Indonesian Journal of Urology
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COMPARISON OF EPITHELIAL CELL COUNTS BETWEEN MIDDLE AND LATERAL LOBES IN BENIGN PROSTATIC HYPERPLASIA (BPH) PATIENT
Get PDFObjective: The aim of this study was to compare the epithelial cell counts in each lobe of prostate glands with benign prostatic hyperplasia (BPH). Material and methods: Twenty-two BPH patients who underwent transurethral resection of the prostate (TURP) in Diponegoro Dua Satu Surgery Hospital Klaten, from May until November 2006 were enrolled in this study. Tissue from each lobe of the prostate gland was separately collected, from the middle (A), left lateral (B), right lateral lobes (C). All samples were fixed in 10% formalin buffer, embedded in paraffin and sectioned in 4 micrometer slices with microtome. After hematoxylin eosin (HE) staining, number of epithelial cells was counted under light microscopy. Difference in epithelial cell counts in each alveolus between the three lobes was statistically analyzed using t-test (p<0,05). Results: Twenty-two patients were included in this study from May to November 2006, mean age was 66,64±7,6 (54-88) years old. The most common occupation was farmer. Almost all patients had symptoms of chronic urinary retention (95,45%). Length of hospital stay was 8,77±2,7 (6-17) days, mean weight of prostate resected was 47,05±23,2 (5-90) grams, mean operative time 77,73±22,24 (45-115) minute, mean volume of irrigation fluid (sterile water) was 24,18±7,87 (5-34) liter. Mean number of cells in groups A, B, and C were 23,67±8,4 (13,6-44,4), 29,22±8,8 (16,4-41,2), and 29,11±8,7 (16,4-41,2) respectively. There was significant difference between groups A and B, and between groups A and C (p<0,05) respectively. Conclusion: There was statistically significant difference in epithelial cell count between the middle lobes compared to lateral lobes of the prostate in BPH surgical samples. These findings are supported by cystoscopic observation of smaller middle lobe compared to the lateral lobes in BPH
NATRIUM DIKLOFENAK UNTUK PENGOBATAN NOKTURIA YANG DISEBABKAN OLEH NOCTURNAL POLYURIA
Get PDFObjective: To investigate the efficacy of diclofenac 50 mg (Non-Steroidal Anti-Inflammatory Drug) in the treatment of nocturnal polyuria. Materials and methods: Twenty four patients (23 male and 1 female) with a mean age of 61 years (range 34 – 80) diagnosed with nocturnal polyuria were recruited. The study period comprised 2 weeks of either placebo or active medication. Following one-week rest period, patients were crossed over to the other medication for a further 2 weeks. Frequency volume charts were completed during the second week of each of the two study periods along with feedback forms to assess any subjective improvement in symptoms during each of the study periods. Results: A significant improvement in the symptoms was noted for diclofenac when compared with the placebo. The mean nocturnal frequency decreased from 3,61 ± 2,45 to 2,39 ± 1,1 (p<0,05) and the mean 24 h urine volume decreased from 1139,64 ± 365 to 1089 ± 324 (p>0,05), but there is no statistically different. No significant side effects were reported. Conclusion: Natrium diclofenac 50 mg are effective in the treatment of nocturnal polyuria causing a decrease in nocturnal frequency with subjective symptom improvement. Our study suggests, Natrium diclofenac not to prolonged treatment. Further research to find the alternative treatment is recommended
LAPAROSCOPIC LIVING DONOR NEPHRECTOMY IN INDONESIA
Get PDFObjective: To evaluate and analyze variables related to the surgical and direct post-operative outcomes of our initial experience of laparoscopic living donor nephrectomies (LLDN). Material & methods: This retrospective analysis describes the first 10 laparoscopic nephrectomies in living donors performed in Cipto Mangunkusumo Hospital. All surgeries were performed by the same surgical team. Variables related to the surgical and post-operative outcome and complications in donors were evaluated and analyzed.Results: The average age of the donors was 31.8 years with male : female ratio of 7 : 3. Thirty percent of them were family related to the recipient. The left kidney was extracted from all patients and multiple renal vessels were found in one cases. The mean operation time was 321.9 ± 27 min, first warm ischemia time was 9.37 ± 3.34 min and estimated blood loss was 270 ± 182.87ml. The hospital stay was 4.1 ± 1.3 days, VAS in the first day post surgery was 3 ± 1 with epidural analgesia needed for 1.8 ± 0.6 days, and drain was kept in for 2.8 ± 1.2 days while urethral cathether for 2.4 ± 1.2. Time to return to work was 16 ± 8.4 days. Conclusion: LLDN results in acceptable blood loss,less post-operative pain, short hospital stay and short time to return to work for the donors, therefore promising to be the gold standard among living donor nephrectomy surgical options.Keywords: Laparoscopic living donor nephrectomy,renal transplantation, Indonesia
