A rare case of spontaneous bladder wall abscess mimicking bladder tumour in young women

INTRODUCTION

Abscess of the bladder wall is a rare urological disorder, with a few cases recorded in the literature. The finding of a bladder wall mass via computed tomography (CT) imaging in a visiting patient is the subject of this report.

CASE DISCUSSION

A 37-year-old woman with persistent pain in the suprapubic area and lower urinary tract symptoms was examined as a case study. Through a CT scan revealed an inhomogeneous structure in the anteroinferior part of the right bladder. A cystoscopy procedure followed by transurethral resection was performed to remove the mass, which was found to be an abscess. A Foley catheter with irrigation was administered after surgery, and the patient goes home in three days.

CONCLUSION

the patient had no symptoms or discomfort in the lower urinary tract after follow-up. Despite the rarity of bladder wall abscesses, cystoscopy can be used to aid diagnosis. Transurethral resection of bladder wall can reduce the mass and eliminate the possibility of malignancy.

Aphallia - congenital absence of the penis: a systematic review

BACKGROUND

Aphallia is a rare congenital anomaly often associated with other urogenital anomalies. The management of aphallia cases for both the immediate and long-term treatment of patients with aphallia pose a major dilemma. Patients are at risk for psychosocial and psychosexual challenges throughout life.

METHODS

A systematic review was conducted on aphallia cases. We searched online databases until March 2023 for relevant articles and performed according to the PRISMA-P guidelines.

RESULTS

Of the 43 articles screened, there were 33 articles included. A total of 41 patients were analyzed qualitatively. Asia is the region with the most aphallia cases with 53% (n:22), while the United States is the country with the most most reported aphallia cases 31% (n:13). Most cases were identified as male sex (n: 40), and most cases were neonate with 68% (n:28) cases. Physical examination generally found 85% (N = 35) with normal scrotal development and palpable testes. The most affected system with anomalies is the genitourinary system with fistulas in 80% (n:29) cases. Initial management in 39% (n:16) of patients involved vesicostomy. Further management of 31% (n:13) included phalloplasty or penile reconstruction, and 12% (n:5) chose female sex. 17% (n:7) of patients refused medical treatment or were lost to follow-up, and 12% (n = 5) patients deceased.

CONCLUSION

Aphallia is a rare condition and is often associated with other inherited genitourinary disorders. In most cases, physical examinations are normal except for the absence of a phallus, and laboratory testing shows normal results. The initial management typically involves the vesicostomy procedure. Subsequent management focuses on gender determination. Currently, male sex is preferred over female. Due to the significant variability, the rarity of cases, and the lack of long-term effect reporting in many studies on aphallia, further research is needed to minimize bias.

A rare pediatric scrotal hemangioma: A case report and comprehensive analysis of n Bloc Excision as definitive treatment

INTRODUCTION AND IMPORTANCE

Hemangiomas, abnormal growths of vascular endothelial cells, are common vascular tumors in children. In contrast, their prevalence is 1-3 % in full-term newborns. Their unique location and associated complications can cause significant distress for patients and families. Prompt treatment is crucial to prevent complications such as fertility issues, hemorrhage, or other related problems. This case study explores the diagnosis and management of scrotal hemangiomas, emphasizing the importance of timely intervention.

CASE PRESENTATION

A 10-year-old boy with a scrotal hemangioma since birth underwent surgical excision due to increased discomfort caused by a new lesion. 2.5 × 2.3 cm hemangioma was successfully removed through En Bloc Excision. The patient experienced a swift recovery, and histopathologic analysis confirmed the diagnosis of cavernous hemangioma. This case underscores the importance of careful monitoring and decisive intervention in managing scrotal hemangiomas.

CLINICAL DISCUSSION

Scrotal hemangiomas often present challenges in diagnosis, mimicking malignant tumors. Clinical examination, ultrasonography, and histopathology are crucial for accurate diagnosis. Various surgical techniques, including En Bloc Excision, have been employed, with postoperative care tailored to individual cases. Precise preoperative diagnosis is essential to distinguish scrotal hemangiomas from other conditions and guide appropriate management strategies.

CONCLUSION

This case study highlights the management of a scrotal hemangioma through En Bloc Excision, emphasizing the importance of considering definitive treatment options. The comprehensive scrotal examination is crucial for accurate diagnosis and effective management of this rare vascular tumor.

A renal aplasia case mimicking radiologically as unilateral renal agenesis in a child with spina bifida, atresia ani and unilateral undescended testis: a case report

BACKGROUND

As a result of the failure of embryogenic kidney formation, a condition can occur where not a single kidney appears and this phenomenon is known as unilateral renal agenesis (URA). Both aplastic and dysplastic kidney are different from renal agenesis, atrophy and renal hypoplasia. However, from this case report it can be seen that there are similarities, both radiologically and macroscopically, between cases of unilateral renal aplasia and renal agenesis.

