ((-2,216) unilateral or bilateral nephrostomy) + 1,694 (symptom duration) + ((-0,862) hypertension), with sensitivity 74,3% and specificity 70,7% in predicting renal function recoverability.Conclusions: Bilateral or unilateral nephrostomy, symptom duration, hypertension and degree of hydronephrosis are factors affecting the decrease in serum creatinine level. They role as independent predictor to predict recoverability of renal function can be considered. Key words: obstructive uropathy, percutaneous nephrostomy, multiple logistic regression
SUCCESS OF PERCUTANEOUS NEPHROLITHOTOMY: COMPARING SPINAL ANESTHESIA WITH GENERAL ANESTHESIA
No full textObjective: The purpose of this study compared the outcome of PCNL under general and spinal anesthesia for the outcome. Material & Methods: PCNL had been performed from 2000 until 2011 with total 760 PCNL divided into 220 PCNL using general anesthesia (Group A) and the remaining 540 PCNL using spinal anesthesia (Group B) The data of both groups were evaluated with Chi square test, and Mann-Whitney test. Result: Stone free rate in Group A was 71.37% similar with Group B 72.97% (p > 0.05). Spinal anesthesia was used more often in patient who had previous surgery 65.5% compared with general anesthesia 36.82% (p < 0.05). The average surgery duration in Group A was longer than group B (77.10 ± 35.59 minutes vs 68.42 ± 30.55 minutes) (p < 0.05). The average length of hospital stay in Group B was shorter than Group A (3.90 ± 2.72 days vs 5.47 ± 4.25 days) (p < 0.05). There was no difference between Group A and Group B in complication and the needs of tranfusion. Conclusion: PCNL under spinal anesthsia was feasible and safe even better in the shorter surgery duration and the length of hospital stay
EFFECTIVITY OF PCNL WITH COMBINED ULTRASOUND AND FLUOROSCOPY
Get PDFObjective: To assess the effectiveness of Percutaneous Nephrolithotomy (PCNL) at age > 65 years and its complication. Material & method: Fifty-four patients with renal and proximal ureteral stones who underwent PCNL with ultrasound techniques combined with X-Ray at Sardjito and Pantirapih hospital, during 2007 to 2012. Laboratory data is in the form of hemoglobin, leukocyte count, trombocyte, haematocrit, natrium, potassium, chloride, BUN, creatinine both pre-operative and post-operative. The samples were divided according to age < 65 years old and above. In analyzing categorical data, we used chi-square test, whereas the numeric data analysis is using independent t-test with p < 0.05. Results: We found no significant differences between the age groups < 65 years and age > 65 years in stone location, presence of hydronephrosis, its grade and location. There also no difference based on operative time, intra-operative procedure, its complication and the day of DJ stents removal and nephrostomy. Both group showed similar result on laboratory findings. However, we found that the older age group have 2 days longer in the length of hospitalization than the younger age groups (p = 0.05) and history of diabetes mellitus and hypertension with p < 0.05. Conclusion: PCNL is a safe and effective procedure with minimal complications for the treatment of kidney and proximal ureteral stone, even for patients with co-morbidity. PCNL technique with guidance of ultrasound for early access would help tomake the operating time shorter and less exposure to ionizing radiation.Keywords: Percutaneous nephrolithotomy, age > 65 years old, effectiveness, safety
PERCUTANEOUS NEPHROLITOTOMY ON THE MANAGEMENT OF CALYX INFERIOR STONES
Get PDFObjectives: To compare the stone free rates of inferior calyceal stones with stone burden < 20 mm, 21-30 mm, and > 30 mm on post-percutaneous nephrolithotomy (PCNL) patients in Cipto Mangunkusumo Hospital. Material & method: The data was collected retrospectively from PCNL medical records in Cipto Mangunkusumo Hospital between January 2000 until May 2012. Patients were followed-up with plain abdominal radiography (BNO) or renal ultrasonography (USG). Stone free status was defined as no residual fragments on radiography or USG. Results: As many as 88 patients with inferior calyceal stones who underwent PCNL were included. Forty-three cases had stone burden < 20 mm, 34 cases with stone burden 21-30 mm, and 11 cases with stone burden > 30 mm. Overall, 81 (92%) cases were defined as stone free. On group < 20 mm, 21-30 mm, and > 30 mm; 41 (95%), 32 (94%), and 8 (73%) cases defined as stone free respectively (p = 0.485). Conclusion: PCNL is the primary modalityon the management of calyx inferior stones with high stone free rate. The stone free rate of these three groups showed no statistically significant difference.Keywords: Percutaneous nephrolithotomy, inferior calyx stone, stone free rate
THE IGF-1 LEVEL OF ESRD PATIENTS AND ITS RISK FACTORS
