Indonesian Journal of Urology
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PREVALENCE OF SEXUAL DYSFUNCTION IN MEDICAL AND NON-MEDICAL PROFESSION WOMEN
No full textObjective: The study was conducted to determine the prevalence of sexual dysfunction and the factors affecting the medical and non-medical profession women using of Female Sexual Function Index (FSFI) as an assessment instrument. Material & Method: Respondents were women aged ≥ 18 years that consist of medical groups, working in the field of health care (doctors, nurses, pharmacists, hospital staff), and non-medical groups that have regular sexual partner and sexually active for 3 months. Data was taken with the Female Sexual Function Index (FSFI), translated into Indonesian. Results: There are 206 respondents consisting of 103 people medical and 103 people non-medical group. Mean age was 32.92 ± 7.23 respondents in the youngest age of 21 years and the oldest 53 years. Most respondents (75.2%) were well educated (graduate diploma) with a long marriage has a range of 6-372 months. The majority of respondents (94.2%) married one time. The overall prevalence of sexual dysfunction (FSFI total score < 55) in the study was 9.2%. Statistically, there was no significant difference in the prevalence of sexual dysfunction (p > 0.05) between the medical groups 12,6% when compared to non-medical group (5.8%). Most interference was in the domain of satisfaction (34.0%) in the medical group and 27.2% in non-medical. Conclusion: The medical profession has high potential to experience sexual dysfunction. Night shifts were associated with the prevalence of sexual dysfunction in healthcare workers. Other factors were not found to be related to sexual dysfunction.Keywords: Sexual dysfunction, factors that affect sexual function
DOXAZOSIN AND MELOXICAM COMBINATION THERAPY FOR BPH TREATMENT WITH LUTS
No full textObjective: To compare the efficacy of combination therapy of 4 mg doxazosin + 15 mg meloxicam with 4 mg doxazosin single therapy for benign prostate hyperplasia (BPH) patients with lower urinary tract symptoms (LUTS). Materials & Methods: A prospective, randomized and double blind study with total of 22 BPH patients with LUTS were randomized to receive 4 mg doxazosin + placebo once daily for 6 weeks or a combination of 4 mg doxazosin + 15 mg meloxicam once daily for 6 weeks. Inclusion criteria included IPSS ≥ 8, age > 50 years, prostate blood flow grade II. Therapeutic efficacy was assessed by comparing changes in IPSS, maximal urinary flow (Q-max) and changes in prostate blood flow between baseline and immediately after 6 weeks of therapy. Results: There was no significant difference in IPSS change between the two treatment groups (delta IPSS 4 ± 1.1 versus 3.7 ± 1.5, p = 0.630). There was a significant difference in Q-max changes between the two groups (delta Q-max 4 ± 1.5 versus 2.1 ± 0.7, p < 0.001). In group therapied with 4 mg doxazosin + 15 mg meloxicam prostate blood flow decreased from grade II to grade I in 9 of 11 patients (81%). Whereas, in the treatment group of 4 mg doxazosin + placebo no reduction was found in prostate blood flow. Conclusion: Combination therapy of 4 mg doxazosin + 15 mg meloxicam once daily for 6 weeks is better than 4 mg doxazosin therapy alone in improving Q-max and decreasing prostate blood flow in BPH patients with LUTS.Keywords: Benign prostate hyperplasia, inflammation, COX-2 inhibitors
EFFECT OF PLASMA ANGIOTENSIN CONVERTING ENZYM IN ERECTILE DYSFUNCTION
No full textObjective:The aim of this study was to know the effect of aging and I/D angiotensin converting enzymes (ACE) gene polymorphisms in modulating plasma ACE level in erectile dysfunction(ED) subjects.Material & method:This case control study carried out in Makassar with 83 male subjects (49 ED subjects and 34 normal subjects). International Index of Erectile Function-5 was used for ED diagnosis while plasma ACE level and genotyping ACE gene examined with ELISA test and Rigat PCR method respectively.Results:The data showed that plasma ACE level siginificantly higher in ED group compared to normal group, while the plasma ACE level consistently raised following the increased of age in ED group but did not statistically significant (p>0.05) compare to normal group. DD genotype in ED group had mean plasma ACE higher compared to ID and II subjects eventhough did not statistically significant.Conclusion: The high level of ACE plasma appeared to have a pivotal rule in ED mechanisms as well as in older ED subjects. DD genotype partly modulated the raising of plasma ACE in ED subject comprared to ID and II genotype. Keywords: Plasma ACE level, erectile dysfunction