CASE PRESENTATION

A 2 year old Javanese boy came to the health facility with complaints of recurrent fever and urinary tract symptoms such as dysuria and straining. Computerized Tomography (CT) scan of the abdomen and urography showed agenesis of the left kidney and a probable spina bifida. Cystourethrography examination was done and showed grade 5 voiding, then retrograde pyelography was performed with the diagnosis of unilateral renal agenesis was made because there was no visible left side collecting system even though there was a duplication in the left ureter. The next examination was carried out by histopathology and immunohistochemistry after resection of the left side of the ureter and the diagnosis increasingly pointed towards renal aplasia after primitive renal structures were found.

CONCLUSIONS

Renal agenesis and aplastic kidney are difficult to differentiate macroscopically and radiologically. Nevertheless, from this case report, we try to provide some interesting points to differentiate cases of unilateral renal agenesis from Renal Dysplasia which presents as unilateral renal aplasia.

Penile and scrotal skin flap combination for circumcised concealed penis: A novel surgical technique

INTRODUCTION AND IMPORTANCE

Circumcised concealed penis (CP) patients will have insufficient penile shaft skin, causing difficulty to perform reconstructive surgery. There hasn't been a single, widely acknowledged surgical procedure for all varieties of CP repairs until lately. We report a novel surgical technique with combination of penile and scrotal skin flap for circumcised concealed penis.

CASE PRESENTATION

A 9-year-old boy concealed penis patient with history of circumcision was corrected with combination of penile and scrotal flap. Three important steps in this technique include preparation of penile skin flap, preparation of scrotal skin flap and skin coverage. Indicators were measured with detail such as the pre- and post-operative penile length, as well as the intraoperative time and bleeding during the operation. After surgery patient achieved a clinically significant improvement in the appearance post operatively including penile length and morphology. During 3 months of follow up there are no complication such as necrosis, contracture, voiding and erectile function are also maintained during follow up.

CLINICAL DISCUSSION

Acquired concealed penis cases usually occur as a complication of neonatal circumcision which causes entrapment of penis by postoperative cicatricial scar over the glans. A new combination technique by using scrotal and penile flap allows mobile and richly vascularized skin of the scrotum to cover defects of penis shaft.

CONCLUSION

This technique is well tolerated for the case. The lack of skin coverage after circumcision procedure can be overcome while preserving all of the rest penile skin.

COMPARISON OF ANDROGEN AND ESTROGEN RECEPTORS’ EXPRESSION IN DARTOS TISSUE OF BOYS WITH AND WITHOUT HYPOSPADIAS

Objective: This study aims to investigate the characteristics of androgen receptors (AR), estrogen receptor 1 (ER1) and estrogen receptor 2 (ER2) expression in dartos tissue of patients with congenital hypospadias, compared to normal penis. Material & Methods: We harvested 63 dartos tissue consisting of 53 congenital hypospadias that underwent urethroplasty (20 distal and 33 proximal) and 10 normal penis that underwent circumcision as controls from September 2017 to September 2018. The expressions of AR, ER1, and ER2 were measured using Quantitative Real-Time PCR (qPCR). All data were analyzed by Prism 7, and one-way ANOVA tests were used to compare gene expressions between the groups. Results: The mean age was 68.99 (± 45.5) and 65.6 (± 25.8) months in boys with and without hypospadias, respectively. The expression of mRNA AR was decreased in proximal (6.26 ± 2.30) and distal hypospadias (6.43 ± 2.22) compared to controls (9.69 ± 1.10), which were statistically significant (p=0.0001 and p<0.0001, respectively). We found a statistically significant difference of ER1 expression compared to controls (p=0.0064). The expression of ER2 was significantly increased in distal (21.03 ± 5.00) and proximal hypospadias (25.21 ± 8.06) groups compared to controls (11.80 ± 2.49) (p<0.0001). There was no statistically significant mean difference in mRNA ER1 expression (p=0.65). Conclusion: The repressed AR and elevated ER mRNA as shown in our study may suggest that defects in those receptors’ interaction and/or balance may contribute to hypospadias and penile curvature condition. Further studies are needed to evaluate any gene-related problems in hypospadias. Keywords: Hypospadias, androgen receptor, estrogen receptor, dartos tissue.  

Expression of mRNA vascular endothelial growth factor in hypospadias patients

Background

Hypospadias is a relatively common genital anomaly in humans, usually followed by inelastic dartos that causes penile chordee. Vascular endothelial growth factor (VEGF) is strongly linked to the viscoelasticity of tissues and their elastic phase. This study aimed to evaluate VEGF expressions in (1) fascia dartos between hypospadias and controls and (2) chordee severity.

Methods

This prospective cohort study involved 65 specimens from patients with hypospadias and ten specimens from controls. The samples were analyzed by quantitative real-time polymerase chain reaction (qPCR) for VEGF expression.

Results

The expressions of VEGF were not different between proximal and distal hypospadias patients and controls (fold change: distal − 0.25; fold change: proximal − 0.2; p = 0.664). The scaled expressions related to chordee severity were mild − 0.1; moderate 0.1; severe − 0.25 (p = 0.660).

