bluuebunny/crossref_metadata_2025 huggingface dataset:
EFFICACY OF SURGICAL SPERM RETRIEVAL IN AZOOSPERMIC PATIENT AND ITS CONTRIBUTION TO IN VITRO RERTILIZATION PROGRAM
Authors: Gde Sanjaya I Putu , Birowo Ponco , Rasyid Nur , Sini Ivan Rizal , Wiweko Budi
Published: August 2019

Objective: This study was made to evaluate efficacy and success rate of Percutaneous Epididymal Sperm Aspiration (PESA), Microsurgical Epididymal Sperm Aspiration (MESA), or Testicular Sperm Extraction (TESE) in azoopsermic patients, and evaluate IVF program’s pregnancy rate by comparing methods of sperm retrieval. Material & method: A descriptive retrospective study to azoospermic patients undergone PESA, MESA or TESE and IVF program in Bunda Hospital Jakarta and Cipto Mangunkusumo Hospital Jakarta in 2011–2012. The data were collected from patients’ medical records and IVF program’s database. Results: There were 146 azoospermic patients with mean age 38.97 ± 7.35 years. Viable sperm was found in 46 patients (31.5%) by PESA and 47 patients (32.2%) by MESA and TESE. The IVF program was followed by 72 patients. Sperm was retrieved by PESA in 43 patients (59.7%) and TESE in 29 patients (40.3%). Pregnancy was achieved in 18 patients in PESA group (25%) and 15 patients (20.8%) in TESE group. Conclusion: Sperm can be retrieved from azoospermic patients by PESA, MESA or TESE, and there was good success rate in pregnancy rate of IVF program by using surgically retrieved sperm.
URINARY RETENTION EFFECT IN THE INCREASED OF PSA EXPRESSION WITHIN PROSTATIC TISSUE
Authors: Djatisoesanto Wahjoe , Soebadi Doddy M , Sudiana I Ketut
Published: August 2019

Objective: To determine whether the increased of PSA expression within prostatic tissue and subsequent systemic blood circulation in acute urinary retention cases of nonmalignant origin were caused by acute inflammation on the prostatic gland. Following this inflammation, PSA willincrease, producing byacinar epitelial cells in the gland and continue to capillary vessels before entering the blood circulation. Material & method: Thirty male Rattus Norvegicus were randomly allocated into 3 groups. A control group underwent urethral manipulation, treatment-1 group and -2 group underwent proximal urethral ligation. Prostatectomy was performed after 24 hours in the control and treatment-1 group. Ligation was removed after 24 hours in treatment-2 group, and prostatectomy performed after 4x24 hours. Each prostate specimen was examined for PSA expression by immunohistochemistry methods in the prostatic gland. Statistical analysis of study data was analyzed by descriptive statistics and performed ANOVA with level of significance α = 0.01.Results: Study results showed an increase PSA expression significantly after urinary retention and returned to normal values four days later after relief of retention.Conclusion: Urinary retention caused acute inflammation on the prostatic gland and increased PSA expression within prostatic tissue. Entry of PSA into stroma and subsequent systemic blood circulation occur through significant increase in PSA production by acinar epithelial cells.
CORRELATION BETWEEN ALDEHYDE DEHYDROGENASE 1A1 LEVEL AND BONE METASTASIS IN PROSTATE CANCER
Authors: Moeljono Abraham , Danarto Danarto
Published: August 2019

Objective: To determine the association between Aldehyde Dehydrogenase 1A1 (ALDH1) expression and metastasis in prostate cancer. Material & methods: This study was a prospectivestudy in 45 patients diagnosed with prostate cancer in Sardjito General hospital. Patient characteristics and patient clinical data were recorded. Paraffin blocks of 45 patient surgery results were performed with immunohistochemical staining with monoclonal antibody of anti ALDH1A1 (EP1933Y, Biocare, dilution 1: 200). ALDH1 expression differences between prostate cancer without metastases and prostate cancer with metastasis was compared and analyzed with Chi-square. Results: This study involved 45 prostate cancer patients with median of age of 74 years. A high Gleason scores was found in 25 (55.6%) patients with prostate cancer and 24 (53.3%) patients had metastasis to the bone. The high expression of ALDH1 was found in 30 (66.7%) patients. The incidence of bone metastasis in patients with prostate cancer was associated with high levels of ALDH1 (p < 0.001, OR, 95% CI 17.88 (3.28-97.83) and was not associated with Gleason score (p = 0.316). Conclusion: Prostate cancer cells with high ALDH1A1 level increased the risk of the incidence of bone metastasis. ALDH1A1 level in prostate cancer cells can be considered as a predictor factor of the bone metastasis in prostate cancer.
FACTORS ASSOCIATED WITH INTRACYTOPLASMIC SPERM INJECTION OUTCOME IN MEN WITH AZOOSPERMIA AND SEVERE OLIGOZOOSPERMIA
Authors: Putra Donny eka , Utomo Trisula
Published: August 2019

Objective: This study is assigned to evaluate factors that associated with intracytoplasmic sperm injection (ICSI) outcome. Material & methods: A retrospective study design is used to evaluate couples who seeking help for infertility problems at Permata Hati Infertility Clinic, Sardjito General Hospital Yogyakarta. The outcome measures were fertilization and clinical pregnancies rates. All analyses were performed with SPSS statistical software, version 20.0. Result: Forty-five couples participated in this study with mean age 33.69 ± 5.38 years for men and 30.53 ± 4.79 years for women. Of 56 ICSI cycles, there were 43 successful fertilizations (95.6%) and 14 clinical pregnancies (31.1%). In multivariate analysis, factors associated with successful clinical pregnancies were women’s age (p = 0.034, 95% CI 0.005-0.8), number of ICSI cycle (p = 0.045, 95% CI 0.001-0.93), and sperm morphology (p = 0.019, 95% CI 1.648- 253). In bivariate analysis, only men’s age is significantly associated with successful fertilization (p = 0.006, 95% CI 7.22-16.43). Conclusion: Factors associated with outcome of ICSI are women’s age, number of ICSI cycle, and sperm morphology.
TOTAL CHOLESTEROL AND C-REACTIVE PROTEIN LEVELS AS A PROGNOSTIC MARKERS OF UROSEPSIS
Authors: Wahyudi Septa surya , Hardjowijoto Sunaryo , Soebadi Doddy M , Soetojo Soetojo , Djojodimedjo Tarmono , Budiono Budiono
Published: August 2019

