Ultrasound Guided Fine Needle Aspiration Biopsy in Renal Tumors

Objective: To assess the sensitivity and specificity of ultrasound guided fine needle aspiration biopsy (FNAB) in renal tumors.Methods: A diagnostic study was performed on 23 patients with renal tumors who visited the Urology Division, Department of Surgery, Dr. Hasan Sadikin General Hospital from January 2011 to August 2012. First time ultrasound guided was performed to the patients before nephrectomy. Renal tissues that were obtained from both procedures were examined histopathologically, and the result from nephrectomy was used as the gold standard. Analysis was conducted by measuring the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the ultrasound guided FNAB. Results: The results showed that the sensitivity value of ultrasound guided FNAB was 85.71%, with 50% specificity, 94.74% PPV and 25% NPV. From 23 patients, only 2 patients had hematoma. Conclusions: Ultrasound guided FNAB is sufficiently sensitive with a fair specificity for diagnosing renal tumors and is safe for patients.Keywords: Renal tumor, sensitivity, specificity, ultasound guided FNAB DOI: 10.15850/ijihs.v3n1.40

Characteristics of Enterovesical Fistula Patients Visiting the Urology Department of Dr. Hasan Sadikin General Hospital Bandung, Indonesia, from 2015 to 2019

Enterovesical fistula (EVF) represents an abnormal channel between the intestine and the bladder. The EVF is a complication of inflammatory or neoplastic diseases and injuries. Diagnosis of EVF can be challenging and often delayed up to several months after the onset of the symptoms. This study aimed to determine the characteristics of patients with enterovesical fistula visiting Dr. Hasan Sadikin General Hospital Bandung, Indonesia. This retrospective descriptive study used the medical records of EVF patients treated in the urology department of Dr. Hasan Sadikin General Hospital from 2015 to 2019 as the secondary data to be analyzed. A total of 58 patients with EVF were enrolled in this study. By gender, that more than half of the patients were male patients (n=30, 51.7%) and 45% of patients were between 41 and 50 years old. The most common symptoms of EVF were pneumaturia and fecaluria which were seen in 30 (51.7%) and 20 (34.5%) patients, respectively. Twenty-nine (50%) patients experienced malnutrition and 18 (31.1%) patients had diabetes mellitus as a comorbid. The most common type of fistula was rectovesical fistula (n=45, 77.6%) and 26 (66.6%) patients suffered from rectosigmoid cancer and malignancy (68.95) had become the most predominant etiology. Escherichia coli was found in 42 (72.4%) urine cultures collected from the patients and cystoscopy with fistula biopsy was found in 43.1% of cases, followed by fistula repair (29.3%) and urethral catheter drainage (15.5%). Hence, malignancy and rectosigmoid cancer become the most common etiology of EVF while cystoscopy with fistula biopsy is the most frequently performed procedure.

Ultrasound Guided Fine Needle Aspiration Biopsy in Renal Tumors

Objective: To assess the sensitivity and specificity of ultrasound guided fine needle aspiration biopsy (FNAB) in renal tumors.Methods: A diagnostic study was performed on 23 patients with renal tumors who visited the Urology Division, Department of Surgery, Dr. Hasan Sadikin General Hospital from January 2011 to August 2012. First time ultrasound guided was performed to the patients before nephrectomy. Renal tissues that were obtained from both procedures were examined histopathologically, and the result from nephrectomy was used as the gold standard. Analysis was conducted by measuring the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the ultrasound guided FNAB. Results: The results showed that the sensitivity value of ultrasound guided FNAB was 85.71%, with 50% specificity, 94.74% PPV and 25% NPV. From 23 patients, only 2 patients had hematoma. Conclusions: Ultrasound guided FNAB is sufficiently sensitive with a fair specificity for diagnosing renal tumors and is safe for patients.Keywords: Renal tumor, sensitivity, specificity, ultasound guided FNAB DOI: 10.15850/ijihs.v3n1.40

Microbial Culture Characteristics and Antimicrobial Susceptibility Patterns Associated with Vesicovaginal Fistula

Vesicovaginal fistula (VVF) is commonly linked with recurrent urinary tract infection (UTI). Thus, the patterns of the pathogenic microorganism becomes important consideration in the management of this disease. This study aimed to describe patient profiles, disease etiology, and antimicrobial susceptibility patterns of microorganisms in VVF patients. This retrospective study was conducted on 49 medical records of vesicovaginal fistula patients seen from January 2016 to December 2020. The most prevalent age group of the patients was 40-50 years old. Analysis demonstrated that the leading etiology for VVF among these patients was malignancy (73.47%). The antimicrobial susceptibility was tested using the disc diffusion method and Escherichia coli (44.90%) and Proteus mirabilis (14.29%) were identified as the bacterial pathogens most frequently isolated from urine samples. Of the 39 patients with significant growth of organism cases, 29 (74.35%) had symptomatic UTIs. The isolated gram-negative bacteria had excellent sensitivity to aztreonam, ertapenem, and meropenem, with a more than 90% susceptibility rate, while the  gram-positive bacteria had good sensitivity to amikacin, cefepime, tigecycline, aztreonam, ertapenem, and meropenem, with a more than 90% susceptibility. In conclusion,  bacterial culture and antibiotic susceptibility test (AST) remains an essential part of managing VVF and their results can be used as a reference for empirical therapy. Amikacin, cefepime, tigecycline, aztreonam, ertapenem, and meropenem should be considered for treatment of UTIs associated with VVF