ESWL FOR RENAL AND URETERAL STONES
No full textObjective: To report patient characteristics and results of Huikang HK-V extracorporeal shockwave lithotripsy (ESWL) machine for renal and ureteral stones. Material & methods: We retrospectively analyzed medical records of all patients treated with ESWL using HK-V deviceat Department ofUrology Soetomo Hospital from May2011 - February 2012. Results: There were 241 selected patients, consisted of 148 men (61.4%) and 93 women (38.6%). Mean age was 47.8 years (range 7-87). ESWL was conducted to 130 single stones and 111 multiple stones, using fluoroscopy as guidance for 166 patients, ultrasound for 31 patients (12.9%) and both for 44 patients (18.3%). Stone location was 109 in lower pole(41%), 69 in middle pole(26%), 41 in proximal ureter (16%), 28 in upper pole (11%), 14 at renal pelvis (5%), 1 at distal ureter(0.3%) and 2 staghorn stone (0.7%).There were 130 patients with stone less than 10 mm (53.9%), 102 with stone 10-20 mm (42.3%), and 9 more than 20 mm (3.7%). There were slightly more left-sided treatment was 141 patients (58.5%). Of 181 patients with hydronephrosis (75%), 104 had DJ stent inserted (43.2%). Overall, we found 158 patients (65.5%) were stone free after treatment, 49 patients (20.3%) with residual stones less than 4 mm and 34 patients (14.1%) had more than 4 mm residuals. Conclusion: ESWL is the treatment of choice for simple renal and ureteral stones less than 20 mm (opaque and non opaque).Keywords:Extracorporeal Shockwave Lithotripsy, renal stones, ureteral stones
ONE-YEAR EVALUATION OF OVERALL URETHRAL STRICTURE MANAGEMENT USING QUESTIONNAIRES AND UROFLOWMETRY
Get PDFObjective: To evaluate the overall outcomes of patients who get definitive treatment of urethral stricture. Material & Method: All patients who underwent various urethral stricture management in Cipto Mangunkusumo Hospital were evaluated over 1 year period. Patient demographics, type of surgery, International Prostate Symptoms Score (IPSS), quality of life (QoL) score, flow rate (FR) and post void residual urine (PVR) of all patients were evaluated at 3 months, 6 months and 1 year after surgery. Results: Out of 230 urethral stricture patients, 65 patients were eligible this study. Mean patient age was 41.19 ± 20.44 years. 37Direct Vision Internal Urethrotomy (DVIU), 20 end-to-end anastomosis, and 8 graft urethroplasties were performed. All patients underwent urethral stricture management showed improvement of IPSS (-22.64, p < 0.001), QoL (-3.36, p < 0.001), FR (16.72 ml/s, p < 0.001) and PVR (-126.23 ml, p < 0.001). Compliant patients showed better improvement of IPSS and FR than non compliant patient after DVIU procedure. Overall, open surgery give better improvement of IPSS and FR than DVIU procedure. These differences were more pronounced in recurrent and long (≥ 2 cm) urethral stricture disease. In open surgery group, end-to-end anastomosis give better improvement in FR compared to graft urethroplasty. Conclusion: Patients undergoing urethral stricture management experienced a significant improvement in self-reported outcomes and functional uroflow studies. Overall, open surgery gives better improvement in FR and IPSS than DVIU procedure. In open surgery group, end-to-end anastomosis give better improvement compares to graft urethroplasty.Keywords: International Prostate Symptoms Score, quality of life, flow rate, post void residual urine, urethral stricture
APOPTOSIS IN IPSILATERAL KIDNEY. COMPARISON BETWEEN GROUP RECEIVING VERAPAMIL AND CONTROL GROUP POST-ARTIFICAL TOTAL UNILATERAL URETERAL OBSTRUCTION