Objective: To investigate whether total cholesterol and C-reactive protein levels could be use as a prognostic factor for outcome in patients with urosepsis. Material & Methods: An analytic observational study using 30 patients assigned for total cholesterol and CRP level at the day of admission, three days later, and on the last day of sepsis or on the dead day. All subjects were managed according to standard urosepsis therapy. At the 14th day of treatment, patients were evaluated with a clinical severity score. Then we classified the outcome as improve/good condition, worse, and died. The variables were statistically tested using Spearman’s rho test with software SPSS 20. P < 0.05 was consider significant. Result: From 30 subjects with urosepsis, we found 15 patients in septic condition, 14 patients had severe sepsis and one patient had septic shock. The mean of total cholesterol level in patient with died and worse was lower than that in patient with good outcome. Day-1 (63.25 mg/dl and 101.38 mg/dl vs 119.5 mg/dl), day-3 (56.0 mg/dl and 93.6 mg/dl vs 128.6 mg/dl) and last day/died day (51.0 mg/dl and 82.25 mg/dl vs 154.8 mg/dl). The mean of CRP level in patient with died and worse was higher than that in patient with good outcome. Day-1 (177.18 mg/l and 146.74 mg/l vs 88.1 mg/l), day 3 (127.1 mg/l and 148.8 mg/l vs 56.2 mg/l) and last day/died day (141.88 mg/l and 88.71 mg/l vs 31.58 mg/l). These were statistically significant between total cholesterol and CRP levels in determining the outcome of urosepsis patient. Day-1 (p 0.000 vs 0.011), day-3 (p 0.000 vs 0.002), and last day/died day (p 0.000 vs 0.000). The coefficient correlation total cholesterol was better than CRP in day-1 (rho -0.633 vs 0.459), day-3 (rho -0.755 vs 0.543), and last day/died day (rho -0.874 vs 0.686). Conclusion: Low total cholesterol and high C-reactive protein levels can be used as poor prognostic in urosepsis patients. Total cholesterol level was better than CRP as a prognostic marker.
URODYNAMICS UTILITY PATTERN AMONG INDONESIAN UROLOGISTS
Authors: Johanes Charles , Wibisono Elita , Rahardjo Harrina Erlianti
Published: August 2019

Objective: Aim of this study was to describe urodynamic utility pattern among Urologists in Indonesia especially in treating lower urinary tract symptoms (LUTS), urinary retention, overactive bladder (OAB), stress urinary incontinence (SUI) and urologic pediatric cases. Materials & methods: Subjects were Indonesian Urologists who attended urological scientific meetings or workshop in Jakarta between February-July2014. They were given questionnaires about urodynamics and its indications. Results: One hundred and eight Urologists completed and returned the questionnaires out of 303 Urologists in Indonesia. Thirty eight Urologists worked at hospitals where urodynamic machine is available, the rest sent their urodynamic cases elsewhere. Most of Urologists ordered urodynamics for LUTS patients with neurological deficit (84.3%) and weak anal sphincter tone/bulbocavernosus reflex (62.0%). In OAB cases, urodynamics was used in cases with failure of medical therapy (70.4%) and neurological deficit (68.5%). Two most common indication criterias in SUI cases were failure of conservative therapy (70.4%) and mixed incontinence cases (SUI with OAB) (60.2%). Neurological deficit (66.7%) and urinary incontinence (26.9%) were the most frequent urodynamic indications applied in children. Conclusion: We described the urodynamic utility pattern among Indonesian Urologists. Availability of urodynamic machine, patient economic capabilities, guideline availability on urodynamics could be the factors affecting this pattern.
HOLMIUM LASER: YAG LITHOTRIPSY IN URETERAL CALCULI MANAGEMENT
Authors: Sunaryo Juhadi , Ali Zulfikar , Danarto H R
Published: August 2019

Objective: To know predictive factors for success of holmium laser: YAG lithotripsy in ureteral calculi management. Materials & Methods: This prospective cohort study was conducted in January 2013 to May 2015 at Kardinah Tegal Hospital Central Java. Patients diagnosed with proximal and distal stones were included. Pediatric, obesity, pregnancy, ureteral anomaly, and ureteroscopy (URS) cannot reach ureteral level of stone were excluded. We used semirigid URS (Wolf) 6/7.5F, monitor video, and holmium laser: YAG litotriptor (Versa Pulse, Lumenis, Germany), with wavelength 2100 nm, output 1-60 watt, fiber length 365 μm, laser power 2.5-10 watt with energy 0.5-1 Joule/5-15 Hz. Results: Of 50 ureteral stone patients, consisted proximal 13 (26%) and distal 37 (74%) were included in this study. Mean age 42.94 ± 11.31 years, with 28 male (56%) and 22 female (44%). Mean stone burden was 88.10 ± 57.41 mm2. There were 6 (12%) patients with multiple stones. This procedure consumed energy 1079.02 ± 1624.00 joule and duration of operation was 19.02 ± 21.17 minutes. We inserted DJ stent after the procedure in 41 patients (82%). There were 2 failure (4%), which were stone migration to kidney and conversion to open surgery. There were significant differences of stone burden (p 0.013), duration of operation (p 0.038), and stone number (p 0.000) with stone free rate, but not in age, sex, stone location and energy. Stone free rate of this procedure was 90%. Conclusion: Stone burden, duration of operation, and stone number were predictive factors for success of holmium laser: YAG lithotripsy in ureteral calculi management.
COMPARISON OF STONE FREE RATE OF STAGHORN STONE, RENAL PELVIC STONE, AND INFERIOR CALYX STONE FOLLOWING PCNL
Authors: Tirtayasa Pande Made Wisnu , Birowo Ponco , Rasyid Nur
Published: August 2019

