61 research outputs found
The management of vesicoureteral reflux in children
No full textVesicoureteral reflux (VUR) is defined as retrograde flow of urine from the bladder to the ureter. It is usually asymptomatic but commonly found in children with urinary tract infection (UTI). The prevalence is about 1-2% in general pediatric population.1 However, the prevalence in children with UTI is much higher, reaching 30-57%.1,2 Similar prevalence (45.8%) is also reported in CiptoMangunkusumo Hospital. 3</jats:p
Extrarenal calyces mimicking retroperitoneal cystic mass with concomitant ureteropelvic junction obstruction: renal pelvis reconstruction using calyx unification
No full textIrfan Wahyudi,1 Arry Rodjani,1 Gerhard Reinaldi Situmorang,1 Prahara Yuri,2 Fakhri Rahman11Urology Department, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia; 2Urology Department, Faculty of Medicine, Universitas Gadjah Mada, Sardjito Hospital, Yogyakarta, IndonesiaAbstract: Extrarenal calyces (ERCs) are a very rare urological anomaly, especially when concomitantly presenting with ureteropelvic junction obstruction (UPJO). Surgical intervention is often necessary in ERCs associated with UPJO, with dismembered pyeloplasty being the most commonly utilized technique. We present a case of UPJO-associated ERCs in which renal pelvis reconstruction using calyx unification was selected as the treatment technique. An 11-year-old boy was referred to our center due to bilateral hydronephrosis and left multicystic kidney disease. Magnetic resonance imaging showed severe left hydronephrosis with concomitant left cystic mass and left UPJO. A 99mTc diethylenetriaminepentaacetic diuretic renal scan showed residual renal function of 25.9% split function and 26.8 mL/minute glomerular filtration rate. Intraoperatively, we found ERCs with severely dilated renal pelvis. The renal pelvis was excised. Major calyces protruding from the kidney were unified using side-to-side anastomosis to form a new structure resembling a renal pelvis, which was further anastomosed to the ureter. Temporary urinary drainage from the affected kidney was achieved using a double-J (DJ) stent and nephrostomy. Pathological examination revealed atrophic transitional epithelial cells. There was no intra- or postoperative complication reported. The nephrostomy tube and DJ stent were removed 2 weeks and 3 months after surgery, respectively. Ultrasonography examination performed at 1 and 9 months after DJ-stent removal showed no hydronephrosis. We conclude that renal pelvis reconstruction using calyx unification can be performed safely and is effective in treating patients with ERCs associated with PUJO. This technique should be considered especially in cases where excision of the renal pelvis cannot be avoided.Keywords: extrarenal calyces, hydronephrosis, reconstructive surgical procedure, ureteropelvic junction obstruction, UPJ
Comparison Between End-to-end Anastomosis and Buccal Mucosa Graft in Short Segment Bulbar Urethral Stricture: a Meta-analysis Study
Get PDFAim: to compare long term follow-up between end-to-end urethroplasty and bucal mucosal graft for the management of patients with short bulbar urethral stricture. Methods:we conducted a meta-analysis of cohort studies. Literature research was performed on the MEDLINE, Science Direct, and EMBASE database including studies from 1980 through 2014. The inclusion criteria were patients with short bulbar urethral strictrure (sized ≤3 cm) undergoing end-to-end anastomosis (EE) and buccal mucosa graft (BMG) with the complication of voiding symptoms and sexual dysfunction ≥12 months. Pooled risk ratio (RRs) and 95% confidence interval (CIs) were calculated using Mantzel-Haenzel method, while the heterogeneity were determined through I2 value. Data analysis were done using Stata software version 10.0 (StataCorp). Results:We analyze 10 studies in this meta-analysis. Sexual dysfunction following EE and BMG were found in 24.6% (45/183) patients and 9.1%
