Complication of trans-rectal prostate biopsy based on Clavien index: 5 years of experience

Trans-rectal prostate biopsy has become the gold standard for early diagnosis of prostate cancer in developing countries. Despite its low risk, there are some post-procedural complications. The complications are classified by using a modified Clavien-Dindo system. The study aimed to recognize complications of trans-rectal prostate biopsy procedure by using Clavien-Dindo classification index. All patients undergoing trans-rectal prostate biopsy procedure in the Department of Urology, Dr. Soetomo General Hospital between January 2015-December 2019, were retrospectively analyzed in terms of post-procedural complaints, underlying comorbidities and ongoing additional examinations. The complaints were compiled into Clavien-Dindo classification. Univariate analysis of various predictors of post-procedural complications was also conducted. It was found 98 complication events from 400 patients (24.5%). Most complications were 1st degree (dysuria, hematuria, urinary retention, fever, rectal pain and bleeding, erectile dysfunction, and constipation).  In univariate analysis, positive results of urinary culture correlated to the emergence of post-procedural complications. In conclusion, the incidence of post-trans-rectal prostate biopsy complication in Dr. Soetomo General Hospital reached 24.5%. From all of the risk factors, positive urinary culture is related to the post-biopsy complication. Most complications are in the 1st grade of Clavien index, suggesting that the procedure is relatively safe and has a low ris

PSA, TZI, RI OF PROSTATE AS RISK FACTORS OF URINARY RETENTION

Objective: To evaluate some parameters as the predictors of urine retention incident in Benign Prostate Hyperplasia (BPH) patients. Materials & Methods: From May to August 2012, a total of 24 BPH patients aged 47-69 years with lower urinary tract symptomps (LUTS) including 12 patients with urine retention  were participated in the study. Prostate specific antigen (PSA) examination was performed on all patients. For urine retention patients, PSA was performed 2 weeks after catheterization as the procedure may affect PSA levels. Transrectal ultrasonography (TRUS) was examined to assess total prostate volume (VTP), transitional zone volume (VZT), transitional zone index (IZT = VZT / VTP), and resistive index of prostate capsulary arteries. Statistic was utilized using simple and multiple logistic regression. Receiver operating characteristic (ROC) was calculated to assess the usefulness of parameters as a predictor of urine retention. Results: There was no significant difference in age between LUTS and BPH patients with urine retention (p = 0,487). There was no relationship between PSA and transitional zone index to incidence of urine retention in BPH patients (PSA; p = 0,173 and TZI; p =  0,192). Multiple logistic regression analysis showed only resistive index of prostate capsulary arteries which correlates with urine retention incidence (p = 0,014), with area under ROC 0,865 (95% CI 0,721 to 1,008) and cut-off value of > 0,675 as a predictor of urine retention incidence. Conclusion: Resistive index of prostate capsulary arteries by transrectal ultrasonography (TRUS) is a predictor of urine retention incidence in BPH patients.Key words: prostate specific antigen, transitional zone index, resistive index of prostate capsulary arteries, benign prostate hyperplasia, lower urinary tract symptoms, urine retention

Sindroma Sepsis Urologi (Urosepsis)

Pasien urosepsis sebaiknya didiagnosa pada tahap awal terutama pada kasus ISK komplikata. Angka mortalitas meningkat bila sepsis atau syok septik muncul, namun prognosis urosepsis secara umum lebih baik dibandingkan sepsis oleh sebab lain. Terapi urosepsis berupa terapi suportif, penggunaan antibiotik yang tepat, dan penanganan kelainan urologi. Drainase obstruksi saluran kemih merupakan pilihan pertama penanganan urosepsis. Sepsis didiagnosa bila terjadi infeksi disertai dengan tanda inflamasi sistemik, dan dapat mengarah ke disfungsi organ dan syok septik. Pasien yang rentan terjadi urosepsis antara lain usia tua, diabetes mellitus, pasien dengan respon imun menurun, pasien kemoterapi, dan pasien AIDS. Faktor lokal yang mempengaruhi urosepsis adalah batu saluran kemih, obstruksi saluran kemih, uropati kongenital, neurogenic bladder, dan pasca tindakan endoskopi. Sepsis dapat disebabkan oleh infeksi bakteri di saluran kemih atau non infeksi (luka bakar, pankreatitis)

