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All Journal Majalah Kedokteran Bandung Indonesian Journal of Urology Folia Medica Indonesiana Indonesian Journal of Cancer JBN (Jurnal Bedah Nasional)
Sunaryo Hardjowijoto
Department Of Urology, Faculty Of Medicine, Universitas Airlangga/ Dr. Soetomo General Academic Hospital, Surabaya
Health Professions Medicine & Pharmacology Public Health Other

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NATRIUM DIKLOFENAK UNTUK PENGOBATAN NOKTURIA YANG DISEBABKAN OLEH NOCTURNAL POLYURIA Sunarno, Eddy; Alif, Sabilal; Hardjowijoto, Sunaryo; P, Widodo J
Indonesian Journal of Urology Vol 16 No 1 (2009)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v16i1.358

Abstract

Objective: To investigate the efficacy of diclofenac 50 mg (Non-Steroidal Anti-Inflammatory Drug) in the treatment of nocturnal polyuria. Materials and methods: Twenty four patients (23 male and 1 female) with a mean age of 61 years (range 34 – 80) diagnosed with nocturnal polyuria were recruited. The study period comprised 2 weeks of either placebo or active medication. Following one-week rest period, patients were crossed over to the other medication for a further 2 weeks. Frequency volume charts were completed during the second week of each of the two study periods along with feedback forms to assess any subjective improvement in symptoms during each of the study periods. Results: A significant improvement in the symptoms was noted for diclofenac when compared with the placebo. The mean nocturnal frequency decreased from 3,61 ± 2,45 to 2,39 ± 1,1 (p<0,05) and the mean 24 h urine volume decreased from 1139,64 ± 365 to 1089 ± 324 (p>0,05), but there is no statistically different. No significant side effects were reported. Conclusion: Natrium diclofenac 50 mg are effective in the treatment of nocturnal polyuria causing a decrease in nocturnal frequency with subjective symptom improvement. Our study suggests, Natrium diclofenac not to prolonged treatment. Further research to find the alternative treatment is recommended.
HUBUNGAN ORKIDEKTOMI DAN DETORSI DENGAN RESPON IMUN TESTIS KONTRALATERAL PADA TORSIO TESTIS Ongkorahardjo, Edwin; Hardjowijoto, Sunaryo; Soetojo, Soetojo
Indonesian Journal of Urology Vol 15 No 1 (2008)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v15i1.361

Abstract

Objective: In attempt to explain effects of orchiectomy and detorsion in contralateral testis immune response after unilateral testicular torsion. Materials and methods: Forty eight rattus norwegicus strain wistar white rats testes underwent 720º unilateral left testicular torsion. The experimental animals were divided into 6 group: 2 had sham operation which served as control, 2 groups had ligation left testicular torsion with subsequent orchiectomy at 4 and 24 hours, 2 groups had ligation left testicular torsion followed by detorsion at 4 and 24 hours. Contralateral testes were analyzed 7 days later for examination percentage of IL-4 producing lymphocyte and immunoglobulin G producing plasma cells in contralateral testis by means of immunohistochemical method. Results: Multivariate analysis result revealed that in unilateral left testicular torsion followed by detorsion at 24 hours group we found IL-4 and IgG had entered intratubules and were different from orchiectomy and control group (p=0,0001 and p=0,0001). This indicated damage of germinal epithelium in contralateral testes caused by imunologic response stimulated by detorsion. In left testicular torsion and orchiectomy or detorsion at 4 hours did not show both IL-4 and IgG in intratubules and no significant different both IL-4 and IgG in extratubules among orchiectomy, detorsion and control group (p=0,326 and p=0,064). This indicated that in 4 hours immune response were not significantly different between those groups and germinal epithelium were still intact. Conclusion: Detorsion in 24 hours testicular torsion had stimulated immune response which caused damage of germinal epithelium in contralateral testis. In 4 hours testicular torsion immune response happened not significantly different between detorsion, orchiectomy and control.
PERBANDINGAN DAN PENYEBARAN ESCHERICHIA COLI DAN KLEBSIELLA PNEUMONIAE PENGHASIL EXTENDED SPECTRUM BETA-LAKTAMASE PADA ISOLAT URINE PASIEN PRIA DENGAN KATETER DAN TANPA KATETER Husada, Satrya; Hardjowijoto, Sunaryo; Gardjito, Widjoseno
Indonesian Journal of Urology Vol 15 No 1 (2008)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v15i1.364

