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COMPARISON BETWEEN GLYCOGEN LEVEL OF KIDNEY TUBULAR CELLS IN DIABETIC KIDNEY STONE PATIENTS AND NON DIABETIC KIDNEY STONE PATIENTS Ramadhan, Ken; Sugandi, Suwandi; Noegroho, Bambang S; Tjahjodjati, Tjahjodjati; Safriadi, Ferry; Siregar, Safendra; Adriansjah, Ricky; Adi, Kuncoro; Sihombing, Aaron Tigor; Yusuf, Makmuri
Indonesian Journal of Urology Vol 18 No 1 (2011)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v18i1.76

Objective: To compare glycogen level of kidney tubular cells in diabetic kidney stone patients with nondiabetic kidney stone patients. Material & method: We reviewed kidney stone patients who underwent nephrectomy in Hasan Sadikin Hospital from February 2008 to January 2009. Age, gender, type of DM, and urine pH were recorded. Glycogen level of kidney tubular cells were evaluated histochemically using HE, PAS, and PAS diastase. The results were categorized into 3 grades, based on the staining appearance compared to liver cells as controls. The results of diabetic group were compared to non diabetic patients. Results: There were 30 patients eligible for this study, 15 in diabetic group and 15 non diabetic patients. In the diabetic group, there were 10 patients with urine pH < 6 and 5 patients with a pH of 6,5. In the non diabetic group all urine pH were > 6,5. Examination revealed that glycogen level of kidney tubular cells in diabetic group was higher than in non diabetic group. Conclusion: Glycogen level of kidney tubular cells in diabetic kidney stone patients was higher than in non diabetic kidney stone patients. Keywords: Tubular cell, kidney stone, diabetes mellitus.

THE ROLE OF BEDSIDE BLADDER SONOGRAPHY FOR DETECTION OF BLADDER TRAUMA Santoso, Jumadi; Adi, Kuncoro
Indonesian Journal of Urology Vol 23 No 1 (2016)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v23i1.80

Objective: To evaluate the role of bedside bladder sonography along with retrograde instilation of saline as a novel diagnostic procedure for suspected bladder trauma. Material & methods: Prospective evaluation of all patients with suspected bladder injuries admitted to the Emergency Department of Hasan Sadikin General Hospital, Bandung, Indonesia, from 2010–2013. Suspected urethral injury patients were excluded. Along with routine Focused Assessment Sonography for Trauma (FAST) procedure, bedside bladder sonography was performed concurrently with retrograde instillation of normal saline 350cc through a Foley catheter. The objective of real-time bladder sonogram was to examine the presence of peri-vesical free fluid turbulence and accumulation during saline instillation, which subsequently indicated a suspected bladder perforation. The accuracy of sonographic results were compared with computerized tomography (CT), cystogram or intraoperative findings. Time to diagnosis was recorded. Statistical analysis was performed to evaluate the sensitivity, specificity, positive predictive value (PPV), negative predictive value(NPV) and diagnostic accuracy. Results: 23 patients met the inclusion criteria. The mean age was 27.21 years old, 87% were males. Based on cystogram or intraoperative finding there are 21 patients have bladder rupture. Among these patients, 14 patients had positive result onbladder sonogram, and all confirmed positive on cystogram and operative finding. Nine patients had negative result on bladder sonogram. While 7 among them have positive result on cystogram or intraoperative finding. Analysis revealed 67% sensitivity, 100% specificity, 100% PPV, and 22.2% NPV. Overall diagnostic accuracy of bladder sonogram was 83.5%. Time to diagnosis were significantly shorter in bedside bladder sonogram compared to CT or cystogram (11.82 ± 2.99 min vs 181.30 ± 88.89 min; p < 0.05). Conclusion: Bedside bladder sonogram is a useful adjunct procedure for diagnosis of bladder trauma. It is time and cost effective, and can be performed in bed-side emergency setting with acceptable accuracy.

THE EFFICACY OF NASOGASTRIC TUBE IN A LARGE BLOOD CLOT EVACUATION DURING CYSTOSCOPY Wallad, Caesar Khairul; Santoso, Jumadi; Adi, Kuncoro
Indonesian Journal of Urology Vol 23 No 2 (2016)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v23i2.224

Objective: In this study we introduce using nasogatric tube as an alternative to procure a safe and efficient way to remove large troublesome blood clots during cystoscopy procedure. Material & methods: We prospectively perform blood clot evacuation using nasogastric tube suction (NGT) on 21 patients in Hasan Sadikin GeneralHospital Bandung,within 6 months period. A 24 fr sheath and 16 fr NGT connected to suction unit with a 300 mmhg negative pressure was set. A repetitive back and forth technique was set in motion during the procedure. Cystoscopy time and NGT suction time was documented. Results: All patients were successfully managed with this method without complication during the procedure. The average time for clot removal was 5 minutes 8 seconds with average cystoscopy time was 20 minutes 12 seconds and average estimated blood clots volume was 483 grams. Conclusion: Evacuation using NGT suction is effective, safe and an efficient way to remove a large bothersome clots.