Nigella sativa Infusion as an Antioxidant Agent Against Gentamicin-Induced Kidney Damaged in Mice

Background: Gentamicin is one of the most common antibiotics related to nephrotoxicity. It has been proposed that the nephrotoxicity is associated with the generation of the reactive oxygen species. Thymoquinone, an active compound of Nigella sativa, shows to have an antioxidant property. The study aims to identify the possible nephroprotective action of Nigella sativa infusion against gentamicin-induced kidney damaged in mice.Methods:This experimental study was carried out in the Department of Cell Biology Laboratory, Universitas Padjadjaran, Bandung from 10th November 2012 to 14th December 2012. There were four groups, each consisting of  6 mice. Group I (control negative), group II (gentamicin 100 mg/kg), group III (3.9 mg Nigella sativa infusion+gentamicin 100mg/kg) and group IV (7.8 mg Nigella sativa infusion+gentamicin 100mg/kg). The kidneys were evaluated histopathologically by light microscope. The percentage average number of normal proximal tubules in group I and the percentage average number of proximal tubules damaged in group II, III and IV were measured.Results: The results showed the percentage average number of the proximal tubules damaged in group II, III and IV were 14.53%, 7.49% and 3.94% respectively. Significant differences were observed between group II and III, group II and IV, and group III and IV.Conclusion:Nigella sativa infusion protects against gentamicin-induced kidney damage in mice.Keywords: gentamicin, kidney, Nigella sativa infusion  Infusa Nigella sativa sebagai Antioksidan Terhadap Kerusakan Ginjal padaTikus yang Diinduksi Gentamisin   LatarBelakang: Gentamisin adalah salah satu antibiotik yang paling sering dihubungkan dengan nefrotoksisitas. Nefrotoksisitas yang terjadi berhubungan dengan pembentukan reactive oxygen species. Thymoquinone, senyawa aktif Nigella sativa, telah terbukti memiliki sifat antioksidan. Penelitian ini bertujuan untuk mengidentifikasi sifat nefroprotektif infusa Nigella sativa terhadap kerusakan ginjal pada tikus yang diinduksi gentamisin.Metode: Penelitian eksperimental ini dilakukan di Laboratorium Departemen Biologi Sel, Fakultas Kedokteran, Universitas Padjadjaran, Bandung dari 10 November 2012 –14 Desember 2012. Ada empat kelompok masing-masing terdiri atas 6 tikus. Kelompok I (control negatif), kelompok II (gentamisin 100 mg /kg), kelompok III (3,9 mg Nigella sativainfus + gentamisin 100mg/kg) dan kelompok IV (7,8 mg Nigella sativa infus + gentamisin 100mg/kg). Ginjal kemudian dievaluasi secara histopatologi dengan mikroskop cahaya. Persentase rata-rata jumlah tubulus proksimal yang normal dalam kelompok I dan persentase rata-rata jumlah tubulus proksimal rusak dalam kelompok II, III dan IV diukur.Hasil: Persentase rata-rata jumlah tubulus proksimal rusak dalam kelompok II, III dan IV adalah 14,53%, 7,49% dan 3,94%. Perbedaan signifikan yang diamati adalah pada kelompok II dengan III, kelompok II dengan  IV, serta kelompok III dan IV.Simpulan: Infusa Nigella sativa infuse melindungi terhadap kerusakan ginjal yang diinduksi gentamisin pada tikus.Kata kunci: gentamisin, ginjal, infusa Nigella sativaDOI: 10.15850/amj.v1n2.35

The Effect of Lycopene on Cancer Cell Apoptosis by Caspase-9 Concentration Measurement in Indonesian Human Prostate Cancer Cell Culture

BACKGROUND: Lycopene is an antioxidant that mostly found in daily ingredients such as tomatoes. Several studies have shown the lycopene potential in preventing prostate cancer. Nevertheless, the clinical use of lycopene as adjunctive therapy for prostate cancer is still under debate. AIM: The objective of the study was to determine the effect of lycopene on human prostate cancer cell culture growth by measuring caspase-9 concentration as a marker of the intrinsic pathway of apoptosis in cells. METHODS: This study was conducted on Indonesian prostate cancer cell culture from a patient with Gleason score 6, divided into 5 subgroups: 2 control groups and 3 treatment groups that were given 1 μM, 2 μM, and 4 μM of lycopene. Measurement of caspase-9 level was performed using enhanced chemiluminescence at 24, 28, and 72 h after lycopene addition in treatment groups. A comparative analysis was performed by two-way ANOVA. RESULTS: The result showed that there was a significant difference of mean caspase-9 levels in the provision of various concentrations of lycopene and time of observation (p < 0.05). Increased of mean caspase-9 levels started at 2 μM dose of lycopene at 48 h and 4 μM at 24 h (p < 0.05) and continue to rise at 72 h, but caspase-9 was not detected at 1 μM dose in every observation. CONCLUSION: There was a significant difference of mean caspase-9 levels in the provision of various concentrations of lycopene and time of observation