Conclusions

VEGF expressions might not affect the severity of hypospadias and chordee, implying the pathogenesis is complex involving many growth factors. Further study with a larger sample size is necessary to clarify and confirm our findings.

Sexual activities during the COVID-19 pandemic in Indonesia

BACKGROUND

Corona Virus Disease 2019 (COVID-19) has spread globally starting from late 2019. The WHO declared it a global pandemic in March 2020, causing nations around the world to introduce various control measures to halt the rapid spread of the disease, such as quarantines, lockdowns, and work from home (WFH) policies. These policies often force people to spend more time at home with their cohabitants, or possibly sexual partners. Various negative feelings experienced during those policies are considered to affect the general mood and sexual life of the population. This study aimed to investigate the difference in mood and sexual activity before and during the COVID-19 pandemic.

METHODS

This research was a cross-sectional pilot study. Authors collected data from 131 randomly selected, sexually active volunteer subjects using a self-administered online questionnaire. Subjects' mood status, behavior, and frequency of sexual intercourse before and during COVID-19 pandemic in Indonesia were analyzed.

RESULTS

Subjects consisted of 67 (51.1%) men and 64 (48.9%) women. Our analysis shows that there was a decline in overall mood scale, and also sexual activity frequency, before and during the pandemic (4.63 vs. 4.03; 80.2% vs. 67.9%, respectively). The COVID-19 pandemic control measures may enable subjects to have more time with their sexual partners at home, but it does not increase the frequency of their sexual activities.

CONCLUSION

There was a slight decrease in overall mood scale and sexual activity frequency during the COVID-19 pandemic recorded among subjects. The authors suspect that depression symptoms, fear, anxiety, irritability, boredom, confusion, and feeling of being isolated experienced during strict pandemic control measures, caused by stressors such as job loss, decreased monthly income, and the current state of the pandemic are influencing these phenomena.

A complete duplicated collecting system with giant ureterocele in adult: Case report

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Ureterocele is rare especially with collecting system duplication in the nonorthotopic (extravesical) position in adult.

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Ureterocele has a variety of clinical manifestations and complications.

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Endoscopic treatment was performed to decompress hydroureteronephrosis.

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In this case, laparoscopy heminephrectomy is needed due to dysfunctional uppers moiety.

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Renal scintigraphy is a gold standard to assess function in the duplex kidney.

Introduction

Ureteroceles is a developmental anomaly with cystic dilation of the distal aspect of the ureter and are often associated with some urological anomaly such as a duplicated system or stenotic ureteric orifice.

Presentation of case

This study reports an ectopic ureterocele in duplication of collecting system associated with double ureters and ureteral ectopia in a woman aged 24 years with minor flank pain. Cystoscopy deroofing of the ureterocele performed and followed by secondary surgery laparoscopic heminephrectomy.

Discussion

Ureteroceles have various clinical manifestations and complications. Treatment for ureterocele depends on age, type of the ureterocele, obstruction to the draining system, and complications. No single method is sufficient for all cases, and management must be individualized. Endoscopic treatment has gradually broadened as a safe, minimally invasive, and effective procedure, but there is no consensus on its effectiveness for treating ectopic ureterocele. However, it is reported that 50–80% of cases after initial endoscopic treatment require secondary surgery.

Conclusions

Ureterocele is reported rarely in adults, especially with duplication of the collection system in the nonorthotopic (extravesical) position in women. Cystoscopy deroofing of the ureterocele can be performed to decompress the hydroureteronephrosis, and laparoscopic heminephrectomy can be performed due to dysfunctional uppers moiety. Long-term follow-up is required to monitor renal function, symptoms, and occurrence of vesicoureteric reflux.

The impact of COL1A1 and COL6A1 expression on hypospadias and penile curvature severity

BACKGROUND

Hypospadias, the most frequent congenital male external genitalia abnormality, is usually associated with curvature of the ventral penis, i.e. chordee. Abnormality of darto tissue has been suggested as the pathophysiology of chordees. Collagen is one of the most abundant fibrous proteins within the extracellular matrix. In this study, we determined the expression of collagen 1 (COL1A1) and COL6A1 in patients with hypospadias and associated them with the severity of penile curvature.

METHODS

We included 60 children < 18 years old, consisting of 20 distal hypospadias, 20 proximal hypospadias patients, and 20 controls in our institution from 2017 - 2020. The expression of COL1A1 and COL6A1 in darto tissue was determined by reverse-transcriptase polymerase chain reaction (qPCR). The penile curvature severity was classified as mild (< 30 degrees), moderate (30-60 degrees), and severe (> 60 degrees).

