Indonesian Journal of Urology
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URINARY DIVERSION AFTER RADICAL CYSTECTOMY, ORTHOTOPIC NEOBLADDER VS ILEAL CONDUIT: A SYSTEMATIC REVIEW AND META-ANALYSIS OF POSTOPERATIVE COMPLICATION
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Objective: The purpose of this study is to compare orthotopic neobladder (ONB) and ileal conduit (IC) formation in terms of surgical outcome and complication. Material & Methods: Computerized bibliographic search on different databases related to this study. The PICO criteria method was applied to define research eligibility, per PRISMA recommendations and conducted a systematic review of the literature with meta-analysis. Weighted mean differences with 95 percent confidence intervals were used to compare continuous outcomes. Results: There were 479 publications were discovered and only 6 studies fulfilled the criteria included. The random-effect model's pooled result for urinary leakage complication revealed a significant difference of 1.62 between ONB and IC with higher incidence in neobladder group (95 percent CI, 1.85, 8.69, P = 0.0004) with non-significant heterogeneity (Chi2 = 0.65, df = 3 (P = 0.89), I2 = 0%). Other complications (ileus complication, anastomosis site stenosis, sepsis, urinary infection) showed non-significant difference. Conclusion: Because of the heterogeneity in several aspects of the analyzed papers, further study comparing Orthotopic Neobladder and Ileal conduit in terms of complication following urinary diversion are needed to confirm superiority of ONB or IC as the urinary diversion of choice.
Keywords: Orthotopic neobladder, ileal conduit, urinary diversion, radical cystectom
SMART E-LEARNING OPTIONS FOR STUDENTS IN MEDICAL RESIDENCY AND CLERKSHIP DURING THE COVID-19 PANDEMIC
Get PDFObjective: This study aimed to evaluate medical resident and clerkship preferences for a variety of available Smart e-Learning options to better cope with this global pandemic. Material & Methods: This cross-sectional study using a web-based national survey was conducted between the 10th-20th of June 2020. As many as 91 of 200 (45.5% response rate) residents and clerks, who were randomly invited, responded to the survey and rated the available modalities for Smart e-Learning. Results: Generally, respondents choose morning scientific online meetings (rated 7.61/10), webinars on case discussion (7.58/10), and pre-recorded tips and tricks on surgery (7.32/10) as their favorite modalities of Smart e-Learning. Conclusion: Scientific meetings among faculty and video based learning are both equally favorite modalities of Smart e-Learning during this pandemic. Meanwhile, morning reports are the least favorite due to the majority of cases are emergency cases that lack interactive discussion. This study may provide more insights for medical faculties into how to better cope with this pandemic and continue to deliver high quality education in the ‘New Normal’ Era using Smart e-Learning options.
Keywords: e-Learning, resident, clerkship, New Normal Era
THE CORRELATION OF LOWER URINARY TRACT SYMPTOMS (LUTS) ON BENIGN PROSTATIC HYPERPLASIA (BPH) PATIENTS AND ERECTILE DYSFUNCTION IN RADEN MATTAHER HOSPITAL JAMBI
Get PDFObjective: This study aims to determine the relationship between Lower Urinary Tract Symptoms (LUTS) in patients with Benign Prostatic Hyperplasia (BPH) and erectile dysfunction at Raden Mattaher Hospital Jambi. Material & Methods: This research is an observational analytic with a cross sectional approach. The sample of this study includes 48 people using total sampling technique. Data analysis was carried out to test the hypothesis by the Spearman correlation test. Results: Based on the results of the Spearman correlation test analysis showed that there was a statistically significant relation (p=0.000) between Lower Urinary Tract Symptoms (LUTS) in patients with Benign Prostatic Hyperplasia (BPH) and erectile dysfunction. Conclusion: There is a significant relation between Lower Urinary Tract Symptoms (LUTS) in patients with Benign Prostatic Hyperplasia (BPH) and erectile dysfunction at Raden Mattaher Hospital Jambi
ANALYSIS OF HEMODIALYSIS PERIODS, AGE, AND SMOKING TOWARDS THE SEVERITY OF ERECTILE DYSFUNCTION IN PATIENTS WITH CHRONIC RENAL FAILURE ON ROUTINE HEMODIALYSIS
Get PDFObjective: This study aims to analyze the factors associated such as hemodialysis periods, age, and smoking with ED severity in CKD patients undergoing routine hemodialysis. Material & Methods: A single-center, cross-sectional study was conducted involving a total 101 patients who were on routine hemodialysis who diagnosed with CKD and experienced complaint in sexual function were included. The severity of ED classified based on the International Index of Erectile Function (IIEF-5). The analysis was carried out descriptively and analytically using the ordinal regression method. Results: Hemodialysis duration (p = 0.044) were significantly related to severity of erectile dysfunction in patient with CKD and on routine hemodialysis. Meanwhile, although both older age (p =0.307) and smoking (p = 0.283) showed a positive estimate, they were not statistically significant. Conclusion: The study indicate that prevalence of ED observed in CKD patient with routine hemodialysis remain high. Several factors significantly contribute in ED severity such as shorter hemodialysis duration
