Sawkar Vijay Pramod
Department of Urology, Faculty of Medicine/Padjajaran University, Hasan Sadikin General Hospital, Bandung.

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GIANT CLEAR CELL RENAL CARCINOMA: A CASE REPORT Palgunadi, I Nyoman; Pramod, Sawkar Vijay
Indonesian Journal of Urology Vol 25 No 2 (2018)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v25i2.388

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Objective: This article is aimed to report an unusual presentation of renal cancer T4N0M0 in which the tumor weighed about 5 kilograms in a patient admitted to Urology Department of Hasan Sadikin Hospital in Bandung, Indonesia, in August 2016. Case presentation: We report a case 62 year old male with history of growing mass in his left abdominal. There are also painless hematuria and weight loss of approximately 10 kg over the past 2 years. Discussion: Physical examination found a significant palpable, immobile and mild tender mass in the left upper quadrant of the abdomen. Abdominal Pelvic Computed Tomography (CT) scan revealed inhomogenous hypodens mass in the left kidney. Resection of the tumor revealed a 5 kg (22 x 25 x 18 cm, with total volume of 9.900 cm3) encapsulated neoplasm. Histophatological examination revealed a clear cell type renal cell carcinoma (RCC) with positive margin and Fuhrmann grade 2. In Asia, a giant chromophobe RCC exceeding 10 kg in weight was reported in 2009. As for previously reported giant clear cell RCC, we found out the data to be very limited. Conclusion: Giant RCC is rare, especially clear cell type in histophatological result. The size of the tumor reported in this article is considered as the largest-sized giant clear cell RCC ever reported in Asia. The size of the tumor in this case presented several challenges in the operative settings. However, the outcome and six months post-operative follow-up of the patient was satisfying in which there was no presence of single symptom within the six-month follow-up period.
A 87 YEARS OLD MALE WITH GIANT PROSTATIC HYPERPLASIA AND BLADDER STONES, THE LARGEST PROSTATE REPORTED IN INDONESIA Vera, Vera; Pramod, Sawkar Vijay
Indonesian Journal of Urology Vol 24 No 2 (2017)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v24i2.277

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Objective: The aim of this article is to report a case of Giant Prostatic Hyperplasia and see the correlation between volume of prostate and benign prostate hyperplasia (BPH) symptoms. Giant BPH is defined as a prostate weight over 200 g or 500 g; the lower threshold was suggested by Japanese authors. It’s extremely rare, with only 16 cases exceeding 500 g till 2013. Case presentation: Patient was an 87-year-old male with chief complaint of haematuria. We performed Transabdominal Ultra Sonography (USG) on the patient. Discussion: Transabdominal USG showed enlarged prostate with median lobe protruding into the bladder measuring 86 x 102 x 76 mm and 348 cc in volume. We performed transvesical prostatectomy. The large prostate was enucleated completely in one piece with 23 stones measuring about 1 cm in size. Grossly, the mass measured 12 x 8 cm and weighed 300 g. Histopathology evaluation revealed BPH. Conclusion: To our knowledge, this is the first giant BPH case being reported in Indonesia. We would like to emphasize that severity of BPH symptoms does not correlate with volume of the prostate. Unfortunately, we can not conclude that there were correlation between body mass index (BMI) and volume due to lack of BMI data from the literature.
INITIAL EXPERIENCE OF LAPAROSCOPIC PARTIAL NEPHRECTOMY IN HASAN SADIKIN GENERAL HOSPITAL BANDUNG Daniswara, Nanda; Pramod, Sawkar Vijay; Sibarani, Jupiter; Safriadi, Ferry
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.v23i1.204

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Objective: To describe our experience about laparoscopic partial nephrectomy to treat localized renal tumour patients in Urology Department Hasan Sadikin General Hospital Bandung. Material & method: In 2014, there were 6 female patients that underwent laparoscopic partial nephrectomy in Hasan Sadikin General Hospital Bandung. In one case, there were tumours on both kidneys. Five patients were underwent transperitoneal approach and 1 patient were undergo retroperitoneal approach. All patients were examined with ultrasonography and Abdominal CT scan with contrast. We also calculate RENAL nephrometry score. Results: There were 6 female patients with left flank pain that undergo laparoscopic partial nephrectomy. In one case, there are tumours on both kidneys. In RENAL nephrometry score calculation, there were 3 patients with 10x score, 1 patient with 11x score, 1 patient with 7x score, and 1 patient with 6p score. From all of them, 4 patients were successfully performed laparoscopic partial nephrectomy, 1 patients was undergo laparoscopic nephrectomyand 1 patient is converted to open partial nephrectomy. Five patients were undergo transperitoneal approach and 1 patient was undergo retroperitoneal approach. Surgery ranged from 180-240 minutes. Intra operative bleeding was ranged from 50-200 cc. Tramadol intravenous was used for post operative pain control. With VAS score in first post operative day was 6, and 2 at the time of discharge. Hospitalized time was ranged from 4-6 days. Conclusion: Laparoscopic partial nephrectomy is an alternative treatment that safe for localized renal tumour. This procedure is depend on the technique and approach from each Urologist. Our limitations are we didn’t have laparoscopic ultrasonography and the tumour close to pelvocalyces system.
EXPERIENCE ON TRANSPERITONEAL LAPAROSCOPIC DIVERTICULECTOMY IN UROLOGY DEPARTMENT HASAN SADIKIN HOSPITAL BANDUNG Ferdian, Vicky; Pramod, Sawkar Vijay
Indonesian Journal of Urology Vol 22 No 2 (2015)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v22i2.188

