Indonesian Journal of Urology
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PROSTATIC CAPSULAR ARTERY RESISTIVE INDEX AND MALE BLADDER OUTLET OBSTRUCTION
No full textObjective: This study aims to explore the relationship between resistive index (RI) with clinical parameters and degree of bladder outlet obstruction (BOO). Materials & Methods: We performed clinical examination which included IPSS, uroflowmetry, transrectal prostate ultrasonography for measurement of prostatic volume and RI of prostatic capsular artery, and pressure flow study. We enrolled patients with lower urinary tract symptoms (LUTS) and prostatic volume of more than 20 ml. Statistical analysis utilised correlation and calculation of sensitivity, specificity, and area under curve of receiver operating characteristics. Results: Twenty-six patients provided consent to enroll in this study. Mean age was 66,5 ± 6,56 years, mean IPSS was 15,9 ± 7,27, and mean prostatic volume 36,0 ± 23,78. Kolmogorov-Smirnov test showed normal distribution of all study variables. There was significant correlation between RI and IPSS, Qmax, and BOO (p < 0,05). Correlation coefficients (r) for prostatic volume and BOO was 0,392 (p = 0,048), for Qmax and BOO was -0.515 (p = 0,007), and RI with BOO was 0,414 (p = 0,035). Using cutoff values for RI ≥ 0,70 and BOO ≥ 4, we found sensitivity of 70,0%, specificity of 50,0%, positive predictive value of 46,7% and negative predictive value of 72,7%. Conclusion: Resistive index of prostatic capsular artery is correlated with BOO and has a role in diagnosis of BOO in men with LUTS related toBenign Prostatic Hyperplasia (BPH).Keywords: Resistive index, transrectal power doppler ultrasonography, lower urinary tract symptoms, bladder outlet obstruction
TERAZOSIN EVALUATION AS MALE LUTS TREATMENT USING IPSS SUB-SCORING RATIO
Get PDFObjective: To evaluate the improvement of Lower Urinary Tract Symptoms (LUTS) in males treated with terazosin based on sub scoring ratio of the International Prostatic Symptoms Score (IPSS). Material & Method: Sixty eight male with LUTS subjected to terazosin 1 mg daily and divided into two groups based on IPSS sub scoring ratio. After 3 months improvement of the symptoms were evaluated using the IPSS. Data analysis was done using paired T-test. The conclusion was based on significance level p<0,05. Results: The IPSS score was improving on both failure to void group (IPSS- v/s >1) and failure to store group (IPSS- v/s ≤1) after 3 months of Terazosin therapy (mean= 9,56 versus 6,94). Statistically superior improvement was observed on failure to voiding group (p=0,0003) (95CI:1,30-3,93). Conclusion: Terazosin is best given to male LUTS with IPSS- v/s >1 although both groups respond well.Keywords:International prostatic symptoms score, sub score, failure to voiding, failure to storage, male, lower urinary tract symptoms
THE USE FGSI AS PREDICTIVE OF UROLOGICAL SIRS PATIENTS
Get PDFObjective: To demonstrate the usefulness of Fournier’s Gangrene Severity Index (FGSI) score for differentiating the outcome between Systemic Inflammatory Response Syndrome (SIRS) patients with upper and lower urological abnormalities. Material & Method:A retrospective study of case records from year 2009-2012 of SIRS patients with urological abnormalities at Saiful Anwar General Hospital (SAGH) Malang was carried out. The data were collected from the Medical Record Division in SAGH Malang. SIRS was clinicaly diagnosed based on medical history, physical examination and laboratory findings. SIRS without urological abnormalities were excluded from the analysis. The FGSI, which was developed to assign a numerical score that describes the severity of disease, was used in our study. This index presents patients vital signs (temperature, heart and respiratory rates) and metabolic parameters (sodium, potassium, creatinine, and bicarbonate levels, hematocrit, and white blood cell count). Patients with SIRS and urological abnormalities were divided according to upper tract and lower tract urological abnormalities. Total FGSI score was classified as mild (0-8), moderate (9-17), severe (> 17). The data were assessed according to whether the patient survived or died.Results:75 of the 203 evaluated patients died. From those 75 patients, 67% were male and 33% were female, 75% with upper urological abnormalities and 25% with lower abnormalities (p < 0,05). From those 203 patients; the results were analyzed with binary logistical regression and Spearman correlation analysis using SPSS 15 softwarewith 95% confidence interval (CI). There is significant relationship between FGSI and outcome of the patient with upper urological abnormalities and lower urological abnormalities, with correlation coefficient more high in relationship between FGSI and outcome of the patient with upper urological abnormalities (0,4 vs 0,1). Conclusion: FGSI is simple and objective outcome predictor to differentiate survival between SIRS patients with upper urological abnormalities and lower urological abnormalities. There is a significant difference in outcome between SIRS patient with upper urological abnormalities and lower urological abnormalities even with same level of FGSI score.Keywords: Fournier’s gangrene severity index, systemic inflammatory response syndrome, upper urological abnormalities, lower urological abnormalities, outcome predictor
