PEDIATRIC URINARY STONE PROFILE IN SAIFUL ANWAR HOSPITAL

Objective: This study aims to provide an overview of the characteristics of age, gender, stone location, stone side, stone analysis, and management of pediatric urinary stone in the tertiary hospital. Material & Methods: This was a retrospective study done over a period of four years from January 2019 - December 2023 in our institution. The patient has undergone supporting examinations to confirm the diagnosis. Clinical data including the patient’s age, gender, stone location, stone side, stone analysis, and management were observed. Data were analyzed descriptively and using SPSS 17.0. Results: Total of 55 cases of upper and lower urinary tract stones were encountered in our study with a mean age of 11.2 years. The highest incidence was 15-18 years old (36.4%). The distribution by gender showed a higher prevalence in males (67.2%) compared female patients (32.8%). The kidney stone was the most frequent clinical presentation (36.3%). From the upper urinary tract stone, the left side becomes the predominant area (54.2%). The most common stone constituent was calcium oxalate (41.8%). The kidney stone was mostly treated with Percutaneous Nephrolithotomy (PCNL) (75.0%). Conclusion: Pediatric urinary tract stone patients in our institution are predominantly male, with a peak rate in 15- 18 years old, most commonly found in the kidney, predominantly on the left side, and the most common stone constituent was calcium oxalate. Th kidney stone is mostly treated with PCNL. Keywords: Bladder stone, pediatric urinary stone, cystolithotripsy

EVALUATION OF PAIN SCALE ON CIRCUMCISION PATIENTS UNDER LIDOCAINE HYDROCHLORIDE LOCAL ANESTHESIA

Objective: Evaluating the pain scale of circumcision patients under lidocaine hydrochloride local anesthesia. Material & Methods: An observational descriptive research was carried out on 30 children with a body weight of 20-29 kilograms from February 2023-April 2023. Circumcision was performed under 2 ampoules of 2% lidocaine as local anesthesia. Data consisted of pain onset measure using a stopwatch and the pain scale were obtained through the Wong-Baker Face Pain Rating Scale (WBFPRS), these variables were recorded when pain occurs post-local anesthesia effects ends. Results: The average onset of pain is 47.73 minutes with the fastest onset of pain was 20 minutes and the longest onset of pain was 72 minutes. The average pain scale as measured by the WBFPRS is 2.33. Conclusion: The average pain scale in this study was less than 3 which indicated that the pain felt did not interfere with activities. Keywords: Circumcision, pain, anesthesia, lidocaine

OBESITY PROFILE AS A RISK FACTOR IN RENAL CELL CARCINOMA PATIENTS: A LITERATURE REVIEW

Objective: This study aims to determine the profile of obesity as a risk factor for developing RCC. Material & Methods: This study is a library research study with journals, articles, and opinions of related experts taken from Google Scholar and Pubmed which was uploaded in 2019-2023. Results: 7 articles met the inclusion, exclusion and topic relevance criteria. Several journals stated that obesity is a strong risk factor for the development of renal cell carcinoma (RCC), although opposite results were found in one study regarding obesity and the prognostic outcome of RCC patients. Discussion: The mechanism of obesity in increasing the risk of RCC is a complex process, which involves the process of insulin resistance, inflammation by pro-inflammatory cytokines, angiogenesis, and proliferative effects as a result of the role of insulin as one of the most important anabolic hormones capable of stimulating cell proliferation, and is exacerbated by imbalanced cell anti-apoptotic mechanisms. Conclusion: No relationship was found between the lipid profile and the incidence of RCC. Little research has been done on lipid profiles for RCC, considering that the largest RCC subtype, ccRCC, is characterized by the accumulation of lipids and glycogen, which has implications for changes in fatty acid and glucose metabolism in its etiology. Further studies are needed to examine the effect of lipid profiles on the risk of renal cell carcinoma. Keywords: Carcinogenesis, obesity profile, renal cell carcinoma

VESICOCUTANEOUS FISTULA AND BLADDER INJURY IN POST HYSTERECTOMY PATIENT: A CASE REPORT

Objective: This article presents a case of vesicocutaneous fistula and bladder injury with intraabdominal adhesion in post-caesarian section and hysterectomy patients. Case(s) Presentation: A 29-year-old woman suffering from vesicocutaneous fistula and bladder injury 10 days after having a hysterectomy due to atonic uterus in post-caesarian delivery. Discussion: Cystography and cystoscopy confirmed the bladder perforation at the posterior and dome. Exploratory laparotomy was then performed and found that a bowel adhesion had occurred following the inflammatory process after the previous procedure. A bladder reconstruction was then performed, and the patient was then catheterized for almost two weeks. Conclusion: A routine follow up then revealed the patient had no more symptom and the surgical wound was closed without any further complication. Keywords: Vesicocutaneous fistula, bladder injury, hysterectomy, bowel adhesio

