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Indonesian Journal of Urology Vol 27 No 1 (2020)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v27i1.536


Objective: Getting the right access to the kidney calyces that has been determined is the most important part of PCNL. Less optimal access can cause an increase in operating time and a decrease in stone free rate. The use of inferior calyx as access decreases the risk of complications, but there are difficulties in reaching the superior calyx, which affects the stone free rate. The angle and depth of the puncture on PCNL can be determined by coronal and sagittal cuts in the non contrast MSCT scan of the abdomen. Material & Methods: This is an analytical study with a prospective cross-sectional method. An analysis was done to 198 samples of patients in Kardinah Tegal Hospital. Samples were taken with 16 slices non-contrast abdominal MSCT using Philips MSCT MX16 (120 kVp; 2x0.75 mm slice thickness). Samples were collected with consecutive sampling method, excluding patients who had a history of other illnesses or surgical history that resulted in anatomical changes in kidney position, age<18 year old, BMI>30 (obesity), grade 4 hydronephrosis (calyces had disappeared). Reconstruction of 3D non contrast abdominal MSCT was performed by measuring the angle of the coronal cut which was simulated as a puncture in the supination position and sagittal cut which was simulated as puncture in pronation position. An imaginary line was drawn from the imaginary point between the iliac crest and 12th rib as high as 3th to 4th lumbar to the inferior renal calyx. Axis was drawn from the inferior renal calyx towards the superior renal calyx. Results: There is significant difference (P=0.000) in the angle of the imaginary line drawn from the inferior calyx to the superior calyx between the right supination position compared to the right pronation position. The angle in the supination position is more gentle 142.8 (±9.7)/(118-165) degrees compared to 96.5 (±13.2)/(11-138) degrees. On the left side, the angle formed from inferior calyx to the superior calyx in the supination position is more gentle 143.4 (±9.6)/(119-162) degrees) compared with 97.3 (±11.2)/(76-132) degrees formed in pronation position, with a value of P=0.000. Conclusion: PCNL puncture with an inferior calyx approach to reach the superior calix on abdominal MSCT without contrast will be easier to do in the supine position. This is because the angle from the inferior calyx to the superior calyx is more gentle in the supine position so that maneuvers are easier to do.
Oligoasthenoteratozoospermia After Trial of Testicular Salvaging Surgery in Testicular Torsion: A Case Report Mahfuz, Muhammad Ainul; Suwanto; Krisna, Muhammad Sidharta
Green Medical Journal Vol 2 No 3 December (2020): Green Medical Journal
Publisher : Fakultas Kedokteran Universitas Muslim Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33096/gmj.v2i3.64


Testicular torsion (TT) is an emergency in urology that happens because of the spermatic cord’s rotation. Decreased of overall sperm parameters after TT often happens in which can endanger the patient’s fertility status. Approach on how to salvage the testicle and to prevent unwanted complications remains as the doctor’s greatest priority. We report a case of oligoasthenoteratozoospermia after surgical detorsion without orchidectomy in testicular torsion. A 19-year-old male, presenting with sudden, progressive, and continuous pain in the right testicle for 4 hours. The right testicle was larger in volume on physical examination, there were a negative phren sign and negative cremasteric reflex. Gray scale ultrasound without Doppler showed changes suggestive of testicular torsion. Emergency surgery revealed a dark-bluish right testicle with a 360o rotation of the spermatic cord. Detorsion without orchidectomy was performed with clinical judgment hoping for the restoration of testicular viability. Sperm analysis was done after one month and oligoasthenoteratozoospermia was found. Although some patients experience decreased overall sperm parameters after TT that perhaps making them infertile, interestingly there is no difference in pregnancy rates among couples with TT men when compared to the general population. The best testicular salvage surgery method to prevent testicular atrophy also has not been determined yet. Thus, the patient should be carefully counseled about the good outcome of pregnancy rate and the chance for testicular atrophy, regardless of what is the surgical choice.