Abstract

Objective: membandingkan dan menelaah penyebaran bakteri Eschericchia coli dan Klebsiella pneumoniae penghasil ESBL pada pasien dengan kateter dan tanpa kateter. Material & methods: Sampel dalam penelitian ini adalah 194 orang pasien di bagian urologi RSU Dr. Soetomo Surabaya Yang memenuhi criteria inklusi, yang dibagi dalam 2 kelompok secara random. Sembilan puluh tujuh orang pasien dipasang kateter dan 97 orang yang lain tidak dipasang kateter. Bakteri yang diteliti adalah Eschericchia coli dan Klebsiella pneumoniae yang menjadi resisten akibat peran ESBL. Semua hasil kultur urine diperiksa dan dicatat. Results: Didapatkan Persentase kejadian E. coli pada pasien yang dipasang kateter lebih tinggi dibandingkan yang tidak dipasang kateter, yaitu 51,2% : 48,8%, sedangkan persentase kejadian K pneumonia pada pasien yang dipasang kateter lebih rendah dibandingkan yang tidak dipasang kateter, yaitu 45,5% : 54,5%. Persentase ESBL negatif pada pasien yang dipasang kateter lebih rendah dibandingkan yang tidak dipasang kateter, yaitu 38,9% : 61,1%, sedangkan persentase ESBL positif pada pasien yang dipasang kateter lebih tinggi dibandingkan yang tidak dipasang kateter, yaitu 72,2% : 27,8%. Persentase penyebaran E. coli dibandingkan K. pneumonia lebih tinggi pada E. coli, yaitu 34,9% : 27,3%. Conclusion: Tidak ada perbedaan penyebab kejadian infeksi oleh kuman E. Coli dan K. Pneumoniae pada pasien dengan kateter dan tanpa kateter. Angka kejadian E. coli dan K. pneumoniae penghasil ESBL pada pasien pemakai kateter lebih tinggi daripada pasien pria tanpa kateter di bagian urologi. Adanya penyebaran klonal E. coli dan K. pneumoniae penghasil ESBL dari pasien satu ke pasien urologi lain.       
EFFICACY AND SAFETY OF LUBRICATING JELLY INSTILLATION TO PREVENT RETROPULSION DURING URETEROLITHOTRIPSY FOR URETERAL STONES Yuanda, Rameshdo; Soebadi, Doddy M; Soetojo, Soetojo; Hardjowijoto, Sunaryo
Indonesian Journal of Urology Vol 24 No 2 (2017)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v24i2.377

Abstract

Objective: We studied the efficacy and safety of lubricating jelly instillation before ureterolithotripsy for prevention of retropulsion and improvement in stone-free rate. Material & methods: We enrolled 22 subjects with ureteral stone in this prospective, randomized, single-blind and controlled clinical trial. Each subject was randomly assigned to the lubricating jelly instillation group (n=11) and control group (n=11). Ureteroscopy and lithotripsy was performed according the standard protocol, using 9.8 F semirigid ureteroscope and pneumatic lithotripter. A 6 F ureteral catheter was advanced beyond the stone, and lubricating jelly was instilled through the catheter lumen. Retropulsion and the presence of residual fragments were evaluated with plain kidneys, ureters and bladder x-ray and ultrasonography, or Non Contrast-enhanced Computed Tomography. Any complication was reported and graded using the Modified Clavien Classification System.Results: The 2 groups had comparable preoperative characteristics. There were no statistically significant difference between the lubricating jelly instillation group and control group regarding the retropulsion rate (54.5% vs 72.7%, ρ=0.375), the stone-free rate (54.5% vs 36.4%, ρ=0.392), and the complication rate (45.5% vs 54.5%, ρ=0.670). Conclusion: Lubricating jelly instillation during ureterolithotripsy has limited value for prevention of retropulsion and improvement in stone-free rate.
RELATIONSHIP OF PERIURETHRAL FIBROTIC IN BPH PATIENT WITH LUTS AND URINARY RETENTION Zamroni, Zamroni; Hardjowijoto, Sunaryo; Soetojo, Soetojo
Indonesian Journal of Urology Vol 24 No 2 (2017)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v24i2.378