Objective: To compare the stone free rates on patients with staghorn, renal pelvic, and inferior calyx stones with stone burden < 20 mm, 21-30 mm, and > 30 mm following percutaneous nephrolithotomy (PCNL) in Cipto Mangunkusumo General Hospital Jakarta. Material & methods: The data were collected retrospectively from PCNL medical records in Cipto Mangunkusumo General Hospital Jakarta between January 2000 and March 2011. Six hundred and twenty-three patients with 651 kidney stones underwent PCNL. The inclusion criteria were staghorn stones, renal pelvic stone, and inferior calyx stone. All cases outside these three criteria and incomplete data were excluded. Stone free status was defined as no residual fragment on radiography or ultrasonography. Results: As many as 364 kidney stones from 344 patients were included, with 47.8% cases of staghorn stones, 31.9% cases of renal pelvic stones, and 20.3% cases of inferior calyx stones. Overall, 273 (75%) cases were defined as stone free. In group < 20 mm, 4 staghorn stones (100%), 18 renal pelvic stones (81.8%), and 34 inferior calyx stones (94.4%) were cleared (p = 0.811). In group 21-30 mm, 20 staghorn stones (95.2%), 52 renal pelvic stones (91.2%), and 26 inferior calyx stones (92.9%) were cleared (p = 1.000). In group > 30 mm, 83 staghorn stones (55.7%), 28 renal pelvic stones (75.7%), and 8 inferior calyx stones (80%) were cleared (p = 0.037). Conclusion: PCNL is an important tool for treating various kinds and sizes of kidney stones with high stone free rate.
THE VALUE OF URINARY CYTOLOGY AND HYDRONEPHROSIS TO PREDICT MUSCLE INVASIVE BLADDER CANCER
Authors: Ardiansyah Ferdi , Danarto H R
Published: August 2019

Objective: We evaluated the value of urinary cytology, and presence of hydronephrosis to predict muscle invasive bladder cancer. Material & methods: We retrospectively analyzed data of 167 patients that diagnosed bladder cancer from medical record at Sardjito General Hospital Yogyakarta, between 2004-2011. Preoperative parameters were evaluated including age, gender, number and location of bladder cancer, urinary cytology, as well as presence of hydronephrosis. The outcome was muscle invasive bladder cancer. Results: A total of 96 (57.5%) patients had positive urinary cytology, 80 (47.9%) had hydronephrosis, most location of tumor were in trigone 43 (25.7%). The youngest patient was 26 years and the oldest was 84 years old, male was most affected in 145 (86.8%). On bivariate analysis, positive urinary cytology and hydronephrosis were associated with muscle invasive bladder cancer (OR 0.08 CI 0.038–0.167; OR 30.24 CI 12.72–71.89, respectively, each p < 0.05). Combination urinary cytology and hydronephrosis incrementally improved prediction of muscle invasive bladder cancer with positive and negative predictive value were 93.9% and 71.4%, respectively. Presence of hydronephrosis was associated with tumor location in trigone (p < 0.05). Conclusion: Urinary cytology and hydronephrosis were associated with muscle invasive bladder cancer, and can be used to predict muscle invasive bladder cancer.
FACTORS ASSOCIATED WITH TUMOR RECURRENCE IN STAGE 1 BLADDER TRANSITIONAL CELL CARCINOMA IN SARDJITO HOSPITAL YOGYAKARTA
Authors: Putra Donny eka , Utomo Trisula
Published: August 2019

Objective: This study is assigned to evaluate factors associated with tumor recurrence in patients with superficial transitional cell carcinoma (TCC) of bladder in Sardjito General Hospital Yogyakarta. Material & methods:A prospective observational study design is conducted to evaluate patients with T1 TCC of bladder between 2011 and 2012. Inclusion criteria was patients with T1 TCC of bladder from pathological report. The independent variables are ages, hemoglobin, albumin, creatinine level, urine cytology, tumor grade, tumor diameter, number of tumor, and intravesical chemotherapy. The outcome measure is tumor recurrence during cystoscopy at 3, 6, 9, and 12 month after first resection. This study used chi-square and logistic regression analysis as statistical methods with p < 0.05 and a = 5% are considered significant. All analyses were performed with SPSS statistical software, version 20.0. Result: Sixty-two patients were participated in this study with mean age 60.62 ± 12.15 years. There were 32 patients (51.6%) who had tumour recurrence during first year that need to be resected. Of these patients, 9 patients (14.5%) had tumour recurrence more than one time during first year. In multivariate analysis, factors associated with tumour recurrence were tumour grade (p = 0.041, CI = 0.008-0.908), number of tumor (p = 0.003, CI = 0.003-0.293), and intravesical chemotherapy (p = 0.022, CI = 0.015-0.719). Conclusion: Degree of tumor differentiation, number of tumor and intravesical chemotherapy are factors affecting recurrence of stage 1 transitional cell carcinoma of the bladder.
THE EFFICACY OF NASOGASTRIC TUBE IN A LARGE BLOOD CLOT EVACUATION DURING CYSTOSCOPY
Authors: Wallad Caesar Khairul , Santoso Jumadi , Adi Kuncoro
Published: August 2019