ANGIOTENSIN II TYPE-1 RECEPTOR (AT1R) DISTRIBUTION IN BPH, HIGH GRADE PIN AND ADENOCARCINOMA OF THE PROSTATE Septiadi, Isdianto; Sugandi, Suwandi; Noegroho, Bambang S; Tjahjodjati, Tjahjodjati; Safriadi, Ferry; Siregar, Safendra; Adriansjah, Ricky; Adi, Kuncoro; Sihombing, Aaron T; Pramod, Sawkar V; Nasution, Ramlan; Hernowo, Betthy S
Indonesian Journal of Urology Vol 17 No 2 (2010)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v17i2.348

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.

ESTROGEN EFFECT ON WISTAR'S VAGINAL EPITHELIUM Surur, Abu; Sugandi, Suwandi; Haroen, Zulhardi; Noegroho, Bambang S; Tjahjodjati, Tjahdjojati; Safriadi, Ferry; Siregar, Safendra; Adriansjah, Ricky; Adi, Kuncoro; Hernowo, Betthy S
Indonesian Journal of Urology Vol 17 No 2 (2010)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v17i2.349

Objective: To evaluate the effect of estrogen on wistar’s vaginal epithelium. Material & method: We divided 30 female wistars into three groups, ten wistars underwent bilateral ovariectomy, 10 wistars underwent bilateral ovariectomy, and estrogen replacement and 10 wistars as control. The second group received estradiol 1 mg/kg/day, directly after ovariectomy. After 4 weeks the vagina was then harvested and stained with hematoxylin-eosin to evaluate the thickness of epithelial layer of vagina. A pair T-test was use for statistical analysis. Results: Estrogen ablation decreased the thickness of epithelial layer in wistar’s vagina. The mean thickness of epithelial layer in vagina were 3, 5, and 10 for each group respectively. The mean epithelial layer of the first group as well as the second group showed significant difference compared to control group (p>0,05), while the first group showed insignificant difference compared to the second group. Conclusion: Estrogen ablation seems to decrease the thickness of vaginal epithelium, while estrogen replacement revealed insignificant effect.

LITOTRIPSI LASER HOLMIUM YAG UNTUK TERAPI BATU URETER Adi, Kuncoro; Safriadi, Ferry; Sugandi, Suwandi; Haroen, Zulhardi; Noegroho, Bambang S; Tjahjodjati, Tjahjodjati
Indonesian Journal of Urology Vol 15 No 2 (2008)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v15i2.352

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 Adi, Kuncoro; Safriadi, Ferry; Sugandi, Suwandi; Haroen, Zulhardi; Noegroho, Bambang S; Tjahjodjati, Tjahjodjati
Indonesian Journal of Urology Vol 15 No 1 (2008)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v15i1.362

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.

FIVE YEARS CHARACTERISTIC OF KIDNEY TRAUMA IN TERTIARY HOSPITAL IN WEST JAVA FROM 2013-2017 Karim, Ilhamul; Adi, Kuncoro
Indonesian Journal of Urology Vol 26 No 2 (2019)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v26i2.455

Objective: Globally, trauma is one of the leading cause of mortality and morbidity. Kidney is an organ that is often affected in trauma cases in urology. This study aimed to determine the characteristics of cases of kidney trauma treated in Hasan Sadikin Bandung Hospital, and used as part of the database of urogenital trauma in Indonesia. Material & Methods: The secondary data was derived from the medical records of patients with kidney trauma treated at Department of Urology in Hasan Sadikin Hospital Bandung for 5 years period (January 2013 to August 2017), as many as 130 cases. Information used was patients’ gender, mechanism of trauma, grading of kidney trauma, associated injury, management, shock, and outcome after treatment. The data obtained was subsequently recapitulated and processed using a spreadsheet. Results: A total 20489 trauma cases admission in Hasan Sadikin Hospital, 477 cases (2.33%) were urogenital trauma, and 130 of which are cases of kidney trauma (0.63%). The majority of patients with kidney trauma are male (87.7%). Based on the mechanism of trauma, 80% of them were related to traffic accidents, especially in motorcycle traffic accidents, as well as the trauma mechanism of falling from a height (13%). There were 69 patients (53.1%) who had major kidney trauma, and 61 patients (46.9%) had minor kidney trauma; specifically, 42.3% grade I and 21.5% grade V kidney trauma. In general, kidney trauma patients experienced multiple trauma, only 19 cases (14.6%) had not associated injury. Most of patients (63%) did not experience shock, and 87.75% of patients survived after treatment. In the timespan of 5 years, 44 patients underwent McAnninch procedure. Conclusion: In Hasan Sadikin Hospital, most cases of kidney trauma were experienced by men, and were caused by blunt trauma in traffic accidents, especially on motorcyclists. Most patients with kidney trauma experienced multiple trauma.