Abstract

Objective: Analyzing the differences between collagen thicknesses in periurethral region from transurethral resection of the prostate (TURP) specimens of Benign Prostate Hyperplasia (BPH) patients with lower urinary tract symptoms (LUTS) and of those with urinary retention. Material & methods: This was an observation analytic study on 30 patients who underwent TURP. Patients who met the inclusion criteria were divided into 2 groups: BPH patients with LUTS and those with urinary retention. Each group consisted of 15 people. The first TURP specimen of proximal verumontanum resection were examined in anatomic pathology using mass on strichrome staining as an examination of periurethral collagen thickness. Collagen will be stained as blue. Periurethral collagen thickness was measured from the basal membrane of transitional epithelium to fibromuscle tissue. Data were then statistically analyzed using independent t-test. Results: The average patient age was 66 ± 7 years old and there was no significant difference between age and periurethral collagen thickness with p=0.175 (p>0.05). The mean prostate volume was 47.19 ± 13.2 ml and there was no significant difference between prostate volume and periurethral collagen thickness with p=0.148 (p>0.05). Average periurethral collagen thickness in BPH patients with urinary retention was 146.67 ± 39.80 micrometers and while in those with LUTS was 205.33 ± 85.6 micrometers. There were no significant differences between periurethral collagen thickness and the occurrence urinary retention with retention of urine with p=0.063 (p>0.05). Conclusion: There were no significant differences between periurethral collagen thickness patients in BPH patients with LUTS and in those with urinary retention. This suggests that periurethral collagen thickness is not associated with the occurrence of urinary retention or LUTS in BPH patients.
THE EFFECT OF COMBINED α1-ADRENERGIC BLOCKERS AND PDE-5 INHIBITORS THERAPY ON IPSS, IIEF-5, QMAX AND PVR PATIENTS BPH WITH LUTS AND ERECTILE DYSFUNCTION Ridha, Muhammad; Hardjowijoto, Sunaryo; Renaldo, Johan
Indonesian Journal of Urology Vol 24 No 2 (2017)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v24i2.379