Objective: In this study we introduce using nasogatric tube as an alternative to procure a safe and efficient way to remove large troublesome blood clots during cystoscopy procedure. Material & methods: We prospectively perform blood clot evacuation using nasogastric tube suction (NGT) on 21 patients in Hasan Sadikin GeneralHospital Bandung,within 6 months period. A 24 fr sheath and 16 fr NGT connected to suction unit with a 300 mmhg negative pressure was set. A repetitive back and forth technique was set in motion during the procedure. Cystoscopy time and NGT suction time was documented. Results: All patients were successfully managed with this method without complication during the procedure. The average time for clot removal was 5 minutes 8 seconds with average cystoscopy time was 20 minutes 12 seconds and average estimated blood clots volume was 483 grams. Conclusion: Evacuation using NGT suction is effective, safe and an efficient way to remove a large bothersome clots.
URINARY NEUTROPHIL GELATINASE-ASSOCIATED LIPOCALIN AND CREATININE SERUM BPH PATIENTS WITH ACUTE URINE RETENTION TO DETECT KIDNEY FUNCTION DISORDERS
Authors: Rahayu Septina , Hardjowijoto Sunaryo , Djojodimedjo Tarmono , Soebadi Mohammad Ayodhia
Published: August 2019

Objective: The main objective of this study was to determine renal function in patients with Benign Prostate Hyperplasia (BPH) in acute urinary retention period and two weeks after catheter insertion using creatinine serum and urinary Neutrophil Gelatinase-Associated Lipocalin (NGAL) biomarker parameters.Materials & Method:This is an observational co-hort study conducted in patients with BPH with acute urinary retention who came to Soetomo General Hospital, Surabaya. All the patients underwent laboratory investigation that were urinary NGAL and creatinine serum, marker of renal function.Result: The mean creatinine serum of 31 samples when retention phase was 1.6 ± 0.9 mg/dL and it decreased after 2 weeks of urinary catheter insertion (1.46 ± 0.89 mg/dL). Mean urinary NGAL level when retention phase was 308.1 ± 244.8 ng/dL, and after 2 weeks after urinary catheter insertion it decreased to 158.5 ± 123.3 ng/dL. There was significant decreasing creatinine serum and urinary NGAL levels in patients with BPH and acute urinary retention in the retention phase 2 weeks after urinary catheter insertion, with p value < 0.006 and < 0.0001, respectively. There was no significant correlation between the duration of retention and urinary retention volume (p>0.05).Conclusion: There was a significant decreasing creatinine serum and urinary NGAL levels in patients with BPH and acute urinary retention in retention phase and two weeks after urinary catheter insertion. There was no significant correlation between the urinary NGAL and creatinine serum and the duration of retention and urinary retention volume.
INITIAL EXPERIENCES WITH THREE RENAL ARTERIES OF KIDNEY ALLOGRAFT IN KIDNEY TRANSPLANTATION: A CASE SERIES
Authors: Prasetyo Tommie , Rasyid Nur , Rodjani Arry
Published: August 2019

Objective: This study reported a case series of our initial experiences in kidney transplantation with three renal arteries of the kidney allograft. Material & methods: The kidney allograft from all of the four cases was harvested with laparoscopic living donor nephrectomy. End-to-side anastomosis was performed from the small artery to the larger main artery before side-to-side anastomosis was performed between the two arteries of equal size. After joining the renal arteries we performed end-to-side anastomosis from the renal vein and artery to the external iliac vein and artery respectively. Results: All of the four cases respond well to the allograft kidney. Three recipients had normal serum creatinine level before 5 days after transplantation. One recipient had undergone hemodialysis once on the third day after transplantation. All of the recipients have no vascular and urologic complications. Conclusion: Multiple renal arteries are no longer considered as a relative contraindication, especially with meticulous anastomosis technique. No vascular and urologic complication was observed from this technique.
Sensitivity and Specificity of Urinalysis to Diagnose Urinary Tract Infection (UTI) in Patients with Urolithiasis at RSUP Dr. Sardjito Hospital
Authors: Purnomo Awang Dyan , Tranggono Untung
Published: August 2019

Objective: Urolithiasis could be caused by urinary tract infection (UTI). UTI in patients with urolithiasis need to be diagnose and manage as soon as possible. This study was aim to determine the diagnostic value of urinalysis examination to diagnose urinary tract infection (UTI) in patients with urolithiasis.Material & method: This study was an observational analytic with cross sectional study design, comparing one diagnostic tool with the gold standard tool to diagnose UTI. Total samples collected were 186 patients at Sardjito General Hospital, Yogyakarta. Urine culture and urinalysis were performed in patients with urinalysis and UTI. The results of urine culture and urinalysis were then compared by 2x2 table.Results: The sensitivity results on leukocyte esterase, eritrocyturia, bacteriuria, and nitrite respectively were 82.7%, 57.14%, 37.59%, and 13.53%. The specificity results on nitrite, bacteriuria, eritrocyturia, and leukocyte esterase respectively were 63.26%, 56.60%, 50.94%, and 33.96%. The highest level of accuracy was leukocyte esterase with 68.81% accuracy.Conclusion: This study showed that leukocyte esterase had good sensitivity with an accuracy of 68.81%. Examination of nitrite had the highest specificity compared to the other variables in urinalysis examination.
ETIOLOGY OF MALE INFERTILITY IN JAKARTA
Authors: Basukarno Ari , Birowo Ponco , Rasyid Nur
Published: August 2019

