Laparoscopic removal of migratory intrauterine contraceptive device to the bladder : A Case report and literature review

The intrauterine contraceptive device (IUCD) is the most frequently used method of reversible contraception with high efficacy. Despite these benefits, rare complications, such as spontaneous migration of the device into adjacent organs, particularly the bladder, are possible. Minimally invasive surgery is a safe and effective procedure with few complications for the management of migrated IUCDs. We presented a 36-year-old multiparous woman referred by her gynecologist who had an IUCD inserted 4 years prior. She had been experiencing dysuria and lower abdomen pain for 3 months. Ultrasonography of the abdomen revealed a hyperechoic lesion on the bladder wall's left anterior-superior portion. An MRI revealed that the device was embedded in the bladder's anterior left wall. Under general anesthesia, a cystoscopy and laparoscopy exploration were subsequently scheduled. Cystoscopy was performed, but the long limb of the IUCD was embedded in the mucosal and muscular layers, preventing its removal from the bladder wall. Laparoscopic retrieval of the IUCD was performed without complications. The patient was discharged 2 days after surgery with a Foley catheter inserted in the bladder for 10 days. When the urethral catheter was removed, a cystoscopy was performed to confirm bladder wall healing. In the postoperative follow-up 1 month after IUCD removal, no abnormalities were observed. Patients with a suspected IUCD migration must undergo a comprehensive evaluation, regardless of whether they are symptomatic or asymptomatic. Before surgical retrieval, imaging such as ultrasonography and MRI were utilized to locate the migrated IUCD and consider therapeutic options. Even though cystoscopy is considered as an effective and safe minimally invasive procedure for managing a migrated IUCD to the bladder, laparoscopic removal could serve as an option once cystoscopy retrieval is failed.

The relationship between income, health insurance, and employment status as prognostic indicators of bladder cancer: A survival analysis

BACKGROUND

Bladder cancer (BC) is one of the health problems. Socioeconomic status (SES) may correlate with patient treatment, possibly impacting patient prognosis. This study aimed to determine the relationship between income, health insurance, and employment status as prognostic indicators of BC.

METHODS

A retrospective observational study for patients diagnosed with BC in a hospital during the 5-year period between January 2019 and December 2023. Kaplan-Meier test analysis was used to generate overall survival curves stratified by income, employment status, and health insurance. Multivariate Cox proportional-hazards regression was used to identify factors associated with worse overall survival.

RESULTS

The results of the analysis on 219 patients showed no difference in patient survival based on income (p>0.05), while employment status and health insurance showed significant difference in patient survival (p<0.05). Moreover, there were 99 (45.2%) patients died, with the average patient being 58 years old and dominant in male patients.

CONCLUSIONS

Prevention of poor outcomes in patients needs to pay attention to certain characteristics, particularly for the loweconomic patients without appropriate national health insurance coverage.

Inflammatory myofibroblastic tumor of the bladder turn malignant: A case report

INTRODUCTION AND IMPORTANCE

Inflammatory myofibroblastic tumor (IMT) of the bladder is a rare sight, which can be distinguished by the proliferation of spindle cells and the presence of a persistent chronic inflammatory infiltrate. IMT is usually benign, but in a few cases it has a tendency for malignant transformation and metastases.

CASE PRESENTATIONS

A 30-year-old male with a history of recurrent hematuria. His initial symptoms was unfrequent painless hematuria. Abdomen multislice computerized tomography (MSCT) with contrast shows an enhancing solid mass with necrotized center measuring +/- 12.9 × 16.5 × 18.9 cm and extending from cavum pelvis to cavum abdomen. Cystectomy and bilateral ureterocutaneostomy were performed. The histology report found an IMT with mitotic cells, a necrotic region, and a positive ki67, which suggest the tumor's malignant transformation. Unfortunately, the patient's overall condition continued to deteriorate, and he passed away seven days after hospital discharge.