VALIDATION OF AFFORDABLE AND APPLICABLE KIDNEY PHANTOM MODEL (AARM) FOR ULTRASOUND-GUIDED PERCUTANEOUS NEPHROSTOMY SIMULATION Septian, Regi; Adi, Kuncoro
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.v27i1.515

Objective: Percutaneous nephrostomy (PN) is a medical skill that requires the repetition of hand and eye coordination exercises. The limited opportunity to achieve learning curve at mastering it, increases the morbidity risk to the patient. We therefore developed an Affordable and Applicable Renal Model (AARM) phantom to simulate percutaneous nephrostomy with ultrasound (USG) guiding. Our goal is to present the development of an affordable cost kidney phantom model and evaluate validity (face, content, and construct) with its reliability. Material & Methods: The AARM phantom made from mixture of gelatin, glycerin and sorbitol, then molded with latex gloves comprising the parenchymal portion and the renal pelvicalyceal system connected to a 10Fr nasogastric tube and a 20 cc syringe. Phantom then assessed by urology residents at Hasan Sadikin Hospital Bandung. Senior resident (n=20) who are adept at performing independent PN then compared with junior resident (n=15), and then we analysis both group skills by measure PN initial puncture time and its failure to establish its validity and reliability. Results: This phantom cost production was 30USD (400.000 IDR) and after tested by urology residents, it had simulated the series of PN action steps which described the face and content validation test, with correlation results (Pearson, p<0.05); Very strong (53.8%), strong (30.8%), and medium (15.4%). The reliability test with cronbach alpha value was 0.934 (reliable if cronbach alpha>0.60). The average initial puncture time measure and PN failure result of junior and senior residents are respectively 37.03 ± 9.5 vs 10.90 ± 0.65 seconds and 4.93 ± 1.33 vs 0.75 ± 0.63 times. When both skills performance was analyzed, the senior resident showed significantly (p<0.01) faster and fewer errors. Conclusion: This AARM phantom had successfully represent the whole sequence actions key step of PN skills and this study has been established its validity (face, content and construct). In addition, this phantom material not only made from affordable cost but also applicable and could be used repeatedly (recycled). We propose the use of this AARM phantom simulator as an initial steps practices to introduce percutaneous nephrostomy skills to residents before they went to the operating room.

CHARACTERISTIC OF IATROGENIC BLADDER TRAUMA PATIENT IN HASAN SADIKIN GENERAL HOSPITAL FROM JANUARY 2013 - JANUARY 2018 Karim, Muhammad Ilhamul; Adi, Kuncoro
Indonesian Journal of Urology Vol 27 No 2 (2020)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v27i2.612

Objective: This study was conducted to determine the characteristics of iatrogenic bladder trauma in Hasan Sadikin General Hospital from January 2013 – January 2018. Material & Methods: The study was conducted by retrospective descriptive methods. We reviewed iatrogenic bladder trauma from medical record at Hasan Sadikin General Hospital from January 2013 to January 2018. The data obtained is subsequently recapitulated and processed using a spreadsheet. Results: Most of the cases were found in female patients. There were 30 cases (73.17%) are recorded. Whilst on male patients, there were only 11 cases (26.83%). The average age was 42.35±2.35 years old. According to AAST grading, a total of 2 patients (4.88%) experienced AAST grade V, 28 patients (68.29%) experienced AAST grade IV, 8 patients (19.51%) experienced AAST grade III, and 3 patients (7.31%) experienced AAST grade I. In addition, there were 31 (75.61%) iatrogenic injuries due to gynecologic surgery, 6 (14.63%) iatrogenic injuries due to digestive surgery, and 4 (9.76%) iatrogenic injuries due to endourology surgery. Of all cases, 30 patients (73.17%) underwent immediate intraoperative reconstruction surgery, whilst the other 11 (26.83%) underwent delayed reconstruction surgery. As for the management, 33 (80.49%) patients underwent bladder repair, 1 (2.44%) patients underwent palliative cystectomy, 2 (4.88%) patients underwent damage control surgery, 3 (7.32%) patients underwent bladder exploration, and 2 (4.88%) patients underwent urethral catheter insertion. From all of 41 cases of patients with iatrogenic bladder injury, there were 3 (7.32%) mortality cases due to prolonged bleeding and sepsis. Conclusion: In this study, iatrogenic bladder trauma mostly affected female patients that underwent gynecologic surgery on the age group of 41-50 years old. Almost all of the cases were treated by bladder repair. By knowing the epidemiology of iatrogenic bladder injury and perform prompt treatment then we can take precautions to reduce the level of morbidity and mortality.

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