TAMSULOSIN OR SOLIFENACIN IN LUTS PATIENTS DUE TO DJ-STENT INSERTION
Get PDFObjective: To evaluate the efficacy of tamsulosin or solifenacin for treatment of Lower Urinary Tract Symptoms (LUTS) due to an indwelling ureteral stent. Material & Method: In this study, we enrolled 24 patients who had polyurethane DJ-stent inserted for urinary stone disease or ureteral stenosis. Patients were divided into 3 equal groups as follows and study medications were started on postoperative day 7. Group I received tamsulosin 0,4 mg once daily, group II received solifenacin 5 mg once daily, and group III only received placebo. LUTS were evaluated using International Prostatic Symptoms Score (IPSS) questionnaire at 7 and 14 days after the procedure and stent insertion. The evaluation of IPSS score included not only total score but also irritative and obstructive subcores. Results: All 24 patients fulfilled the inclusion and exclusion criteria, mean age of tamsulosin group was 54,3 years old, solifenacin group was 45,3 years old and placebo was 46,7 years old. There was significant difference in the total IPSS and irritative subscores between groups who received either tamsulosin or solifenacin (group I and II), whereas the obstructive subscore showed a difference though not statistically significant. Conclusion: Tamsulosin or solifenacin significantly improved irritative symptoms of LUTS in patients with an indwelling ureteral stent.Keywords: Lower urinary tract symptoms, DJ-stent, tamsulosin, solifenacin
ESTROGEN-TESTOSTERONE RATIO IN PLEXUS PAMPINIFORM OF NORMAL RABBITS AND RABBITS WITH LEFT ARTIFICIAL VARICOCELE
No full textObjective: To evaluate estrogen-testosterone ratio in rabbits with a left artificial varicocele. Material& Method: Eight rabbits were divided into two groups.The first group underwent ligation of left renal vein to induce artificial varicocele and the second group underwent a sham operation as control group. Eight week after ligation, blood samples were taken from the pampiniform plexus in both groups. Serologic examination (ELISA) was performed to measure testosterone and estrogen level. The t-test was used to compare the differences of the estrogen-testosterone ratios, a p value < 0,05 is considered significant.Results: Testosterone level was increased with 279% and estrogen level was increased with 33% blood from the pampiniform plexus in group 1 compared with group 2 (normal rabbits). The ratio of estrogen-testosterone between the control group and the artificial varicocele group were 1 : 3. Differences of the ratio between two groups were statistically significant (p < 0,05). Conclusion: Estrogen-testosterone ratio was lower in varicocele rabbit compared with normal rabbits.Keywords: Estrogen-testosteron ratio, left artificial varicocele
VESICO-VAGINAL FISTULA: EXPERIENCE OF 11 YEARS
Get PDFObjective: To evaluate the outcome of surgical repair in patients with vesico-vaginal fistula at Cipto Mangunkusumo Hospital. Material & Method: A retrospective study of 30 patients with vesico-vaginal fistula, who underwent surgical repair of the fistula at Urology Department Cipto Mangunkusumo Hospital between the period of 1998-2008, were reviewed. Patients were analyzed with regard to age, location of fistula, etiology, size of fistula, and surgical approach. The outcome of the surgery was analyzed. Results: This study included 30 patients who underwent surgery with age between 18-69 years old. The most common etiology was due to obstetrical trauma and hysterectomy. Bladder trigone was the most common location of fistulae (40%). During the surgery the transvesical (43%) approach was commonly used. However, the most excellent outcome was surgery by transvesical-transvaginal approach (100%). Success rate of fistula repair was 73%. Conclusion: This disease is a medically and psychosocially devastating condition for the patient. The diagnosis was easy but complicated in decision of treatment. Best results were observed by transvesical-transvaginal approach. Keywords: Vesico-vaginal fistulae, surgical approach, surgical outcome
STONE COMPOSITION PATTERN OF KIDNEY STONE
Get PDFObjective: The purpose of this study was to know the bacterial and sensitivity pattern towards antimicrobials on kidney stones and to know the stone composition of kidney stones. Material &Method: Data were collected from medical record in 1 year period from January until Desember 2008 with descriptive study design. Results: We found 59 patients in that period, 32 males and 27 females, the mean age was 52,5 ± 10,31 with age 31 – 75 years old, most patients came from Bantul (16,9%) and 25,4% patients were housewives. From urine analysis we found leucocyturia (44,1%), erythrocyturia (39,0%), nitrituria (3,4%) and bacteriuria (6,8%). Urine culture showed E. coli (12,5%) and Candida (12,5%) being the most common causative microorganism. No antimicrobials was sensitive to all bacteriae while all antifungal was sensitive to candida. Stone composition showed ammonium (98%), calcium oxalate (91,8%), calcium non oxalate (93,9%), carbonate (22,4%), cholesterol (14,3%), uric acid (10,2%) and phosphate acid (10,2%). Conclusion: The most common stone composition were ammonium, calcium oxalate, and calcium non oxalate. E. coli still being the most common causative microorganism.Keywords: Kidney stone, stone composition, urinary tract infection, urine analysis, urine culture