Case Report: Iatrogenic trauma of the bladder due to long-term unidentified intrauterine device malposition inside the bladder with rectovesical fistula [version 2; peer review: 2 approved]

According to reports, there are 1.9–3.6 incidences of IUD migration and uterine perforation for every 1000 IUD insertions. It is important to note that bladder perforation caused by a misplaced IUD is uncommon and is thought to happen most frequently during insertion. Here, we describe a patient who presented with symptoms related to the malposition of IUD inside the bladder. It is feasible to draw the conclusion that the cystoscopy technique should be taken into consideration as a suitable therapy option for such injuries in this organ. When a problem cannot be effectively treated by cystoscopy alone, laparotomy should be considered

LITOTRIPSI LASER HOLMIUM YAG UNTUK TERAPI BATU URETER

Objective: To assess the efficacy of pulsed holmium:YAG laser lithotripsy for ureteral stone therapy. Material and method: Ninety-one patients (70 males and 21 females) with age range 20 – 76 years underwent 93 ureteroscopic procedures for 101 ureteral stones. A preoperative diagnosis was established by ultrasound scanning and intravenous urography. An 8 F rigid Karl-Storz ureteroscope was used for a holmium:YAG laser (OmniPulse MaxTM 80 watt Holmium Laser System Model 1210-VHP, Trimedyne,Inc. Irvine CA, USA) as energy source for laser lithotripsy. The stone localization was mostly at the lower third of the ureter. The mean stone size was 9,6 mm, mean duration of procedure was 48,1 minutes, and the mean hospital stay was 2,1 days. Results: The overall stone clearance rate was 95,6% with the best results for stones in the middle third of the ureter (100%). At follow up we noted two patients with residual stones and two patients with a perforation of the ureteral wall. Conclusion: The Holmium:YAG laser is effective for ureteral stone treatment with a high success rate. Special attention and care should be afforded in impacted ureteral stones.

PENGETAHUAN, TINGKAH LAKU, DAN TINDAKAN KLINIS DOKTER UMUM PADA PENATALAKSANAAN BPH

Objective: To evaluate the Primary Care Physician’s (PCPs) knowledge, attitude and clinical behavior in managing patients with BPH, as an input in the review of BPH guideline of Indonesian Urology Association. Material & method: The mailing included a cover letter, questioner consist of 10 questions survey, survey instrument and a post-paid envelope. A 10-questions survey were validated according to BPH guideline by Indonesian Urology Association (IUA). PCPs who work in district health offices and registered in district health office of Indonesian Health Ministry in Bandung, were selected as respondents. Results: 75% of sampled primary care physician working in 71 district health offices responded. 83% of respondent did not know the BPH guideline that had been published by Indonesian Urology Association. Although 88% of PCP’s knew about the symptoms of BPH, only 32% heard about of International Prostate Symptoms score. However, only 13 % were reported applying the symptoms score. Regarding to mandatory examination by the guideline, 64% of PCPs reported performing digital rectal examination, and 47% reported ordering urinalysis test. The recommended test such as PSA and serum creatinine level only asked 24% and 60% by PCPs. Only 21% of PCPs knew about the uroflowmetry but never ordering the test. 47% of PCPs reported using α blockers and 2% using finasteride for treating BPH. The referral was conducted by PCPs mostly due to urinary retention and hematuria. 70% of PCPs would refer the patients to urologist and the others to general surgeon and general internist. Conclusion: Although PCPs play role up to certain extent in diagnosing and managing of BPH, most of them are not interested in looking for reference

ULTRASONOGRAFI UNTUK PREDIKSI LASERASI PARENKIM GINJAL DAN HEMATOMA PERIRENAL PADA PASIEN TRAUMA TUMPUL ABDOMEN DENGAN KECURIGAAN TRAUMA GINJAL

Objective: To evaluate the sensitivity and the specificity of the ultrasound in predicting renal parenchyma laceration and perirenal hematoma in patients with abdominal blunt trauma with suspicion of renal trauma, as confirmed by operative findings in the explorative laparotomy. Material & methods: From March 2005 to March 2006, we found 28 patients admitted to the emergency department with abdominal blunt trauma with suspicion of renal trauma. Every patient was scanned sonografically to detect the presence of the renal parenchyma laceration and perirenal hematoma. All those patients underwent laparotomy for any certain indication, but not because of ultrasound findings. The ultrasound findings then were checked with the operative findings. Results: The sensitivity of the ultrasound in predicting renal parenchyma laceration is 53.8%, while its sensitivity in predicting perirenal hematoma is 75%. The specificity of ultrasound in predicting both renal parenchyma laceration and perirenal hematoma is 100%. Conclusion: Ultrasound for kidney trauma is sensitive in predicting the presence of perirenal hematoma, but not sensitive in predicting the presence of a renal parenchyma laceration. Ultrasound is very specific in predicting if both perirenal hematoma and renal parenchyma laceration are present