CLINICAL DISCUSSIONS

IMT is comprised of spindel cells and inflammatory cells. IMT might become aggressive locally, recurring, or progress to malignancy. Fifty percent of IMTs are caused by rearrangements of the anaplastic lymphoma kinase (ALK) gene on chromosome 2p23, resulting in ALK-1 overexpression. A change from uniform spindled cells to atypical polygonal cells or plump cells with oval vesicular nuclei, prominent nucleoli, and mitoses is indicative of malignant transformation.

CONCLUSION

This case emphasizes the importance of continuous monitoring and raising awareness about the possibility of malignant transformation of IMT. Understanding the characteristics of the findings could result in better decision-making and outcomes.

Renal cell carcinoma in autosomal dominant polycystic kidney disease: A case report

Autosomal dominant polycystic kidney disease (ADPKD) is one of the congenital cystic renal diseases with the highest incidence. ADPKD was suspected of being a risk factor for the emergence of RCC. A 65-year-old male complained of numbness in both knees for a week. The patient came to a neurosurgeon and was advised to perform a lumbosacral MRI. The patient had no complaints. The patient had a history of hypertension but was never treated. Computed tomography intravenous pyelogram (CT-IVP) revealed a heterogeneous lobulated mass in the upper to the middle of the right kidney to the right renal hilus. It also revealed multiple cysts, in both kidneys. The patient underwent an open radical nephrectomy in the right kidney with minimal bleeding. Three years revealed no pain at the surgery site or hematuria. Abdominal MRI revealed no recidive mass. This case report comprehensively described an autosomal dominant polycystic kidney disease that coexists with RCC. malignant lesions were found in ADPKD cases without any clinical symptoms of malignancy. M malignant lesions could be discovered by chance in nephrectomy specimens. Autosomal dominant polycystic kidney disease with renal cell carcinoma is a unique presentation. Despite the rarity of the situation, the patient was successfully treated.

Impact of statin on renal cell carcinoma patients undergoing nephrectomy. Does it affect cancer progression and improves survival? A Systematic Review and Meta-Analysis

INTRODUCTION

Renal cell carcinoma (RCC) is regarded as one of the most common malignant tumors. Various concomitant medications in RCC patients undergoing surgery are investigated to explore the potential for improving survival and preventing disease recurrence, including statin. It has been observed that these drugs induce apoptosis, thereby inhibiting tumor growth and angiogenesis. We aimed to perform a systematic review and meta-analysis to enhance the level of evidence for statin in RCC.

METHODS

A systematic literature search was conducted in several online databases, including PubMed, Scopus, and Sciencedirect, using terms relevant to the use of statins in RCC patients undergoing nephrectomy for publications published up to July 2023, according to a registered review procedure (CRD42023452318). The Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias of the included study. Review Manager 5.4 was used for all analyses.

RESULTS

Seven articles was eligible for our study. The analysis revealed that patients receiving statin had a better overall survival compared to patients who does not receive statin (HR 0.71, 95% CI 0.51-0.97, p = 0.03, I2 = 76%). However, there was insignificant difference in terms of CSS, DFS, and PFS between RCC patients receiving statin and without statin.

CONCLUSIONS

Statin has substantial benefits for improving OS. Even though the outcomes for CSS, DFS, and PFS were insignificant, the potential role of statins as a supplementary therapy in surgically treated RCC still requires further investigation.

Ureteral small cell neuroendocrine carcinoma: A case report and short review

INTRODUCTION AND IMPORTANCE

Primary small cell neuroendocrine carcinoma (SCNEC) in the urinary tract represents less than 0.5 % of urinary tract cancers, and bladder or prostate are the most common sites. Early diagnosis and treatment of ureteral SCNECs are challenging due to nonspecific clinical symptoms and radiographic findings.

CASE PRESENTATION

Here, we described a diagnostic and therapeutic challenge of a 56-yearold male with recurrent right flank pain that did not relieve with analgesics alone. The patient underwent several non-invasive to invasive procedures revealing nonspecific inflammation pathology of the ureter that later developed into protruded papillary mucosa resembling polypoid cystitis. Later, an abdominal multi-slice computed tomography examination suggested a malignant mass and was confirmed as SCNEC from the pathological analysis. After several successful chemotherapy cycles and surgical procedures, cancer reoccurred, and the patient's general condition deteriorated. He passed away a year after a radical cystoprostatectomy and nephroureterectomy on his right side.