(11/122) patients, respectively (overall RR 2.54; 95% CI: 1,44-4,47; p=0.001). Voiding symptoms following EE and BMG were found in 14% (8/57) patients and 12.5% (7/56) patients, respectively (overall RR 0.77; 95% CI: 0.3–2.0; p=0.591). Furthermore, stricture recurrent following EE and BMG were 8.4% (8/107) and 30% (14/46), respectively (overall RR 0.38; 95% CI: 0.17–0.84; p=0.016). The effectiveness of EE and BMG were
found to be equal as both demonstrated few complications. BMG were found to be superior than EE terms of minimal sexual dysfunction complication. On the contrary, EE were found to be superior than BMG in terms of stricture recurence following short bulbar urethral stricture surgery. Conclusion:BMG can be considered as the primary treatment rather than EE for managing short urethral stricture cases
TESTICULAR TORSION: CAUSATIVE FACTOR IN DELAYED MANAGEMENT
No full textObjective: Analyzing the factors causing delays in the management of patients with testicular torsion in Dr. Cipto Mangunkusumo General Hospital Jakarta. Material & methods: This research is a retrospective research using questionnaire from patients as primary data and from Dr. Cipto Mangunkusumo General Hospital medical records or urologic reports as secondary data from 1st January 2011 to 30th April 2015. Results: 4 patients diagnosed with left testicular torsion admitted to hospital with >4 hours onset (as a prehospital factor). 3 of 4 patients were adult, who came with left testicle pain. The minimum VAS score perceived is 2. 3 of 4 patients had 540o medial left testicle rotation intraoperatively while all patients left testicles were unvital. Conclusion: Further examination is required to diagnose testicular torsion in adult-geriatric. Non-specific complaints, such as lower abdominal pain or painful testicles and mild pain in scrotum were some of the most important factors, thus causing delays in testicular torsion management. However, a comprehensive education to all health workers, especially for doctors is still required, because the complaints of pain in patients with testicular torsion does not always appear acutely. This becomes important for early identification of patients with testicular torsion, in order to prevent delay in management
RISK FACTORS FOR URETHROCUTANEOUS FISTULAS FORMATION AFTER ONE STAGE HYPOSPADIAS REPAIR
Get PDFObjective: To evaluate risk factors that contribute to urethrocutaneous fistulas formation after one stage hypospadias repair. Material & method: A case control study was performed on hypospadias patients that underwent one stage hypospadias repair. We analyzed the correlation of urethrocutaneous fistula formation with patient age, hypospadias classification, chordee severity, other urogenital anomalies, history of hormonal therapy, suture size, duration of operation, type of dressing, type of stent, duration of stenting, and three types of operation technique, which are TIP, Duckett, and Onlay Island Flap. Results: There were 116 patients with mean age 5,7 ± 3,9 years old (4 months – 19 years old). Urethrocutaneous fistula occured in 12 patients (10,3%). From the data analysis, we didn’t find any significant correlation between urethrocutaneous fistula formation and patient’s age (p = 0,426), hypospadias classification (p = 0,695), chordee severity (p = 0,564), other urogenital anomalies (p = 0,964), history of hormonal therapy (p = 0,739), suture size (p = 0,248), duration of operation (p = 0,856), type of dressings (p = 0,580), type of stents (p = 0,600), and duration of stenting (p = 0,796). We also didn’t find any significant correlation between urethrocutaneous fistula formation and operation technique TIP vs Duckett (p = 0,314), and TIP vs Onlay Island Flap (p = 0,644). Conclusion: There were no significant correlation between urethrocutaneous fistula formation and patient age, hypospadias classification, chordee severity, other urogenital anomalies, history of hormonal therapy, suture size, duration of operation, type of dressing, type of stent, and duration of stenting. There were also no significant correlation between urethrocutaneous fistula formation and operation technique TIP vs Duckett, and TIP vs Onlay Island Flap.
