Zulfikar Ali, Zulfikar
Sub Bagian Urologi/Bagian Bedah, FK Universitas Indonesia/RSUPN Cipto Mangunkusumo, Jakarta

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SUPERIOR INFERIOR CALYCES AXIS IN SAGITTAL VERSUS CORONAL PROJECTION OF NON CONTRAST ABDOMINAL MULTISLICE COMPUTED TOMOGRAPHY: AN ANATOMICAL STUDY IN SUPINE PCNL Krisna, Muhammad Sidharta; Soeroharjo, Indrawarman; Ali, Zulfikar
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

Abstract

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.
PROSTATE SPECIFIC ANTIGEN LEVEL FOLLOWING TRANSURETHRAL RESECTION OF THE PROSTATE Aritonang, Johannes; Ali, Zulfikar
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.v27i1.499

Abstract

Objective: To evaluate the correlation of the weight of the resected prostate with the reduction of the PSA level. Material & methods: This is a prospective study of all BPH patients undergoing TURP procedure in Kardinah Hospital, Tegal, with a timeframe of April–June 2018. Patients consumed α-blocker and 5-α reductase inhibitor medication before the procedure were eliminated from the study. The data collected were the estimated prostate weight calculated using transabdominal ultrasonography (TAUS) of the prostate, PSA level before and after the procedure, and the calculated weight of the resected prostate. The resected tissues of the prostate were examined by an anatomy pathologist and the PSA level will be examined at 1, 14, and 30 days after the surgery. Data was analyzed using repeated measure ANOVA with SPSS version 23.0. Results: We included 35 cases of prostate enlargement in our center. 2.8% of the patients didn’t undergo definitive surgical procedure due to be postponed with various reasons. The patients mean age is 64.2 ± 8.26 with average BMI is 21.8 ± 3.56kg/m2. The median value of the prostate volume is 43.8 mL. The median preoperative PSA level was 8.7 ng/dL, while the median value of the 1st day, 14th days, and 30th days post-operative PSA level were17.67 ng/dL, 6.93 ng/dL, and 3.2 ng/dL, respectively, with significant reduction of PSA level (p<0.001). Conclusion: PSA level post-TURP shows a significant decrease. Every milliliters (mL) prostatic tissue resected could reduce the PSA level for 0.11 ng/mL. This calculation could further be used to predict how much tissue needed to resect, to treat the symptoms, and obtain normal PSA level. In addition, further research is needed, especially with larger sample size and longer follow up period to confirm these findings.
MANAGEMENT OF BLADDER STONE WITH HOLMIUM-YAG LASER AT KARDINAH HOSPITAL TEGAL Abshari, Fatan; Ali, Zulfikar
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.v27i1.473

Abstract

Objective: Transurethral lithotripsy using Holmium-YAG laser has been reported to be beneficial in breaking up bladder stones with large size (>4cm in diameter) with lower risk of mucosal injury and hematuria. The aim of this study is to evaluate the utilization of Holmium-YAG laser for the management of bladder stones at Kardinah General Hospital, Tegal. Material & Methods: This is a cross-sectional study conducted from January 2017 to March 2017. Patient’s demography, which included age, sex, length of surgery, stone size, and laser’s energy count were recorded. Results: We included 120 patients in this study. Mean of patients age in this study was 51.93 years old with age range were 41-85 years old. Most of the patients were male (109 vs 11) with a mean size of stone 25.09 ± 3.04 mm. Length of surgery ranges from 15 to 75 minutes and mean energy of the laser 28.99 ± 19.34 kJ. There was 100% stone’s clearance following surgery with no major complication occurred. Conclusion: Holmium-YAG laser is effective in managing bladder stones at Kardinah General Hospital particularly for large size stones. Length of surgery and energy of laser used depend on the stone size in which bigger stone size is associated with longer surgery time and bigger laser energy needed.
THE SIZE PROFILE OF EXTERNAL URETHRAL ORIFICIUM IN MALE ADULT Susanto, Gaeta Nurprimavera; Danarto, Raden; Ali, Zulfikar
Indonesian Journal of Urology Vol 26 No 1 (2019)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v26i1.431

Abstract

Objective: External urethral orificium (EUO) is the outermost part of the urethra. It lies on the outside, then the operation tool for endourology transurethra must pass urethra meatus externus first before they can go deeper. Unfortunately there is no study addresses the size of EUO of male adults in Indonesia. This study was aimed to know the size of the EUO in males adult. Material & Methods: This study was a prospective study by taking the primary data in the Sardjito General Hospital and Kardinah General Hospital, Tegal and implemented during the period from October to December 2016. There were 50 samples of males adult. The exclusion criteria in this study were male patients with meatal stenosis or patients with a history of surgery on the penis or instrumentation of the urethra. External urethra orifice size measurements performed with a digital caliper, and then converted to scale the size of Fr. The data were then analyzed by Npar test with the Kolmogorov-Smirnov test, and then T-test with linear regression. Results: There were 50 adult male patients with a mean age of 52.54 ± 10.34 years. For sizes vary with the size of 16.5-26.4 Fr. From the analysis of the size of the EUO obtained a mean size of 22.72 ± 2.62 for Indonesian adult male. Conclusion: The average size of the adult male EUO was 22.72 ± 2.62 Fr. 
EFFICACY OF BLADDER TRAINING PROCEDURE IN PATIENTS UNDERGOING TURP Harimurti, Nicolaus Kresno; Ali, Zulfikar; Utomo, Trisula
Indonesian Journal of Urology Vol 25 No 1 (2018)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v25i1.400

