Arry Rodjani
Department of Urology, Faculty of Medicine/Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta.

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Milestones of kidney transplantation in Indonesia Susalit, Endang; Rasyid, Nur; Mochtar, Chaidir A.; Alfarissi, Fekhaza; Soeroto, Adhitama A.; Hamid, Agus Rizal A.H.; Wahyudi, Irfan; Marbun, Maruhum B.H.; Rodjani, Arry
Medical Journal of Indonesia Vol 26, No 3 (2017): September
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (489.945 KB) | DOI: 10.13181/mji.v26i3.1770

Abstract

Although kidney transplantation in Indonesia has started since 1977, it has only covered less than 3% ESRD treatment methods. This indicates that the development of kidney transplantation program in Indonesia is still stagnant. Based on observation, the growth of kidney transplantation in Indonesia can be divided into several eras, which are: the birth of new treatment for ESRD era, the expected growth era, the first downfall, the stable period, the unstable period, the rebirth of kidney transplant era, and the explosive growth era. Many factors contribute to this issue including the government policy, the funding problems, the limited donor pool, the dissenting cultural views, the number of human resources, the need for multi-disciplinary approach, and the life-after-graft care. However, many improvements have been made to increase kidney transplantation i.e. the government support for opening new kidney transplant centers, the use of minimally invasive techniques, the development of pediatric kidney transplant, and National Insurance coverage for transplantation. These conditions are expected to improve the number of kidney transplantation in Indonesia.
ONE-YEAR EVALUATION OF OVERALL URETHRAL STRICTURE MANAGEMENT USING QUESTIONNAIRES AND UROFLOWMETRY Mediana, Ervita; Wahyudi, Irfan; Rodjani, Arry
Indonesian Journal of Urology Vol 21 No 2 (2014)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v21i2.29

Abstract

Objective: To evaluate the overall outcomes of patients who get definitive treatment of urethral stricture. Material & Method: All patients who underwent various urethral stricture management in Cipto Mangunkusumo Hospital were evaluated over 1 year period. Patient demographics, type of surgery, International Prostate Symptoms Score (IPSS), quality of life (QoL) score, flow rate (FR) and post void residual urine (PVR) of all patients were evaluated at 3 months, 6 months and 1 year after surgery. Results: Out of 230 urethral stricture patients, 65 patients were eligible this study. Mean patient age was 41.19 ± 20.44 years. 37Direct Vision Internal Urethrotomy (DVIU), 20 end-to-end anastomosis, and 8 graft urethroplasties were performed. All patients underwent urethral stricture management showed improvement of IPSS (-22.64, p < 0.001), QoL (-3.36, p < 0.001), FR (16.72 ml/s, p < 0.001) and PVR (-126.23 ml, p < 0.001). Compliant patients showed better improvement of IPSS and FR than non compliant patient after DVIU procedure. Overall, open surgery give better improvement of IPSS and FR than DVIU procedure. These differences were more pronounced in recurrent and long (≥ 2 cm) urethral stricture disease. In open surgery group, end-to-end anastomosis give better improvement in FR compared to graft urethroplasty. Conclusion: Patients undergoing urethral stricture management experienced a significant improvement in self-reported outcomes and functional uroflow studies. Overall, open surgery gives better improvement in FR and IPSS than DVIU procedure. In open surgery group, end-to-end anastomosis give better improvement compares to graft urethroplasty.Keywords: International Prostate Symptoms Score, quality of life, flow rate, post void residual urine, urethral stricture.
COMPARISON OF SEXUAL DYSFUNCTION BETWEEN END-TO-END ANASTOMOSIS AND BUCCAL MUCOSA GRAFT Yuri, Prahara; Wahyudi, Irfan; Rodjani, Arry
Indonesian Journal of Urology Vol 21 No 2 (2014)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v21i2.36