CLINICAL DISCUSSIONS

The occurrence of primary SCNEC is a highly uncommon phenomenon. As SCNEC arises from pluripotent stem cells that have differentiated into neuroendocrine cells, some patients may exhibit paraneoplastic syndrome. The patient's prognosis of this tumor is poor, even for patients in the earliest phases, because SCNEC is characterized by highly aggressive local invasion and distant metastases.

CONCLUSIONS

This case highlights the importance of accurate early diagnosis and treatment of recurrent flank pain and considering the possibility of a malignant tumor as the cause of obstruction.

Parameatal urethral cyst: A case series of three rare cases and literature review

INTRODUCTION AND IMPORTANCE

Parameatal urethral cyst is a rare benign congenital urethral disorder with limited reports in the literature. The formation of the cyst is believed due to the obstruction of the paraurethral duct. This disorder usually does not produce symptoms even though, in an advanced case, urinary retention and flow disturbance may occur.

CASE PRESENTATION

Herewith, we report case series of parameatal urethral cysts in 5, 11, and 17 years old boys treated with complete surgical cyst excision. The first was 11 years-old-boy with asymptomatic 7 mm swelling in his urethral meatus. The second case was a 5 years-old-boy with 5 mm swelling in his urethral meatus with the complaint of urinary stream distortion. The third case involved a 17-year-old adolescent with a 4 mm cystic bulge in his urethral meatus that caused urinary distortion.

CLINICAL DISCUSSIONS

In these cases, the cysts were completely removed with surgical excision and the patients underwent circumcision. Histological examination revealed a cyst wall lined with squamous and columnar epithelium. Good cosmetic result without any recurrent mass and voiding difficulties was reported after 2 weeks of follow-up.

CONCLUSIONS

This study reported three cases of parameatal urethral cysts late presentation at an older age due to no prior symptoms. The patients were managed with surgical excision of the cyst resulting in good cosmesis outcome and without recurrence.

Male genital trauma caused by self-mutilation: A first case series report in Indonesia

INTRODUCTION AND IMPORTANCE

Genital self-mutilation (GSM) is a rare phenomenon with a spectrum ranging from a superficial laceration to complete amputation of the external genitalia. These could result in severe impairment of genitourinary functions. Psychotic disorder adds to the complexity of the patients. Since GSM is underreported, we report the first case series in Indonesia.

CASE PRESENTATION

Four included patients comprised different injuries to the external genitalia, from a superficial laceration to penile amputation. Notably, these patients exhibited psychotic traits. Initial management consisted of bleeding control, debridement, and primary suturing. Depending on the extent of the injury, the repair comprised of spermatic cord ligation, penile reconstruction using a skin flap, defect closure with urethral spatulation, and exploration. We successfully managed all the patients surgically before undergoing psychotherapy to improve the patient's overall well-being and to reduce the risk of similar reoccurrence of GSM behavior.

CLINICAL DISCUSSION

The majority of GSM cases were associated with psychotic disorders. The current reports' injuries include penile laceration, total penile amputation, unilateral castration, and combined injury to the penis and scrotum. Although most GSM is not life-threatening, it may cause emergent, complex, and serious complications such as massive hemorrhage and severe infections. Appropriate investigations with systematic treatment strategies are required, especially in complex cases.

CONCLUSION

The incidence of genital self-mutilation necessitates a prompt evaluation of organ viability and the possibility of preserving tissue for optimal urinary and sexual outcomes. Interdisciplinary collaboration is required as the primary concern for management in cases of genital self-mutilation involving male genitalia and underlying psychological disorders.

