Garuda - Garba Rujukan Digital

PROGNOSTIC FACTORS TOWARD BLADDER CANCER PATIENT RECOVERY AFTER RADICAL CYSTECTOMY SURGERY Triyaka, Rendy; Ahmad Zulfan Hendri
Indonesian Journal of Urology Vol 28 No 2 (2021)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v28i2.678

Objective: This study aimed to know independent prognostic factors to predict the recovery time of bladder cancer patients after radical cystectomy. So that it would be a consideration to determine patient feasibility before surgery and after surgery management. Material & Methods: This study was an observational analytical study with a retrospective approach to examine the relationship between pre-surgery variables of the bladder cancer patients and the duration of treatment post radical cystectomy. Results: From the results of this study, it is known that the average length of postoperative care for older patients (above 65 years) was lower when compared to patients under 65 years with averages of 17.08 and 18.03 days respectively p-value of this analysis was 0.781. Patients with low hemoglobin, albumin, and HALP scores had longer postoperative hospitalization periods but with P values of 0.384, 0.276, and 0.603, the ileal conduit has the longest hospitalization treatment period between the two other procedures, with a P-value of 0.904. It was found that the average length of postoperative care for underweight patients was 16.5 days and for patients with normal BMI was 19.59 days. The difference between these averages showed a p-value of 0.396 it is known that the average length of postoperative care for older patients (above 65 years) was lower when compared to patients under 65 years with averages of 17.08 and 18.03 days respectively. The p-value of this analysis was 0.781 it was found that patients with low hemoglobin, albumin, and HALP scores had longer postoperative treatment periods, p-value 0.384, 0.276, and 0.603. The average duration of postoperative care for patients who applied the ERAS protocol tended to be faster (15.67 days) compared to patients who did not apply the ERAS protocol (18.16 days). Nevertheless, the p-value of this difference was 0.518. Conclusion: This study concludes that there is no prognostic factor that can independently predict the duration of treatment of bladder cancer patients post-radical cystectomy. Therefore in-depth assessment of various factors is required before performing radical cystectomy to achieve the best postoperative recovery rates.

Reducing post-radical cystectomy complications with enhanced recovery after surgery (ERAS) protocol: is it time to change? Ahmad Zulfan Hendri; Muhammad Mauny Puteh; Said Alfin Khalilullah; Andy Zulfiqqar
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 52, No 4 (2020)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Radical cystectomy (RC) remains associated with a greater number of postsurgical complications than any urological procedure. Enhanced recovery after surgery (ERAS) protocol is a multimodal perioperative care pathway designed to achieve early postsurgical recovery. We evaluated the perioperative outcome of post-RC patients, comparing the effectiveness of ERAS to conventional recovery protocols. We identified 37 patients who underwent RC for bladder cancer from 2016 to 2018. The characteristics, complication rate and clinical outcomes were evaluated in these groups of patients. In this study, the mortality was 8.1%, and the complications were 37.8%. The most frequent complications were anastomotic leakage (16.2%), wound dehiscence (13.5%), infections/sepsis (8.1%), and paralytic ileus (8.1%). The ERAS protocol significantly reduced operative time (p=0.001; OR=216; CI95%: 12.0-3855.2) and reduced overall complications (p=0.04; OR= 0.14 CI95%: 0.016-1.132). Extensive complications and mortality develop following the RC procedure. Meanwhile, refinement in perioperative care has been reducing the rate of serious complications. The ERAS protocol distinctly reduces the post-RC complication rate.