PSA LEVEL AND ADVERSE EVENTS IN SIXTH AND TENTH SERIES DOCETAXEL CHEMOTHERAPY IN CASTRATE-RESISTANT PROSTATE CANCER (CRPC) PATIENTS

Objective: This study aims to compare the efficacy of docetaxel on PSA levels and to analyze the adverse events caused by docetaxel. Material & Methods: The study design was retrospective cohort. Participants were prostate cancer patients at Saiful Anwar Hospital who received androgen deprivation therapy with increased PSA level 3 times the nadir or 2 bone lesions or soft tissue lesions > 2cm. PSA levels were assessed monthly. Participants were grouped into 6 and 10 series regimens. Adverse events of nausea, diarrhea, alopecia, SGOT SGPT abnormailties, creatinine abnormalities, anemia, and neutropenia were observed. Statistical analysis was performed using a differential T-test. Results: A total of 32 participants were involved. The PSA levels between 6 and 10 series groups were as follows: 1st month (142.2 vs 28.24 ng/mL,p=0.000), 2nd month (101.78 vs 16.98 ng/mL,p=0.001), 3rd month (472.35 vs 13.95 ng/mL,p=0.439), 4th month (120.64 vs 4.0 ng/mL,p=0.180), 5th month (64.325 vs 24.6 ng/mL, p=0.015), 6th month (41.915 vs 20.7 ng/mL,p=0.497). Adverse events in the 6 and 10 series regimens were nausea (25% vs 81.25%), diarrhea (37.5% vs 50%), alopecia (6.25% vs 43.75%), SGOT SGPT abnormalities (25% vs 56.25%), creatinine abnormalities (6.25% vs 37.5%), anemia (18.75% vs 31.25%), leukocytosis (6.25% vs 0%), and neutropenia (25% vs 12.5%). Adverse events in 6 series regimen began to occur in 3rd series with 1 participant experiencing nausea, and the most were 3 participants experiencing diarrhea in 6th series. Adverse events in 10 series regimen began to occur in 4th series with 1 participant experiencing nausea, 1 participant experiencing SGOT SGPT abnormalities, 1 participant experiencing diarrhea, and the most were 4 participants experiencing nausea in the 9th series. Conclusion: The 10 series of docetaxel chemotherapy is not superior to 6 series. Adverse events are more prominent in the 10 series. Keywords: Docetaxel, PSA, adverse events

INTRAVESICAL FOREIGN BODIES MIMICKING BLADDER CALCULI: A CASE REPORT

Objective: In this case report, we will present a patient with an intravesical foreign body mimics bladder calculi. Case(s) presentation: A 37-year-old man presented with pain in the suprapubic area. The patient had a history of several urological procedures. First, at the age of 11 years, He had an augmentation cystoplasty due to a congenital neurogenic bladder. Later, at the age of 15 and 20, He experienced two traumatic bladder ruptures requiring open repair, and the Mitrofanoff appendicovesicostomy for intermittent self-catheterization was performed. Discussion: The patient underwent an emergency cystoscopy that revealed calcified cut ends of four urethral catheter tips. Cystolitholapaxy was performed to crush these calcified foreign bodies facilitating cystoscopic removal. Conclusion: A 37-year-old man presented with intermittent suprapubic pain caused by intravesical foreign bodies. Hence, Cystolitholapaxy was performed to remove these calcified foreign bodies. The patient was observed and discharged from the hospital after seven days of treatment. Keywords: Bladder, foreign bodies, suprapubic pain, vesica urinaria

SECONDARY BLADDER CARCINOMA METASTASIS FROM OTHER ORGAN: A LITERATURE REVIEW

Objective: This review article discusses the importance of considering metastasis malignancy in the differential diagnosis of high-grade urothelial lesions. Material & Methods: The review presents a summary of metastasis of bladder carcinoma from various organs. The most common sources of secondary bladder tumors are stomach, breast, colon cancer, and melanoma. The article highlights the need for careful evaluation and further workup in patients being treated for metastatic cancer who present with hematuria and symptomatic anemia. Results: Diagnosis of secondary bladder carcinoma involves imaging, cystoscopy, and transurethral resection. Biopsies should be collected from patients with suspected urothelial bladder metastasis from other cancer origins or those with suggestive symptoms. The article emphasizes the importance of differentiating metastatic adenocarcinoma of the lung from primary bladder adenocarcinoma, especially when bladder examination does not correlate with imaging results. It also discusses the increased risk of secondary bladder carcinoma in rectal cancer survivors who have undergone radiation therapy. Conclusion: In conclusion, secondary bladder carcinoma metastasis from other organs presents a diagnostic dilemma and requires comprehensive evaluations. Healthcare professionals should consider metastasis malignancy in the differential diagnosis of high-grade urothelial lesions, especially in the absence of readily available clinical history of primary cancer. Keywords: Bladder cancer, secondary tumors, metastasis, differential diagnosis, primary cancer