Effect of SARS-CoV-2 viral infection on male sexual hormones levels post COVID-19 exposure: A systematic review and meta-analysis

Introduction: The COVID-19 can affects on human testicles, thus will interfere the production of important male sexual hormone such as testosterone. Our study provides scientific evidence through systematic reviews and meta-analyses that focus on the effects of SARSCoV- 2 virus infection on male sexual hormonal disorders in patients post-exposure to COVID-19. Methods: This meta-analysis was made in accordance with the PRISMA guidelines. The outcomes of this study were the level of total testosterone, free testosterone, LH and FSH. Chi-square and I2 tests were used to evaluate heterogeneity between studies. The standardized mean deviation (SMD) with 95% CI were used and analysis was performed using the Review Manager 5.4 software. Results: The four included studies reported a total of 256 patients with COVID-19 with time of follow-up time post COVID-19 varying from one month to 7 months. The mean age distribution among the study were 34-57 years old. Total testosterone level (SMD = -158.71; 95% CI= -205.30 – -112.12; p < 0.00001) was significantly higher at follow-up post COVID-19, while LH (SMD = 0.40; 95% CI = 0.15-0.65; p = 0.002) was lower. The free testosterone level and FSH level showed no significant difference between baseline and after following up post COVID-19. Conclusions: At follow up, the total testosterone level in patients with SARS-CoV-2 infection appeared to be elevated while LH was lower compared to the baseline

Comparison of Efficacy And Safety Silodosin 8 Mg Once Daily And Silodosin 4 Mg Twice Daily in BPH Patients With Luts

Objective: This study was aimed to compare the efficacy and side effect of silodosin 8mg once daily and silodosin 4mg twice daily in BPH-LUTS patients after 4 and 12 weeks. Material & Methods: Single blind randomized controlled trials in 60 male patients aged ≥45 years with BPH-LUTS from July 2017 to October 2017 was divided into groups who received 8mg of silodosin once daily and those who received 4mg of silodosin twice daily. Efficacy and adverse events were evaluated after 4 and 12 weeks of treatment. Results: There was no significant difference of mean age of the two groups was 67.93 ± 6.49 years and 69.07 ± 6.28 years respectively (p 0.49). Both doses of this drug decreased the International Prostate Symptom Score (IPSS) and significantly increased the maximum urinary flow (Qmax) (p0.05). Ejaculation disorder was the most common side effect in all groups (6.7% and 5%) and there was no significant difference between the two groups (p>0.05). Conclusion: The administration of 8mg of once daily silodosin has similar efficacy as 4mg twice daily silodosin. There were no adverse events differences in the two groups. Ejaculation disorder is the most common adverse event of silodosin administration

Comparison of different scoring systems for predicting in-hospital mortality for patients with Fournier gangrene