Abstract

Objective: Catheter management is conducted to the patients undergoing transurethral resection of the prostate (TURP). There were many arguments between clinical practitioners about bladder training procedure after TURP procedure. This study aims to determine whether there is a relationship between bladder training action and success of spontaneous micturition in post TURP procedure in patients with urinary retention caused by prostate enlargement. Material & methods: Randomized clinical trial was conducted at Kardinah General Hospital, Tegal from October 2015 to February 2016. 44 study participants who underwent TURP were randomly allocated into two groups. In Group I, patient’s Folley catheter was clamped prior to its removal (bladder training group); and in Group II was not clamped (control group). Results: Mean age of patients was 64.48 ± 8.1 years old. There were 23 patients (52.3%) have had history of recurrent urinary retention and 21 patients (47.7%) have had not (p=0.560). There were 4 patients (17.4%) in Group I and 1 patient (4.7%) in Group II who required re-catheterization and discharge with catheter. There was no statistically significant difference in spontaneous micturition rate between bladder training group and control group (p=0.187).  Conclusion: The result of the current study identified that bladder training to patients undergoing TURP procedure had no significant impact in spontaneous micturition.
PENGARUH VOLUME BULI-BULI TERHADAP PANJANG PROSTAT PADA PEMERIKSAAN ULTRASONOGRAFI TRANSABDOMINAL Ali, Zulfikar; Mochtar, Chaidir A
Indonesian Journal of Urology Vol 16 No 1 (2009)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v16i1.357

Abstract

Objective: To study the effects of different bladder volumes on the length of prostatic protrusion as measured by transabdominal ultrasonography. Materials & Method: We did an observational study on 48 patients with BPH and urinary retention in Urology outpatient clinic of Cipto Mangunkusumo Hospital Jakarta from 1 March 2006 to 28 February 2007. The bladder of each patient was filled with 50 ml normal saline and increased stepwise by 50 ml each time until either an urge to void or a volume of 500 ml was reached. Length of prostatic protrusion was measured by transabdominal ultrasonography at each volume of bladder filling in every patient. Results: The average length of prostatic protrusion in 50, 100, 150, and 200 ml bladder filling was 11,14; 11,42; 11,88; 10,20 mm respectively. There is no statistically significant difference in the length of prostatic protrusion with transabdominal ultrasonography in each bladder volume. Conclusion: Prostatic protrusion length can be measured with bladder volumes between 50 ml to 200 ml and shows no significant difference.
Patients’ Characteristics and Factors Influencing Success Rate of ESWL in Rumah Sakit Umum Daerah Kardinah, Tegal Cipta, Wahid; Ali, Zulfikar
Indonesian Journal of Urology Vol 24 No 1 (2017)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v24i1.265

Abstract

Objective: To evaluate which factors influencing success rate of extracorporeal shock wave lithotripsy (ESWL) in Kardinah Hospital Tegal. Material & methods: This was a retrospective study from secondary database of patients diagnosed with ureter or kidney stone whom underwent ESWL procedure in RSUD Kardinah Tegal from April 2012 to November 2015. Multivariate analysis and Chi-square analysis from SPSS ver. 19 were used to evaluate all the factors related to success rate of ESWL. Results: There were 314 patients included in this study with 59.5% of them were male patients. The average age of patients was 50 ± 5.5 years old. In 256 cases of kidney stones, there were 69 (26.9%) cases with size <10mm, 160 (62.5%) cases with a size of 10-20mm, and with a size >20mm by 27 (10.5%) cases. For ureteral stones, there were 46 (79.3%) cases with size <10mm, 11 (18.9%) cases with a size of 10-20mm, and 1 (1.7%) case with size >20mm. In general there were 238 (75.7%) of patients received no additional ESWL procedure while 61 (19.4%) patients underwent 2nd ESWL procedure, 33 (10.5%) patients underwent 3rd ESWL procedure, and 11 (3.5%) patients underwent more than 4 ESWL procedures. Kidney stones with a size <10mm, ureteral stones with size <10mm got, and location of the stone had p value of p=0.0015, p=0.001, and p=0.031 respectively. Other factors such as gender, age, stone opacity, and the number of shock given did not affect the success of ESWL. Type of lithotripter were not related to SFR in patient with kidney stone but was significantly related in ureter stone with p=0.078 and p=0.04 respectively. Conclusion: Most of patients reached stone free condition after the first ESWL procedure. Factors that influence the success of ESWL were the stone size and stone location. Kidney stone size <10mm and ureter stone <10mm had the highest SFR. Types of lithotripter were not related to SFRs in patients with kidney stone but were significantly related in ureteral stone with Medispec EM1000 electromagnetic and Huikang HK-V electromagnetic had the highest SFRs.
HOLMIUM LASER: YAG LITHOTRIPSY IN URETERAL CALCULI MANAGEMENT Sunaryo, Juhadi; Ali, Zulfikar; Danarto, H R
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.v23i1.206