The role of hyperbaric oxygen therapy in Fournier's Gangrene: A systematic review and meta-analysis of observational studies

Purpose:

Management of Fournier’s Gangrene (FG) includes broad-spectrum antibiotics with adequate surgical debridement, which should be performed within the first 24 hours of onset. However, this treatment may cause significant loss of tissue and may delay healing with the presence of ischemia. Hyperbaric oxygen therapy (HBOT) has been proposed as adjunctive therapy to assist the healing process. However, its benefit is still debatable. Therefore, this systematic review and meta-analysis aimed to evaluate the effect of HBOT as an adjunct therapy for FG.

Materials and Methods:

This study complied with the Preferred Reporting Items for Systematic Reviews and Meta-analyses protocol to obtain studies investigating the effect of HBOT on patients with FG. The search is systematically carried out on different databases such as MEDLINE, Embase, and Scopus based on population, intervention, control, and outcomes criteria. A total of 10 articles were retrieved for qualitative and quantitative analysis.

Results:

There was a significant difference in mortality as patients with FG who received HBOT had a lower number of deaths compared to patients who received conventional therapy (Odds Ratio 0.29; 95% CI 0.12 – 0.69; p = 0.005). However, the mean length of stay with Mean Difference (MD) of -0.18 (95% CI: -7.68 – 7.33; p=0.96) and the number of debridement procedures (MD 1.33; 95% CI: -0.58 – 3.23; p=0.17) were not significantly different.

Conclusion:

HBOT can be used as an adjunct therapy to prevent an increased risk of mortality in patients with FG.

Clear-cell renal cell carcinoma and glioblastoma multiforme coexistence: Double primary malignancy, does it have a causal relationship?

Background:

Multiple primary malignancies (MPMs), especially coexistence of renal cell carcinoma (RCC) and glioblastoma multiforme (GBM), are rare. The most likely clinical diagnosis in patient with tumor in another organ is metastatic brain tumor. Although GBM is the most common brain tumor, it is rarely coexistent with other malignancies.

Case Description:

A 64-year-old female presented with headache and dizziness, along with abdominal pain for 2 weeks before being admitted. The abdominal computed tomography (CT) scan showed a kidney tumor. The patient developed left hemiplegia, and the brain CT scan showed an intracranial tumor. The patient suggested for radical nephrectomy and craniotomy tumor removal. Histopathology of the kidney and brain tumor revealed two different features, which showed RCC and GBM. Immunohistochemistry result confirmed the diagnosis of GBM and IDH1 wild type; coexistent with clear cell RCC.

Conclusion:

The coexistence of carcinoma and glioma should be regarded as coincidental cases if it did not accomplish the criteria for tumor-to-tumor metastasis or proven to be a genetic syndrome. This case report provides an addition to the literature about double primary malignancy in a single patient. More studies are needed to confirm whether they have causal relationship or merely coincidental findings.

Prostate-Specific Antigen and Time to PSA Nadir as Prognostic Significance in Castration-Resistant Prostate Cancer

Highlight:Assessing the survival rate in castration-resistant prostate cancer was descriptived.PSA level between survivor and non survivor was significant but not for PSA nadir level, TTN and TTC.Initial PSA level can predict survival prognosis rate of castration-resistant prostate cancer patients. Abstract:High mortality rates was often found in castration-resistant prostate cancer (CRPC). Our aim on this research was to assess the PSA level and time to PSA nadir as a prognostic tool for survival in CRPC patients. Several factors are considered to be useful as prognostic marker in CRPC patients. This study was a descriptive study assessing the survival rate in castration-resistant prostate cancer. Evaluation data included sex, age, initial PSA level, final PSA level, time to PSA nadir (TTN), time to CRPC progression (TTC), and survival status. A total of 24 patients with CRPC were evaluated in this study. There was significant difference found of initial PSA level between survivor (445.7 + 165.6 ng/mL) and non-survivor (200.7 + 144.9 ng/mL). There were no significant differences were also found in PSA nadir level, TTN and TTC between survivor and non-survivor groups. This study revealed that there was association between initial PSA level on survival rate of CRPC patients. Initial PSA level could be used to predict survival prognosis in CRPC patients.

