METABOLIC RISK FACTORS OF URINARY STONE DISEASE IN CHILDREN

Objective: To evaluate metabolic risk factor of urinary stone disease in children. Material & method: In this hospital-based preliminary study, children with urinary stone disease who underwent stone removal in Hasan Sadikin Hospital were included. Control group consisted children with other diseases, matched for age and BMI. Blood evaluation (uric acid, calcium and phosphate) and 24-hour urine evaluation (calcium, phosphate, sodium, magnesium, uric acid, acidity, and urine volume) were measured before the stone removal. Stone analysis was performed later. Data was analyzed using Kruskal Wallis and Spearman correlation test. Results: Eight subjects with urinary tract stone and 8 normal subjects were included to the study. This study included 4 (50%) subjects with renal stone, 3 (37,5%) subjects with bladder stone, and 1 (12,5%) subject with distal urethral stone. Stone analysis revealed 6 (75%) calcium oxalate, 1 (12,5%) calcium phosphate, and 1 (12,5%) struvite stone. There was no significant difference in blood calcium, phosphate, and uric acid between groups. 24 hours urinary calcium level was higher in subjects with stone disease (40,8 mg vs 10,6 mg, p=0,027). Urinary calcium-to-creatinine ratio was also higher in stone disease (0,23 vs 0,02 mg/mg creatinine, p=0,002). There was no significant difference of other urinary electrolites and uric acid level between groups. Conclusion: Twenty four hours urinary calcium level and urinary calcium-to-creatinine ratio is higher in children with urinary stone disease. Keywords: Urinary stone disease, children, metabolic risk factors

Association of Lower Urinary Tract Symptoms and Benign Prostatic Enlargement in Patients with Hypertension

Development of hyperplastic nodules in the transition zone of the prostate is the characteristic of Benign prostatic enlargement (BPE). Men with hypertension have a high risk of severe lower urinary tract syndrome (LUTS). This restrospective cohort analytic study investigated the association between LUTS and BPE in hypertension patients. Subjects were BPE patients with primary hypertension who visited the urology clinic of Dr. Hasan Sadikin General Hospital Bandung that were sampled consecutively from 2017 to 2020. Three hundred and twenty-four patients from the urology department participated in the study. These patients were categorized into  mild LUTS (IPSS 1-7)  (n=37, 11.4%), moderate LUTS (IPSS 8-19) (n=169, 52.2%), and severe LUTS (IPSS 20-35) (n=118, 36.4%). A positive correlation (r = 0.761, p = 0.000) and weak positive correlation (r = 0.152, p = 0.006) were found between systolic blood pressure and prostate volume and between LUTS and systolic blood pressure, respectively. In addition, there was also a weak positive correlation between diastolic blood pressure and prostate volume (r = 0.065, p = 0.245) and LUTS (r = 0.015, p = 0.784). Thus, there is an association between hypertension and prostate enlargement and the severity of lower urinary tract symptom

Torsion Testicular Patient Characteristics

Testicular torsion is an emergency urological condition that is caused by the torsion of the spermatic cord structures, causing disruption of circulation of the affected testicle. This study aimed to describe the characteristics of patients with testicular torsion treated at Dr. Hasan Sadikin General Hospital Bandung from January 2016 to January 2020. This was a retrospective descriptive study on 34 medical records of patients diagnosed and treated for testicular torsion. Nine patients (29.4%) were 21 years old. The onset was mostly between 6 to 24 hours (38.2%), followed by between 2–7 days (23.5%), less than 6 hours (20.6%), between 1–2 weeks (8.8%), and between 2–4 weeks (8.8%). Left testicular torsion were more frequent than the right torsion (61.8% vs. 38.2%). The etiology of the torsion was mostly idiopathic with no identifiable precedent (88%). Orchidectomy was more frequently performed compared to orchiopexy (78.4% vs. 21.6%). All but one patient (97.1%) presented with testicular pain as the main symptom. Patients presented mostly with a high risk TWIST score (64.7%); however, more presented with low risk compared to the intermediate risk TWIST score (26.5% vs. 8.8%). Orchidectomy is the most frequently performed operation on pre-pubertal and adult patients, possibly due to relatively delayed presentation (>24 hours) to the hospital to receive treatment. Patients were mostly younger; predominantly with high TWIST score and affected left testicle