Get PDFObjective: Obstruction of the urinary tract has marked effects on renal blood flow, glomerular filtration rate (GFR), and tubular function. Ureteral obstruction results in an injury response that can progress to irreversible renal fibrosis and tubular damage by apoptosis. Materials and Methods: Forty five rabbits aged 13-17 weeks with body weights of 1250-1750 grams were divided into 4 groups. Group 1 underwent a sham operation and group 2 had unilateral ureteral ligation to cause total obstruction. Groups 3 and 4 also underwent unilateral ureteral ligation but with verapamil given on day 0 and day 7 respectively. Apoptosis to the renal tubules were assessed after nephrectomy on day 14 using immunohistochemistry by counting the number cell deaths/high power field (hpf). Results: The groups that received verapamil showed significantly less apoptosis compared to those without verapamil (2,73 vs 12,46 cell deaths/hpf; p<0,05). However, there was no significant difference between groups 3 and 4 (2,73 vs 2,89 cell deaths/hpf; p>0,05), although both groups still showed more cell deaths compared to group 1 (0,38 cell deaths/hpf). Conclusion: Verapamil appears to significantly decrease apoptosis during total unilateral ureteral obstruction. However, it cannot replace the benefit of relieving total obstructio
PROFILE OF BLADDER TRANSITIONAL CELL CANCER IN SOETOMO HOSPITAL SURABAYA
Get PDFObjectives: To describe the characteristic of bladder transitional cell cancer (TCC). Material & methods: We reviewed the medical records of patients with bladder TCC admitted in Soetomo General Hospital Surabaya, from January 2008 until December 2012. The data regarding demographic characteristics, clinical presentation and staging, grading and staging based on pathological examinations results, and the management of the cancer.Results: The 126 cases, consisted of 102 men (81%) and 24 women (19%) with its ratio was 4.2 : 1. All male patients were heavy cigarette smokers. Mean age was 57.8 years, peak incidence was50-59 years. Hematuria was the mostfrequent clinical presentation (112 patients, 88.9%), urinary retention and other complaints (12 patients, 9.5%), and chronic dysuria (2 patients, 1.6%). Clinical staging was T1 as NMIBC in 7 patients (5.7%). MIBC consisted of T2 in 37 patients (30.3%), T3 in 35 patients (28.7%), T4 in 43 patients (35.2%). The pathological grading as an high-grade were 74 patients (64.3%). All patients had underwent TURBT for diagnosis and staging, followed by definitive treatment. It consisted of TURBT and chemotherapy bladder instillation in 7 patients (5.6%), radical cystectomy in 13 patients (10.3%), EBRT in 5 patients (4%), MVAC chemotherapy in 24 patients (19%), EBRT and chemotherapy with MVAC in 3 patients (2.4%). There were 74 patients (58.7%) underwent TURBT alone.Conclusion: Bladder TCC was in advanced stage when diagnosed, most of the patients received only TURBT and refused further treatment. Keywords: Bladder transitional cell cancer, characteristics, managements
CORRELATION OF FOLLICLE STIMULATING HORMONE AND LUTEINISING HORMONE WITH TESTICULAR SPERM BIOPSY RESULT
Get PDFObjective: To investigate the correlation of follicle stimulating hormone (FSH) and luteinising hormone (LH) with testicular sperm biopsy result in azoospermia patients. Material & methods: This is a cross sectional descriptive analytic study. Data were collected from medical record in Klinik Permata Hati Sardjito General Hospital Yogyakarta. We divided them into two groups, sperm group and non-sperm group of sperm biopsy result. We recorded the level of FSH and LH pre-operation. The results were expressed as mean ± standard deviation (SD). The correlation coefficient (r) between various parameters was determined by analysis for Spearman’s rank correlation test. Results: We found 35 patients who met the inclusion and exclusion criteria during 2010-2012, who performed testicular biopsy, age range between 28-44 yo. The mean of FSH on sperm group (12.75 mIU/mL) was higher than non-sperm group (7.26 mIU/mL). The mean of LH on sperm group (5.8 mIU/mL)was also slightly higher than non-sperm group (5.70 mIU/mL). We found weak correlation between FSH level and testicular