Diagnosis value of prostate specific antigen density (PSAD) and prostate specific antigen (PSA) in bone metastases of prostate cancer among Indonesian population Ahmad Zulfan Hendri; Andy Zulfiqqar; Indrawarman soeharjo; Raden Danarto
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 52, No 2 (2020)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Cancer prostate (PCa) is currently reported as the most diagnosed cancer in males. Bone metastases in PCa indicate poor prognosis and the major cause of pain and death. Early diagnosis of metastases is important in PCa management. Prostate specific antigen (PSA) velocity was used to predict overall survival and metastasis-free survival. However, this test should be conducted 2 times, for at least 4 weeks apart. Therefore, a cross-sectional test with higher positive probability value is needed. This study aimed to compare PSA density (PSAD) and PSA level to evaluate patients at risk of bone metastases in Yogyakarta, Indonesia. Aretrospective study with a total subject of 106 patients with (n = 31) and without (n = 75) bone metastases were analyzed. The initial PSA measurement, as well as bone scan and prostate volume, were evaluated in all patients. Bone survey found to be positive in 31/106 (29.2%) patients. The total of 50(47.2%), 10(9.4%) and 46(43.4%) patients had PSA level <50, 50-100 and >100ng/mL, respectively. Furthermore, receiver operating characteristic (ROC) area under the curve of PSAD (0.75) was higher that that ofPSA (0.65).PSAD more than 0.15 indicated sensitivity of 93% and specificity of 38%, while PSA more than 20 ng/mL shown sensitivity 82% and specificity 21%. In conclusion, PSAD level more than 0.15 shows high sensitivity and specificity in causing potential skeletal metastases. Using this PSAD cut-off value, unnecessary investigation canbe avoided.

Prostat cancer profile in Dr. Sardjito General Hospital Yogyakarta Yurisal Akhmad Dany; Ahmad Zulfan Hendri; Indrawarman Soerohardjo
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 53, No 3 (2021)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Prostate cancer is the fourth most common type of non-skin malignancy in male malignancies. In Indonesia, the definitive data are unreported, however, Globocan reported prostate cancer in 5th place in 2018. Early diagnosis and treatment of this cancer are associated with reduced mortality rates. This study aimed to investigate the profile of prostate cancer in Dr. Sardjito General Hospital, Yogyakarta, Indonesia. A retrospective study involving a total of 90 prostate cancer patients who underwent follow-up care at Dr. Sardjito General Hospital, Yogyakarta in the period of 2015 to 2020 was conducted. Data of the patients from their medical records consisted of age, gender, prostate volume, PSA level, testosterone level, hydronephrosis, TURP history, histopathology results, Gleason scores, ISUP grade, and staging TNM were collected. The average of patients age was 67 ±10.4 y.o. where 22 (24.4%) patients aged < 60 y.o., 34 (37.8%) patients aged 61-70 y.o. and 34 (37.8%) patients aged >70 y.o. Almost of all patients (87 patients or 97.8%) were diagnosed as adenocarcinoma. Most of patients (73 patients or 81.4%) had prostate volume (TAUS) > 30 cm3 with the median at diagnosis was 51 cm3 (38.3 – 104.4). Furthermore, the median of PSA for diagnosis was 234.4 (94.4 – 1720.3) ng/mL and the median of testosterone level at diagnosis was 317 (10 - 384) ng/dL. In conclusion, most patients with prostate cancer are identified as adenocarcinoma with metastatic stage. In general, the prostate cancer patients age more than 61 years old with prostate volume (TAUS) > 30 cm3. In addition, prostate volume and testosterone level can be routinely used as initial screening and periodic assessment to evaluate prognosis and disease progression.

Characteristics of Bladder Cancer in Dr. Sardjito General Hospital Yogyakarta: a 5-Year Report Fitra Hardian Prisnamurti; Ahmad Zulfan Hendri; Aria Danurdoro
Indonesian Journal of Cancer Vol 16, No 1 (2022): March
Publisher : National Cancer Center - Dharmais Cancer Hospital