Purpose: To compare different scoring systems for predicting in-hospital mortality in patients with Fournier gangrene (FG).Methods: A comprehensive literature search was performed to find all scoring systems that have been proposed previously as a predictor for in-hospital mortality in patients with FG. Data of all patients with FG who were hospitalized in one of Indonesia’s largest tertiary referral hospitals between 2012 and 2022 were used. The receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of the scoring systems.Results: Ten scoring systems were found, i.e., Fournier’s Gangrene Severity Index (FGSI), Uludag FGSI, simplified FGSI, NUMUNE Fournier score (NFS), Laboratory Risk Indicator for Necrotizing Fasciitis, age-adjusted Charlson comorbidity index, sequential organ failure assessment (SOFA), quick SOFA, acute physiology and chronic health evaluation II, and surgery APGAR score (SAS). Of 164 FG patients included in the analyses, 26.4% died during hospitalization. All scoring systems except SAS could predict in-hospital mortality of patients with FG. Three scoring systems had areas under the ROC curve (AUROC) higher than 0.8, i.e., FGSI (AUROC 0.905, 95% confidence interval (CI) 0.860–0.950), SOFA (AUROC 0.830, 95% CI 0.815–0.921), and NFS (AUROC 0.823, 95% CI 0.739–0.906). Both FGSI and SOFA had sensitivity and NPV of 1.0, whereas NFS had a sensitivity of 0.74 and an NPV of 0.91.Conclusion: This study shows that FGSI and SOFA are the most reliable scoring systems to predict in-hospital mortality in FG, as indicated by the high AUROC and perfect sensitivity and NPV.</p

Comparison of different scoring systems for predicting in-hospital mortality for patients with Fournier gangrene

Purpose: To compare different scoring systems for predicting in-hospital mortality in patients with Fournier gangrene (FG).Methods: A comprehensive literature search was performed to find all scoring systems that have been proposed previously as a predictor for in-hospital mortality in patients with FG. Data of all patients with FG who were hospitalized in one of Indonesia’s largest tertiary referral hospitals between 2012 and 2022 were used. The receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of the scoring systems.Results: Ten scoring systems were found, i.e., Fournier’s Gangrene Severity Index (FGSI), Uludag FGSI, simplified FGSI, NUMUNE Fournier score (NFS), Laboratory Risk Indicator for Necrotizing Fasciitis, age-adjusted Charlson comorbidity index, sequential organ failure assessment (SOFA), quick SOFA, acute physiology and chronic health evaluation II, and surgery APGAR score (SAS). Of 164 FG patients included in the analyses, 26.4% died during hospitalization. All scoring systems except SAS could predict in-hospital mortality of patients with FG. Three scoring systems had areas under the ROC curve (AUROC) higher than 0.8, i.e., FGSI (AUROC 0.905, 95% confidence interval (CI) 0.860–0.950), SOFA (AUROC 0.830, 95% CI 0.815–0.921), and NFS (AUROC 0.823, 95% CI 0.739–0.906). Both FGSI and SOFA had sensitivity and NPV of 1.0, whereas NFS had a sensitivity of 0.74 and an NPV of 0.91.Conclusion: This study shows that FGSI and SOFA are the most reliable scoring systems to predict in-hospital mortality in FG, as indicated by the high AUROC and perfect sensitivity and NPV.</p

Comparison of different scoring systems for predicting in-hospital mortality for patients with Fournier gangrene

Purpose: To compare different scoring systems for predicting in-hospital mortality in patients with Fournier gangrene (FG).Methods: A comprehensive literature search was performed to find all scoring systems that have been proposed previously as a predictor for in-hospital mortality in patients with FG. Data of all patients with FG who were hospitalized in one of Indonesia’s largest tertiary referral hospitals between 2012 and 2022 were used. The receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of the scoring systems.Results: Ten scoring systems were found, i.e., Fournier’s Gangrene Severity Index (FGSI), Uludag FGSI, simplified FGSI, NUMUNE Fournier score (NFS), Laboratory Risk Indicator for Necrotizing Fasciitis, age-adjusted Charlson comorbidity index, sequential organ failure assessment (SOFA), quick SOFA, acute physiology and chronic health evaluation II, and surgery APGAR score (SAS). Of 164 FG patients included in the analyses, 26.4% died during hospitalization. All scoring systems except SAS could predict in-hospital mortality of patients with FG. Three scoring systems had areas under the ROC curve (AUROC) higher than 0.8, i.e., FGSI (AUROC 0.905, 95% confidence interval (CI) 0.860–0.950), SOFA (AUROC 0.830, 95% CI 0.815–0.921), and NFS (AUROC 0.823, 95% CI 0.739–0.906). Both FGSI and SOFA had sensitivity and NPV of 1.0, whereas NFS had a sensitivity of 0.74 and an NPV of 0.91.Conclusion: This study shows that FGSI and SOFA are the most reliable scoring systems to predict in-hospital mortality in FG, as indicated by the high AUROC and perfect sensitivity and NPV.</p