Objective: The etiology and risk factors of male infertility in huge Indonesian population has not yet been defined. This study was aim to evaluate the distribution and pattern of male infertility in Jakarta. Material & Methods: Retrospective study of Infertility database of Cipto Mangunkusumo Referral Hospital Jakarta, Bunda Hospital Jakarta, and ASRI Hospital Jakarta from 2005 until 2015 were analyzed using SPSS ver. 20. Patients’ characteristic and demography were stated. Results: There were 1062 patients with most of them suffered from primary infertility of their first time-marriage. Average age of husband, wife, and duration of marriage were 36.63± 7.10, 32.32 ± 4.92, and 5.7 ± 4.18 years old respectively. Smoking habit was recorded in 25% of patients while exposure and occupational hazard were only found in less than 2% of them. Coital problems occured in 17% of patients with 30% of them did not have routine sexual intercourse per week. Physical examination revealed that more than 70% of them had varicocele while USG Doppler of scrotum found varicocele in less than 50%. Only 5.13% of patients had normal sperm analysis, mostly azoospermia. Hormonal abnormality occured in more than 30% patients, varied in testosterone, FSH, and LH level.Conclusion: Male infertility was mostly caused by abnormal sperm characteristics followed by abnormal hormonal analysis. Exposure and occupational hazard did not play a big role in male infertility. Future study in risk factors of abnormal sperm characteristics could be done.
RELATIONSHIP BETWEEN RENAL STONE LOCATION WITH STONE-FREE RATE AFTER ESWL
Authors: Siregar Laudeo Dhanaba , Warli Syah Mirsya
Published: August 2019

Objective: This study aims to evaluate the relationship between stone location and stone location in kidney stone to the stone-free rate after Extracorporeal Shock Wave Lithotripsy (ESWL) procedure. Material & method: This is a non-experimental research using descriptive analytic method with retrospective study design that takes data from patient medical record diagnosis of urinary tract stones and ESWL action from January 2011 until December 2013 in the Department of Surgery Division of Urology General Hospital H. Adam Malik, Medan. Results: It was found that if the size of the stone only is the only factor that counts in patients who get a urinary tract stones ESWL therapy, it is not found a statistically significant relationship. Stone location plays an important role in the incidence of stone-free patients with urinary tract stones ESWL therapy. Conclusion: ESWL therapeutic efficacy in the treatment of patients with kidney stones is not only determined by the size and location of the stone, but is also determined by the number of stones, stone composition, frequency ESWL is used, and the thickness of the skin of the patient.
CORRELATION BETWEEN PCAR WITH IPSS SCORE, QMAX, AND POST VOIDING RESIDUAL URINE AND ITS CUT-OFF VALUE IN DETERMINING BOO IN PATIENTS WITH BPH LUTS
Authors: Nurhadi Pradana , Hakim Lukman , Djojodimedjo Tarmono , Hardjowijoto Sunaryo
Published: August 2019

Objective: This study was conducted to determine the correlation between Presume Circle Area Ratio (PCAR) and IPSS score, Qmax, and post voiding residual urine (PVR) and to find PCAR cut-off value in determining the presence Bladder Outlet Obstruction (BOO) in Benign prostatic hyperplasia (BPH) Lower Urinary Tract Symptoms (LUTS). Materials & Methods: This study was observational analytic study with 30 BPH LUTS patients as subjects during the period September 2015 to January 2016. The determined variables were PCAR, IPSS score, Qmax, post voiding residual urine (PVR) and analyzed using the SPSS program v21. Results: There were 30 patients who met the inclusion and exclusion criteria with the mean age of 67.47 years. In the correlation test, there was insignificant correlation between PCAR with IPSS (r=0.138, p=0.467), a significant correlation between PCAR with Qmax (r=0.468, p=0.009), PCAR with PVR (r=0.399, p=0.029), PCAR with BOO (r=0.491, p=0.006) PCAR cutoff value is 0.65 with sensitivity of 69% and specificity of 71%. Conclusion: PCAR has a significant correlation with PVR, Qmax and BOO but no significant with IPSS score. PCAR value >0.65 indicating BOO in BPH LUTS. PCAR can be used as an alternative non-invasive examination in determining the existence of BOO.
CHARACTERISTIC OF URINARY RETENTION IN DEPARTMENT OF UROLOGY SOETOMO GENERAL HOSPITAL SURABAYA
Authors: Wardhana Sonny Andikha , Soebadi Moh. Ayodhia , Hardjowijoto Sunaryo
Published: August 2019

Objectives: We analyze our data of patients with urinary retention that have been managed in Soetomo general hospital to know our prevalence, causes and its management. Material & methods: We retrospectively reviewed the medical records of the patients with urinary retention who admitted on our department between January 2011 and December 2012.  Results: During 2 years between January 2011 until December 2012, a total number of urinary retention was 295 cases among 1282 urology emergency cases, with sex ratio of urinary retention in men and women was 85.7% : 14.3%. Of the study population 264 (89.5%) presented with acute urine retention while 31 (10.5%) had chronic urine retention. Most of urinary retention was caused by bladder stone (33.3%) in children, urethral stricture (26.8%) in young adult men, BPH (71.3%) in elder men and cystitis (26.3%) in women. Trial of voiding without catheter (TWOC) that performed in 60 of the BPH patients, was succeeded in 43 (71.6%) of the patients and failed in 17 (28.4%). Emergency treatment of urinary retention were urethral catheter (83.7%) and cystostomy (16.3%). Conclusion: Urinary retention is one of emergency in urology that most common occur in men. Urine retention found among the participants was mainly AUR rather than CUR. Most of urinary retention was caused by bladder stone in children, urethral stricture in young adult men, BPE in elder men and cystitis in women. The most emergency management was urethral catheter. Trial of voiding without catheter showed a high success rate, so it can be considered as definitive non-surgical therapy in selective patient.
RETROPERITONEAL LAPAROSCOPIC DISMEMBERED PYELOPLASTY FOR URETEROPELVIC JUNCTION OBSTRUCTION (UPJO)
Authors: Daniswara Nanda , Sibarani Jupiter
Published: August 2019