No full textObjective: To identify the Insulin-like Growth Factor–1 (IGF-1) level of End Stage Renal Disease (ESRD) and non ESRD populations, and correlation between IGF-1level and ESRD incidences. Material & Method: This case study was carried out in Yogyakarta with 72 volunteers. The cases involved Chronic Kidney Disease (CKD) patients. The controls were non-CKD patients. CKD parameters were established with PERNEFRI diagnostic criteria. Comparison of IGF-1 levels between case and control groups was performed through ANOVA, with confidence level of 95%. Bivariate analysis to identify the correlation between IGF-1 plasma level, smoking status, illness history and body mass index (BMI) by determining odds ratio (OR) of individual risk factor of p < 0.05. Results: We enrolled 72 volunteers, 45 male and 27 female subjects. Of the 45 male patients, 15 CKD and 30 non CKD patients served as cases and controls, respectively. The difference in plasma IGF-1 level was detected in the case and control groups (42.01 ± 10.66 vs. 56.05 ± 24.91) (p < 0.05). The result of bivariate analysis showed passive smoking status, IGF-1 plasma level, DM history and hypertensive illness history had correlation with ESRD incidence with odds ratios of 7.88 (p < 0.005; CI: 1.6-37.5) for passive smokers, 4.3 (p < 0.05, CI: 1.36 to 13.33) for IGF-1 level, 21.5 (p < 0.05; CI) for DM history and 12.4 (p < 0.05; CI: 3.7 to 41) for hypertensive history. Conclusion: There was difference in IGF-1 plasma level between ESRD and non-ESRD patients. The IGF-1 plasma level, passive smoking status, diabetes history, and hypertensive history have correlation with ESRD incidence.Keywords: Insulin-like Growth Factor–1 level, End Stage Renal Disease, case control, odds ratio
SENSITIVITY AND SPECIFICITY OF PROSTATIC BIOPSY RESULT BASED ON PROSTATE VOLUME
Get PDFObjective: To compare the sensitivity and specificity of both types of prostate biopsies, between 6 core biopsy/sextant biopsy with volume based biopsy prostate. Material & method: The subjects were patients that have been performed prostate biopsy in Hasan Sadikin Hospital in 2006 – 2010. The data was divided into two groups, the group A (before 2009) 327 patients had performed 6 cores biopsy, group B (after 2009), the biopsy was performed based on prostate volume (volume < 40 cc : 8 cores, volume 40-60 cc : 10 coresand volume > 60 cc : 12 cores). Biopsy results confirmed by definitive results from surgery, then analyzed specificity and sensitivity between two groups. The analytical statistic test using unpaired T test and Levene’s test. Results: There were 654 patients divided in two groups. The data in both groups were similar based on analytical statistic test using unpaired t test (p = 0.28) and the data was in normal distribution (Levene’s test = p > 0.05). The group A, mean age 67.4 years, mean prostate volume 32.53 cc and mean PSA levels 29.89 ng/dl and at group B, mean age 66.7 years, mean prostate volume 30.89 cc and mean PSA levels 16.92 ng/dl. Volume based cores method in prostate biopsy have higher sensitivity and specificity compared with 6 core biopsy (97.5% vs 94.0%) and (92.2% vs 77.8%). Conclusion: The sensitivity and specificity of prostate biopsy was increased in volume based cores compared to 6 cores biopsy. Keywords: Prostate biopsy, volume based
INTRATESTICULAR INJECTION OF 20% HYPERTONIC SODIUM CHLORIDE AS A NOVEL CASTRATION METHOD: A PRECLINICAL STUDY
Get PDFObjectives: To demonstrate that intratesticular injection of 20% hypertonic sodium chloride can result in permanent castration and to evaluate serum changes in sodium chloride levels. Materials and Methods: A total of 40 Wistar rats were divided into 4 groups, consisting of bilateral orchidectomy (n=10), control (n=10) and 2 groups receiving intratesticular injections of 20% sodium chloride (n=10 in each group). Serum testosterone was measured on day 0, day 1, day 15 and day 30. Serum sodium chloride was assessed before injection, at 1 hour and 24 hours after injection. All testicles were harvested for histological examination. One way ANOVA and student t-test were used for statistical analysis. Results: Serum testosterone decreased to castrate levels in the orchidectomy and injected groups with no significant difference (p>0,05). Significant rise in serum sodium chloride was found 1 hour post injection (p<0,05) but after 1 day it decreased significantly (p<0,05). There was no significant difference in histopathological findings between the 2 injected groups after day 15 and 30 (p>0,05). Conclusion: Twenty percent hypertonic chloride injection has the same permanent castration effect with bilateral orchidectomy in rats. The serum sodium chloride changes did not reach the lethal level for rats. Therefore this treatment has a promising potential as a novel and cost-effective castration method with the additional benefit of retaining both testes
CORRELATION OF ROUTINE URINE CULTURE AND STONE CULTURE TO POST-OPERATIVE SIRS