Effect of cyclooxygenase-2 inhibitors in double J stent removal

Background: Celecoxib is a selective cyclooxygenase-2(COX-2) inhibitor that can reduce the inflammatory process during double J (DJ) stent removal procedure. This study aimed to determine the differences in pain levels in patients undergoing DJ stent removal under local anesthesia by oral administration of celecoxib before the procedure. Materials and methods: A total of 46 male patients who underwent removal of DJ stent under local anesthesia from December 2019 to February 2020 were included. Patients were divided into two groups according to oral administration of celecoxib 3 hours before the procedure. The visual analog scale (VAS) and side effects were compared between the two groups. Results: The mean patient age was 50.26 ±14.92 years in the group without celecoxib and 50.35 ±15.61 years in the group with celecoxib. The mean intraoperative VAS score was significantly higher in the group without celecoxib (6.87 ± 1.51) than that in the group with celecoxib (3.74 ± 1.65) (p=0.04). The VAS scores on the first day after the procedure were 2.08 ±0.79 and 1.34 ± 0.98 in the groups without and with celecoxib, respectively (p=0.53). Only 1 patient had nausea as side effect of celecoxib. Conclusion: Celecoxib can reduce pain during DJ stent removal

ANGIOTENSIN II TYPE-1 RECEPTOR (AT1R) DISTRIBUTION IN BPH, HIGH GRADE PIN AND ADENOCARCINOMA OF THE PROSTATE

Objective: The aim of the study was to detect the differences in number and the distribution of angiotensin II type-1 receptor (AT1R) in BPH, high grade PIN, and adenocarcinoma of the prostate. Material & method: A prospective study was performed in RSHS, in collaboration with the Department of Anatomical Pathology. Prostate samples were taken by TUR of the prostate, and then divided into 5 groups. They were BPH, high grade PIN, adenocarcinoma of the prostate in 3 difference grades (well, moderate, and poorly differentiated). Kidney tissue for control. Immunohistochemical staining was done to determine the angiotensin II type-1 (AT1R) receptor distribution as primary antibody used was mouse monoclonal antibody AT1 (TONI-1): sc-57036, Santa Cruz Biotechnology Inc., CA. Results: Angiotensin II type-1 receptor was found in material of BPH, high grade PIN and adenocarcinoma of the prostate. The number and distribution of the receptors were not different. Conclusion: There are no significant differences in number and distribution of angiotensin II type-1 receptor on BPH, high grade PIN, and adenocarcinoma of the prostate

Common Practice of Hypospadias Management by Pediatric Urologists in Indonesia: A Multi-center Descriptive Study from Referral Hospitals

BACKGROUND: Hypospadias is the second most common congenital anomalies among human congenital disabilities. There are over 300 surgery techniques being introduced to treat hypospadias. The successful of hypospadias repair is assessed by several outcomes as well as complications following surgery. AIM: This study aims to show the multicenter hypospadias data in Indonesia descriptively. METHODS: All the data were compiled based on questionnaires, which were distributed to Indonesian pediatric urologists. The questionnaire includes several questions containing demographic aspect, preferred techniques being used, and complications being found regarding hypospadias repair. RESULTS: Eighteen Indonesian pediatric urologists from 12 centres involved in this study. The data were collected from June – September 2018 based on the surgeon’s experience throughout 2017. From 591 cases based on the returned questionnaire, penile-type hypospadias was the most common type of hypospadias being treated (35.7%) followed by penoscrotal (28.9%) and scrotal-type (12.9%). Moderate severity of chordee was mostly seen among all cases (40.6%). Tubularised incised plate (TIP), + Thiersch Duplay, was the most common technique being used to treat hypospadias (44.3%), followed by onlay island preputial flap (14.9%) and two-stage technique (14%). The incidence of urethrocutaneous fistulae in this study was 13.9%. CONCLUSION: This study showed how Indonesian pediatric urologists dealt with hypospadias cases. TIP + Thiersch Duplay procedure being the preferred technique used by most participants and the rate of urethrocutaneous fistulae as one of the complications was comparable with previous studies

TUBULARIZED INCISED PLATE URETHROPLASTY FOR ONE-STAGE HYPOSPADIA REPAIR IN CHILDREN AT HASAN SADIKIN HOSPITAL BANDUNG

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

Preoperative Hormonal Stimulation In Hypospadias: A Systematic Review

Introduction: Preoperative hormonal stimulation with testosterone or estrogen is an emerging treatment modality for hypospadias, which can potentially improve surgical outcomes and reduce the risk of complications. This review aims to evaluate the current knowledge on preoperative hormonal stimulation in hypospadias. Methods: This study was a combination of a systematic review followed by a meta-regression analysis performed on PubMed, Google Scholar, DOAJ, and Cochrane. The study included randomized controlled trials, prospective and retrospective cohort studies, and before-and-after studies with or without control. The search was performed in English and was limited to articles published between January 1, 2000, and December 31, 2020. Results: The database search yielded 188 articles, which were systematically eliminated, leaving 15 relevant articles. The analyzed articles showed that testosterone is the most commonly used hormonal treatment in hypospadias, followed by dihydrotestosterone (DHT) and estrogen. Testosterone may be given in topical, parenteral, or oral formulations, while DHT is most often used in topical form. Conclusions: Preoperative stimulation with testosterone or DHT is associated with increased penile length and glans circumference before surgery, which may ease the reconstruction process. In addition, testosterone and DHT increase the rate of neovascularization and reduce the risk of postoperative complications