PENGARUH VOLUME BULI-BULI TERHADAP PANJANG PROSTAT PADA PEMERIKSAAN ULTRASONOGRAFI TRANSABDOMINAL
Get PDFObjective: To study the effects of different bladder volumes on the length of prostatic protrusion as measured by transabdominal ultrasonography. Materials & Method: We did an observational study on 48 patients with BPH and urinary retention in Urology outpatient clinic of Cipto Mangunkusumo Hospital Jakarta from 1 March 2006 to 28 February 2007. The bladder of each patient was filled with 50 ml normal saline and increased stepwise by 50 ml each time until either an urge to void or a volume of 500 ml was reached. Length of prostatic protrusion was measured by transabdominal ultrasonography at each volume of bladder filling in every patient. Results: The average length of prostatic protrusion in 50, 100, 150, and 200 ml bladder filling was 11,14; 11,42; 11,88; 10,20 mm respectively. There is no statistically significant difference in the length of prostatic protrusion with transabdominal ultrasonography in each bladder volume. Conclusion: Prostatic protrusion length can be measured with bladder volumes between 50 ml to 200 ml and shows no significant difference
PSA, TZI, RI OF PROSTATE AS RISK FACTORS OF URINARY RETENTION
Get PDFObjective: To evaluate some parameters as the predictors of urine retention incident in Benign Prostate Hyperplasia (BPH) patients. Materials & Methods: From May to August 2012, a total of 24 BPH patients aged 47-69 years with lower urinary tract symptomps (LUTS) including 12 patients with urine retention were participated in the study. Prostate specific antigen (PSA) examination was performed on all patients. For urine retention patients, PSA was performed 2 weeks after catheterization as the procedure may affect PSA levels. Transrectal ultrasonography (TRUS) was examined to assess total prostate volume (VTP), transitional zone volume (VZT), transitional zone index (IZT = VZT / VTP), and resistive index of prostate capsulary arteries. Statistic was utilized using simple and multiple logistic regression. Receiver operating characteristic (ROC) was calculated to assess the usefulness of parameters as a predictor of urine retention. Results: There was no significant difference in age between LUTS and BPH patients with urine retention (p = 0,487). There was no relationship between PSA and transitional zone index to incidence of urine retention in BPH patients (PSA; p = 0,173 and TZI; p = 0,192). Multiple logistic regression analysis showed only resistive index of prostate capsulary arteries which correlates with urine retention incidence (p = 0,014), with area under ROC 0,865 (95% CI 0,721 to 1,008) and cut-off value of > 0,675 as a predictor of urine retention incidence. Conclusion: Resistive index of prostate capsulary arteries by transrectal ultrasonography (TRUS) is a predictor of urine retention incidence in BPH patients.Key words: prostate specific antigen, transitional zone index, resistive index of prostate capsulary arteries, benign prostate hyperplasia, lower urinary tract symptoms, urine retention
MANAGEMENT OF URETER STONES USING ESWL COMPARED TO URS
Get PDFObjective: To evaluate the management of ureterolithiasis using Extracorporeal Shock Wave Lithotripsy (ESWL) EDAP Sonolith Technomed compared to ureteroscopy (URS) with holmium:YAG laser lithotripsy. Material & Method: Research was conducted at Central Pertamina Hospital Jakarta by comparative analysis. The data was taken from patients’ medical records diagnosed with ureterolithiasis who had been treated from January to Desember 2009.Results: Central Hospital Pertamina Jakarta had treated 127 patients with urolithiasis from January to December 2009. Most frequent therapeutic modality was URS, which was followed by ESWL.Double J stents were used in 19,8% of the treatmentin combination with URS, more common than ESWL. Stone free rate in urolithiasis was not significantly different between treatment with URS and ESWL, although stone free rate of URS was higher than ESWL.Use of DJ stent didn’t affect stone free rate of urolithiasis from two of these modalities.Conclusion: Stone free rate of these modalities was below of stone free rate at literatures published, because evaluation from stone free rate of this research was taken after the treatment or 1-2 days after the treatment with imaging of KUB and USG.Keywords: Urolithiasis, extracorporeal shock wave lithotripsy, ureteroscopic,DJ stent, stone free rate
EFFECT OF URETHRAL DILATION ON ANTERIOR URETHRAL STRICTURE RECURRENCE AFTER INTERNAL URETHROTOMY IN MALES