No full textObjective: This study evaluated the correlation between preoperative urine culture and intraoperative stone culture and the impact of stone culture findings on post-operative systemic inflammatory response syndrome. Material & Method:Patients with kidney stones who underwent percutaneous nephrolithotomy (PCNL) from February to May 2012 were prospectively analyzed. A pre-operative urine culture was obtained in the morning before the operation, fragmented stone collected were cultured in Departement of Microbiology. Patients were monitored closely in the postoperative period for signs of systemic inflammatory response syndrome (SIRS). Results:A total of 33 patients underwent PCNL and examined for urine cultures, stone culture and postoperative SIRS, 15 (45.45%) patients with positive urine culture, 18 patients (54.54%) with positive stone culture but only 1 patient (3.03%) had same pathogen (p = 0.629). Ten patients (55.6%) with positive stone cultures had evidence of systemic inflammatory respose syndrome postoperatively. The calculated stone culture value for sensitivity, specificity, positive predictive value and negative predictive value were 100%, 65.2%, 55.6%, and 100%. Preoperative hydronephrosis (p = 0.003) and operative time (p = 0.001) are identified as the key risk factors for SIRS after PCNL.Conclusion: Positive stone culture are better predictors for SIRS after PCNL. Stone culture examination is an essential in directing the proper antibiotic therapyin patients with SIRS after PCNL. Keywords: Percutaneous nephrolithotomy (PCNL), urine culture, stone culture, systemic inflammatory response syndrome after PCNL
IPP AS PREDICTIVE FACTOR FOR ACUTE URINARY RETENTION IN BPH PATIENTS
No full textObjective: To demonstrate usefulness of Intra Prostatic Protrusion (IPP) as Predictive Factor for Acute Urinary Retention (AUR) in Benign Prostate Hyperplasia (BPH) Patients. Material & methods: Cross sectional retrospective study of case records from January to July 2012 of BPH patients at Saiful Anwar General Hospital (SAGH) Malang was carried out. The data were collected from the Medical Record Division in SAGH Malang. We noted age, prostate volume, IPP, IPSS and urinary retention status. The patients were classified by IPP degree < 5 mm (group A), 5-10 mm (group B), 10 -15mm (group C), > 15mm (group D) and we compared all parameters that we noticed. Results: Eighty patients, mean age was 66.32 years were enrolled. Transabdominal ultrasound determined the mean IPP was 13.5 mm, and prostatic volume 95 cc. IPP values were distributed as follows: group A 10 (12.5%), group B 25 (31.25%), group C 24 (30%), group D 21 (26.25%), with AUR incidence in group A 20%, group B 36%, group C 79%, and group D 81%. The IPP showed a significant correlation with urinary retention (r = 0.8, p < 0.05, OR = 15) and IPSS (r = 0.6, p < 0.05). Conclusion: IPP can be used as predictive factor for the incidence of acute urinary retention in BPH Patients.Keywords: Intra Prostatic Protrusion, Acute Urinary Retention, Benign Prostate Hyperplasia
TRANSPLANTATION OF ALLOGENIC ADIPOSE-DERIVED STEM CELL IMPROVE URETHRAL MUSCLE-COLLAGEN RATIO AFTER VAGINAL DISTENSION
Get PDFObjective:To investigate the effects of allogenic adipose-derived stem cell (ADSC) transplantation on urethral tissue regeneration after vaginal distension in a rat model.Material & Method:32 female wistar rats underwent vaginal distension (VD) for 4 h. Subsequently, PKH-labeled ADSCs (2 x 105 in 200 µl PBS, ADSC group, n = 18) or PBS (200 µl, placebo group, n = 18) were injected into periurethral tissue. Two and four weeks following transplantation (ADSC or PBS), voiding behavior (frequency) and muscle-collagen ratio of urethral tissue were measured to evaluate urethral sphincter regeneration. Data were analysed by paired-t test, one-way ANOVA and post hoc LSD.Results:Mean voiding frequency was significantly different in the ADSC group at two weeks (p<0.0001), but not significantly different at four weeks (p=0.448) when compared with the placebo group.Masson’s trichrome staining revealed that the muscle-collagen ratio of urethral tissue was not significantly different between study groups at two or four weeks (p=0.053 or p=0.166 respectively). Muscle-urethral ratio was more specific showing a significant difference at two weeks (p=0.043). There were significant differences about muscle-collagen or muscle-urethral ratio between control and placebo groups (p<0.05), whereas between control and ADSC groups no significant difference was observed (p>0.05).Conclusion:ADSC transplantation promotes urethral muscle-collagen ratio with development of striated muscle after vaginal distension, so that can improve voiding behavior in a rat model.Keywords:Adipose-derived stem cell, vaginal distension, rat-SUI model, muscle-collagen ratio, voiding stain on paper