Background: Bladder cancer is the eleventh most common malignancy worldwide and the sixth cancer in men. Bladder cancer shows a male predominance with a sex ratio of 4:1. Most bladder cancers are transitional cell carcinoma, and the other tumors are squamous cell carcinoma, adenocarcinoma, and rare entities like small cell carcinoma. Clinical stage and grade are the most critical determinants of the prognosis of bladder cancer. Therefore, this study aims to evaluate the characteristics of bladder cancer in Dr. Sardjito General Hospital, Indonesia. Methods: We reviewed the medical records of patients with bladder cancer admitted to Dr. Sardjito General Hospital Yogyakarta from January 2015 until December 2020. The data were about demographic characteristics, clinical presentation and staging, grading and staging based on pathological examinations results, and cancer management. Results: This study found 282 patients with bladder tumors. Fifty patients did not meet the inclusion criteria so the remaining 232 patients consisted of 169 male patients (72.8%) and 62 female patients (27.2%). The stages of tumors when the patients first came in were T1 diagnosed in 46 patients (22.7%), T2 diagnosed in 81 patients (40%), T3 diagnosed in 11 patients (5.4%), and T4 diagnosed in 64 patients (31.6%). A total of 30 patients were found to have secondary bladder tumors. The pathological anatomy results showed that 177 patients (76.2%) had transitional cell carcinoma and 33 patients adenocarcinoma (14.2%). All patients had undergone Transurethral Resection of Bladder Tumor (TURBT) for diagnosis and staging, followed by definitive treatment. It consisted of TURBT and chemotherapy bladder instillation in 46 patients (19.8%), radical cystectomy in 84 patients (36.2%), partial cystectomy in 4 patients (1.7%), and multimodal therapy (en-bloc transurethral resection of bladder tumors (ERBT) and chemotherapy) in 26 patients (11.2%). There were 72 patients (31%) who underwent TURBT alone. Conclusions: From a 5-year study, we found similar results with previous studies that the most common bladder histopathological result is urothelial carcinoma. However, most patients presenting to our hospital have higher stages and grades, requiring radical treatment. These differences warrant a larger and more comprehensive, multi-center study in Indonesia.

The Relationship of Perioperative Blood Transfusion With Bladder Cancer Mortality In Radical Cystectomy Patients Aria Utama Nur Qohari; Ahmad Zulfan Hendri
Indonesian Journal of Cancer Vol 14, No 3 (2020): September
Publisher : National Cancer Center - Dharmais Cancer Hospital

Background: Perioperative blood transfusion is correlated to adverse effects which lead to mortality on a few cases of patients with malignancy, especially kidney tumors. The objective of this study is to evaluate the relationship between blood transfusion timings and survival of patients with bladder cancer who undergo radical cystectomy and measure the differences in the outcomes between patients undergoing intraoperative blood transfusion and patients undergoing blood transfusion after surgery.Methods: This research is a retrospective analytic study with a cohort design. Thirty patients with bladder tumors who performed radical cystectomy and did not undergo perioperativechemotherapy were included in the study data. Recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were analyzed by the Kaplan-Meier method and compared between groups with log-rank tests. Chi-square test was used for comparative evaluation of each group. Univariate and multivariate analyzes were performed to evaluate the relationship between clinical and pathological variables with risks such as RFS, CSS, and OS. P<.005 were considered statistically significant, and SPSS software was used for the entire analysis process.Results: From a total of 29 patients who had a radical cystectomy, 22 patients received perioperative blood transfusion. The 17 patients had the transfusion intraoperatively while the rest had the transfusion after the operation. The mean of blood loss was 1491 cc and the mean of survival was 13.2 months. Intraoperative blood transfusion was associated with a significantly increased risk of disease recurrence (HR: 1.32; P=.034), bladder cancer mortality (HR: 1.65; P=.015), and all-cause mortality (HR: 12.38; P=.013).Conclusions: Intraoperative blood transfusion is significantly associated with an increased risk of cancer mortality. Further investigation is needed to determine the biological mechanismsunderlying patient outcomes.

Correlation of neutrophil ratio to lymphocyte levels before therapy with the incidence of metastasis, lymph node involvements, in urothelial type muscle invasive bladder cancer in Indonesia Rudi Rafian; Ahmad Zulfan Hendri; Indrawarman Soerohardjo; Raden Danarto
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 54, No 3 (2022)
Publisher : Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19106/JMedSci005403202208

