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A 87 YEARS OLD MALE WITH GIANT PROSTATIC HYPERPLASIA AND BLADDER STONES, THE LARGEST PROSTATE REPORTED IN INDONESIA Vera, Vera; Pramod, Sawkar Vijay
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.v24i2.277

Objective: The aim of this article is to report a case of Giant Prostatic Hyperplasia and see the correlation between volume of prostate and benign prostate hyperplasia (BPH) symptoms. Giant BPH is defined as a prostate weight over 200 g or 500 g; the lower threshold was suggested by Japanese authors. It’s extremely rare, with only 16 cases exceeding 500 g till 2013. Case presentation: Patient was an 87-year-old male with chief complaint of haematuria. We performed Transabdominal Ultra Sonography (USG) on the patient. Discussion: Transabdominal USG showed enlarged prostate with median lobe protruding into the bladder measuring 86 x 102 x 76 mm and 348 cc in volume. We performed transvesical prostatectomy. The large prostate was enucleated completely in one piece with 23 stones measuring about 1 cm in size. Grossly, the mass measured 12 x 8 cm and weighed 300 g. Histopathology evaluation revealed BPH. Conclusion: To our knowledge, this is the first giant BPH case being reported in Indonesia. We would like to emphasize that severity of BPH symptoms does not correlate with volume of the prostate. Unfortunately, we can not conclude that there were correlation between body mass index (BMI) and volume due to lack of BMI data from the literature.

GIANT CLEAR CELL RENAL CARCINOMA: A CASE REPORT Palgunadi, I Nyoman; Pramod, Sawkar Vijay
Indonesian Journal of Urology Vol 25 No 2 (2018)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v25i2.388

Objective: This article is aimed to report an unusual presentation of renal cancer T4N0M0 in which the tumor weighed about 5 kilograms in a patient admitted to Urology Department of Hasan Sadikin Hospital in Bandung, Indonesia, in August 2016. Case presentation: We report a case 62 year old male with history of growing mass in his left abdominal. There are also painless hematuria and weight loss of approximately 10 kg over the past 2 years. Discussion: Physical examination found a significant palpable, immobile and mild tender mass in the left upper quadrant of the abdomen. Abdominal Pelvic Computed Tomography (CT) scan revealed inhomogenous hypodens mass in the left kidney. Resection of the tumor revealed a 5 kg (22 x 25 x 18 cm, with total volume of 9.900 cm3) encapsulated neoplasm. Histophatological examination revealed a clear cell type renal cell carcinoma (RCC) with positive margin and Fuhrmann grade 2. In Asia, a giant chromophobe RCC exceeding 10 kg in weight was reported in 2009. As for previously reported giant clear cell RCC, we found out the data to be very limited. Conclusion: Giant RCC is rare, especially clear cell type in histophatological result. The size of the tumor reported in this article is considered as the largest-sized giant clear cell RCC ever reported in Asia. The size of the tumor in this case presented several challenges in the operative settings. However, the outcome and six months post-operative follow-up of the patient was satisfying in which there was no presence of single symptom within the six-month follow-up period.

LATERAL PERCUTANEOUS NEPHROLITHOTOMY: A CASE SERIES Wijayanti, Zola; Vijay Pramod, Sawkar
Indonesian Journal of Urology Vol 27 No 2 (2020)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v27i2.580

Objective: To report our experience on lateral PCNL in the management of complex kidney stone in patients with many morbidities. Case(s) Presentation: In our hospital, there were 2 cases of incomplete stone clearance after PCNL which underwent lateral PCNL. The first case was a 47 years old woman who was morbidly obese and some cardiac problems such as coronary artery disease (CAD) and arrhythmia. Her intravenous pyelography shows that she has incomplete double collecting system with kidney stone in her upper moiety. She underwent PCNL in supine position which was halted due to arrhythmia with rest stone on her upper moiety system. The second case was a 57 years old male with multiple right kidney stone with hydronephrosis in his upper calyceal system. He has some comorbidities such as obese and CAD. He had history of open kidney surgery and right PCNL. Due to incomplete stone clearance after first procedure and some morbidities of those patients, we decided to perform PCNL on lateral position of both cases. The surgery went successfully with duration of 100 minutes in average with less than 100cc of blood loss. Both of the patients were discharged on second operation day without any complication. Discussion: Positioning for the patient who undergo PCNL is important. The lateral position of PCNL is useful in morbid obesity and have least effect on cardiac and respiratory function. This technique proved to increase patient comfort and safety. Conclusion: Lateral PCNL is safe and effective procedure to treat kidney stone in patients with history of incomplete stone clearance after supine or prone PCNL. It also can be performed safely in patients with comorbidities.