Objective: To share our experience of retroperitoneal laparoscopic dismembered pyeloplasty as the treatment of Ureteropelvic Junction Obstruction (UPJO) in Department of Urology, Hasan Sadikin Hospital Bandung. Material & Methods: Boy 8 years old came for a chance to relieve mass at both flank region especially at left flank region. From the ultrasonography there were bilateral hydronephrosis. We decided to urethrocystoscopy, bilateral ureteral catether insertion, bilateral retrograd pyelography guided with c-arm and left retroperitoneal laparoscopic dismembered pyeloplasty. Results: Operative time was 240 minutes and blood loss was about 200cc. Double J Stent was used for ureteral stenting. Parenteral ketorolac was given as needed to control the pain. The Visual Analogue Scale (VAS) post operative day 1 until 4 were6, 4,, 2, 2 respectively. Urethral catheter was removed at post operative day 2 and drain was removed at post operative day 3. Operating wound was good. Patient was hospitalization until post operative day 4. Left nephrostomy was removed at postoperative day 7 after there was no leakage, confirmed with left antegrad pyelography. From post operative ultrasonography we found that hydronephrosis at left kidney became almost normal. Conclusion: In our opinion that the retroperitoneal laparoscopic dismembered pyeloplasty is an alternative treatment for UPJO. This procedure depends on experience and pristine surgical tehnique from the surgeon
NORMATIVE DATA OF PENILE LENGTH ON CHILDREN AGE GROUPS WITH TANNER CLASSIFICATION IN HASAN SADIKIN HOSPITAL
Authors: Wallad Caesar Khairul , Sibarani Jupiter , Tjahjodjati Tjahjodjati
Published: August 2019

Objective: It has been reported that normal value of penile length were varied among countries. Difference in race, ethnicity, genetics and nutrition plays a factor in penile length. Micropenis is an abnormality in which penile length were considered smaller in comparison of  a ‘normal penile length’. There are published article in Asia and Europe in terms of local penile length figures unfortunately none in West Java. This study was aim to establish local data as a reference in order to define micropenis. Material & method: All subjects in pediatric outpatient clinics were collected with cross sectional method. Exclusion criteria includes: congenital penile disease (hypospadias, burried penis, chordee, fistulas, webbed, etc), history of hormonal therapy, malnourished, and congenital syndromes. Subjects will undergone examination of stretched penile length. Results: A total of 276 children were included in the study with 23 subjects in each Tanner groups. The average penile length in Hasan Sadikin Hospital were inferior in all groups in contrast with the Tanner age groups as cited in table 1. Conclusion: Normative local data of penile length is necessary. Not using the local reference may result in underestimation and overdiagnosis.
COMPARATION OF DIAGNOSTIC VALUE B-MODE ULTRASOUND WITH COLOR DOPPLER TWINKLING ARTIFACT FOR DETECTING RESIDUAL STONE AFTER PCNL
Authors: Wardhana Sonny Andikha , Rizaldi Fikri , Djojodimedjo Tarmono , Hardjowijoto Sunaryo
Published: August 2019

Objective: To compare the accuracy of B-Mode US and color Doppler twinkling artifact for detecting residual stone after Percutaneous Nephrolithotomy (PCNL) with Non-contrast CT (NCCT) as the standard diagnostic. Material & methods: In this prospective study, 30 patients who underwent Percutaneous Nephrolithotomy (PCNL) were examined with US and NCCT. In US, echogenicity and posterior-shadow (PS) parameters were evaluated and compared with color-Doppler ultrasonography (CDUS) twinkling artifact and NCCT signs. The results then analyzed statistically with Kappa and McNemar tests. Results: More positive residual stone results with color Doppler twinkling artifact in 14 patients than B-Mode US in 11. NCCT detected 17 residual stone with the most location in inferior calyx. (n=10, 58.8%). The sensitivity, specificity and difference positive-negative likehood ratio of B-Mode US were 64.7%, 92.3% and 8.02, both Kappa test was significant (p=0.125) and McNemar tests was significant (p=0.002). The color Doppler twinkling artifact has 82.3%, 92.3%, and 10.5 for sensitivity, specificity and difference positive-negative likehood ratio, the Kappa test was significant (p=0.00), McNemar test was not significant (p=1.00). Conclusion: Color Doppler twinkling artifact was valid, highly sensitive and accuracy better than B-mode US in detecting residual stone after PCNL procedure.
THE EFFECT OF ANDROGEN DEPRIVATION THERAPY ON THE LIPID PROFILE AND BLOOD GLUCOSE LEVEL IN PROSTATE CANCER PATIENTS IN ADAM MALIK GENERAL HOSPITAL MEDAN
Authors: Irawan Willi , Warli Syah Mirsya
Published: August 2019

Objective: The aim of this study is to observe the effect of Androgen Deprivation Therapy (ADT) on patients with advanced stage of prostate cancer on the lipid profile and blood glucose level. Material & Methods: This is a descriptive cross-sectional study and include the prostate cancer patients which were admitted to Urology Policlinic in Haji Adam Malik General Hospital, Medan from June 2014 – June 2015 and also received ADT. Results: From June 2014 – June 2015, a total of 25 prostate cancer patients receiving ADT was included in this study with an average age of 67.08 ± 7.48 years old. The median prostate specific antigen (PSA) level of this group of patients is 19.6 ng/mL and the lowest and highest value of 3.4 and 278 ng/mL respectively. ADT administration is found to cause a significant elevation of 2-hour postprandial blood glucose (121.12 ± 21 mg/mL vs 134.64 ± 33.35 mg/mL, p-value=0.011) and Glycosylated hemoglobin (5 ± 0.5% vs 5.5 ± 0.79%, p-value=0.000) (HbA1c) after 6 months of therapy. Additionally, ADT administration within 3 and 6 months of duration had also significantly increased triglyceride (TG) level when compared to before treatment (104.4 ± 38.67 vs 131.2 ± 32.27 vs 127 ± 33.43 respectively, p-value=0.005). Conclusion: ADT treatment in prostate cancer patients increase triglyceride levels after 3 and 6 months of treatment followed by 2-hour postprandial blood glucose and HbA1C levels after 6 months of the treatment.
THE EFFICACY OF DUTASTERIDE AND GREEN TEA TOWARDS BLEEDING ON BPH AFTER TURP: STUDY THEIR EFFECT ON HIF-1α EXPRESSION & HEMATOCRIT
Authors: Irawan Andry , Riwanto Ignatius , Nugroho Eriawan Agung
Published: August 2019