Abstract

Objective: The aim of this study was to compare long term follow-up of sexual dysfunction between end-to-end anastomosis or buccal mucosa graft in short segment bulbar urethral stricture. Material & Method: We performed a meta analysis of cohort study. The data sources was MEDLINE from 1980 through 2011. A fixed effects model with Mantel-Haenszel method was used to calculate the pooled Risk Ratio (RRs) and 95% Confidence Interval (CIs). We assessed the heterogeneity by calculating the I2 statistic. All analyses were performed with Stata statistical software, version 10.0 (Stata Corp). Results: We analyzed 6 cohort studies. End-to-end anastomosis and buccal mucosa graft patients who complained about sexual dysfunction were 24.6% (45/183) and 9.1% (11/122) respectively, with overall RR 2.54 (95% CI, 0.22-0.69, p = 0.001). Conclusion: Buccal mucosa graft showed a superior outcome compared to end-to-end anastomosis, based on sexual dysfunction in ≤ 3 cm bulbar urethral stricture treatments.Keywords: Sexual dysfunction, end-to-end anastomosis, buccal mucosa graft, anterior urethral stricture.
EFFECT OF URETHRAL DILATION ON ANTERIOR URETHRAL STRICTURE RECURRENCE AFTER INTERNAL URETHROTOMY IN MALES Hapsari, Edhi; Hamid, Agus Rizal AH; Rodjani, Arry; Firdaoessaleh, Firdaoessaleh; HR, Danarto
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.v20i1.38

Abstract

Objective: The aim is to evaluate the effect of urethral dilation on anterior urethral stricture recurrences after direct vision internal urethrotomy (DVIU). Material & Method: Patients were classified into 2 groups after internal urethrotomy for urethral dilation or observation. All strictures included were anterior, single, and causing partial obstruction. Urethral dilation was performed using a metal sound. This procedure was performed every 1 or 2 weeks in the first and second month after operation and then once a month for 1 year or in case of voiding complaints or low flow rate (< 10 mL/s). Follow up at least until 1 year after DVIU. Results: A total of 32 cases could be reviewed, of which are 21 had urethral dilation and 11 observation only. In the urethral dilation group, we found 4 recurrences (19%) with mean time to recurrence 10,52 months. In the observation group, we found 7 recurrent cases (63,63%) with a mean time to recurrence of 8,09 months. P value is 0,02 which means urethral dilation significantly decreased the chance of stricture recurrence. By Kaplan Meier survival analysis, urethral dilation had a better and longer time to recurrence. Conclusion: In this study, regular meatal dilation is proven to prolong the time to recurrence of an anterior urethral stricture after DVIU. Keywords: Urethral dilation, anterior urethral stricture, stricture recurrence.
VESICO-VAGINAL FISTULA: EXPERIENCE OF 11 YEARS Taher, Taufik Rakhman; Zulfikar, Zulfikar; Wahyudi, Irfan; Rodjani, Arry
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.v20i1.39

Abstract

Objective: To evaluate the outcome of surgical repair in patients with vesico-vaginal fistula at Cipto Mangunkusumo Hospital. Material & Method: A retrospective study of 30 patients with vesico-vaginal fistula, who underwent surgical repair of the fistula at Urology Department Cipto Mangunkusumo Hospital between the period of 1998-2008, were reviewed. Patients were analyzed with regard to age, location of fistula, etiology, size of fistula, and surgical approach. The outcome of the surgery was analyzed. Results: This study included 30 patients who underwent surgery with age between 18-69 years old. The most common etiology was due to obstetrical trauma and hysterectomy. Bladder trigone was the most common location of fistulae (40%). During the surgery the transvesical (43%) approach was commonly used. However, the most excellent outcome was surgery by transvesical-transvaginal approach (100%). Success rate of fistula repair was 73%. Conclusion: This disease is a medically and psychosocially devastating condition for the patient. The diagnosis was easy but complicated in decision of treatment. Best results were observed by transvesical-transvaginal approach. Keywords: Vesico-vaginal fistulae, surgical approach, surgical outcome.
EVALUATION OF COSMETIC AND SATISFACTION RATE AFTER URETHROPLASTY PROCEDURE USING PPPS Hapsari, Edhi; Wahyudi, Irfan; Rodjani, Arry
Indonesian Journal of Urology Vol 19 No 1 (2012)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v19i1.48