Doxorubicin and ifosfamide for recurrent renal synovial sarcoma: The first case report in Indonesia

Introduction and importance

Synovial sarcoma (SS) is the fourth most common soft tissue sarcoma. The primary treatment for renal SS is radical surgical resection of the tumor. However, there are several stages of SS that need systemic treatment. The consensus regarding systemic treatment remains unclear. Therefore, we reported a case of an 18-year-old male with recurrent renal SS treated with doxorubicin and ifosfamide as systemic chemotherapy.

Case presentation

An 18-year-old male was admitted with a chief complaint of right flank pain for three months. He had a history of radical nephrectomy due to a suspicion of Wilms tumor. The histopathological and immunohistochemistry results showed a SS of the kidney. One year after the surgery, the patient came with a sign of a residual tumor. The diagnosis of recurrent renal SS was established after the physical examination, and Second-line chemotherapy was not administered because the patient refused any further treatment. However, the patient showed a partial response after the first chemotherapy session, indicating the benefit of the treatment.

Clinical discussion

The chemotherapy regimen is generally considered safe and can be widely used in clinical practice. Partial response was shown after six courses of treatment. Ifosfamide-based chemotherapy was also used in some reported cases. Most of the cases reported in the current literature were only managed by surgery without using chemotherapy. These cases had various RFS, ranging from 5 to 25 months.

Conclusion

Doxorubicin and ifosfamide are useful as first-line chemotherapy for recurrent renal synovial sarcoma.

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Synovial sarcoma is a rare tumor.

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There has not been any consensus on systemic treatment for synovial sarcoma.

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Partial response are apparent in patients after receiving six courses of Doxorubicin and Ifosfamide.

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The regimen has a potential role as systemic chemotherapy for recurrent renal synovial sarcoma.

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More trials are needed before the regimen can be used in daily practice.

Duplication and Multiseptate Urinary Bladder: A Rare Case Report

The multiseptate bladder is a congenital bladder anomaly that is very rare and often accompanied by other congenital abnormalities. This condition could result in intravesical obstruction and kidney failure in more serious conditions. A 3-year-old girl without any complaint was consulted by the Pediatric Surgery Department with postoperative cloacal type malformation anorectal (MAR) postero-sagittal anorecto-vagino-urethroplasty (PSARVUP) + sigmoidectomy. Magnetic Resonance Imaging (MRI) of the pelvis showed the appearance of four interconnected multiple fluid lesions. Cystoscopy was performed and found many septa with varied positions and forms. From the cystography during the operation, it was seen duplication of the right and left bladder. There was no further operative treatment in the field of urology because no urinary tract obstruction and normal renal function were found in this study.

Bladder Chondrosarcoma in A Male: A Rare Case Report

Chondrosarcoma is a rare variant of bladder tumor and one of the rare types of soft tissue sarcoma. This case happened on a 36-year-old male who complained of lumps in his lower abdomen, accompanied by difficulties in passing urine and painful urination, without hematuria. We performed TURBT and histopathological examination showed low-grade chondrosarcoma. The patient was diagnosed with low-grade bladder chondrosarcoma. The patient was treated for chemotherapy and radiotherapy. However, after undergoing one cycle of chemotherapy, the patient refused to continue the therapy.

Scrotal abscess due to urethral fistula in spinal cord injured patient with prolonged indwelling urinary catheter

We report a case of scrotal abscess due to urethral fistula in a paraplegic patient with spinal cord injury. On clinical examination, an urinary catheters was placed, and the left scrotal area were swollen, redness and painless. Retrograde urethrography suggested an urethral fistula with extension spreading of contrast medium into the scrotum. The case was diagnosed as urethral fistula with scrotal abscess. The patient was successfully treated with cystostomy, scrotal incision, and pus drainage. Early detection and proper management provide opportunities to improve the outcome of this disease.