Abstract

Purpose: Assess the efficacy of combined α1-adrenergic blocker (tamsulosin 0,4 mg) and PDE5 inhibitor (tadalafil 5 mg) therapy compared to tadalafil or tamsulosin alone in treating patient BPH with LUTS and ED. Material and methods: A randomised, double blind experimental study assessed 36 sexually active men with ED and LUTS suggestive of BPH.  All patients were randomized to 3 groups: tamsulosin 0,4 mg (n=12), tadalafil 5mg (n=12), and combination of tamsulosin 0,4 mg and tadalafil 5 mg (n= 12), once daily for 6 weeks.  Changed in IPSS scores and QoL index, IIEF-5 scores, Qmax, PVR and blood pressure were assessed and compared to baseline. Complication and serious adverse event were also monitored.  Outcomes were assessed using ranked analysis of variance (ANOVA) and Kruskall-Wallis depends on data distribution and homogenity.Results:  Tamsulosin 0,4 mg once daily for 6 weeks were significantly improved IPSS score and QoL index and Qmax from baseline.  Tadalafil 5 mg once daily for 6 weeks were significantly improved IPSS score, QoL index and IIEF-5 index from baseline. Combined tamsulosin and tadalafil therapy were significantly improved IPSS score, QoL index, IIEF-5 index and Qmax from baseline.  Significantly better improvement on IIEF-5 dan Qmax from baseline were observed on the combination of tamsulosin and tadalafil compared to monotherapy with tamsulosin or tadalafil after 6 weeks in  patients BPH with LUTS and erectile dysfunction. There was no significant decreased in systolic and diastolic blood pressure from combined treatment compared to single treatment.Conclusions: Combined tamsulosin and tadalafil therapy was significantly better in improving IIEF aObjective: Assess the efficacy of combined α1-adrenergic blocker (tamsulosin 0.4 mg) and PDE5 inhibitor (tadalafil 5 mg) therapy compared to tadalafil or tamsulosin alone in treating patient Benign Prostate Hyperplasia (BPH) with lower urinary tract symptom (LUTS) and erectile dysfunction (ED). Material & methods: A randomised, double blind experimental study assessed 36 sexually active men with ED and LUTS suggestive of BPH. All patients were randomized to 3 groups: tamsulosin 0.4 mg (n=12), tadalafil 5mg (n=12), and combination of tamsulosin 0.4 mg and tadalafil 5 mg (n= 12), once daily for 6 weeks. Changed in IPSS scores and QoL index, IIEF-5 scores, Qmax, PVR and blood pressure were assessed and compared to baseline. Complication and serious adverse event were also monitored. Outcomes were assessed using ranked analysis of variance (ANOVA) and Kruskall-Wallis depends on data distribution and homogenity. Results: Tamsulosin 0.4 mg once daily for 6 weeks were significantly improved IPSS score, QoL index and Qmax from baseline. Tadalafil 5 mg once daily for 6 weeks were significantly improved IPSS score, QoL index and IIEF-5 index from baseline. Combined tamsulosin and tadalafil therapy were significantly improved IPSS score, QoL index, IIEF-5 index and Qmax from baseline. Significantly better improvement on IIEF-5 dan Qmax from baseline were observed on the combination of tamsulosin and tadalafil compared to monotherapy with tamsulosin or tadalafil after 6 weeks in  patients BPH with LUTS and erectile dysfunction. There was no significant decreased in systolic and diastolic blood pressure from combined treatment compared to single treatment. Conclusion: Combined tamsulosin and tadalafil therapy was significantly better in improving IIEF and Qmax, but not significantly better in improving IPSS and PVR compared to monotherapy with tamsulosin or tadalafil alone. Combined therapy was well tolerated without serious adverse effect.nd Qmax, but not significantly better in improving IPSS and PVR compared to monotherapy with tamsulosin or tadalafil alone.  Combined therapy was well tolerated without serious adverse effect.
TESTICULAR CANCER IN SOETOMO HOSPITAL SURABAYA: RETROSPECTIVE STUDY Mukti, Ade Indra; Hakim, Lukman; Djatisoesanto, Wahjoe; Hardjowijoto, Sunaryo
Indonesian Journal of Urology Vol 25 No 1 (2018)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v25i1.386

Abstract

Objective: The aim of this study was to determine the characteristics of the testicular cancer that were managed in Soetomo Hospital. Materials & Methods: This was a retrospective descriptive study. We reviewed the medical records of patient with testicular tumor admitted in Soetomo Teaching Hospital Surabaya, from January 2008 until December 2013. The data regarding demographic characteristics, clinical presentation, grading and staging based on pathological examination result, and the management of the cancer. Data was presented in tabular and narrative in order to know the number and percentage of testicular cancer in Surabaya. Results: There were 46 patients with testicular cancer with mean age of 27.1 ± 7.9 years. Peak incidence was 15–35 years old (54%). Testicular mass was the most frequent clinical presentation in 42 patients (91%), abdominal mass and other complaints in 4 patients (9%). Most of the patients live outside Surabaya in 34 patients (72%). Location of the tumor was more frequently in scrotum, which occured in 42 patients (91%). A total of 4 patients (9%) were found to have a history of UDT. Based on the TNM staging, patients with stage pT3 were as many as 20 patients (43%), pT4 11 patients (24%), pT2 7 patients (15%) and pT1 4 patients (9%). In regional lymph nodes staging (N) N3 were as many as 26 patients (57%), N0 9 patients (20%), N2 5 patients (11%) and N1 2 patients (4%). Metastase staging (M) M0 was found in 27 patients (58%) and M1 tumor was found 42%. The major pathological finding was seminoma in 37 patients (80%), Yolk sac tumor in 4 patients (9%), Embryonal Ca in 1 patient (2%), Teratoma in 1 patient (2%) and mixed germ cell tumor in 3 patients (7%). The most widely theraphy was underwent orchidectomy followed by PEB chemotheraphy in 29 patients (64%), 3 patients (6%) underwent EBRT and PEB chemotheraphy, 5 patients (11%) underwent PEB chemotheraphy, There were 9 patients (19%) underwent orchidectomy alone. Group of seminoma tumor show normal limit of tumor marker α-FP and β-HCG and increased in non seminoma. Conclusion: Testicular cancer mostly appears in younger males. Most of testicular cancer was seminoma, diagnosed in advanced stage with metastase 42% of the patient. Most of the patients received orchidectomy followed by PEB chemotheraphy.
THE EFFECT OF POVIDONE IODINE INTRARECTAL TO REDUCE BACTERIURIA, BACTEREMIA, AND SIRS AFTER TRUS PROSTATE BIOPSY Aulia, Rifky; Rizaldi, Fikri; Hardjowijoto, Sunaryo
Indonesian Journal of Urology Vol 25 No 1 (2018)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v25i1.413