CORRELATION OF THE IMPACT OF TAMSULOSIN/DUTASTERIDE COMBINATION THERAPY ON ERECTILE DYSFUNCTION (ED) IN BENIGN PROSTATIC HYPERPLASIA (BPH) IN PKU MUHAMMADIYAH GOMBONG HOSPITAL, KEBUMEN
Get PDFObjective: This study assessed the impact of a fixed-dose combination 5α-reductase inhibitor (5-ARI) dutasteride 0.5 mg and the α-blocker (AB) tamsulosin 0.4 mg on erectile dysfunction (ED) using The International Index of Erectile Function-5 (IIEF-5) score and Erectile Hard Score (EHS) in patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Material & Methods: This was an analytical cross-sectional with consecutive sampling. We reviewed the medical records of the symptomatic BPH patients. Then we interviewed The International Prostate Symptom Score (IPSS), Quality of Life (QOL), IIEF-5, and EHS scores after administered combination therapy. The data were analyzed with SPSS IBM 21.0 using univariate and then bivariate analysis. Results: Forty (40) patients fulfilled inclusion criteria. The results showed that the frequency of patients at most in the age range of 50-59 years (40%), most of IPSS after therapy showed mild grade 45%, and moderate grade 55%. The QOL average score is 2.08, most of the patients felt pleased (35%). IIEF-5 average score after treatment is 11.6 (moderate ED) and the EHS is 2.48 (grade 2: tumescence with minimal rigidity). The Spearman test showed that there was no correlation between IPSS and IIEF-5, the score is -0.658. Then, the Spearman correlation score between BPH grade after combination treatment and ED grade is 0.739 and had a statistically significant 0.000 (p<0.001). Conclusion: This research shows that there is a correlation of the impact of tamsulosin/ dutasteride combination therapy on ED in BPH with secondary LUTS.
Keywords: BPH, erectile dysfunction, tamsulosin/dutasteride combination
GIANT NON-FUNCTIONING ADRENOCORTICAL CARCINOMA
Get PDFObjective: This study aims to report a case of a 51 year old male who was referred to our Department of Urology and was diagnosed with a nonfunctioning giant ACC. Case(s) Presentation: The case report describes a 51-year-old Indonesian man who presented to our department with complaints of persistent upper left abdomen discomfort, previously misdiagnosed as dyspepsia. He was diagnosed as having non-functioning adrenocortical carcinoma and underwent open adrenalectomy. Discussion: Although the patient is 51 years old and the tumor has grown to a signify cant size, no lymph node involvement or metastases was found and resection margins were found to be negative. In our patient, functional adrenal work-up results were normal. This has led us to suspect a non-functioning adrenal tumor. Metastatic work-up with CT cranial, chest, and bone survey were performed, with negative result. The biopsy result after resection confirmed the diagnosis of ACC. Conclusion: ACC is a rare aggressive tumor, malignant with poor prognosis. In our case, the non-secretory mass was diagnosed late by manifestation of mass effect symptoms in the upper left quadrant of the abdomen and was previously misdiagnosed as symptoms of dyspepsia. The functional work-up of adrenal masses helped in the determination of its non-functional status. Early diagnosis of ACC and early surgical excision helps in improving the overall survival rate of the patient.
Keywords: Non-functioning, adrenocortical carcinoma (ACC), adrenalectomy, case report
RENAL ARTERY THROMBOSIS SECONDARY TO BLUNT ABDOMINAL TRAUMA: RARE CASE SERIES
Get PDFObjective: This study aims to report the possibility of non-operative management (NOM) as a Renal artery thrombosis (RAT) treatment. Case(s) Presentation: In this series, we reported 3 cases of unilateral RAT secondary to blunt abdominal trauma treated with NOM, where patient had complete bed rest, close observation, laboratory tests, and serial imaging. During a first-month follow-up, hypertension, renal abscess, persistent flank pain, or impairment of renal function were not found in the patients. However, after a one-year follow-up, an atrophic kidney appeared due to RAT in one of our cases. Discussion: RAT secondary to blunt abdominal trauma is rare. However, the management of RAT is still controversial. Renal preservation with NOM possesses reasonable success because the risk of complication does not exceed that of revascularization, and is currently considered. Conclusion: NOM is considered a treatment option in the cases of unilateral RAT with good contralateral renal function. This treatment provides a minimal number of complications.