RESULTS

qPCR showed that COL1A1 and COL6A1 expression was significantly downregulated in the distal (0.88 (0.38-2.53) and 0.54 (0.16-4.35), respectively) and proximal 0.76 (0.33-2.57) and 0.57 (0.18-1.38), respectively) hypospadias groups compared to controls (1.85 (0.24-4.61) and 0.93 (0.17-4.06), respectively) with p-values of 0.024 and 0.018, respectively. Furthermore, there was a moderate correlation between COL1A1 and COL6A1 expression (r = 0.458, p < 0.0001). Interestingly, COL1A1 and COL6A1 were also significantly downregulated in the moderate and severe chordee groups compared to the mild chordee groups, with p-values of 0.003 and 0.037, respectively.

CONCLUSIONS

Aberrant COL1A1 and COL6A1 expression might affect abnormalities in darto tissue and penile curvature severity in hypospadias patients.

Expression of mRNA Mastermind-like Domain-containing 1, Androgen Receptor, and Estrogen Receptor in Patients with Hypospadias

BACKGROUND: Androgen (AR) and Estrogen (ER) hormones play an important role in the prenatal and postnatal development of the urogenital tract and especially the penis. Growth factors also influence the development of genital structures. Little is known about the exact role of Mastermind Like Domain 1 (MAMLD1) in sexual development. A role in sex differentiation through supporting testosterone production in critical periods of male development has been suggested. MAMLD1 mutations result in hypospadias with and without a disorder of sexual development (DSD) primarily because of compromised testosterone production around the critical period for fetal sex development, but the underlying etiology remains unclear. AIM: The objective of this study was to investigate the correlation between gene factor MAMLD1, AR, ER1, and ER2 with the incidence of hypospadias. OBJECTIVE: The objective of this study was to investigate the correlation between gene factor MAMLD1, AR, ER1, and ER2 with the incidence of hypospadias. METHODS: From 2017-2018, peri-urethral dartos were harvested from 46 patients with proximal hypospadias, 24 patients with distal hypospadias and 10 patients with normal penile were used as controls. The expressions of MAMLD1, AR, ER1, and ER2 were investigated by one-step quantitative polymerase chain reaction. RESULTS: Median age was 5 years old in the 70 patients with hypospadias and 6 years old in the control subjects. Total specimens taken included 24 distal penile, 46 proximal penile, and 10 normal penile specimens. We found decreasing MAMLD1 and AR expressions, but ER2 expression increased in patients with hypospadias compared to controls, which was statistically significant (p < 0.001). A positive correlation between MAMLD1 and AR was found in patients with hypospadias (r = 0.062; p = 0.038). CONCLUSIONS: Decreasing of MAMLD1 and AR expression was followed by increasing ER2 expression in patients with hypospadias. MAMLD1 had a positive correlation with AR so the defect of MAMLD1 may influence AR and increase the incidence of hypospadias.

Risk factors for urethrocutaneous fistula following hypospadias repair surgery in Indonesia

INTRODUCTION

Hypospadias is one of the most common congenital malformations with a worldwide increasing trend over the years. Despite advancements in hypospadias repair, complications still occur. One of the most common complications of hypospadias repair surgery is Urethrocutaneous fistula. Studies attempting to analyze the association between the complication and risk factors are always beneficial, especially for studies performed in different areas of the world. We hypothesize that several evaluated risk factors among Indonesian hypospadias patients could be associated with the occurrence of urethrocutaneous fistula after the repair procedure.

OBJECTIVE

To determine the risk factors associated with urethrocutaneous fistula after hypospadias repair surgery by collecting and analyzing data obtained from multiple centers in Indonesia.

MATERIALS AND METHODS

A nationwide, retrospective study with 12 hospitals in Indonesia of children with a diagnosis of hypospadias was conducted. The collected data, taken from patients admitted in 2018, from each center's medical records consisted of patient identity, repair technique used, neourethra length, percutaneous cystostomy, and splint size as independent variables speculated to be possible risk factors correlated to the presence of urethrocutaneous fistulae. Binomial logistic regression analysis was performed using SPSS 21.0 to determine the relationship between urethrocutaneous fistulae as a post-repair complication and possible risk factors.

RESULTS

We collected 591 hypospadias cases from 12 centers in 9 cities in Indonesia. Most patients came when they were already at the age of more than four years old (60.4%). The chordee-only and failed urethroplasty groups are excluded from the analysis as they are not classified as true hypospadias. Most repairs were performed by using the Tubular Incised Plate (TIP) with Thiersch-Duplay technique (44.16%). Most of the reconstructed neourethra are 2-3 cm in length (32.13%). The 8 Fr urethral splint (46.41%) was mostly used during the operation. Most surgeons decided not to perform cystostomy throughout the procedure (61.03%) based on personal preferences. Urethrocutaneous fistula was found in 80 patients (15.27%) out of the total patients who underwent the surgery. The binomial logistic regression analysis shows that age (OR = 1.398, p = 0.015), the decision to not perform cystostomy (OR = 2.963, p = 0.014), and splint size (OR = 1.243, p = 0.023) are significantly associated (p < 0.05) with the development of urethrocutaneous fistula.

CONCLUSION

Age and splint size are significant risk factors for urethrocutaneous fistula after hypospadias repair in Indonesia, whereas performing percutaneous cystostomy during the repair decreases the risk for urethrocutaneous fistula occurrence.