Abstract

Objective: To know predictive factors for success of holmium laser: YAG lithotripsy in ureteral calculi management. Materials & Methods: This prospective cohort study was conducted in January 2013 to May 2015 at Kardinah Tegal Hospital Central Java. Patients diagnosed with proximal and distal stones were included. Pediatric, obesity, pregnancy, ureteral anomaly, and ureteroscopy (URS) cannot reach ureteral level of stone were excluded. We used semirigid URS (Wolf) 6/7.5F, monitor video, and holmium laser: YAG litotriptor (Versa Pulse, Lumenis, Germany), with wavelength 2100 nm, output 1-60 watt, fiber length 365 μm, laser power 2.5-10 watt with energy 0.5-1 Joule/5-15 Hz. Results: Of 50 ureteral stone patients, consisted proximal 13 (26%) and distal 37 (74%) were included in this study. Mean age 42.94 ± 11.31 years, with 28 male (56%) and 22 female (44%). Mean stone burden was 88.10 ± 57.41 mm2. There were 6 (12%) patients with multiple stones. This procedure consumed energy 1079.02 ± 1624.00 joule and duration of operation was 19.02 ± 21.17 minutes. We inserted DJ stent after the procedure in 41 patients (82%). There were 2 failure (4%), which were stone migration to kidney and conversion to open surgery. There were significant differences of stone burden (p 0.013), duration of operation (p 0.038), and stone number (p 0.000) with stone free rate, but not in age, sex, stone location and energy. Stone free rate of this procedure was 90%. Conclusion: Stone burden, duration of operation, and stone number were predictive factors for success of holmium laser: YAG lithotripsy in ureteral calculi management.
METABOLIC SYNDROME TRAITS IN UROLITHIASIS PATIENTS Aritonang, Johannes; Ali, Zulfikar
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.v27i2.490

Abstract

Objective: To explore the relation of MetS and urolithiasis in our center. Material & Methods: This is a prospective study of all patients diagnosed with urolithiasis in Kardinah Hospital, Tegal, from April to June 2018, who were screened for metabolic syndrome criteria. The data was collected from the medical record and analyzed with SPSS ver. 23. Results: We included 71 cases of urinary tract stone in our center. 8.4% of the patients didn’t undergo definitive therapy for stones caused by patients’ preferences or the surgery being postponed with various reasons. The patient's mean age is 54.7 ± 11.24, with a male to female ratio 2.4:1. The average BMI is 20.9 ± 2.3 kg/m2. Most of the stones are found in kidney (38.0%) and bladder (26.8%). The average blood pressure is 127.2 ± 7.96 mmHg for systolic pressure and 81.6 ± 5.77 mmHg for diastolic pressure. The average values of lipid profile include total cholesterol, high- and low-density lipoprotein, and triglyceride were 177.0 ± 35.92, 52.0 (27-96), 107.3 ± 37.58 and 131 (50-406), respectively. The mean of patient’s blood glucose level is 122 mg/dL, and the highest level is 203 mg/dL. Conclusion: Not all of the MetS traits found in our patients in Kardinah Hospital. The HDL level is the only variable that shown abnormal level and it could be included into one of the MetS criteria of diagnosis. Thus, this observational study needs further research to confirm the correlation between urolithiasis and MetS, and also the underlying mechanism.
METABOLIC SYNDROME TRAITS IN UROLITHIASIS PATIENTS Aritonang, Johannes; Ali, Zulfikar
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.v27i2.490

Abstract

Objective: To explore the relation of MetS and urolithiasis in our center. Material & Methods: This is a prospective study of all patients diagnosed with urolithiasis in Kardinah Hospital, Tegal, from April to June 2018, who were screened for metabolic syndrome criteria. The data was collected from the medical record and analyzed with SPSS ver. 23. Results: We included 71 cases of urinary tract stone in our center. 8.4% of the patients didn’t undergo definitive therapy for stones caused by patients’ preferences or the surgery being postponed with various reasons. The patient's mean age is 54.7 ± 11.24, with a male to female ratio 2.4:1. The average BMI is 20.9 ± 2.3 kg/m2. Most of the stones are found in kidney (38.0%) and bladder (26.8%). The average blood pressure is 127.2 ± 7.96 mmHg for systolic pressure and 81.6 ± 5.77 mmHg for diastolic pressure. The average values of lipid profile include total cholesterol, high- and low-density lipoprotein, and triglyceride were 177.0 ± 35.92, 52.0 (27-96), 107.3 ± 37.58 and 131 (50-406), respectively. The mean of patient’s blood glucose level is 122 mg/dL, and the highest level is 203 mg/dL. Conclusion: Not all of the MetS traits found in our patients in Kardinah Hospital. The HDL level is the only variable that shown abnormal level and it could be included into one of the MetS criteria of diagnosis. Thus, this observational study needs further research to confirm the correlation between urolithiasis and MetS, and also the underlying mechanism.