LATERAL PERCUTANEOUS NEPHROLITHOTOMY: A CASE SERIES Wijayanti, Zola; Vijay Pramod, Sawkar
Indonesian Journal of Urology Vol 27 No 2 (2020)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v27i2.580

Objective: To report our experience on lateral PCNL in the management of complex kidney stone in patients with many morbidities. Case(s) Presentation: In our hospital, there were 2 cases of incomplete stone clearance after PCNL which underwent lateral PCNL. The first case was a 47 years old woman who was morbidly obese and some cardiac problems such as coronary artery disease (CAD) and arrhythmia. Her intravenous pyelography shows that she has incomplete double collecting system with kidney stone in her upper moiety. She underwent PCNL in supine position which was halted due to arrhythmia with rest stone on her upper moiety system. The second case was a 57 years old male with multiple right kidney stone with hydronephrosis in his upper calyceal system. He has some comorbidities such as obese and CAD. He had history of open kidney surgery and right PCNL. Due to incomplete stone clearance after first procedure and some morbidities of those patients, we decided to perform PCNL on lateral position of both cases. The surgery went successfully with duration of 100 minutes in average with less than 100cc of blood loss. Both of the patients were discharged on second operation day without any complication. Discussion: Positioning for the patient who undergo PCNL is important. The lateral position of PCNL is useful in morbid obesity and have least effect on cardiac and respiratory function. This technique proved to increase patient comfort and safety. Conclusion: Lateral PCNL is safe and effective procedure to treat kidney stone in patients with history of incomplete stone clearance after supine or prone PCNL. It also can be performed safely in patients with comorbidities.

PREDICTION OF HYPOECHOIC LESIONS ON ULTRASOUND OF PROSTATE CANCER BASED ON PSA INTERVAL AND GLEASON GROUP Ivan Mangunsong, Albert; Pramod, Sawkar Vijay; Safriadi, Ferry; Hernowo, Bethy S
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.v28i2.676

Objective: To evaluate hypoechoic lesion in transrectal ultrasonography of prostate (TRUS-P) predictive value on prostate cancer based on PSA Interval and Gleason Group. Material & Methods: An observational analytic study with a cross-sectional design take place from January 2015 to December 2018 analyzing patients who had undergone TRUS-P Biopsy at Hasan Sadikin Hospital. Patients are divided into several subgroups according to different PSA levels. A p-value < 0.05 was considered statistically significant. PPV, NPV, and Youden’s index were all indexes reflecting the performance of a diagnostic test. Results: There were 35 cases (49.3%) with a visible hypoechoic lesion in TRUS and 36 cases (41.7%) without a visible hypoechoic lesion. In our study, 23.9% of the patients with hypoechoic lesions were diagnosed with prostate cancer on TRUSP-Biopsy. The results of the analysis with Youden’s index show that PSA at intervals of 10-20 is the best predictor of diagnostic values. Then we analyzed the overall detection rate based on PSA interval. Patients with PSA > 20 ng/ml, hypoechoic lesions were significantly associated with Gleason Group. Conclusion: We concluded in our study that the hypoechoic lesion in transurethral ultrasonography of prostate could improve the predictive efficacy for diagnosing prostate cancer.

