Indonesian Journal of Urology
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STAGED URETHROPLASTY FOLLOWING SEVERE ELECTRIC BURNS TO PERINEUM AND GENITALIA: A CASE REPORT
Get PDFObjective: This study aims to know the surgical treatment of electrical injuries, perineum, and scrotum. Case(s) Presentation: A 55-year-old male sustained electric burns to the back, perineum and scrotum. The patient failed to void following removal of the catheter 6 weeks later, hence the patient was referred to the urology department for further management. was counselled for a two-phase urethral surgery. Discussion: In our case, the patient had sustained perineal and scrotal burns when he sat over a live wire. This led to the loss of skin and soft tissues, needing massive musculoskeletal and skin grafts. Our patient underwent a number of revision surgeries leading to repeated scarring of the perineal tissues and skin. Conclusion: Electrical injuries to the perinium and genitalia are rare. Hence the surgical strategy of electrical injuries requires a step-wise approach. Initially, conservative debridement needs to performed so as to preserve any tissue of questionable viability and ensure subsequent adequate soft-tissue coverage. The reconstructive surgical procedures bring about satisfactory outcomes.
Keywords: Electrical injury, perineum, scrotum, surgical strategy.
 
ALLIUM STENT IN EXTENSIVE URETERAL STENOSIS: LESSON LEARNED FROM ITS FIRST OFF LABEL USED IN INDONESIA
Get PDFObjective: This study aims to determine the use of allium stents for ureteral stenosis. Case(s) Presentation: This study reported a case of 50-year-old-male with right ureteral stenosis that underwent allium installation, the first ever used in Indonesia. Discussion: . Long-term ureteral stenting is commonly used when major surgery is not an option for patients. Metallic stents offer an alternative method to address the blockage in a single procedure, without the risk of issues like tissue erosion, infection, or tube encrustation. The design of the Allium stent ensures that the ureter remains open by providing direct support to the walls, resulting in better dilation compared to the double-J stent. In this study, the patient who received an Allium stent could benefit from its use. The stent has shown effectiveness in treating ureteral stenosis, relieving bothersome urinary symptoms, and reducing the need for frequent visits to the operating room for JJ stent replacement. Conclusion: Allium stents improve quality of life in patients with irritative symptoms from JJ stents, reducing Re-operations of JJ insertion, and hospital stay.
Keywords: Ureteral stenosis, allium stent, Indonesia
COMPARISON OF PRE AND POST-TURP EVALUATION IN BPH PATIENTS USING IPSS AND UROFLOWMETRY IN TERTIARY HOSPITAL
Get PDFObjective: To present the data about LUTS using International Prostatic Symptoms Score (IPSS) and uroflowmetry on BPH patients following TURP. Material & Methods: This retrospective study reviewed patients diagnosed as BPH with LUTS undergone TURP from Dr. Saiful Anwar General Hospital medical records from January 2021 to January 2023. The basic clinical characteristics, IPSS, and uroflowmetry results were collected. Furthermore, the comparison of IPSS score and uroflowmetry prior and 7 days after surgery were analyzed. Results: From a total of 286 patients, 94 patients met the inclusion criteria. Improvement of LUTS and quality of life (QoL) obtained from IPSS were observed before and after TURP (19.13 vs 2.78, p<0.001; 4.38 vs 0.33, p<0.001). Similar improvement was also showed for maximum flow rate (QMax) and post-void residual (PVR) volume obtained from uroflowmetry result (7.90 vs 17.85, p<0.001; 66.25 vs 27.05, p<0.001) with 90.43% patients had Qmax >15 ml/sec after the procedure. Conclusion: This study showed the evidence of early improvement of IPSS and uroflowmetry results in BPH patients after TURP. The indicators were sufficient to evaluate the satisfaction result of patient complaining LUTS.
Keywords: BPH, IPSS, uroflowmetry, TURP
NEONATAL SCROTAL WALL NECROTIZING FASCITIS (FOURNIER GANGRENE SCROTUM) IN A ONE MONTH OLD NEONATAL: A RARE CASE REPORT
Get PDFObjective: In this report, we present our case of a one-month-old neonatal with Fournier gangrene who was referred to our hospital. Case(s) Presentation: A one-month-old patient came from a referral hospital with chief complaint had a diaper rash since 6 days before hospital admission, fever existed, and patient’s scrotal became swollen and appear white spot. The patient was referred to Ulin General Hospital Banjarmasin for a necrotomy debridement. Discussion: We recommend more than one antibiotic to cover it, including one specifically targeted toward it. Both Enterococcus and S. aureus have been implicated as the causative organisms of Fournier gangrene in previous reports. Conclusion: Fournier gangrene in neonatal is a rare case and potentially life-threatening disease, it is a progressive gangrenous of the genitalia, perineum and perianal regions.