BLADDER RECONSTRUCTION DURING SEPARATION OF A CONJOINT TWIN ISCHIOPAGUS TRIPUS

Objective: Conjoined twins represent one of the rarest congenital anomalies occurring with a varying incidence of about approximately 1 : 50.000 - 1 : 200.000 births. Ischiopagus conjoined  twinning (Fuse at the hip region) is even rare representing only 6% of all conjoined  twins. Here we report our experience in lower urinary tract reconstruction during separation of a conjoined twin ischiopagus tripus in Hasan Sadikin Hospital, Bandung. Case(s) Presentation: Two years old female conjoined twins, weighing in total of 8 kilograms, were brought to our hospital. The twins were fused  at  the lower  halves of  their bodies with two separate lower limbs at the right side and a fused left lower limb. External genitalia were absent. From CT Angiography we found four kidneys, two in each child with two separate bladders, with right ureter of baby A and left ureter of  baby B enter the  right bladder, while left ureter of  baby A and  right ureter of  baby B enter the left bladder. There was one cloaca that drains urine and feces. During the separation surgery, we performed ureteroneocystostomy and temporary ureteral stenting, followed by cystostomy. The pediatric surgeon performed bowel separation by stapling technique, pelvic wall separation, ileostomy, and pelvic floor reconstruction. The orthopedic surgeon performed femur separation, pelvic floor reconstruction, reconstruction of the pelvic ring, and femur reconstruction. The patients underwent defect closure, which performed by plastic surgeon. The operation was successful, without any complication to the kidney and the urinary tract of both babies. Discussion: Ischiopagus conjoined twins are the most complex conjoined twins and occur in only 6% of all conjoined twin cases. Ischiopagus is usually located along the axis with the head located on the opposite side. This case usually has one umbilicus and the two bodies are fused below this level, the union occurs in the lower abdomen and the pelvis. The internal organs that usually coalesce in cases of ischiopagus conjoined twins are liver, lower gastrointestinal, and genitourinary. The fused gastrointestinal part is the ileo-colic part of terminal ileum (Meckel's diverticulum). Conclusion: The separation of conjoined twin is a unique challenge due to its complex anatomy and physiology. Although advancement in imaging and monitoring has improved the survival rate separation can be successfully achieved only with meticulous planning and team work

THE EFFECT OF SUKUN LEAF (ARTOCAPTUS ALTILIS) EXTRACT ON RENAL ISCHEMIA/REPERFUSION INJURY IN WISTAR RATS WITH PARAMETER OF KIDNEY HISTOPATHOLOGICAL FINDINGS SERUM CYSTATIN-C AND SERUM CYSTATIN-C

Objective: To determine the effects breadfruit leaf extract (Artocaptus altilis)in Wistar rats, which had induced renal ischemic-reperfusion injury, with evaluation of serum cystatin C level and kidney histopatologic findings. Material & Methods: A total of 30 Wistar rats, three groups of ten, were included in the study and were performed in Bandung Eijkman Animal Laboratory. In group I (sham group), a right nephrectomy was done. In group II (control), a right nephrectomy was also done and the left renal pedicles were occluded for 60 minutes and reperfused for 60 minutes. In group III (treatment), the treatment was equal with group II, and breadfruit leaf extract (4.75%) was administered intraperitoneally. At the end of the study, a left nephrectomy was performed on all groups. Afterward, serum cystatin C levels and kidney histopathological findings of all rats were examined. Data were analyzed by an unpaired numerically comparative analysis with SPSS 20.0 software. Results: The mean of serum Cystatin C in group I was 3183.2 ± 680.9 pg/dL, group II  was 3776.4 ± 326.7pg/dL, and group III was 3492.7 ± 1.326.7pg/dL. The mean of histopathology renal score was also assessed, group I was 4.4 ± 0.52, group II was 8.6 ± 0.84, and group III was6.3 ± 1.70. Comparative test of serum cystatin C level, using ANOVA test and Benferroni post hoc test, in the treatment group has a p-value of > 0.05, it showed that there were no significant differences on the value of cystatin C level on the treatment group. In correlation test of renal histopathology score, suing Kruskal-Wallis test and Mann-Whitney post hoc test has a p-value of < 0.05, therefore there were significant differences on the mean value of renal histopathology score in the treatment group, with Eta correlation coefficient 0.847. Conclusion: The beneficial effects of breadfruit leaf extract can be attributed to its protective effects on renal cells damage. This treatment has an important role in reducing renal injury resulting from renal ischemia-reperfusion. However, breadfruit leaf extract did not significantly improve renal function based on serum cystatin C level. &nbsp