Comparison of Tissue Preservation using Formalin and Ethanol as Preservative Formula See Woan Shian; Arifin Soenggono; Sawkar Vijay Pramod
Althea Medical Journal Vol 3, No 3 (2016)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (251.392 KB)

Background: Tissue preservation can be performed through embalming, by providing the chemical embalming fluid to the human remains. Formalin’s preservative formula is the foundation for modern methods of embalming. Unfortunately, this preservative formula has several disadvantages. While Ethanol’s preservative formula is a considerable agent to replace formalin’s preservative formula. The aim of this study was to compare the tissue preservation using formalin and ethanol as preservative formula.Methods: This study was carried out from September–October 2014 in the Laboratory of the Department of Anatomy, Faculty of Medicine, Universitas Padjadjaran. The study used the laboratory experimental method with consecutive sampling of 16 Wistar Rats. Thirty two soleus muscles and thirty two colons were collected and divided into two groups. Each group consisted of 16 soleus muscles and 16 colons. Group 1 was preserved with formalin’s preservative formula and Group 2 was preserved with ethanol’s preservative formula. The two groups were preserved for six weeks. The tissue’s color, consistency, odor and the growth of bacteria were determined before and after treatment.Results: Tissues preserved with ethanol’s preservative formula had better tissue preservation in the aspect of color and odor, compared with formalin’s preservative formula. Both preservative formulas showed no growth of bacteria in tissues but failed to retain the consistency. All the data were analyzed with Chi-square test.Conclusions: Ethanol’s preservative formula preserves better quality of tissue compared to formalin’s preservative formula. [AMJ.2016;3(3):359–63] DOI: 10.15850/amj.v3n3.880

Laparoscopic Transperitoneal Approach for Vesicovaginal Repair : The First Experience in Hasan Sadikin Hospital Jumadi Santoso; Sawkar Vijay Pramod
Jurnal llmu Bedah Indonesia Vol. 43 No. 1 (2014): September 2014
Publisher : Ikatan Ahli Bedah Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.46800/jibi-ikabi.v43i1.75

Background. Obstetric fistula is a severe and debilitating condition occurring throughout the developing world. Although there are no accurate data on the incidence and prevalence of the condition, the majority of vesicovaginal fistulas develop after obstetric procedure, with delayed labour accounting for 90% of cases. Several techniques are available for repairing the fistulas. Transperitoneal approaches give good results even for difficult posterior located fistulas, but are associated with increased morbidity compared with the transvaginal approach. We performed a laparoscopic repair and omentum interposition. The objective of this article is to report our first experience in transperitoneal laparoscopic repair of vesicovaginal fistula in Hasan Sadikin Hospital. Method. A 31–year–old female presented with vesicovaginal fistula after sectio caersaeran because of de- layed labour. After a failed trial of conservative treatment with catheter drainage, a transperitoneal laparoscopic repair was performed. Cystoscopy was performed initially to confirm the fistula location and for bilat- eral ureteric catheterization. A 4–port technique was performed with the patient in the position with her legs in lithotomy position. Without opening the bladder, the fistula tract was excised with separation of the bladder from the anterior vagina wall. Both the bladder and vagina walls were then closed separately using intracorporeal suturing with an interpositional omentum. Results. Total operative time was 270 min. Normal diet was resumed on day 1, drain was removed on post operative day 1 and patient was discharged on the second day with an indwelling catheter. Food cosmetic result on wound operation and no leakage under cystogram after 2 weeks. The catheter was removed after 2 weeks. Conclusion. Laparoscopic transperitoneal repair of vesicovaginal fistula with omentum inteposition is feasible in Hasan Sadikin Hospital with good outcomes, short hospital days, and good cosmetics result. Still need more same cases before a final conclusion

Transperitoneal Laparoscopic Ureterolithotomy for Large Distal Ureteric Stone: The first Experience in Hasan Sadikin Hospital, Bandung Bacilius Agung Priyosantoso; Sawkar Vijay Pramod
Jurnal llmu Bedah Indonesia Vol. 43 No. 1 (2014): September 2014
Publisher : Ikatan Ahli Bedah Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.46800/jibi-ikabi.v43i1.76