Abstract

Objective: To evaluate patients or parents cosmetic satisfaction rate after urethroplasty procedures in patients with hypospadia. Material & Method: We prospectively collected data from parents whose children underwent urethroplasty procedures in Cipto Mangunkusumo Hospital since early 2001 until mid 2009, within 18 years old age. Data collected were age, first and last time of operation, type of hypospadia, characteristic of hypospadia, technique used for urethroplasty and time of operation. We also asked questionnaire about parental background and Pediatric Penile Perception Score (PPPS) questions, which contains (1) Satisfaction in shape and position of the urethral meatus, (2) Satisfaction in penile glans appearance, (3) Satisfaction in penile skin appearance, (4) Satisfaction in overall penile appearance. Each question has 4 types of score: very satisfied is 3, satisfied is 2, unsatisfied is 1, and very unsatisfied is 0. Using Kruskal Wallis and Mann Whitney statistical analysis, we analyzed the association between parental background, type of hypospadia, and technique used for urethroplasty with PPPS. Results: From 178 patients, 76 can be contacted. Mean age of first operation is 5,67 ± 3,66; mean PPPS for meatal appearance is 1,88 ± 0,46; mean PPPS for glans is 2,02 ± 0,32; mean PPPS for penile skin is 1,95 ± 0,39; mean PPPS for general appearance is 1,89 ± 0,45 and mean PPPS is 7,75 ± 1,31. Total PPPS based on type of hypospadia: distal hypospadia 8,1 ± 1,19; medial hypospadia 7,31 ± 1,10 and for proximal hypospadia 7,75 ± 1,32. Total PPPS based on operation technique: TIP 7,72 ± 1,17; Duckett 7,14 ± 1,35 and Onlay Island Flap 8,4 ± 1,8. Using Kruskal Wallis statistic analysis, parents satisfaction rate is significantly associated with monthly income and type of hypospadia (p
THE ROLE OF UROLOGISTS IN MANAGEMENT OF DISORDERS OF SEX DEVELOPMENT Wahyudi, Ilham; Wahyudi, Irfan; Sumadipradja, Kanadi; Batubara, Jose RL; Rodjani, Arry
Indonesian Journal of Urology Vol 19 No 1 (2012)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v19i1.49

Abstract

Objective: To evaluate disorder of sex development (DSD) profile at Cipto Mangunkusumo Hospital (RSCM), the management profile, and the role of urologist on diagnostic and therapeutic management. Material & method: We retrospectively collected data from medical record of all DSD cases managed by pediatric endocrinologist, urologist, obstetric gynaecologist at RSCM from January 2002 up to December 2009. 2006 IICP criteria was used as classification. The management profile and the role of urologist were evaluated. Results: there were 133 DSD cases with the majority of cases was congenital adrenal hyperplasia (CAH) followed by androgen insensitivity syndrome (AIS). Most of the cases were diagnosed before one year old and other on pubertal period. Karyotyping, laboratory examination, ultrasonography, genitography, uretrocystoscopy, kolposcopy, diagnostic laparascopy were performed as diagnostic management. Gender assignment was performed by multidisciplinary team. Masculinizing surgery, feminizing surgery, and gonadectomy was done as therapeutic management. Conclusion: The majority case on RSCM’s DSD profile was CAH. The management was performed by multidisciplinary team. Gender assignment decision should be based upon thorough diagnostic evaluation. The urologist has important role on diagnostic and therapeutic management. Keywords: Disorder of sex development, diagnostic management, gender assignment, therapeutic management, urologist.
LAPAROSCOPIC LIVING DONOR NEPHRECTOMY: FEASIBILITY AND FIRST EXPERIENCE IN INDONESIA Mochtar, Chaidir A.; Wahyudi, Irfan; Rasyid, Nur; Rodjani, Arry; Birowo, Ponco; Atmoko, Widi; Satyawan, Yopie Tjandradiguna; Tiera, Hery
Indonesian Journal of Urology Vol 19 No 2 (2012)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v19i2.55