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Objective: To described our experiences in treating large bladder diverticulum using transperitoneal laparoscopic techniques in Urology Department Hasan Sadikin Hospital, Bandung. Material & method: There were 3 patients with bladder diverticulum due to bladder outlet obstruction. There are 2 males and 1 female patients. The bladder outlet obstruction was caused by BPH in both male patients and urethral stenosis in female patient. The bladder diverticles were located in left lateral bladder wall in 2 patients and right lateral bladder wall in 1 patient. All the patients underwent two stages procedure. Initially, we perform correction of the obstruction. Next stages were transperitoneal laparoscopic diverticulectomy. Result: The operating time was improving in each procedure, with average time was 180 minutes. Drain was removed in 3 days in one patient and 2 days in 2 patients. Cystostomy was removed in POD 14 in all patients. One month post operatively, we performed cystography and all of the patients had a normal result without any extravasation. The patients was discharge on day 7 in one patient and day 4 in 2 patients post operatively, with minimal pain. Until now, patient was still under follow up and no major complication was found. Conclusion: Transperitoneal laparoscopic diverticulectomy is a save alternative for the management of bladder diverticulum with minimal post-operative pain and length of stay.
Comparison of Tissue Preservation using Formalin and Ethanol as Preservative Formula Pramod, Sawkar Vijay; Soenggono, Arifin; Shian, See Woan
Althea Medical Journal Vol 3, No 3 (2016)
Publisher : Althea Medical Journal

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (187.384 KB)

Abstract

Background: Tissue preservation can be performed through embalming, by providing the chemical embalming fluid to the human remains. Formalin’s preservative formula is the foundation for modern methods of embalming. Unfortunately, this preservative formula has several disadvantages. While Ethanol’s preservative formula is a considerable agent to replace formalin’s preservative formula. The aim of this study was to compare the tissue preservation using formalin and ethanol as preservative formula.Methods: This study was carried out from September–October 2014 in the Laboratory of the Department of Anatomy, Faculty of Medicine, Universitas Padjadjaran. The study used the laboratory experimental method with consecutive sampling of 16 Wistar Rats. Thirty two soleus muscles and thirty two colons were collected and divided into two groups. Each group consisted of 16 soleus muscles and 16 colons. Group 1 was preserved with formalin’s preservative formula and Group 2 was preserved with ethanol’s preservative formula. The two groups were preserved for six weeks. The tissue’s color, consistency, odor and the growth of bacteria were determined before and after treatment.Results: Tissues preserved with ethanol’s preservative formula had better tissue preservation in the aspect of color and odor, compared with formalin’s preservative formula. Both preservative formulas showed no growth of bacteria in tissues but failed to retain the consistency. All the data were analyzed with Chi-square test.Conclusions: Ethanol’s preservative formula preserves better quality of tissue compared to formalin’s preservative formula. [AMJ.2016;3(3):359–63] DOI: 10.15850/amj.v3n3.880 
LAPAROSCOPIC LEFT HEMINEPHRECTOMY IN COMPLETE DOUBLE COLLECTING SYSTEM WITH MULTIPLE UPPER MOEITY KIDNEY STONE Parardya, Aga; Pramod, Sawkar Vijay
Indonesian Journal of Urology Vol 22 No 2 (2015)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v22i2.181

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Objective: Laparoscopic heminephrectomy was firstly reported by Jordan and Winslow in 1993. Laparoscopic heminephrectomy has recently been described as a feasible procedure for the treatment of poorly functioning renal moiety in the duplex kidney. However, this minimally invasive technique is a complex procedure that has remained confined to the hands of experienced teams, with a limited number of reports of relatively few cases. In Indonesia, it has rarely been done. Material & method: A 49-year-old male with chief complaint of pain at the left flank for 2 months. From IVU, we found double collecting system with left upper moiety kidney stone. Then we performed laparoscopic left heminephrectomy. Result: Operative time was 2 hours 30 minutes with bleeding < 100 mL. Post operative VAS was 3 with paracetamol analgetic. Patient was discharged 5 days after operation without any complaint. Conclusion: Laparoscopic heminephrectomy is safe to treat patient with complete double collecting system with multiple upper moeity kidney stone.
LAPAROSCOPIC RADICAL CYSTECTOMY WITH ILEAL CONDUIT URINARY DIVERSION, FIRST EXPERIENCE IN BANDUNG Jouwena, Davis Roland Gustav; Pramod, Sawkar Vijay
Indonesian Journal of Urology Vol 22 No 2 (2015)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v22i2.175