Abstract

Objective: To compare the incidence of bacteruria, bacteremia, and Systemic Inflammatory Response Syndrome (SIRS) after Transrectal Ultrasound (TRUS) of prostate biopsy for the patients whom given intrarectal povidone iodine, enema, prophylactic antibiotic with given enema and prophylactic antibiotic. Material & Methods: A Randomised, experimental study, 20 samples of men with suspicious of prostate cancer were divided into two groups, first group (control) were given enema (dulcolax supp 10 mg) and prophylactic antibiotic (ciprofloxacin 1000 mg), second group (treatment) were given enema (dulcolax supp 10 mg) prophylactic antibiotic (ciprofloxacin 1000 mg), and intrarectal povidone iodine befotre TRUS of prostate biopsy. Urine and rectal swab culture examination were performed before biopsy then urine, blood culture, and blood leucocyte 2 days after biopsy. To assess any bacterial translocation from rectum to urinary tract, we match the post biopsy urine culture antibiogram and rectal swab culture antibiogram before biopsy. Complications and serious adverse effects were also monitored. Outcomes were assessed using Unpaired T Test and Mann Whitney depends on the data distribution and homogeneity. Results: There was no significant difference bacteriuria between groups (p=0.26). Bacteremia and SIRS were not found within two groups 2 days after prostate biopsy.  Post biopsy bacteriuria positive patients antibiogram were compared with pre biopsy swab rectal culture antibiogram, there was no significant difference between two groups. But, significant correlation of pre biopsy rectal swab culture with post biopsy urine culture (p=0.04) were noted. Conclusion: Intrarectal povidone iodine before TRUS of prostate biopsy were not needed as part of rectal preparation, since enema and prophylactic antibiotic was proven to decrease the incidence of bacteriuria, bacteremia, and SIRS after TRUS of prostate biopsy. The occurrance of bacteriuria were caused by bacterial translocation from rectum to urinary tract.
EFFECT OF PERIURETHRAL INJECTION ADIPOSE-DERIVED STEM CELLS IN NERVE HEALING AND VOIDING BEHAVIOR FOR THE TREATMENT OF STRESS URINARY INCONTINENCE IN A RAT MODEL Rizaldi, Fikri; Purwati; Sandhika, Willy; Budiono; Hardjowijoto, Sunaryo
Indonesian Journal of Urology Vol 28 No 1 (2021)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v28i1.713