No full textObjective: The aim is to evaluate the effect of urethral dilation on anterior urethral stricture recurrences after direct vision internal urethrotomy (DVIU). Material & Method: Patients were classified into 2 groups after internal urethrotomy for urethral dilation or observation. All strictures included were anterior, single, and causing partial obstruction. Urethral dilation was performed using a metal sound. This procedure was performed every 1 or 2 weeks in the first and second month after operation and then once a month for 1 year or in case of voiding complaints or low flow rate (< 10 mL/s). Follow up at least until 1 year after DVIU. Results: A total of 32 cases could be reviewed, of which are 21 had urethral dilation and 11 observation only. In the urethral dilation group, we found 4 recurrences (19%) with mean time to recurrence 10,52 months. In the observation group, we found 7 recurrent cases (63,63%) with a mean time to recurrence of 8,09 months. P value is 0,02 which means urethral dilation significantly decreased the chance of stricture recurrence. By Kaplan Meier survival analysis, urethral dilation had a better and longer time to recurrence. Conclusion: In this study, regular meatal dilation is proven to prolong the time to recurrence of an anterior urethral stricture after DVIU. Keywords: Urethral dilation, anterior urethral stricture, stricture recurrence
CORRELATION BETWEEN PROSTATIC URETHRAL ANGLE WITH CLINICAL PARAMETERS AND BOO IN LUTS ASSOCIATED WITH BPH
No full textObjective: We investigated the correlation of the PUA on clinical parameters and bladder outlet obstruction (BOO) in men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). Material & Method: This study was performed between January to April 2011. A cross sectional analysis of 24 men with LUTS associated BPH aged > 50 years was performed. Patients underwent evaluation including International Prostatic Symptom Score (IPSS), transrectal ultrasonography, uroflowmetry, and pressure-flow study. Statistical analysis was performed to evaluate correlation of the PUA on clinical parameters and bladder outlet obstruction (BOO). Results: A total of 24 patients, aged 51 to 78 years were enrolled in this study. The mean value of total IPSS, prostate volume, PUA, and Qmax was 22 (range 7-35), 34,4 cm3 (range 21–70 cm3), 37,3° (range 25°–55°), and 10,5 mL/s (range 4,2–17,9 mL/s), respectively. Pearson’s correlation analysis showed that PUA was not significantly correlated with IPSS (p = 0,117), Qmax (p = 0,434), total prostate volume (p = 0,213). Patients with increased PUA (PUA > 35°) had higher incidence and degree of BOO (p < 0,05). Conclusion: PUA may be one method to assess the presence of BOO in men with LUTS associated BPH. Our investigation suggest that PUA may help in the treatment of individuals by better predicting their likely classification from a pressure-flow study.Keywords: Prostatic urethral angle, benign prostatic hyperplasia, lower urinary tract symptoms, bladder outlet obstruction
ANTIBIOTIC PROPHYLAXIS WITH DIFFERENT ANTIBIOTIC REGIMEN IN PROSTATE BIOPSY PATIENTS
Get PDFObjective: To know the incidence of urinary tract infection (UTI) with different antibiotic prophylaxis for transrectal ultrasonography (TRUS) prostate biopsy. Material & Method: The study included 34 patients at Soetomo Hospital Surabaya, who were divided into 2 groups, each group consisting of 17 patients. In the first group patients received 1000 mg of ciprofloxacin orally, in the second group cefotaxime 1000 mg iv was given prior to biopsy. The two groups were compared in terms of UTI incidence as observed from the blood levels of leukocytes, C-reactive protein (CRP) and urine culture 3 days after the procedure. Results: Based on blood leukocyte levels, there was no statistically significant difference between the two groups (p = 0,74 and p = 0,42). So was the comparison of CRP levels. There was no other significant difference found (p = 0,53 and p = 0,27). From the results of urine culture, the ciprofloxacin group had positive urine culture results lower than the cefotaxime group (29,4% : 35,3%), although it was not statistically significant (p = 1,0). Conclusion: Based on the parameters of blood leukocytes levels, CRP and urine culture, there were no differences in the incidence of UTI after biopsy in the two groups.Keywords: TRUS prostate biopsy, UTI, ciprofloxacin, cefotaxime
ATHEROSCLEROTIC PLAQUE OF RENAL VASA RECTA ON PATIENT WITH CALCIUM STONE
No full textObjective: We would like to identify whether atherosclerotic plaque inside renal vasa recta correlates with the formation of calcium stone. Material & Method: Samples are taken from kidney tissue removed by nephrectomy due to stone and non-stone disease. Histopathological examination with specific staining was performed by a single pathologist to find the atherosclerotic plaques inside the renal vasa recta. The result of each group was compared, and then analyzed using the Chi square test/Fischer exact test (SPSS ver.16.0; p < 0,05). Results: We found that the risk of calcium lithiasis is two-fold higher in the group with atherosclerotic plaques inside the renal vasa recta. (PR = 2,15; p < 0,05). Conclusion: Calcium stone are more likely to occur on patients with renal vasa recta atherosclerotic plaque, as possible sequelae of vascular injury.Keywords: Atherosclerotic plaque, vasa recta, calcium renal stone