Comparison of different scoring systems for predicting in-hospital mortality for patients with Fournier gangrene

Purpose: To compare different scoring systems for predicting in-hospital mortality in patients with Fournier gangrene (FG).Methods: A comprehensive literature search was performed to find all scoring systems that have been proposed previously as a predictor for in-hospital mortality in patients with FG. Data of all patients with FG who were hospitalized in one of Indonesia’s largest tertiary referral hospitals between 2012 and 2022 were used. The receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of the scoring systems.Results: Ten scoring systems were found, i.e., Fournier’s Gangrene Severity Index (FGSI), Uludag FGSI, simplified FGSI, NUMUNE Fournier score (NFS), Laboratory Risk Indicator for Necrotizing Fasciitis, age-adjusted Charlson comorbidity index, sequential organ failure assessment (SOFA), quick SOFA, acute physiology and chronic health evaluation II, and surgery APGAR score (SAS). Of 164 FG patients included in the analyses, 26.4% died during hospitalization. All scoring systems except SAS could predict in-hospital mortality of patients with FG. Three scoring systems had areas under the ROC curve (AUROC) higher than 0.8, i.e., FGSI (AUROC 0.905, 95% confidence interval (CI) 0.860–0.950), SOFA (AUROC 0.830, 95% CI 0.815–0.921), and NFS (AUROC 0.823, 95% CI 0.739–0.906). Both FGSI and SOFA had sensitivity and NPV of 1.0, whereas NFS had a sensitivity of 0.74 and an NPV of 0.91.Conclusion: This study shows that FGSI and SOFA are the most reliable scoring systems to predict in-hospital mortality in FG, as indicated by the high AUROC and perfect sensitivity and NPV.</p

Comparison of different scoring systems for predicting in-hospital mortality for patients with Fournier gangrene

Purpose: To compare different scoring systems for predicting in-hospital mortality in patients with Fournier gangrene (FG).Methods: A comprehensive literature search was performed to find all scoring systems that have been proposed previously as a predictor for in-hospital mortality in patients with FG. Data of all patients with FG who were hospitalized in one of Indonesia’s largest tertiary referral hospitals between 2012 and 2022 were used. The receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of the scoring systems.Results: Ten scoring systems were found, i.e., Fournier’s Gangrene Severity Index (FGSI), Uludag FGSI, simplified FGSI, NUMUNE Fournier score (NFS), Laboratory Risk Indicator for Necrotizing Fasciitis, age-adjusted Charlson comorbidity index, sequential organ failure assessment (SOFA), quick SOFA, acute physiology and chronic health evaluation II, and surgery APGAR score (SAS). Of 164 FG patients included in the analyses, 26.4% died during hospitalization. All scoring systems except SAS could predict in-hospital mortality of patients with FG. Three scoring systems had areas under the ROC curve (AUROC) higher than 0.8, i.e., FGSI (AUROC 0.905, 95% confidence interval (CI) 0.860–0.950), SOFA (AUROC 0.830, 95% CI 0.815–0.921), and NFS (AUROC 0.823, 95% CI 0.739–0.906). Both FGSI and SOFA had sensitivity and NPV of 1.0, whereas NFS had a sensitivity of 0.74 and an NPV of 0.91.Conclusion: This study shows that FGSI and SOFA are the most reliable scoring systems to predict in-hospital mortality in FG, as indicated by the high AUROC and perfect sensitivity and NPV.</p