Correlations Between Staging and Chemotheraphy Response with Testicular Carcinoma Non-Seminoma at Dr. Soetomo Hospital, Surabaya, Indonesia

The purpose of this study to describe patientscharacteristics, correlation between stagingnon-seminomacancer and chemotherapyresponse. Data on age, location of tumor, staging, serum levels of the tumor marker post operative, adjuvant therapy, chemotherapy side effects, and response of patient to chemotherapy were gained from medical records inSoetomo Hospital Surabaya from January 2012 to December 2015, and analyzed with SPSS. Correlation between staging and chemotherapyresponse, correlation primary tumor staging (pT) and Metastasis (M), correlation regional lymph nodes staging (N) and metastasis (M), correlation serum tumor marker and chemotherapy response was proccessed by Spearman correlation test. There were no significant correlation between pT staging and M and no significant correlation between N and M staging. Based on tumor markers (S), mostly patients were S2. There were no significant correlation between the response to chemotherapy and serum tumor marker levels. In category of staging group, the mostare 14 patientsstage III. BEP was the most adjuvant Chemotherapy.Nausea and vomiting were The most complained during chemotherapy. Anemia were the most hematologic side effects of chemotherapy.There are no significant correlation between the staging of non-seminoma and the response to chemotherapy. Conclusion: Non seminoma mostly happened in young males. Non-seminoma responses to chemotherapy. Patients in early stage would give a good response to chemotherapy compared to those with advanced stage. After chemotherapy, evaluation should be done to the patients' complaints and complete blood count to detect side effects.

Correlations Between Staging and Chemotheraphy Response with Testicular Carcinoma Non-Seminoma at Dr. Soetomo Hospital, Surabaya, Indonesia

The purpose of this study was to describe patients’ characteristics, correlation between staging non-seminoma cancer and chemotherapy response. Data on age, location of tumor, staging, serum levels of the tumor marker post operative, adjuvant therapy, chemotherapy side effects, and response of patient to chemotherapy were gained from medical records in Soetomo Hospital Surabaya from January 2012 to December 2015, and analyzed with SPSS. Correlation between staging and chemotherapy response, correlation primary tumor staging (pT) and Metastasis (M), correlation regional lymph nodes staging (N) and metastasis (M), correlation serum tumor marker and chemotherapy response was proccessed by Spearman correlation test. There were no significant correlation between pT staging and M and no significant correlation between N and M staging. Based on tumor markers (S), mostly patients were S2. There were no significant correlation between the response to chemotherapy and serum tumor marker levels. In category of staging group, the most are 14 patients stage III. BEP was the most adjuvant Chemotherapy. Nausea and vomiting were The most complained during chemotherapy. Anemia were the most hematologic side effects of chemotherapy. There are no significant correlation between the staging of non-seminoma and the response to chemotherapy. Conclusion: Non seminoma mostly happened in young males. Non-seminoma responses to chemotherapy. Patients in early stage would give a good response to chemotherapy compared to those with advanced stage. After chemotherapy, evaluation should be done to the patients' complaints and complete blood count to detect side effects. 

Predictor factor of inguinal lymph lode metastasis in men with penile cancer at Sanglah General Hospital, Denpasar, Bali

Background: To know predictor factors of inguinal node metastasis in penile cancer. Methods: A retrospective study about penile cancer in Sanglah Hospital, Bali, from 2011 to 2015. Patients had undergone partial or total penectomy, and inguinal node dissection or excisional biopsy for histopathology finding. Results: A 65 penile cancer patients were diagnosed for 5 years. Mean age was 53,24 ± 13,42 years. Fifteen were excluded and 25 of 50 patients (50%) had inguinal node metastasis. There were significant correlation between pathologic stage (p=0,021), histologic grade (p=0,020) and vascular invasion (p=0,008) with the presence of inguinal node metastasis. Primary tumor of pT1 showed 14% inguinal node metastasis compared to pT2 (42%), pT3 (67%), and pT4 (100%). Histologic grade I, had 22% inguinal node metastasis compared to grade II (50%), and grade III (100%). Only 39% patients without vascular invasion had inguinal node metastasis compared to 83% with vascular invasion. Conclusion: Pathologic stage of primary tumor, histologic grade and vascular invasion were predictor factors of inguinal node metastasis in penile cancer.