biopsy (r = 0.095), while on LH level was found negative correlation with testicular biopsy (r = -0.053). There were 42.85% patients with negative sperm result within normal range of FSH and 100% with normal range of LH. The Level of FSH with positive result ranged between 1.94-19.7 mIU/mL and LH level with positive result were 1.38-17.69 mIU/mL. Conclusion: FSH and LH were important plasma hormones correlated with spermatogenesis. FSH level between 1.94-19.7 mIU/mL and LH level between 1.38-17.69 mIU/mL could be used as reliable criteria for testicular sperm biopsy.Keywords: Follicle stimulating hormone, luteinising hormone, testicular sperm biopsy, azoospermia
EFFICACY OF DICLOFENAC COMPARED TO PLACEBO IN PAIN RELIEF DURING REMOVAL OF URETHRAL CATHETER
Get PDFObjective: To investigate efficacy of diclofenac compared to placebo in relieving pain on removal of indwelling urethral catheters. Materials and methods: This study was a randomized controlled trial, double blind, comparing diclofenac with placebo in relieving pain on removal of indwelling urethral catheters. Adult male patients with indwelling catheters admitted in surgical ward of RSUP Dr. Sardjito Yogyakarta who met the inclusion criteria were recruited. The independent variables were diclofenac or placebo treatment, while the dependent variables were visual analogue scale (VAS) score, and the external variables were age, education level, and duration of indwelling urethral catheter. We gave patients diclofenac or placebo in capsules 2 hours before urethral catheter removal. Immediately after removal by assistant, the patient filled VAS form. We used Chi-square test, independent T-test, and bivariate analysis with SPSS program version 11.5, with p<0,05 was set as statistically significant level. Results: Thirty patients met inclusion criteria. Mean VAS score of both groups was 33,467 + 20,4577, diclofenac group was 31,567 + 20,0934, and placebo group was 35,367 + 21,3412. There was no statistically significant difference of VAS score between both groups (p=0,844). Conclusion: Efficacy of diclofenac and placebo in relieving pain when performing urethral catheter removal is not significantly different
CORRELATION OF PSA, PV, AND IPP IN DETECTING BOO CAUSED BY PROSTATE ENLARGEMENT
Get PDFObjective: To define the relationship between intravesical prostatic protrusion (IPP), prostate specific antigen (PSA), and prostate volume (PV), and to determine which one is the best predictor of bladder outlet obstruction (BOO) due to benign prostatic enlargement. Material & method: 95 male patients > 40 years old presenting with LUTS and BPH, between January until July 2012. They were evaluated with digital rectal examination (DRE), International Prostate Symptoms Score (IPSS), total PSA serum, uroflowmetry, post-void residual urine measurement, IPP and PV using transabdominal ultrasound. Statistical analysis included Chi-square and Spearman’s Rank correlation test.Receiver Operator Characteristic (ROC) curves were used to evaluate the correlation of PSA, PV, and IPP with BOO. Results: Mean PSA was significantly higher in obstructed patients (8.6 ng/mL; 0.76-130) compared to non-obstructed patients (6.44 ng/mL; 1.0-40.6). Mean PV was significantly larger in obstructed patients (50.33 mL ± 24.34) compared to non-obstructed patients (45.39 mL ± 23.43). Mean IPP was significantly greater in obstructed patients (7.29 ± 2.78) compared to non-obstructed patients (6.59 ± 2.93). The Spearman rho correlation coefficients were 0.617, 0.721, and 0.797, for PSA, PV, and IPP, respectively. Using ROC curves, the areas under the curve for PSA, PV, and IPP were 0.509, 0.562 and 0.602, respectively. The positive predictive values of PV, PSA, and IPP were 59.7%, 55.6% and 60.2% respectively. Conclusion: PSA, PV, and IPP measured through transabdominal ultrasonography are noninvasive and accessible method that significantly correlates with BOO in BPH patients. IPP is a better predictor for BOO than PSA or PV.Keywords: Bladder outlet obstruction, intravesical prostatic protrusion, prostate specific antigen, prostate volume, transabdominal ultrasound, benign prostate hyperplasia