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Objective: To report our experience in performing laparoscopic radical cystectomy with ileal conduit urinary diversion (extracorporeal reconstruction). Material & method: This study was take place in Hasan Sadikin Hospital Bandung. A 54-year-old male with histologically proven transitional cell carcinoma of the bladder cT2bN0M0 underwent a laparoscopic radical cystoprostatectomy and ileum dissection was performed under laparoscopy. Ileal conduit and stoma reconstruction performed extracorporeal through small incision between ports (about 4cm). Results: The surgical margins were free of disease. The operative time was 360 minutes. Estimated blood loss was 600cc. Hospital stay was 5 days. Patient was discharge with no complication of post-op wound, and urine production about 1500cc/24hrs via stoma. Conclusion: Laparoscopic radical cystectomy with ileal conduit extracorporeal reconstructive urinary diversion could be the preferred means in managing bladder tumor on selective case.
RETROPERITONEAL VS TRANSPERITONEAL LAPAROSCOPIC URETEROLITHOTOMY Putra, Rosadi; Safriadi, Ferry; Pramod, Sawkar Vijay
Indonesian Journal of Urology Vol 22 No 2 (2015)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v22i2.193

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Objective: To compare retroperitoneal versus transperitoneal laparoscopic ureterolithotomy in effectivity, pain scale and early complications. Material & methods: In this prospective comparison study from January 2013 to June 2014, 32 patients with proximal and mid ureteral stones underwent retroperitoneal laparoscopic ureterolithotomy or transperitoneal laparoscopic ureterolithotomy. The randomization occured on consecutive sampling on a 1 : 1 basis. Group 1 and 2 consisted of patients who underwent retroperitoneal laparoscopic ureterolithotomy and transperitoneal laparoscopic ureterolithotomy, respectively. Demographic and clinical variable, operative time, length of stay, ureteral suturing, pain scale according to visual analog scale (VAS) and early complications data were collected and analyzed. Statistical analysis was performed with SPSS® version 17.0 using student T-test and Mann-Whitney U tests with p value < 0.05 considered statistically significant. Results:VAS on day 1 between the 2 groups was statistically significant, and was higher in group 2 (p < 0.05). According to the Clavien-Dindo classification of surgical complication all the patients were in grade 1 classification. The differences in operative time, length of stay, ureteral suturing, visual pain analog score on day 3, and early complications between the 2 groups were not statistically significant.Conclusion: Transperitoneal laparoscopic ureterolithotomy is significantly associated with pain than retroperitoneal laparoscopic ureterolithotomy in first day after surgery. Successful stone removal remains the same in both groups.
TRANSPERITONEAL LAPAROSCOPIC URETEROLITHOTOMY FOR LARGE DISTAL URETERIC STONE Priyosantoso, Bacilius Agung; Pramod, Sawkar Vijay
Indonesian Journal of Urology Vol 22 No 1 (2015)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v22i1.103

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Objective: This study is aim to share our experience (in videos) in Laparoscopic ureterolithotomy for large distal ureteric stone with transperitoneal approach. Material & methods: A 37 years old male has been diagnosed with a right hydronephrosis due to proximal ureterolithiasis and stone at left calyx inferior, first and stone migrated to right distal ureter on 12 hours prior surgery, in Hasan Sadikin Hospital Bandung. He underwent laparoscopic ureterolithotomy with transperitoneal approach. Results: We successfully perform laparoscopic ureterolithotomy with transperitoneal approach on a 37 years old male patient who diagnosed with a right hydronephrosis due to distal ureterolithiasis and stone at left calyx inferior. Duration of operation was 45 minutes. Patient was discharged at 2nd postoperative day without any complications. Conclusion: A transperitoneal laparoscopic ureterolithotomy for distal ureteric stone is a safe and feasible technique that should be an options on every patients who is planning to undergo distal ureterolithotomy especially large stone. Keywords: Transperitoneal, laparoscopy, distal ureterolithotomy.
ATHEROSCLEROTIC PLAQUE OF RENAL VASA RECTA ON PATIENT WITH CALCIUM STONE Pramod, Sawkar Vijay; Sugandi, Suwandi; Sihombing, Aaron T.; Makmuri, Makmuri
Indonesian Journal of Urology Vol 20 No 1 (2013)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v20i1.45

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Objective: We would like to identify whether atherosclerotic plaque inside renal vasa recta correlates with the formation of calcium stone. Material & Method: Samples are taken from kidney tissue removed by nephrectomy due to stone and non-stone disease. Histopathological examination with specific staining was performed by a single pathologist to find the atherosclerotic plaques inside the renal vasa recta. The result of each group was compared, and then analyzed using the Chi square test/Fischer exact test (SPSS ver.16.0; p < 0,05). Results: We found that the risk of calcium lithiasis is two-fold higher in the group with atherosclerotic plaques inside the renal vasa recta. (PR = 2,15; p < 0,05). Conclusion: Calcium stone are more likely to occur on patients with renal vasa recta atherosclerotic plaque, as possible sequelae of vascular injury.Keywords: Atherosclerotic plaque, vasa recta, calcium renal stone.