Laparoscopic Nephroureterectomy in the Upper Urinary Tract Urothelial Carcinoma with Transvaginal Extraction

BACKGROUND: The upper urinary tract urothelial carcinoma (UTUC) is a rare urological malignancy. Laparoscopic nephroureterectomy (LNU) is one of the options for minimally invasive surgery for UTUC. It has similar oncological outcomes compared to open nephroureterectomy. One of the techniques developed for specimen extraction is the transvaginal route. Transvaginal specimen extraction has advantages in the reduced risk of complications, faster recovery time, and better end result. CASE PRESENTATION: A 37-year-old woman complained of intermittent pain in her right flank for the past 2 months, with significant weight loss. No other significant symptoms occurred. Her general condition was good with a Karnofsky Performance scale index is 90. In the right periumbilical area, there was a mobile, smooth mass palpated with the size of 10 × 12 cm. There was no tenderness. The patient underwent URS and biopsy of the right ureteral mass with pathological analysis resulting in UTUC. Then, the patient underwent laparoscopic radical nephroureterectomy. CONCLUSION: Although the surgical procedure was safe for the patient and more effective in terms of less morbidity, faster healing time, and better cosmetic appearance, transvaginal extraction of the kidney needs to be further studied, particularly relating to the little experience of this new technique.

Increased tumor-associated macrophages in the prostate cancer microenvironment predicted patients' survival and responses to androgen deprivation therapies in Indonesian patients cohort

Background

Tumor-associated macrophages (TAMs) and microvessel density (MVD) play an essential role for tumor progression in prostate cancer (PCa). In this study, we evaluated the association between TAMs, the infiltration with tumor angiogenesis and the response to androgen deprivation therapies (ADTs) in PCa to evaluate TAM infiltration as a predictive factor for PCa survival.

Materials and methods

Fifty-four specimens were collected and stained with CD 68 antibody to investigated TAM infiltration in tumor. Von Willebrand factor was stained to evaluate MVD around the cancer foci. We assessed the association between patient's age, preoperative serum prostate-specific antigen, pathologic Gleason sum (GS), TAM infiltration, MVD, and the response to ADT for 5 years after PCa diagnosis.

Results

The median TAM was observed in 28 (6-76)/high power field (x400). Increasing TAM correlated with increasing tumor angiogenesis (P < 0.001, r = 0.61), and the response to ADT was significantly better in patients with fewer TAMs (<28) than in patients with higher TAMs (>28) (P = 0.003). TAM infiltration was significantly higher in those with higher serum prostate-specific antigen, higher GS, and metastasis. Multivariate analysis showed that GS, ADT type, and MVD number were significant prognostic factors for response to ADT in PCa (P < 0.0001). An increased infiltration of TAM [hazards ratio (HR) = 4.47; 95% confidence interval (CI): 1.97–10.15], MVD (HR = 2.66; 95% CI: 1.27–5.61), metastatic status (HR = 2.29; 95% CI: 0.14-0.60), and prostate volume (HR = 2.19; 95% CI: 1.27–3.12) significantly correlated with shorter survival in PCa patients by univariate analysis (P < 0.05). Multivariate analyses revealed that TAM and metastatic status significantly correlated with poor overall survival.

Conclusions

TAM infiltration is associated with response to ADT and increased tumor angiogenesis in PCa. GS, ADT type, and MVD in PCa specimens are useful predictive factors for poor response to ADT. Increasing TAM and positive metastatic status were prognostic factors for a poorer survival in PCa patients.

Lumbrokinase effects on pro- and anti-apoptotic gene expression in Wistar rats with testicular torsion

Background

Testicular reperfusion is believed to be the mechanism by which testicular injury occurs in the ischemic testis. This study was performed to determine the therapeutic efficacy of lumbrokinase for treating ischemia-reperfusion (IR) injury-induced bilateral testicular torsion.

Methods

Twenty-four male rats were equally divided into the following groups: torsion only (T), torsion plus lumbrokinase (TL), torsion-detorsion only (TD) and torsion-detorsion plus lumbrokinase (TDL) groups. The right testicle in each groups sample was rotated 720° for 4 h, followed by orchiectomy. The rats in the TD (TD and TDL) groups additionally underwent detorsion for 1 h after the initial rotation. Testicular tissues were collected for measuring anti-apoptotic B-cell lymphoma-2 (BCL-2) and pro-apoptotic BCL-2-associated X protein (BAX) gene expression levels using real-time polymerase chain reaction.

Results

Pro- and anti-apoptotic gene expression levels were increased in the TD groups. Lumbrokinase was significantly effective in lowering BAX expression levels, particularly those in the TDL group compared with those in the TD group (P<0.05). Lumbrokinase did not significant change BCL-2 expression levels.

Conclusion

The administration of lumbrokinase before orchiectomy can protect against IR-induced testicular damage by reducing pro-apoptotic gene expression levels.