Keyword: Fournier gangrene, scrotal, neonata
PRELIMINARY RESULTS OF DELAYED PRIMARY BLADDER EXSTROPHY RECONSTRUCTION IN FEMALE PATIENT: A CASE REPORT
Get PDFObjective: Reporting a rare case and provide a view of bladder extrophy management. Case(s) Presentation: A 12-year-old female complained of an open abdominal wall below the umbilicus accompanied by continuous incontinence of urine since birth. The MRI showed diastasis symphisis 5.1 cm and a soft tissue defect in the suprapubic region, suspicious of bladder exstrophy. Bladder mucose biopsy showed squamous metaplasia. The patient underwent pelvic osteotomy, bladder wall closure, bladder neck reconstruction, abdominal closure with double keystone flap with proceed mesh, and external fixation. A cystostomy catheter was placed until one week after surgery, and the patient was able to hold the urge to urinate and started to move around while sitting. Two months after the reconstruction, the primary closure and keystone removal on skin defect were carried. The patient was already able to walk and continence the urine. Discussion: Bladder extrophy is a rare condition. Currently delayed reconstruction on bladder growth is the subject of debate and speculation. The patient’s condition in this presented case improved, this is in accordance with the literature that states that delayed reconstruction can still be considered in special conditions that do not allow early reconstruction. Conclusion: Delayed bladder reconstruction and bladder neck reconstruction can improve the anatomy of the bladder and quality of life on certain cases.
Keywords: Bladder exstrophy, bladder reconstruction, female bladder exstrophy
CASE SERIES AND REVIEW ON THE MANAGEMENT OF BLADDER CALCULI CAUSED BY IUD MIGRATION
Get PDFObjective: Comparing two cases of the management of bladder calculi caused by Intra Uterine Device (IUD) migration with other similar cases worldwide. Case(s) Presentation: A forty-eight-year-old woman diagnosed by Abdominal Non-contrast Computed Tomography (NCCT), already done IUD extraction through the bladder approach also hysteroscopy to evaluate the position from the womb side, and continued with the stone removal by vesicolithotripsy. The second case revealed a bladder stone with IUD tail presence based on Kidney Ureter Bladder (KUB), performed vesicolithotomy, and IUD was found attached to the stone. Both patients’ conditions improved after surgeries. IUD migration into the bladder causes perforation, stone formation, and Urinary Tract Infection (UTI). NCCT, KUB, and Ultrasonography can be used as imaging modalities for initial screening when IUD migration is suspected. Discussion: The managements consist of open cystolithotomy, transurethral grasping forceps, or minimally invasive laparoscopy. Open and laparoscopic surgery should be considered for the IUD removal with partial penetration due to vesicouterine fistula and high-risk stone removal, especially for the large stone with IUD embedded inside. Conclusion: Minimally invasive methods are efficient, safe, and frequently preferred for the bladder stone caused by IUD migration.
Keywords: Bladder stone, IUD, migration.
 
AN UNDIAGNOSED FOURNIER’S GANGRENE IN ADVANCED UROGENITAL CANCER WITH INCARCERATED INGUINAL HERNIA
Get PDFObjective: This study aims to report an undiagnosed Fournier’s gangrene. Case(s) Presentation: A 62-year-old male with advanced urogenital cancer and an incarcerated inguinal hernia. Sudden-onset scrotal pain was initially diagnosed as hydrocele with an incarcerated hernia. Radiological examinations not revealing typical Fournier's gangrene features. Despite the absence of classical symptoms, further investigation uncovered a complex medical history involving urogenital issues, failed catheterization, and urethrotomy. The patient presented with malnutrition, weight loss, and signs of systemic distress. Discussion: Pus and necrotic tissue were debrided, with cultures indicating E. Coli growth. Biopsies suggested carcinoma, requiring further evaluation at a tertiary facility. Despite complications, the patient showed an excellent prognosis after a 14-day hospital stay. Conclusion: This case underscores the atypical presentation of Fournier's gangrene, emphasizing the need for comprehensive assessment in patients with scrotal pain. The association with advanced urogenital cancer adds complexity to diagnosis and management, highlighting the importance of a multidisciplinary approach.