Communicating Fistula Between Colocutan and Nephrocutan With Renal Stones and Renal Replacement Lipomatosis. A Case Report

Colocutaneous fistula with nephrocutaneous fistula is a rare condition. Renal replacement lipomatosis is the result of the atrophy and destruction of renal parenchyma. We report a 60-year-old male with intermittent drainage mucus and fluid from ulcer of his right lumbar region. Renal ultrasound and plain abdominal X-ray revealed a chronic parenchymal disease with stone of the right kidney. Fistulography showed a fistula tract connecting the skin and the right pelvicalyceal system and the colon. Computerized tomography demonstrated a renal calculus with a massive fatty proliferation. The patient was planned for right nephrectomy and excision of the sinus tract.

A Rare Case of Repeated Migration and Transurethral Extrusion of Ventriculoperitoneal Shunt

Bladder migration and transurethral extrusion is an extremely rare complication of ventriculoperitoneal (VP) shunt. Only eight cases have been reported in the English literature since 1995. We report a case of a 4-year-old boy with cerebral palsy, hydrocephalus, and VP shunted on both sides who presented with a protruded distal VP shunt from his urethral orifice. The patient was reported for having previous shunt extrusion through the anus. The patient was treated on by a multidisciplinary approach, involving a neurosurgeon and urologist. Shunt removal with simple procedure was smoothly achieved without morbidities. He was discharged home in satisfactory condition.

Urologic cancer in Indonesia

Non-communicable diseases, including cancer, start to become more common in Indonesia. According to the government statement, incidence of malignant diseases increased annually up to 8% in the last decade and these diseases become the seventh leading cause of death in Indonesia. On the basis of the latest Globocan report on cancer incidence in Indonesia, prostate cancer ranks sixth; followed by bladder (12th) and kidney (18th). More than half of patients with kidney cancer are diagnosed in the advanced stage. Besides renal cell carcinoma, there are significant number of people affected with squamous cell and transitional cell carcinoma because of kidney stones. Radical nephrectomy or cytoreductive nephrectomy was the primary treatment, mostly done as an open procedure. Transitional cell carcinoma is the commonest histology type in bladder cancer cases followed by squamous cell carcinoma, which almost always related to bladder stones. Unfortunately, >70% of our cases were diagnosed with muscle invasive bladder cancer, and ∼60% of these patients refused further radical treatment. Incidence of prostate cancer is increasing rapidly and it becomes the third most common cancer in men. However, most of our patients are diagnosed in the advanced stage. Radical prostatectomy or external beam radiotherapy is the treatment of choice in localized disease. Nearly 40% of the elderly patients are treated with primary androgen deprivation therapy. Therefore, it requires more research by the Indonesian urologists and other healthcare providers to diagnose these cancers in earlier stage as well as community education for prevention.

Indonesian prostate cancer risk calculator (IPCRC): an application for predicting prostate cancer risk (a multicenter study)

AIM

to develop a prediction risk model of prostate cancer based on Indonesia population.

METHODS

we included all benign prostate hyperthrophy (BPH) and PCa patients who had prostate biopsy and prostatectomy between January 2009 and December 2013 from 5 urology centers in Indonesia. The relationship between the possibility of PCa with the following variables including: age; PSA level, prostate volume (by transabdominal ultrasound or transrectal ultrasound) and digital rectal examination (DRE) finding. We calculated a predictive scoring equation to predict the possibility of PCa using chi-square analysis, Kolmogorov-Smirnov test, multiple logistic regression and ROC curve. Then, we designed an application for predicting prostate cancer risk called Indonesian Prostate Cancer Risk Calculator (IPCRC).

RESULTS

there were 784 PCa and 1173 BPH patients were used for developing the risk calculator in our study. The mean ages, PSA and prostate volume are 66.9±8.1 years old; 72.4±248.9 ng/ml and 49.6±28.2 ml, respectively. Abnormal DRE was found in 637 PCa and 56 BPH. We included age, PSA level, abnormal DRE finding (all showed significant p<0.05 in univariate model). Additionally, although not significant, we included prostate volume (p=0.157) due to its clinical importance. The corrected ROC analysis showed AUC 0.935, sensitivity of 90.1% and specificity 80% in predicting the prostate cancer in our population.