Common Practice of Hypospadias Management by Pediatric Urologists in Indonesia: A Multi-center Descriptive Study from Referral Hospitals

BACKGROUND:

Hypospadias is the second most common congenital anomalies among human congenital disabilities. There are over 300 surgery techniques being introduced to treat hypospadias. The successful of hypospadias repair is assessed by several outcomes as well as complications following surgery.

AIM:

This study aims to show the multicenter hypospadias data in Indonesia descriptively.

METHODS:

All the data were compiled based on questionnaires, which were distributed to Indonesian pediatric urologists. The questionnaire includes several questions containing demographic aspect, preferred techniques being used, and complications being found regarding hypospadias repair.

RESULTS:

Eighteen Indonesian pediatric urologists from 12 centres involved in this study. The data were collected from June – September 2018 based on the surgeon’s experience throughout 2017. From 591 cases based on the returned questionnaire, penile-type hypospadias was the most common type of hypospadias being treated (35.7%) followed by penoscrotal (28.9%) and scrotal-type (12.9%). Moderate severity of chordee was mostly seen among all cases (40.6%). Tubularised incised plate (TIP), + Thiersch Duplay, was the most common technique being used to treat hypospadias (44.3%), followed by onlay island preputial flap (14.9%) and two-stage technique (14%). The incidence of urethrocutaneous fistulae in this study was 13.9%.

CONCLUSION:

This study showed how Indonesian pediatric urologists dealt with hypospadias cases. TIP + Thiersch Duplay procedure being the preferred technique used by most participants and the rate of urethrocutaneous fistulae as one of the complications was comparable with previous studies.

Extrarenal calyces mimicking retroperitoneal cystic mass with concomitant ureteropelvic junction obstruction: renal pelvis reconstruction using calyx unification

Extrarenal calyces (ERCs) are a very rare urological anomaly, especially when concomitantly presenting with ureteropelvic junction obstruction (UPJO). Surgical intervention is often necessary in ERCs associated with UPJO, with dismembered pyeloplasty being the most commonly utilized technique. We present a case of UPJO-associated ERCs in which renal pelvis reconstruction using calyx unification was selected as the treatment technique. An 11-year-old boy was referred to our center due to bilateral hydronephrosis and left multicystic kidney disease. Magnetic resonance imaging showed severe left hydronephrosis with concomitant left cystic mass and left UPJO. A ^99mTc diethylenetriaminepentaacetic diuretic renal scan showed residual renal function of 25.9% split function and 26.8 mL/minute glomerular filtration rate. Intraoperatively, we found ERCs with severely dilated renal pelvis. The renal pelvis was excised. Major calyces protruding from the kidney were unified using side-to-side anastomosis to form a new structure resembling a renal pelvis, which was further anastomosed to the ureter. Temporary urinary drainage from the affected kidney was achieved using a double-J (DJ) stent and nephrostomy. Pathological examination revealed atrophic transitional epithelial cells. There was no intra- or postoperative complication reported. The nephrostomy tube and DJ stent were removed 2 weeks and 3 months after surgery, respectively. Ultrasonography examination performed at 1 and 9 months after DJ-stent removal showed no hydronephrosis. We conclude that renal pelvis reconstruction using calyx unification can be performed safely and is effective in treating patients with ERCs associated with PUJO. This technique should be considered especially in cases where excision of the renal pelvis cannot be avoided.

Laparoscopic repair of vesicovaginal fistulae with a transperitoneal approach at Universitas Gadjah Mada Urological Institute: a case report

BACKGROUND

A vesicovaginal fistula is an abnormal fistulous tract extending between the bladder and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault. In addition, the sequelae from these fistulae have a profound effect on the patients in view of their physical, psychological, and social dimensions. The treatment of vesicovaginal fistula is surgical in most cases and the choice of the repair technique is controversial. We evaluated the benefits of a laparoscopic approach in a patient with vesicovaginal fistulae. Here, we present our first experience using a simplified laparoscopic approach technique to repair vesicovaginal fistulae in our country.

CASE PRESENTATION

A 46-year-old Javanese woman presented with urinary incontinence following an abdominal hysterectomy 3 months earlier and received laparoscopic repair. A cystoscopy was performed to confirm the fistula orifice and a stent was inserted into the fistula tract from her bladder to her vagina. A tamponade was inserted into her vagina up to the vaginal apex, to be able to identify the vagina. She had adhesions; therefore, adhesiolysis was performed using a combination of sharp and blunt dissection to expose the vaginal stump and the superior aspect of her bladder. A simple cystotomy was performed and extended to include the fistulae site, and then the defect was repaired by using a running stitch. A second layer of closure was performed in an imbricating fashion with the same suture. The vagina defect was not closed separately but covered with an omental flap. This procedure takes approximately 2.5 hours; estimated blood loss was minimal and there were no intraoperative complications. She had no recurrent symptoms 6 months after surgery.

CONCLUSION

Our case report concludes that the simplified laparoscopic approach to vesicovaginal fistulae is a viable option for successful repair and that it reduces the size of bladder opening, causes minimal bleeding, and gives successful relief.