Objective: This study proves differentiation of the combination of dutasteride and green tea, dutasteride, green tea, and placebo alone and their association with differences in hematocrit levels and the expression of hypoxia induced factor-1 alpha (HIF-1α) in patients with Benign Prostate Hyperplasia (BPH) were performed Trans urethral resection of the prostate (TURP) surgery. Material & method: Experimental study with the draft "randomized control trial". Comparing angiogenesis changes between groups of BPH patients who underwent TURP surgery to assess the expression of HIF-1α and Δ Ht (Hematocrit) after administration of dutasteride, green tea with combination of dutasteride and green tea for 14 days. Results: The combination of dutasteride and green tea was not significant in reducing the expression of HIF-1α. Mean P1 group (59.32 ± 14.69); P2 group (59.11 ± 20.73); P3 group (64.21 ± 14.95); K group (58.16 ± 16.00). Kruskal test results obtained p=0.491 walis which means the difference percentage of HIF-1α among the 4 groups was not significant. The mean Δ Ht P1 group (0.61 ± 0.204); P2 group (0.54 ± 0.250); P3 group (0.41 ± 0.275); group K (0.41 ± 0.275). In statistical test with Mann Whitney test comparing the percentage reduction obtained Ht levels dutasteride group against group of green tea obtained p=0.213 means that there is no significant difference. Where a significant difference to the other groups. Conclusion: The combination of dutasteride and green tea for 14 days before TURP surgery does not reduce the expression of HIF-1α in BPH patients who underwent TURP surgery. Δ Ht significant decline in the combination group compared with other groups and might be influenced by several factors during TURP surgery.
EXTRAPERITONEAL LAPAROSCOPIC RADICAL PROSTATECTOMY: INITIAL EXPERIENCE AND LEARNING CURVE OF A VERY LOW VOLUME CENTER
Authors: Yunir Peri Eriad , Hamid Agus Rizal AH , Umbas Rainy , Mochtar Chaidir Arif
Published: August 2019

Objective: This study is aimed to report and evaluate the experience and learning curve of extraperitoneal Laparoscopic Radical Prostatectomy (LRP) performed in Cipto Mangunkusumo General Hospital Jakarta. Material & method: We collected all data of patients that had been performed extraperitoneal LRP from June 2013 until February 2016, retrospectively. We divided those data into 3 groups with equal number in each group. We compared the preoperative (age, prostate volume, PSA level and prostate cancer staging), intraoperative (surgery time, total blood loss, conversion to open surgery and other organ injury), and postoperative (postoperative length of stay) variables between those 3 groups using ANOVA and Kruskal-Wallis test. Results: We performed 15 extraperitoneal LRP from June 2013 until February 2016 with patient’s mean age was 64.40 (SD ± 5.30) years old and mean prostate volume was 42.39 (SD ± 29.21). In this study, we found significant differences in surgery time, total blood loss, and postoperative length of stay (LOS) in all group with decrease on each intraoperative and postoperative variables. We also found no conversion to open surgery or other organ injury in all patients. Conclusion: The increase of surgeon’s experience and the number of surgery, and the consistency undergo the procedure of LRP demonstrate a decrease in surgery time, intraoperative blood loss and LOS in LRP patients.
PROGNOSTIC FACTORS OF RENAL CANCER
Authors: Kurnia Riyan Adi , Warli Syah Mirsya , Siregar Ginanda Putra
Published: August 2019

Objective: Course of the disease of kidney cancer may be unpredictable. For example, between 4.2–7.1% of patients with tumours ≤4 cm that are usually slow-growing may have metastases at diagnostic and are at an elevated risk of disease-specific mortality. Conversely, as many as 40% of patients with lymph node metastases were diagnosed at nephrectomy are alive 5 year after surgery. Several approaches have been proposed to help predict the course of disease of kidney cancer and to distinguish between poor and favourable risk patients. In this study, we review the existing prognostic factors and compared with established prognostic models. Material & methods: This is an analytic descriptive study of all kidney cancer patients treated at Haji Adam Malik Hospital between 2011 and 2015. Individual patient data was collected from medical record and compiled. Results: The number of samples analyzed in this study were 38 patients. We found seven patients remain alive of the entire sample. From the results of the univariate test, the factors that have a significant relationship with the mortality rate were low KPS (<80), weight loss, and nephrectomy. From the results of multivariate analysis, nephrectomy is the only prognostic factor in patients with kidney cancer. Mortality rate was 0.056x lower in patients who underwent nephrectomy compared with patients who did not underwent nephrectomy. Conclusion: Despite the high mortality rate that is found in this study, nephrectomy still has a place in kidney cancer management, even in patients with advanced stage.
TUBULARIZED INCISED PLATE URETHROPLASTY FOR ONE-STAGE HYPOSPADIA REPAIR IN CHILDREN AT HASAN SADIKIN HOSPITAL BANDUNG
Authors: Oetama Harris , Siregar Safendra
Published: August 2019

Objective: To determine the outcome of tubularized incised-plate (TIP) urethroplasty for  one stage hypospadia repair in children. Material & methods: A 7-year retrospective experience at Hasan General Sadikin Hospital Bandung on the outcome of tubularized incised plate for one-stage hypospadias repair in children during 2009-2015. Results: A total of 102 children was undergone one stage hypospadias repair with TIP urethroplasty. The mean age was 6.97 years old. As much as 65 (63.72%) children had distal, and 37 (36.28%) children had proximal hypospadia. The mean length of surgery was 112.56 minutes. Post operative complications was rarely found, consisting of 5 (6.32%) children had urethrocutaneus fistula formation and 11 (13.9%) children had haematoma. 4 (10.81%) children with proximal hypospdia and 1 (1.53%) children with distal hypospadia had urethrocutaneus fistula formation. 4 (6.15%) children with distal hypospadia and 7 (18.91%) children with proximal hypospadia had haematoma. Conclusion: Tubularized incised-plate (TIP) urethroplasty for one stage hypospadia repair in children was highly effective with rare complications comparable with recently published study.
PROSTATE CANCER RISK CALCULATOR COMPARISON: IPCRC vs KPCRC vs PCPT-RC vs ERSPC-RC IN PREDICTING PROSTATE CANCER AT HASAN SADIKIN HOSPITAL
Authors: Tansol Christiano , Safriadi Ferry
Published: August 2019