Keywords: Hypospadias, one stage urethroplasty, urethrocutaneous fistula
Childhood renal cell carcinoma
No full textRenal cell carcinoma (RCC) in children isseldom found. The incidence of thistumor in childhood is estimated to be 0.1-0.3% out of all neoplasms and 2-7% out ofall malignant renal tumors. The Third NationalCancer Survey reported an incidence of only four casesof RCC per year compared to 117 per year of Wilms’tumor.The incidence of RCC has not been reported inIndonesia. This is the first case of childhood RCCfound in our institution. To the best of our knowl-edge, this is the first report of childhood RCC in In-donesia.</jats:p
RELATION BETWEEN COMPLICATING FACTORS OF HYPOSPADIA AND COMPLICATIONS AFTER TIP: A RETROSPECTIVE STUDY
No full textObjective: This study aims to find an association between hypospadias complicating factor for complications that occurred after hypospadias reconstruction, focusing on tubularized incised plate (TIP) as reconstruction techniques are most commonly used. Material & methods: The study data was obtained from medical records of urologic hypospadias patients in Cipto Mangunkusumo General Hospital, Jakarta. Samples are those who underwent hypospadias reconstruction in Cipto Mangunkusumo General Hospital, since April 2002 until May 2014 with a total sampling method. Data were analyzed using SPSS ver 14. Results: We collected 127 patients who underwent the TIP technique with a mean patient age and treatment duration was 7.58 years and 10.95 days. Fistule is the most common complication in patients with post-TIP hypospadias accounting for as high as 32 (25.2%). Bivariate analysis showed a significant correlation between the location of the hypospadias meatus (distal) with torsion of the penis (n = 2; p 0.019). Conclusion: On the basis of the technical complications TIP, such as fistules, meatus stenosis, urethral stricture, torsion of the penis, and glans dehiscence, then the indication for TIP should be clear or selective
COMPARISON OF KETOROLAC VERSUS DICLOFENAC AS TREATMENT FOR ACUTE RENAL COLIC: A SYSTEMATIC REVIEW AND A NETWORK META-ANALYSIS (DIRECT AND INDIRECT COMPARISON)
Get PDFObjective: The purpose of this study is to compare which analgesic is better between ketorolac and diclofenac. Material & Methods: A systematic search was conducted in Pubmed, Science Direct, Cochrane, EBSCO, Proquest database, and PICO analysis was used in determining the study question. The included article in the analysis was randomized controlled trials. Results: A total of 6 articles were included in the analysis, with no significant differences between ketorolac and diclofenac both in a direct comparison and indirect comparison (OR 2.74 [95%CI 0.72 – 10.43]; p= 0.14 and OR 0.51 [95%CI 0.29 – 0.91]; p= 0.49). Conclusion: Both ketorolac and diclofenac have the same efficacy in treating renal colic
SUBURETERAL MUCOSA INJECTION WITH DETRANOMER/HYALURONIC ACID FOR VESICOURETERAL REFLUX TREATMENT: SYSTEMATIC REVIEW
No full textObjective: The aim of this study is to search the success rate of detranomer-hyaluronic acid (Dx/HA) used as injection through endoscopy approach and grades of vesicoureteral reflux (VUR) that could affect it success rate. Material & methods: We searched the literatures from MEDLINE database and PubMed from year 2001 until 2013. The data was analyzed using Random Effects Model with the method of Mantzel-Haenzel to analyze the success rates of dextranomer/hyaluronic acid and was determined by 95% Confidence of Interval (CI) disclosure. Meta-regression was performed to adjust the success rate compared with the grade of VUR as covariate. We assessed the heterogeneity by calculating the I2 statistic. All analyses were performed with Stata Statistical Software Version 12.0 (StataCorp). Results: We identified 9 literatures in full review. Of 1105 ureters that were injected with dextranomer/hyaluronic acid, 817 (72%; CI: 67-76%) were successfully treated according to author’s definition. The success rates of Dx/HA for pediatric with grade 1 VUR reached 80% (95% CI: 66-89%), whereas in grade 5 VUR only 50% (95% CI: 34-66%; p<0.05). Conclusion: The overall success rate of dextranomer/hyaluronic acid injection treatment was 72% after 3 months, although success rates varied widely among studies. Preoperative grade of VUR was significantly associated with treatment outcome. Increased VUR grade negatively affected success rates
COMPARISON OF SEXUAL DYSFUNCTION BETWEEN END-TO-END ANASTOMOSIS AND BUCCAL MUCOSA GRAFT
Get PDFObjective: The aim of this study was to compare long term follow-up of sexual dysfunction between end-to-end anastomosis or buccal mucosa graft in short segment bulbar urethral stricture. Material & Method: We performed a meta analysis of cohort study. The data sources was MEDLINE from 1980 through 2011. A fixed effects model with Mantel-Haenszel method was used to calculate the pooled Risk Ratio (RRs) and 95% Confidence Interval (CIs). We assessed the heterogeneity by calculating the I2 statistic. All analyses were performed with Stata statistical software, version 10.0 (Stata Corp). Results: We analyzed 6 cohort studies. End-to-end anastomosis and buccal mucosa graft patients who complained about sexual dysfunction were 24.6% (45/183) and 9.1% (11/122) respectively, with overall RR 2.54 (95% CI, 0.22-0.69, p = 0.001). Conclusion: Buccal mucosa graft showed a superior outcome compared to end-to-end anastomosis, based on sexual dysfunction in ≤ 3 cm bulbar urethral stricture treatments.Keywords: Sexual dysfunction, end-to-end anastomosis, buccal mucosa graft, anterior urethral stricture
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