Ahmad Zulfan Hendri
Division Of Urology, Department Of Internal Medicine, Faculty Of Medicine, Public Health And Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia

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Reducing post-radical cystectomy complications with enhanced recovery after surgery (ERAS) protocol: is it time to change? Ahmad Zulfan Hendri; Muhammad Mauny Puteh; Said Alfin Khalilullah; Andy Zulfiqqar
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 52, No 4 (2020)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (213.514 KB) | DOI: 10.19106/JMedSci005204202007

Abstract

Radical cystectomy (RC) remains associated with a greater number of postsurgical complications than any urological procedure. Enhanced recovery after surgery (ERAS) protocol is a multimodal perioperative care pathway designed to achieve early postsurgical recovery. We evaluated the perioperative outcome of post-RC patients, comparing the effectiveness of ERAS to conventional recovery protocols. We identified 37 patients who underwent RC for bladder cancer from 2016 to 2018. The characteristics, complication rate and clinical outcomes were evaluated in these groups of patients. In this study, the mortality was 8.1%, and the complications were 37.8%. The most frequent complications were anastomotic leakage (16.2%), wound dehiscence (13.5%), infections/sepsis (8.1%), and paralytic ileus (8.1%). The ERAS protocol significantly reduced operative time (p=0.001; OR=216; CI95%: 12.0-3855.2) and reduced overall complications (p=0.04; OR= 0.14 CI95%: 0.016-1.132). Extensive complications and mortality develop following the RC procedure. Meanwhile, refinement in perioperative care has been reducing the rate of serious complications. The ERAS protocol distinctly reduces the post-RC complication rate.
Diagnosis value of prostate specific antigen density (PSAD) and prostate specific antigen (PSA) in bone metastases of prostate cancer among Indonesian population Ahmad Zulfan Hendri; Andy Zulfiqqar; Indrawarman soeharjo; Raden Danarto
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 52, No 2 (2020)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (250.553 KB) | DOI: 10.19106/JMedSci005202202005

Abstract

Cancer prostate (PCa) is currently reported as the most diagnosed cancer in males. Bone metastases in PCa indicate poor prognosis and the major cause of pain and death. Early diagnosis of metastases is important in PCa management. Prostate specific antigen (PSA) velocity was used to predict overall survival and metastasis-free survival. However, this test should be conducted 2 times, for at least 4 weeks apart. Therefore, a cross-sectional test with higher positive probability value is needed. This study aimed to compare PSA density (PSAD) and PSA level to evaluate patients at risk of bone metastases in Yogyakarta, Indonesia. Aretrospective study with a total subject of 106 patients with (n = 31) and without (n = 75) bone metastases were analyzed. The initial PSA measurement, as well as bone scan and prostate volume, were evaluated in all patients. Bone survey found to be positive in 31/106 (29.2%) patients. The total of 50(47.2%), 10(9.4%) and 46(43.4%) patients had PSA level <50, 50-100 and >100ng/mL, respectively. Furthermore, receiver operating characteristic (ROC) area under the curve of PSAD (0.75) was higher that that ofPSA (0.65).PSAD more than 0.15 indicated sensitivity of 93% and specificity of 38%, while PSA more than 20 ng/mL shown sensitivity 82% and specificity 21%. In conclusion, PSAD level more than 0.15 shows high sensitivity and specificity in causing potential skeletal metastases. Using this PSAD cut-off value, unnecessary investigation canbe avoided. 
Prostat cancer profile in Dr. Sardjito General Hospital Yogyakarta Yurisal Akhmad Dany; Ahmad Zulfan Hendri; Indrawarman Soerohardjo
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 53, No 3 (2021)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (514.187 KB) | DOI: 10.19106/JMedSci005303202104