Keywords: Fournier’s gangrene, urogenital cancer, incarcerated inguinal hernia
EXPERIENCE OF TESTICULAR CANCER PATIENT LONG TERM FOLLOW-UP IN TERTIARY REFERRAL HOSPITAL
Get PDFObjective: This study aims to determine the survivability testicular cancer patients at a tertiary hospital in Malang, Indonesia. Material & Methods: This is study conducted from January 2021 to January 2022 at Saiful Anwar General Hospital in Malang, East Java. Involving 32 testicular cancer patients. Data was obtained through medical record January 2017 – January 2022. Analysis was carried out to determine the survivability of the patient. Results: The results showed that the proportion of 1 to 5 year survival rate in testicular cancer patients was 96% and 21%. Kaplan Meier test showed significant difference of patient survival in the radiation therapy exposure (p=0.021), Karnofsky score (p=0.010), tumour type (p=0.019), and response of chemotherapy (p=0.015). Conclusion: The survival rate of testicular cancer patients are strongly influenced by the karnofsky score, radiation therapy exposure, tumour type, and chemotherapy response. Therefore early diagnosis and treatment plays an important role in improving survival rate of the patients.
Keywords: Testicular cancer, survival rate, seminoma, non seminoma
SUCCESSFUL TRANSURETHRAL RESECTION OF ANTERIOR URETHRAL VALVE IN CHILDREN : A CASE REPORT
Get PDFObjective: This case report will present transurethral resection of double anterior urethral valves in tertiary hospital. Case(s) Presentation: A three-year-old boy who complained of a poor stream of urine and discomfort during micturition. From the radiological examination, the main finding was found on ultrasound (USG), with thickening of the bladder wall without upper tract abnormality. On panendoscopy, we found double anterior urethral valves at bulbar part and trabeculation in bladder. Discussion: The resection of the valves was performed and achieved an excellent result included normal stream of urine and there was no discomfort during micturition. Conclusion: Anterior Urethral Valve is a rare case that can be caused a lower urinary tract obstruction. A good understanding of AUV’s radiological and endoscopic anatomy is required to differentiate it from other diseases, essential to prevent further injury, and also to decide for appropriate management.
Keywords: Anterior Urethral Valve, Congenital Anomaly, Urinary Obstructio
THE ROLE OF DOCETAXEL AS FIRST-LINE CHEMOTHERAPY ON PSA LEVEL AND QOL IN CRPC PATIENTS
Get PDFObjective: Prostate cancer is the second most common cancer in men and the fifth leading cause of death worldwide. 10-20% of cases can progress to a more aggressive stage called castration-resistant prostate cancer (CRPC) with a higher death rate. Clinical guidelines recommend docetaxel as first-line chemotherapy and evaluated using the PSA test. This study aims to investigate the effect of docetaxel chemotherapy on PSA levels in CRPC. Material & Methods: A retrospective study was conducted from January 2016 until August 2022 according to the medical records database Saiful Anwar Hospital. There were 16 patients who met the inclusion criteria, including male patients with a diagnosis of CRPC who received castration therapy and found an increase in PSA 3 times of nadir or found 2 or more bone metastatic lesions or soft tissue lesions > 2 cm, received 6 series of docetaxel chemotherapy, and have a PSA data was performed before and after chemotherapy. Statistical analysis was performed using a differential T-test. Results: The results, obtained were significantly different (p<0.05) on the average PSA (log) pre-post chemotherapy, visual analog scale (VAS), and quality of life, and not significantly different on BMI pre-post chemotherapy. Conclusion: 6 cycles of docetaxel chemotherapy resulted in a decrease in PSA levels of CRPC significantly. It showed an excellent response to docetaxel chemotherapy in managing CRPC patients. Limitations of this study were specifically the retrospective cohort study model and the ability to reduce PSA levels in assessing the prognosis of CRPC.
Keywords: Castration-resistant prostate cancer, chemotherapy, docetaxel, prostate-specific antigen