PERIPROSTATIC NERVE BLOCK AND INTRAPROSTATIC INFILTRATION ON TRUS-P GUIDED BIOPSY
No full textObjective: This study is aimed to determine the effectiveness and complications of periprostatic block and intraprostatic infiltration anesthesia for transrectal prostate biopsy. Material & Method: Two consecutive group of patients, periprostatic block (group A) and intraprostatic infiltration (group B), underwent transrectal ultrasound (TRUS) guided prostate biopsy were entered into the study. Exclusion criteria were severe systemic infection, local infection (prostatitis, proctitis, anorectal abscess, and fissure), hemorrhoid (external and/or internal), and chronic pelvic pain (bladder pain syndrome (BPS) or other pelvic disease. Each group enrolled 58 patients. The patients were requested to choose indicate degree of pain on visual analog score (VAS) 3 times, during probe insertion (VAS1), during anesthesia (VAS2), and during the biopsy (VAS3). Complications from the procedures were recorded. The data were analyzed using Mann-Whitney and independent t-test. Results: There were no significant difference in average age of groups, 65,69 ± 7,019 years for group A and 65,34 ± 7,633 years for group B (p = 0,647). The VAS3 score of group B 5,17 ± 0,653 was significantly lower than group A 5,9 ± 0,612 (p < 0,001). The change in VAS score (VAS3-VAS2) in group B 0,55 ± 0,535 also significantly lower than group A 1,00 ± 0,530 (p = 0,004). The average days with pain were not significant on both group, group A 1,16 ± 0,362 day and group B 1,12 ± 0,329 day (p = 0,594). The duration of bleeding was significantly higher on group B 1,32 ± 0,562 day than group A 1,10 ± 0,307 day (p = 0,026). Conclusion: Intraprostatic infiltration resulted in less pain during prostate biopsy, but also reported more bleeding after the procedure than the periprostatic block.Keywords: Intraprostatic infiltration, periprostatic nerve block, transrectal ultrasound guided prostate biopsy
CHANGES IN ERECTILE FUNCTION BEFORE AND AFTER PROSTATE BIOPSY
Get PDFObjective: To evaluate erectile function before and after transrectal ultrasound (TRUS) guided prostate biopsy using International Index of Erectile Function-5 (IIEF-5) and Erection Hardness Score (EHS) instrument. Material & Method: We conducted a study on 17 BPH LUTS patients who underwent TRUS guided prostate biopsy from January to April 2011 in Urological Minimal Invasive Installation (IIU) Dr. Soetomo Hospital. Out of 17 patients, three patients had mild ED, while 14 other patients had normal erectile function before the procedure. After TRUS guided prostate biopsy, we performed erectile function assessment using the IIEF-5 and EHS at weeks I, II, and IV. Results: Pathological examination of all specimens from prostate biopsy results revealed BPH. There were 2 patients with hematuria and 1 patient with rectal bleeding shortly after the biopsy, which resolved spontaneously less than 24 hours. Based on the IIEF-5 there were 4 patients (23,5%) with decreased erectile function in the evaluation of first week after prostate biopsy, and it reduced to 2 patients (11,7%) whose erectile function was still decreasing in the evaluation week II, while in fourth week evaluation there was 1 patient (5,9%) with decreased erectile function. Based on EHS data obtained, there were 5 patients (29,4%) with decreased scores in evaluations week II, and in the evaluation of week IV there were no patients having erectile function problems compared with EHS data before prostate biopsy. Conclusion: TRUS guided prostate biopsy can have temporary effect on erectile function.Keywords: Erectile dysfunction, prostate biopsy, international index of erectile function-5, erection hardness score
PREOPERATIVE KETOROLAC EFFECT ON POSTOPERATIVE PAIN ON TURP PATIENTS
Get PDFObjective: The aim of this study is to study the effect of preoperative Ketorolac on postoperative pain after transurethral prostatectomy at Sardjito Hospital Yogyakarta. Material & Methods: This is a cross sectional, analytic, prospective study. We divided benign prostatic hyperplasia patients, from October 2011 until February 2012 into two groups. Group I was given Ketorolac 30 mg intravenously twice daily starting one day before operation and in the morning before procedure. Group II did not receive Ketorolac preoperatively. Patients underwent transurethral operation with spinal anesthesia. We assessed postoperative pain at 24 hours using Visual Analogue Scale (VAS). Results: Twenty four patients were included in this study with mean age 66 years old with the youngest 45 years old and the oldest 80 years old (SD 8,77744). Group I (17 patients), VAS score 1 to 7 with median 3 and mean 3,4118 (SD 1,66053). Group II (7 patients) VAS score 1 to 8 with median 3 and mean 3,8571 (SD 2,8357). We count it using Mann-Whitney U (p = 0,951). Conclusion: There is no significance difference in post-operative pain after transurethral prostatectomy with preoperative ketorolac administration.Keywords: Ketorolac, bupivacaine, visual analogue scale, transurethral prostatectomy