Abstract

Prostate  cancer  is  the  fourth  most  common  type  of  non-skin  malignancy  in  male malignancies. In Indonesia, the definitive data are unreported, however, Globocan  reported  prostate  cancer  in  5th  place  in  2018.    Early  diagnosis  and  treatment  of  this  cancer  are  associated  with  reduced  mortality  rates.  This  study aimed to investigate the profile of prostate cancer in Dr. Sardjito General Hospital,  Yogyakarta,  Indonesia.  A  retrospective  study  involving  a  total  of  90  prostate cancer patients who underwent follow-up care at Dr. Sardjito General Hospital, Yogyakarta in the period of 2015 to 2020 was conducted. Data of the patients from their medical records consisted of age, gender, prostate volume, PSA  level,  testosterone  level,  hydronephrosis,  TURP  history,  histopathology  results,  Gleason  scores,  ISUP  grade,  and  staging  TNM  were  collected.  The  average of patients age was 67 ±10.4 y.o. where 22 (24.4%) patients aged < 60 y.o., 34 (37.8%) patients aged 61-70 y.o. and 34 (37.8%) patients aged >70 y.o. Almost of all patients (87 patients or 97.8%) were diagnosed as adenocarcinoma. Most of patients (73 patients or 81.4%) had prostate volume (TAUS) > 30 cm3 with the median at diagnosis was 51 cm3 (38.3 – 104.4). Furthermore, the median of PSA for diagnosis was 234.4 (94.4 – 1720.3) ng/mL and the median of testosterone level  at  diagnosis  was  317  (10  -  384)  ng/dL.  In  conclusion,  most  patients  with  prostate  cancer  are  identified  as  adenocarcinoma  with  metastatic  stage.  In  general, the prostate cancer patients age more than 61 years old with prostate volume  (TAUS)  >  30  cm3.  In  addition,  prostate  volume  and  testosterone  level  can be routinely used as initial screening and periodic assessment to evaluate prognosis and disease progression.
PROGNOSTIC FACTORS TOWARD BLADDER CANCER PATIENT RECOVERY AFTER RADICAL CYSTECTOMY SURGERY Triyaka, Rendy; Ahmad Zulfan Hendri
Indonesian Journal of Urology Vol 28 No 2 (2021)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v28i2.678

Abstract

Objective: This study aimed to know independent prognostic factors to predict the recovery time of bladder cancer patients after radical cystectomy. So that it would be a consideration to determine patient feasibility before surgery and after surgery management. Material & Methods: This study was an observational analytical study with a retrospective approach to examine the relationship between pre-surgery variables of the bladder cancer patients and the duration of treatment post radical cystectomy. Results: From the results of this study, it is known that the average length of postoperative care for older patients (above 65 years) was lower when compared to patients under 65 years with averages of 17.08 and 18.03 days respectively p-value of this analysis was 0.781. Patients with low hemoglobin, albumin, and HALP scores had longer postoperative hospitalization periods but with P values of 0.384, 0.276, and 0.603, the ileal conduit has the longest hospitalization treatment period between the two other procedures, with a P-value of 0.904. It was found that the average length of postoperative care for underweight patients was 16.5 days and for patients with normal BMI was 19.59 days. The difference between these averages showed a p-value of 0.396 it is known that the average length of postoperative care for older patients (above 65 years) was lower when compared to patients under 65 years with averages of 17.08 and 18.03 days respectively. The p-value of this analysis was 0.781 it was found that patients with low hemoglobin, albumin, and HALP scores had longer postoperative treatment periods, p-value 0.384, 0.276, and 0.603. The average duration of postoperative care for patients who applied the ERAS protocol tended to be faster (15.67 days) compared to patients who did not apply the ERAS protocol (18.16 days). Nevertheless, the p-value of this difference was 0.518. Conclusion: This study concludes that there is no prognostic factor that can independently predict the duration of treatment of bladder cancer patients post-radical cystectomy. Therefore in-depth assessment of various factors is required before performing radical cystectomy to achieve the best postoperative recovery rates.