Abstract

Objective: To investigate whether ADSCs are capable of nerve repair in stress urinary incontinence. Material & Methods: Thirty rats were allocated to five groups for receiving a periurethral injection with Phosphate Buffer Saline (PBS) (B1,B2) and Adipose-derived Stem Cells (C1, C2). Functional assessments with Voided Stain on Paper (VSOP) Method were reassessed at 2 and 4 weeks after injection. The rat SUI model was generated by Vaginal Distention (VD). The regeneration of peripheral nerve was evaluated by PGP 9.5 immunohistochemical staining. Results: Results revealed significant peripheral nerve differences between ADSC group and other groups in 28 days using PGP 9.5 staining. Our functional assessment, Voided Stain on Paper (VSOP), showed that ADSC group had significant improvement in 14 days; unfortunately, our 28 days improvement was not substantial. Conclusion: Periurethral injection of ADSCs improves urine pattern in SUI-induced rats and increase the amount of peripheral nerve. This method may be a potential strategy for SUI treatment.
Embryonal Rhabdomyosarcoma of Prostate in Adult: A Rare Case Report Dimas Panca Andhika; Sunaryo Hardjowijoto
Folia Medica Indonesiana Vol. 57 No. 2 (2021): June
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (399.309 KB) | DOI: 10.20473/fmi.v57i2.21594

Abstract

Rhabdomyosarcoma is the fifth most common type of soft tissue solid tumor in children and the most common in the last two decades. Rhabdomyosarcoma of the urogenital organ is a rare mesenchymal tumor, covering 22% of all Rhabdomyosarcoma cases. The two most common histologic types are alveolar and embryonal, whereas botryoid and spindle cells are rarely found. We reported a case of embryonal Rhabdomyosarcoma of the prostate. In this study, we improved the understanding of Embryonal Rhabdomyosarcoma of the prostate on 23 years old male who had a history of swelling in the perineal area and a history of falling from a height in the groin area 5 months before. The patient complains of the difficulty of urinating and hematuria one month after falling. We underwent drainage of the swelling area, found pus 100cc and took a sample for pathological examination. The result was embryonal rhabdomyosarcoma. Prostate volume was 122cc, PSA 5,32 and PSAD 0,04. The CT scan result was solid mass size 15x8x18 cm at perineum enhance to the pelvic cavity, push the bladder to the superior, rectum to posterior, and urethra posterior to the left side. We diagnosed this patient as Embryonal Rhabdomyosarcoma prostate T2bG1N0M0 (stage 3) group 3 and intermediate-risk group. The patient underwent VAC chemotherapy based on D.9803 (IRS V) protocol and planned radiotherapy, but it stopped at halfway because of profuse bleeding. Embryonal Rhabdomyosarcoma is an aggressive tumor, especially in adults. However, there was limited evidence and guideline to diagnose and manage the disease.
Co-Authors A.A. Ketut Agung Cahyawan W Agung Dwi Wahyu Widodo Anak Agung Ngurah Oka Diatmika Aryati Aryati Aulia, Rifky Basuki B Purnomo, Basuki B Budiono Dimas Panca Andhika Doddy M Soebadi Doddy M. Soebadi Eddy Sunarno, Eddy Edwin Ongkorahardjo, Edwin Endang Joewarini Endi Prilansa Mahadi Fadhli Hasan Fauriski Febrian Prapiska, Fauriski Febrian Gondo Mastutik heri budiono I Wayan Yudiana I'tishom, Reny Ida Bagus Putra Pramana Johan Renaldo Juniastuti Juniastuti Kusuma, Raditya Lukman Hakim Lukman Hakim M. Andriady S. Nasution M. Asro Abdih Marta Hendry, Marta Meles, Dewa Ketut Moh. Ayodhia Soebadi Mohamad Ayodhia Soebadi Mohammad Ayodhia Soebadi Muhammad Ridha Mukti, Ade Indra Nurhadi, Pradana Purwati Purwati Purwati putri, Karinda triharyu caesari RIFKYA ULIA, RIFKYA Rizaldi, Fikri Sabilal Alif Satrya Husada, Satrya septa surya wahyudi, septa surya Septina Rahayu, Septina Soetojo Soetojo Suhartono Taat Putra Tarmono Djojodimedjo Taufik Indrawan Triyono Karmawan Sukmana Pria wahjoe djatisoesanto Wardhana, Sonny Andikha Wayan Suarsana Widjoseno Gardjito, Widjoseno Widodo J P Widodo J Pudjirahardjo Widodo J Pujiraharjo Willy Sandhika Yuanda, Rameshdo Zamroni Zamroni