CHARACTERISTICS OF URETEROVAGINA FISTULA PATIENTS AT HASAN SADIKIN HOSPITAL BANDUNG IN 2017 -2021

Objective: The study aims to determine the characteristics of ureterovaginal fistula patients at Hasan Sadikin Hospital in Bandung for the 2017-2021 period. Material & Methods: This research was conducted using a descriptive method with a cross-sectional approach. The inclusion criteria in this study were all patients who experienced ureterovaginal fistula and underwent surgery at Hasan Sadikin Hospital. Exclusion criteria in this study were incomplete patient data until the variables studied did not exist. Results: From a total of 35 people who experienced ureterovaginal fistula the most in 2020 were 7 people (23.3%). The mean age was 39.93 ± 11.26 years, the longest distance to surgery was 10.17 ± 9.56 months, and duration of hospitalization 7.31 ± 5.45 days. The highest percentage of age who experienced ureterovaginal fistula was 36-45 years as many as 3 people (30%). Based on the etiology, the most common was supravaginal hysterectomy as many as 5 people (45.5%). The most frequently performed procedure in this study was ureteroneocystostomy with a percentage of 65%. Conclusion: The most common cases of ureterovaginal fistula in 2017 to 2021 were in 2020, the most common age for experiencing ureterovaginal fistula was 36-45 years of age and the most common etiology was supravaginal hysterectomy. Keywords: Ureterovaginal fistula, characteristics, Hasan Sadikin Hospita

LONG-TERM ADMINISTRATION OF TAMSULOSIN INCREASE APOPTOSIS ON PROSTATE CELL OF BPH PATIENT: STUDY ON TGF-ß1, SMAD-4, AND NF- KB

Objective: In this study we aimed to know further mechanism and relation between the long-term usage of tamsulosin with the apoptotic mechanism on prostatic cells of BPH patients qualitatively. Material & Methods: A Case-control study from prostate resection specimens. Subjects were 20 male who underwent the TUR-P procedure, were divided into two groups equally, a group who got long-term administration of tamsulosin 0.4 mg, and one without tamsulosin. TGF-β1 and Smad-4 expression was measured by Enzyme-Linked Immunosorbent Assay (ELISA), meanwhile expression of NF- kB measured by immunohistochemistry assay. Results: There was a significant difference on the Independent T-Test that showed an increase in expression of TGF-β1 and Smad-4 expression and a decrease in expression of NF- kB p= 0.003 (p<0,05) from a group of patients who got long-term oral administration of tamsulosin 0.4 mg, compared with a group of patients who didn’t get any treatment. Conclusion: Long-term tamsulosin would induce an apoptotic process in the prostate cells shown by the activity of TGF-β1, Smad-4, and NF- kB. Keywords: BPH, tamsulosin, TGF-β1, Smad-4, NF- kB, apoptosi

CLINICAL PROFILE OF PATIENTS WITH HYPOSPADIAS IN SAIFUL ANWAR GENERAL HOSPITAL, MALANG

Objective: This study aims to present the clinical profile of hypospadias patients in the Urology Department of Saiful Anwar Hospital. Material & Methods: This retrospective study analysed the characteristics of delayed hypospadias cases at Saiful Anwar General Hospital in Malang. The study utilized a descriptive design with a quantitative approach, conducted from January 2019 to February 2024. All patients with hypospadias who visited were included in this study. Data were presented in percentage format to illustrate the distribution of cases. Results: Among the 250 patients, 242 (97%) were classified as having a delayed diagnosis. Of all the cases, 141 (56%) were located in Malang. Proximal hypospadias was the most prevalent anomaly, affecting 131 (52%) of the patients. Additionally, there were 88 cases (35% of the total) of mid-shaft hypospadias and 31 cases (13% of the total) of distal hypospadias. Out of the total, 39 patients (16%) had undescended testis (UDT), while 53 patients (22%) had bifid scrotum as an additional condition. Of the 46 patients, 18.4% experienced preterm labor, and approximately 78% of the newborns, specifically 194 of them, had a birth weight over 2500 grams. The healthcare provider participated in 226 out of 232 births, accounting for 97% of the total. The condition was primarily diagnosed by obstetricians, who identified 42% of cases, while midwives identified 58% of the cases. Conclusion: Most hypospadias patients presenting at Saiful Anwar Hospital are diagnosed late, with proximal hypospadias being the most prevalent type. Accompanying conditions include bifid scrotum, occurring in 22%, and undescended testes, present in 16% of cases. This finding presents a potential opportunity to enhance the standard of care. Keywords: Hypospadias, UDT, bifid scrotum