Bladder cancer is cancer originated from the bladder mucosa or urothelium. Bladder cancer is the 9th most common malignancy worldwide and the most common malignancy of the urinary tract. Studies show that cancer triggers an inflammatory response, which causes changes in circulating inflammatory cells. Examination of neutrophils and lymphocytes is an inexpensive examination, reproducible, and easily obtained. Neutrophil to lymphocyte ratio (NLR) values have been used in several studies to evaluate the inflammatory response that occurs in tumors. In urology, the importance of NLR has been recognized in predicting progression and aggressiveness in urothelial bladder tumors, kidney cancer (RCC/renal cell carcinoma), and upper tract urothelial carcinoma (UTUC). This study was a cross-sectional study obtained retrospectively by evaluating the medical records of patients diagnosed with muscle-invasive bladder cancer (MIBC) at Dr. Sardjito General Hospital, Yogyakarta, Indonesia from January 2017 to December 2019. The NLR data were categorized into NLR < 2.5 and > 2.5. As much as 150 patients with bladder cancer were included in this study, with a mean age of 56.43 ± 13.60 years. In the comparison of NLR values and the incidence of metastasis, there were 15 people (20%) with NLR values < 2.5 who had metastasis while 32 people (42.7%) from the group with NLR > 2.5 had metastasis (p = 0.003). In the comparison of NLR values and nodule involvement, there were 25 (33.3%) patients with NLR < 2.5 and 39 (52%) patients with NLR > 2.5 (p = 0.021). This study showed that patients with metastatic bladder tumors and lymph node involvement had a significantly higher NLR value. It can be concluded the NLR value can be used to predict the metastatic level and lymph node involvement in patients with bladder tumors. Even though it is not a specific marker of inflammation, the NLR examination is simple, affordable, easy to obtain, and widely available.

Analysis of hematological parameters in bladder cancer in early and advanced stages at Dr. Sardjito Hospital Hidayu Permata Hardi; Indrawarman Soerohardjo; Ahmad Zulfan Hendri
JKKI : Jurnal Kedokteran dan Kesehatan Indonesia JKKI, Vol 14, No 1, (2023)
Publisher : Faculty of Medicine, Universitas Islam Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20885/JKKI.Vol14.Iss1.art2

Background: Bladder cancer (BC) is the tenth most common cancer in both males and females. Early detection can improve the patient's chances of survival, giving patients with BC a good prognosis. The hematological parameter determines the number of leukocytes, hemoglobin, platelets, and Neutrophil-Lymphocyte Ratio (NLR) in the body. The presence of abnormal values on hematological parameters indicates that the patient is in poor condition.Objective: This study aims to compare hematological parameters between early-stage and advanced BC at Dr. Sardjito Hospital.Methods: This study was a retrospective cross-sectional study using patient medical records. By using the results of the anatomical pathology, pre-operative hematology evaluated the influence on the bladder cancer stage. The sample used consisted of 130 bladder cancer patients. Chi-square and regression statistical tests were used to analyze the collected data.Results: The advanced-stage group had considerably higher leukocytosis than the early-stage group (p = 0.000). Anemia predominated more in the later-stage group than in the earlier stage (p = 0.048). Additionally, the advanced-stage group experienced thrombocytosis more frequently than the early-stage group (p = 0.000). NLR was higher in the advanced compared to the early-stage group (p = 0.000).Conclusion: Patients with advanced bladder cancer were more likely to experience abnormal hematological parameters levels than those with the earliest stages of the disease.

SMART E-LEARNING OPTIONS FOR STUDENTS IN MEDICAL RESIDENCY AND CLERKSHIP DURING THE COVID-19 PANDEMIC zulfiqqar, Andy; Ahmad Zulfan Hendri; Soeroharjo, Indrawarman
Indonesian Journal of Urology Vol 30 No 1 (2023)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v30i1.813

Objective: This study aimed to evaluate medical resident and clerkship preferences for a variety of available Smart e-Learning options to better cope with this global pandemic. Material & Methods: This cross-sectional study using a web-based national survey was conducted between the 10th-20th of June 2020. As many as 91 of 200 (45.5% response rate) residents and clerks, who were randomly invited, responded to the survey and rated the available modalities for Smart e-Learning. Results: Generally, respondents choose morning scientific online meetings (rated 7.61/10), webinars on case discussion (7.58/10), and pre-recorded tips and tricks on surgery (7.32/10) as their favorite modalities of Smart e-Learning. Conclusion: Scientific meetings among faculty and video based learning are both equally favorite modalities of Smart e-Learning during this pandemic. Meanwhile, morning reports are the least favorite due to the majority of cases are emergency cases that lack interactive discussion. This study may provide more insights for medical faculties into how to better cope with this pandemic and continue to deliver high quality education in the ‘New Normal’ Era using Smart e-Learning options. Keywords: e-Learning, resident, clerkship, New Normal Era.

Title

Found 9 Documents
Search

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Title Search

Found 9 Documents Search

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Title

Found 9 Documents
Search