Keywords: Renal artery thrombosis, non-operative management.
 
OUTCOMES ANALYSIS OF TRANSURETHRAL RESECTION OF THE PROSTATE (TURP) AND TRANSURETHRAL VAPORIZATION OF THE PROSTATE (TUVP) IN PATIENT WITH BENIGN PROSTATE HYPERPLASIA: SYSTEMATIC REVIEW
Get PDFObjective: This systematic review aims to compare IPSS score and Uroflowmetry (Qmax) results between Transurethral Resection of The Prostate (monopolar and bipolar TURP) and Transurethral Vaporization of The Prostate (PVP, ThuVARP, Biolitec, TUEVP, BPV). Material & Methods: Articles were obtained through online searches using Medline, Google Scholar, and Cochrane Library using keywords Transurethral Resection of The Prostate (TURP) dan Transurethral Vaporization of The Prostate (TUVP) and IPSS or Qmax. Results: A total of 6 RCTs and 3 Cohort consisted of 1212 BPH patients treated with TURP (B-TURP and B-TURP) or TUVP (TUVP, BPV, Biolitec, ThuVARP, GLVP(PVP)). There is a significant difference result of IPSS score and Qmax at the third month of follow-up after both therapies. Conclusion: The post-operative IPSS score and Qmax results at the third month of follow-up in BPH patients treated with TURP or TUVP presents varied results. TURP has a better post-operative IPSS score compared to Biolitec Laser, but not superior when compared with TUEVP, BPV, ThuVARP, and PVP. Notably, TURP has better post-operative Qmax results than BPV, TUEVP, and ThuVARP, but not when compared with PVP.
 
EXPERIENCE OF BILATERAL SYNCHRONOUS PERCUTANEOUS NEPHROLITHOLAPAXY (PCNL)
Get PDFObjective: This case report will present bilateral synchronous percutaneous nephrolitholapaxy (PCNL) that was performed in Saiful Anwar General Hospital Malang for the first time. Case(s) Presentation: 49 years old male with flank pain on both sides continuously. Non contrast abdominal Computed Tomography (CT) scan showed bilateral pyelum stone and bilateral hydronephrosis. From blood analysis, the creatinine serum was 1.5 mg/dL and ureum serum was level 69.8 mg/dL. Discussion: Bilateral synchronous PCNL was performed in prone position, and stone fragmentation was done with pneumatic lithotripter, the operation last for about 2 hours with minimal amount of bleeding. After 3 months of follow-up, urology ultrasound and abdominal X-ray shows no residual stone, and normal ureum-creatinine level (0.77mg/dL; 43.7mg/dL). Conclusion: Bilateral synchronous PCNL is a safe choice to be done in order to treat bilateral pyelum stone, it can decrease length of stay , total cost therapy, and morbidity of the patient
COMPLICATION AND SAFETY OF TRANSPERINEAL PROSTATE BIOPSY USING NOVEL AFFORDABLE VY PROBE (TPPB-VY) IN CLINICAL PRACTICE : A PILOT STUDY
Get PDFObjective: This study was aimed to know the complication and safety of TPPB-VY in clinical practice. Material & Methods: TPPB were performed in 34 patients between January 2019 and Juni 2021. Ethical approval of this study was sought from the hospital authorities (IRB number: LB.02.01/X.6.5/ 55/2020). Patients underwent systematic 10-12 core TPPB depend on the prostate volume with intravenous light sedation. The patient was included to the study if PSA ≥ 4 ng/ml and/or Digital Rectal Examination (DRE) results suggestive of prostate cancer. Procedures were performed without any antibiotic prophylaxis or an enema before the procedure and post procedure the patients just get an oral fluoroquinolones and low potent analgetics (if needed). The complication include pain level post procedure (using VAS), perineal hematoma, fever and retention post biopsy were recorded. Results: In all, 34 patients were included in the study. The result showed that perineal pain perceived by patients post procedure were 76.47% (26 out of 34 patients) but the VAS score just mild around 0-2. There were 23.53% (8 out of 34 patients) hematuria, 5.88% (2 out of 34 patients) acute urinary retention and 2.9 % (1 out of 34 patients) perineal hematoma. No fever or clinical infection was observed and 82.35% (28 out of 34 patients) patients presented with minor complications (ClavienDindo I). Only one of the patients were hospitalized due to the post-biopsy complication that need intervention. Conclusion: This is the first study TPPB using Novel Affordable VY probe. The results show clinically insignificant complication without infection. TPPB using Novel Affordable VY probe is feasible and safe