Meta-analysis of Optimal Management of Lower Pole Stone of 10 - 20 mm: Flexible Ureteroscopy (FURS) versus Extracorporeal Shock Wave Lithotripsy (ESWL) versus Percutaneus Nephrolithotomy (PCNL)

BACKGROUND

the optimal management of lower calyceal stones is still controversial, because no single method is suitable for the removal of all lower calyceal stones. Minimally invasive procedures such as extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and flexible ureteroscopy (fURS) are the therapeutic methods for lower calyceal stones. The aim of this study was to identify the optimal management of 10-20 mm lower pole stones.

METHODS

a meta-analysis of cohort studies published before July 2016 was performed from Medline and Cochrane databases. Management of 10-20 mm lower pole stone treated by fURS, ESWL and PCNL with follow-up of residual stones in 1-3 months after procedure were include and urinary stone in other location and size were excluded. A fixed-effects model with Mantzel-Haenzel 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 Review manager 5.3.

RESULTS

we analized 8 cohort studies. The stone free rate from 958 patients (271 PCNL, 174 fURS and 513 ESWL), 3 months after operation, was 90.8% (246/271) after PCNL; 75.3% (131/174) after fURS; and 64.7% (332/513) after ESWL. Base on stone free rate in 10-20 mm lower pole stone following management, PCNL is better than fURS (overall RR was 1.32 (95% CI 1.13 - 1.55); p<0.001 and I2=57%) and ESWL (overall risk ratio 1.42 (95% CI 1.30 - 1.55); p=<0.001 and I2 = 85%). But, if we compare between fURS and ESWL, fURS is better than ESWL base on stone free rate in 10-20 mm lower pole stone management with overall RR 1.16 (95% CI 1.04 - 1.30; p=0.01 and I2=40%).

CONCLUSION

percutaneus nephrolithotomy provided a higher stone free rate than fURS and ESWL. This meta-analysis may help urologist in making decision of intervention in 10-20 mm lower pole stone management.

Intracorporeal Dilatation Plus Al-Ghorab Corporoglandular Shunt for Salvage Management of Prolonged Ischemic Priapism

Ischemic priapism (IP) is a urological emergency that requires early intervention in order to prevent irreversible structural and functional changes. The purpose of penile shunt surgery is to passage out ischemic blood in the corpus cavernosum (CC), restoring the normal circulation within these structures. Here, we present our first experience using modification of Al-Ghorab shunt procedure to treat severe and prolonged IP. The Al-Ghorab shunt procedure was modified by the retrograde insertion of a 7/8 Hegar dilator into the opening of the distal cavernous tissue via the original Al-Ghorab incision. Priapism was successfully relieved, and no recurrent IP was reported.

Effects of Pipemidic Acid, Phenazopyridine HCL and Sodium Diclofenac on Pain Perception Following Endoscopic Urological Surgery: Double-blinded Randomized-Controlled Trial

AIM

to evaluate the analgesic effect, the side effects and the safety of analgesics following endoscopic urological procedure.

METHODS

eighty patients who underwent endoscopic urological surgery at Kardinah Hospital, Tegal from June to July 2015 were divided into four groups. The experimental group was administered analgesic for 4 days pipemidic acid (A) 400 mg bid, or phenazopyridine (B) 200 mg tid, or sodium diclofenac (C) 50 mg bid and the control (D) group was administered placebo tid for 4 days. The analgesic effects were assessed using Visual Analog Scale (VAS). Association between variables was assessed using Cramers V and Kruskall Wallis.

RESULTS

the endoscopic urological procedures consisted of 30 patients for URS, 6 patients for lithotripsy, 17 patients for TURP, 24 patients for removal JJ stent and 3 patients for cystoscopy. The mean age of group A, B, C and D (control) was 50.1 (13.7), 50.7 (14.8), 49.1 (13.4), and 49.6 (14.3) years, respectively, and follow-up period was 7 days. The VAS score in all experimental groups was less than control group on day 1 to 7 following endoscopic urological procedures (p<0.05). In the experimental group, there was no difference between groups B and C (p>0.05). Group A demonstrated a more favourable analgesic effect than B and C (p<0.05). No serious side effects were detected in any of the cases.

CONCLUSION

we conclude that oral analgesics are effective for pain relief following endoscopic urological surgery. Pipemidic acid was found to have a superior analgesic effect than phenazopyridine HCl and sodium diclofenac.

Comparison Between End-to-end Anastomosis and Buccal Mucosa Graft in Short Segment Bulbar Urethral Stricture: a Meta-analysis Study

AIM

to compare long term follow-up between end-to-end urethroplasty and bucal mucosal graft for the management of patients with short bulbar urethral stricture.