Objective: To compare the validated calculators of Indonesian Prostate Cancer Risk Calculator  (IPCRC) vs Korean Prostate Cancer Risk Calculator (KPCRC) vs Prostate Cancer Prevention Trial Risk Calculator (PCPT-RC) vs European Randomized Study of Screening for Prostate Cancer Risk Calculator (ERSPC-RC) in predicting prostate cancer in our patients at Hasan Sadikin Hospital Bandung. Material & methods: This study is a prospective study conducted from August 2014 – December 2015 at Urology Clinic at Hasan Sadikin Hospital that included all patients with BPH or suspected PCa who have been undergoing prostate biopsy. Variables such as age, PSA level, prostate volume (transabdominal or transrectal ultrasound) and digital rectal examination (DRE) finding were recorded. Risk calculation was generated using each risk calculator. Data were analyzed using Chi-square analysis, Kolmogorov-Smirnov, and finally receiver operating characterisitic (ROC) curve. All statistical analyses were performed with SPSS version 20.  Results: There were 89 BPH and 43 PCa patients between August 2014 – December 2015. The mean age, PSA and prostate volume are 65.78 ± 8.33 years; 121.16 ± 375.76ng/ml; 55.86 ± 31.9ml respectively. Abnormal DRE was found in 27 PCas and 4 BPHs. Receiver operator curve analysis of IPCRC showed AUC 0.861 vs KPCRC (AUC=0.779) vs ERSPC-RC (AUC=0.745) vs PCPT-RC (AUC=0.794) vs PSA (AUC 0.794), sensitivity 81.4% and specificity 71.9% with cut-off point 19.67 for the IPCRC in predicting the prostate cancer in our center. Conclusion: IPCRC is better than KPCRC, PCPT-RC and ERSPC-RC in predicting prostate cancer in our center.
EFFICACY AND SAFETY OF LUBRICATING JELLY INSTILLATION TO PREVENT RETROPULSION DURING URETEROLITHOTRIPSY FOR URETERAL STONES
Authors: Yuanda Rameshdo , Soebadi Doddy M , Soetojo Soetojo , Hardjowijoto Sunaryo
Published: August 2019

Objective: We studied the efficacy and safety of lubricating jelly instillation before ureterolithotripsy for prevention of retropulsion and improvement in stone-free rate. Material & methods: We enrolled 22 subjects with ureteral stone in this prospective, randomized, single-blind and controlled clinical trial. Each subject was randomly assigned to the lubricating jelly instillation group (n=11) and control group (n=11). Ureteroscopy and lithotripsy was performed according the standard protocol, using 9.8 F semirigid ureteroscope and pneumatic lithotripter. A 6 F ureteral catheter was advanced beyond the stone, and lubricating jelly was instilled through the catheter lumen. Retropulsion and the presence of residual fragments were evaluated with plain kidneys, ureters and bladder x-ray and ultrasonography, or Non Contrast-enhanced Computed Tomography. Any complication was reported and graded using the Modified Clavien Classification System.Results: The 2 groups had comparable preoperative characteristics. There were no statistically significant difference between the lubricating jelly instillation group and control group regarding the retropulsion rate (54.5% vs 72.7%, ρ=0.375), the stone-free rate (54.5% vs 36.4%, ρ=0.392), and the complication rate (45.5% vs 54.5%, ρ=0.670). Conclusion: Lubricating jelly instillation during ureterolithotripsy has limited value for prevention of retropulsion and improvement in stone-free rate.
RELATIONSHIP OF PERIURETHRAL FIBROTIC IN BPH PATIENT WITH LUTS AND URINARY RETENTION
Authors: Zamroni Zamroni , Hardjowijoto Sunaryo , Soetojo Soetojo
Published: August 2019

Objective: Analyzing the differences between collagen thicknesses in periurethral region from transurethral resection of the prostate (TURP) specimens of Benign Prostate Hyperplasia (BPH) patients with lower urinary tract symptoms (LUTS) and of those with urinary retention. Material & methods: This was an observation analytic study on 30 patients who underwent TURP. Patients who met the inclusion criteria were divided into 2 groups: BPH patients with LUTS and those with urinary retention. Each group consisted of 15 people. The first TURP specimen of proximal verumontanum resection were examined in anatomic pathology using mass on strichrome staining as an examination of periurethral collagen thickness. Collagen will be stained as blue. Periurethral collagen thickness was measured from the basal membrane of transitional epithelium to fibromuscle tissue. Data were then statistically analyzed using independent t-test. Results: The average patient age was 66 ± 7 years old and there was no significant difference between age and periurethral collagen thickness with p=0.175 (p>0.05). The mean prostate volume was 47.19 ± 13.2 ml and there was no significant difference between prostate volume and periurethral collagen thickness with p=0.148 (p>0.05). Average periurethral collagen thickness in BPH patients with urinary retention was 146.67 ± 39.80 micrometers and while in those with LUTS was 205.33 ± 85.6 micrometers. There were no significant differences between periurethral collagen thickness and the occurrence urinary retention with retention of urine with p=0.063 (p>0.05). Conclusion: There were no significant differences between periurethral collagen thickness patients in BPH patients with LUTS and in those with urinary retention. This suggests that periurethral collagen thickness is not associated with the occurrence of urinary retention or LUTS in BPH patients.