Abstract

Objective: To report our first experience laparoscopic living donor nephrectomy (LLDN). Material & Method: A 37 year-old man was planned for the living-donor transplantation. The recipient was a 63 year-old man sufferingfrom end stage renal disease, and hypertensive heart disease. The donor and recipient were allowed for positive qualification evaluated preoperatively. We applied a transperitoneal approach for the left kidney. Results: The operation time was 300 minutes and the estimated blood loss was 600 mL. The first warm ischemia time was 15 minutes and 24 seconds. There were no major intraoperative and postoperative complications. The donor began oral intake and mobilization within 10 hours and was hospitalized for 4 days. The recipient’s serum creatinine levels reached near baseline levels (1,5 mg/dL) at day 6. Conclusion: LLDN is technically feasible in Indonesia and may increase the rate of kidney donation in Indonesia due to the minimally invasive nature of the procedure.Keywords: Renal transplantation, laparoscopic living donor nephrectomy, Indonesia.
RISK FACTORS FOR URETHROCUTANEOUS FISTULAS FORMATION AFTER ONE STAGE HYPOSPADIAS REPAIR Fariz, Mohammad; Rodjani, Arry; Wahyudi, Irfan
Indonesian Journal of Urology Vol 18 No 2 (2011)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v18i2.73

Abstract

Objective: To evaluate risk factors that contribute to urethrocutaneous fistulas formation after one stage hypospadias repair. Material & method: A case control study was performed on hypospadias patients that underwent one stage hypospadias repair. We analyzed the correlation of urethrocutaneous fistula formation with patient age, hypospadias classification, chordee severity, other urogenital anomalies, history of hormonal therapy, suture size, duration of operation, type of dressing, type of stent, duration of stenting, and three types of operation technique, which are TIP, Duckett, and Onlay Island Flap. Results: There were 116 patients with mean age 5,7 ± 3,9 years old (4 months – 19 years old). Urethrocutaneous fistula occured in 12 patients (10,3%). From the data analysis, we didn’t find any significant correlation between urethrocutaneous fistula formation and patient’s age (p = 0,426), hypospadias classification (p = 0,695), chordee severity (p = 0,564), other urogenital anomalies (p = 0,964), history of hormonal therapy (p = 0,739), suture size (p = 0,248), duration of operation (p = 0,856), type of dressings (p = 0,580), type of stents (p = 0,600), and duration of stenting (p = 0,796). We also didn’t find any significant correlation between urethrocutaneous fistula formation and operation technique TIP vs Duckett (p = 0,314), and TIP vs Onlay Island Flap (p = 0,644). Conclusion: There were no significant correlation between urethrocutaneous fistula formation and patient age, hypospadias classification, chordee severity, other urogenital anomalies, history of hormonal therapy, suture size, duration of operation, type of dressing, type of stent, and duration of stenting. There were also no significant correlation between urethrocutaneous fistula formation and operation technique TIP vs Duckett, and TIP vs Onlay Island Flap. Keywords: Hypospadias, one stage urethroplasty, urethrocutaneous fistula.
Laparoscopic Live Donor Nephrectomy: Comparison of Left-sided and Right-sided Approach in Our First 50 Cases Marcelino, Albertus; Mochtar, Chaidir Arif; Wahyudi, Irfan; Baskoro, Bagus; Rodjani, Arry; Rasyid, Nur
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.v22i1.89

Abstract

Objectives: To compare the operative results and outcomes between right and left laparoscopic live donor nephrectomy (LLDN). Methods: We retrospectively analyzed the first 50 consecutive LLDN in Indonesia performed between November 2011 and February 2013. Of these patients, 6 underwent right LLDNs and 44 left LLDNs. All patients underwent LLDNs in Cipto Mangunkusumo Hospital. All LLDNs were done by the same surgical teams. Intraoperative, post-operative donor and recipient data results were compared.Results: There were no significant differences of intraoperative, post-operative and recipient data results in both groups.  The first warm ischemic time (mean±SD, 6min 55sec±145sec vs 7min 37sec±177 sec, p>0.05), the second warm ischemic time (41min 35sec ± 7min 45sec vs 48min 36sec ± 8min 41sec, p>0.05), and the operative time (4hour 41min ± 31min vs 4hour 32min ± 49 min, p>0.05) showed similar results in the right and left LLDN, respectively. Active mobilization on 72-hour post-operation was found in 83,3% in the right LLDN compared to 95,5% (p>0.05). There were no delayed graft function and post-operative hemodialysis within one week in the recipients of right LLDN group. Conclusion: Right LLDN has equal operative results and outcomes compared to left LLDN. Right-sided LLDN may be a judicious approach for donors with unfavorable characteristics of the left kidney.