CONCLUSION

we have developed the Indonesian Prostate Cancer Risk Calculator which includes age, PSA, DRE, and prostate volume as its variables. Future prospective study to validate the risk calculator is needed.

PROFILE OF BLADDER TRANSITIONAL CELL CANCER IN SOETOMO HOSPITAL SURABAYA

Objectives: To describe the characteristic of bladder transitional cell cancer (TCC). Material & methods: We reviewed the medical records of patients with bladder TCC admitted in Soetomo General Hospital Surabaya, from January 2008 until December 2012. The data regarding demographic characteristics, clinical presentation and staging, grading and staging based on pathological examinations results, and the management of the cancer.Results: The 126 cases, consisted of 102 men (81%) and 24 women (19%) with its ratio was 4.2 : 1. All male patients were heavy cigarette smokers. Mean age was 57.8 years, peak incidence was50-59 years. Hematuria was the mostfrequent clinical presentation (112 patients, 88.9%), urinary retention and other complaints (12 patients, 9.5%), and chronic dysuria (2 patients, 1.6%). Clinical staging was T1 as NMIBC in 7 patients (5.7%). MIBC consisted of T2 in 37 patients (30.3%), T3 in 35 patients (28.7%), T4 in 43 patients (35.2%). The pathological grading as an high-grade were 74 patients (64.3%). All patients had underwent TURBT for diagnosis and staging, followed by definitive treatment. It consisted of TURBT and chemotherapy bladder instillation in 7 patients (5.6%), radical cystectomy in 13 patients (10.3%), EBRT in 5 patients (4%), MVAC chemotherapy in 24 patients (19%), EBRT and chemotherapy with MVAC in 3 patients (2.4%). There were 74 patients (58.7%) underwent TURBT alone.Conclusion: Bladder TCC was in advanced stage when diagnosed, most of the patients received only TURBT and refused further treatment. Keywords: Bladder transitional cell cancer, characteristics, managements.

Prostate-specific antigen and prostate-specific antigen density cutoff points among Indonesian population suspected for prostate cancer

Purpose:

Racial differences exist in the incidence of prostate cancer (PCa). Although many studies have looked at the performance of prostate-specific antigen (PSA) and PSA density (PSAD) in the detection of PCa, only a few have looked at it in relation to Indonesian men. The objective of this study is to find out better PSA and PSAD cutoff point in the detection of PCa in Indonesian men.

Methods:

A total of 404 consecutive Indonesian men underwent prostate biopsy for suspicion of PCa from 2008 to 2011. The biopsy criteria include one or more of the following: serum PSA more than 10 ng/mL, PSAD more than 0.15 if PSA 4–10 ng/mL, hypoechoic lesion during transrectal sonography and/or abnormal digital rectal examination.

Results:

Forty five out of 404 (11.1%) had positive biopsies. The mean age, prostate volume, PSA and PSAD were respectively 64.06 years, 43.03 mL, 45.59 ng/mL and 1.15. Of the 404, 131 cases (32.4%) were confirmed to be urinary retention. Positive urine culture found in 182 cases (45%). The cutoff point to detect PCa as estimated by the receiver operating characteristics was 6.95 ng/mL for PSA (sensitivity 97.8%, specificity 19.6%) and 0.7072 for PSAD (sensitivity 62.2%, specificity 78.7%). Positive predictive value for this PSA and PSAD cutoff point were 11.6% and 27.5% respectively (P=0.004 and P=0.000). There was a significant correlation between hypoechoic lesion and positive biopsy results (P =0.000). Urinary retention elevates PSA cutoff point to 14.55 (sensitivity 90.9%, specificity 50%), while positive urine culture alters almost no PSA cutoff elevation.

Conclusions:

PSA and PSAD cutoff point for Indonesian men in this series is relatively different from international consensus. Furthermore, these data show that PSA and PSAD cutoff point must be adjusted to racial variation to discriminate between malignant and benign disease. Urinary retention is a significant factor for PSA cutoff increase.