Background. Laparoscopic ureterolithotomy has become an alternative to open surgery for removing large stones that is not amenable to endoscopic treatment. In most of the published literature, laparoscopic ap- proach for lower ureteric stone is described to be less successful than middle and upper ureter. Identifica- tion in anatomical landmarks and exposing the distal ureter has been the major boundaries in establishing laparoscopic distal ureteral stone. We hope to provide clarity and feasibility that may increase our knowledge in laparoscopic ureterolithotomy for large distal ureteral stone. Aim. The obbjective is to share our experience in laparoscopic ureterolithotomy for large distal ureteric stone with transperitoneal approach Methods. A 37 years old male has been diagnosed with a right hydronephrosis due to proximal ureterolithiasis and stone at left calyx inferior, first and stone migrated to right distal ureter on 12 hours prior surgery. He underwent laparoscopic ureterolithotomy with transperitoneal approach. Results. We successfully perform laparoscopic ureterolithotomy with transperitoneal approach on a 37 y.o male patient who diagnosed with a a right hydronephrosis due to distal ureterolithiasis and stone at left calyx inferior. Duration of operation was 45 minutes. Patient was discharged at 2nd postoperative day without any complications. Conclusion. A Transperitoneal laparoscopic ureterolithotomy for distal ureteric stone is a safe and feasible technique that should be an options on every patients who plan to undergo distal ureterolithotomy especially large stone

ASSESSMENT OF TOBACCO SCREENING AND SMOKING CESSATION RECOMMENDATION AMONG UROLOGISTS IN INDONESIA : A CROSS SECTIONAL ANALYSIS USING NATIONAL SURVEY Pramana, Henry; Pramod, Sawkar Vijay; Safriadi, Ferry
Indonesian Journal of Urology Vol 31 No 1 (2024)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v31i1.877

Objective: This study aims to assess the urologist role on tobacco screening and smoking cessation among bladder cancer patients in Indonesia. Material & Methods: A questionnaire regarding tobacco uses screening and smoking cessation recommendation practice patterns was sent to urologists in Indonesia via Ikatan Ahli Urologi Indonesia (IAUI) or Indonesian Urological Association (IUA). The survey was established by Google Form and was sent by email. Responses were automatically integrated to Google spreadsheet. Results: Total of 111 responses from 569 urologists in Indonesia were received, and of the respondents 96% were male and 4% were female. 70% urologists always educate their patients about smoking as one of risk factor for bladder cancer and only 4% never did it. Most common answer for the reason is patients never ask their urologists about it (7%). More than half (59%) of urologists sometimes discuss smoking cessation and 78% always recommend quitting smoking. The majority of responders have never smoked cigarettes (56%), 35% were former smokers, and 9% were current smokers. Conclusion: This study revealed that majority of urologists always educate that smoking is one of risk factor for bladder cancer and recommend to quit smoking. However, only 37% always discuss tobacco use cessation with their patients. Keywords: Tobacco use, smoking cessation, bladder cancer, urologist.

ASSOCIATION BETWEEN BODY HEIGHT AND DOUBLE J STENT INTRAVESICAL POSITION AND ITS RELATION WITH THE INDONESIAN VERSION OF URETERAL STENT SYMPTOM QUESTIONNAIRE (USSQ) Pramod, Sawkar Vijay; Siregar, Safendra; El Haq, Faris
Indonesian Journal of Urology Vol 31 No 2 (2024)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v31i2.880

Objective: This study aims to determine the relationship between the patient’s body height with the intravesical double J stent position and whether its position is related to the ureteral stent symptom questionnaire (USSQ). Material & Methods: A cohort study with a study population of patients inserted with double J stent size 4.7 Fr and length 26 cm was carried out at the Department of Urology Hasan Sadikin Academic Medical Center from July 2021 to July 2022. We assess the patient’s demographic features and different body heights into two categories, below and above average. Then we evaluate its stent position using a plain abdominal X-ray and the USSQ score. Results: Ninety samples were included in this study; 30 of them had a midline intravesical double J stent position, 30 pieces of contralateral, and 30 samples of ipsilateral. Only body height correlated to the stent’s position (p<0.05). The results of comparative statistical tests or the association of postoperative complications between 7 days and 30 days in the position of the double J stent midline, contralateral and ipsilateral had significant results (p<0.05). Stent with ipsilateral position showed a lower USSQ score. Conclusion: Men and women above the average height have a lower risk for migration stent to the contralateral side and are also associated with lower USSQ scores. Keywords: Double J stent, USSQ score, double J stent position.

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