METHODS

we conducted a meta-analysis of cohort studies. Literature research was performed on the MEDLINE, Science Direct, and EMBASE database including studies from 1980 through 2014. The inclusion criteria were patients with short bulbar urethral strictrure (sized 3 cm) undergoing end-to-end anastomosis (EE) and buccal mucosa graft (BMG) with the complication of voiding symptoms and sexual dysfunction 12 months. Pooled risk ratio (RRs) and 95% confidence interval (CIs) were calculated using Mantzel-Haenzel method, while the heterogeneity were determined through I2 value. Data analysis were done using Stata software version 10.0 (StataCorp).

RESULTS

We analyze 10 studies in this meta-analysis. Sexual dysfunction following EE and BMG were found in 24.6% (45/183) patients and 9.1% (11/122) patients, respectively (overall RR 2.54; 95% CI: 1,44-4,47; p=0.001). Voiding symptoms following EE and BMG were found in 14% (8/57) patients and 12.5% (7/56) patients, respectively (overall RR 0.77; 95% CI: 0.3-2.0; p=0.591). Furthermore, stricture recurrent following EE and BMG were 8.4% (8/107) and 30% (14/46), respectively (overall RR 0.38; 95% CI: 0.17-0.84; p=0.016). The effectiveness of EE and BMG were found to be equal as both demonstrated few complications. BMG were found to be superior than EE terms of minimal sexual dysfunction complication. On the contrary, EE were found to be superior than BMG in terms of stricture recurence following short bulbar urethral stricture surgery.

CONCLUSION

BMG can be considered as the primary treatment rather than EE for managing short urethral stricture cases.

Association between tumor-associated macrophages and microvessel density on prostate cancer progression

Background

To evaluate tumor-associated macrophages (TAMs) infiltration and microvessel density as possible prognostic factors related to prostate cancer (PCa) progression.

Methods

Immunostaining of TAMs in prostate biopsy specimens was performed using a monoclonal antibody CD68 and microvessel density (MVD) using von Willebrand factor (vWF) from 25 specimens with high-grade prostatic intraepithelial neoplasia (HGPIN) and 25 specimens with PCa after transurethral resection of the prostate (TURP). Six microscopic (×200) fields were selected for TAM counting and six microscopic (×100) fields were selected for MVD counting around the cancer foci. Association between age, preoperative prostate-specific antigen (PSA), pathologic Gleason sum (GS), TAM, MVD, extracapsular extension, and metastasis were assessed using Pearson/Spearman, Student t test/Mann-Whitney U test and one-way analysis of variance/Kruskal-Wallis test.

Results

The mean of age, PSA, TAMs, and MVD were 69.1 ± 9.9, 67.1 ± 92.4, 26.2 ± 11.9, and 31.4 ± 14.0, respectively, from 50 specimens with PCa and HGPIN. Increasing TAMs number was not correlated with increasing MVD number and there was no significant mean difference statistically (P > 0.05) in TAMs and MVD although the mean of TAMs number was higher in PCa versus HGPIN but significant in PSA level (P < 0.001). In PCa specimens, age, PSA, TAMs, and MVD number were higher in patients with metastatic and extracapsular extension, but not significant statistically (P > 0.005). There was no correlation between TAMs and MVD (P > 0.001).

Conclusions

TAMs and MVD had increased PCa but did not provide independent prognostic value. Increasing numbers of TAMs was not always followed by an increase in MVD. HGPIN is the most likely precursor for PCa.

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.

Effective dose and adverse effects of maintenance Bacillus Calmette-Gue'Rin in intermediate and high risk non-muscle invasive bladder cancer: a meta-analysis of randomized clinical trial

AIM

To evaluate the effective dose and adverse effects of BCG doses.

METHODS

We searched published RCTs in Medline and Cochrane database before October 2013. Article using maintenance BCG after TUR in intermediate-high risk non-muscle invasive bladder cancer (NMIBC) and followed for effectiveness, local and systemic side effect are included. Low risk patients, other dose and MIBC were excluded.

RESULTS

Meta-analysis of 6 clinical trials involving 2719 intermediate-high risk NMIBC patients showed recurrence rate in full dose (81 mg), low dose (27 mg) and very low dose (13.5 mg) were 33.3%, 34.7% and 30%, respectively. Meta-analysis of 2175 patients, 81 mg BCG was found to be superior to 27 mg in reducing tumour recurrences (RR 0.86; 95% CI 0.77-0.96, I2=0% and p=0.008). Meta-analysis of 544 patients, the effectiveness reducing tumour recurrences in 27 mg BCG was found to be superior to 13,5 BCG (RR 0.66; 95% CI 0.49-0.89, I2=8.8% and p=0.006). Systemic side effects were happened in 25%, 28.5%, and 15.5% in the doses 81.27 and 13.5 mg BCG, respectively. Low dose was superior to full dose in affecting systemic side effect (p=0,000) but no difference in affecting local side effect (p=0.137) in the meta-analysis of 1816 patients in 2 clinical trials.

CONCLUSION

Full dose BCG had superior outcome to reduce recurrences compared to low dose and very low dose. There were no significant differences between each dose in local side effect. However full dose regimen has higher systemic side effect compared to low and very low dose.