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Laparoscopic Transperitoneal Approach for Vesicovaginal Fistula Repair: the First Experience Santoso, Jumadi
Indonesian Journal of Obstetrics and Gynecology Volume. 2, No. 4, October 2014
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To report our first experience in transperitoneal laparoscopic repair of vesicovaginal fistula in Dr. Hasan Sadikin Hospital. Method: A 31-year-old female presented with vesicovaginal fistula after cesarean section. Patient complained of urinary incontinence since 5 years ago. After a failed trial of conservative treatment with catheter drainage, a transperitoneal laparoscopic repair was performed. Initially, cystoscopy was performed to confirm the fistula location and for bilateral ureteric catheterization. A 4-port technique was performed with the patient in lithotomy position and slightly Trendelenburg. Without opening the bladder, the fistula tract was excised and the bladder was separated from the anterior vaginal wall. Both the bladder and vaginal walls were then closed separately using intracorporeal suturing, interposed with the omentum. Result: Total operative time was 270 minutes. Normal diet was resumed on day 1, drain was removed on the first day after surgery, and the patient was discharged on the second day with an indwelling catheter. Surgical wound showed good cosmetic result and no leakage was identified from cystogram after 2 weeks. The catheter was removed after 2 weeks. Conclusion: Laparoscopic transperitoneal repair of vesicovaginal fistula with omentum inteposition is feasible in Dr. Hasan Sadikin Hospital with good outcome, short hospital stay, and good cosmetic result. [Indones J Obstet Gynecol 2014; 4: 223-225] Keywords: laparoscopy, vesicovaginal fistula

Laparoscopic Transperitoneal Approach for Vesicovaginal Fistula Repair: the First Experience Santoso, Jumadi
Indonesian Journal of Obstetrics and Gynecology Volume. 2, No. 4, October 2014
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To report our first experience in transperitoneal laparoscopic repair of vesicovaginal fistula in Dr. Hasan Sadikin Hospital. Method: A 31-year-old female presented with vesicovaginal fistula after cesarean section. Patient complained of urinary incontinence since 5 years ago. After a failed trial of conservative treatment with catheter drainage, a transperitoneal laparoscopic repair was performed. Initially, cystoscopy was performed to confirm the fistula location and for bilateral ureteric catheterization. A 4-port technique was performed with the patient in lithotomy position and slightly Trendelenburg. Without opening the bladder, the fistula tract was excised and the bladder was separated from the anterior vaginal wall. Both the bladder and vaginal walls were then closed separately using intracorporeal suturing, interposed with the omentum. Result: Total operative time was 270 minutes. Normal diet was resumed on day 1, drain was removed on the first day after surgery, and the patient was discharged on the second day with an indwelling catheter. Surgical wound showed good cosmetic result and no leakage was identified from cystogram after 2 weeks. The catheter was removed after 2 weeks. Conclusion: Laparoscopic transperitoneal repair of vesicovaginal fistula with omentum inteposition is feasible in Dr. Hasan Sadikin Hospital with good outcome, short hospital stay, and good cosmetic result. [Indones J Obstet Gynecol 2014; 4: 223-225] Keywords: laparoscopy, vesicovaginal fistula

Relationship of Prostate-Urethral Angle and Intravesical Prostatic Prtusion with International Prostatic Symptoms Score and Uroflowmetry in Benign Prostatic Hyperplasia Patients Tjahjodjati, Tjahjodjati; Santoso, Jumadi
International Journal of Integrated Health Sciences Vol 3, No 2 (2015)
Publisher : International Journal of Integrated Health Sciences

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (3061.039 KB)

Objective: To investigate the correlation between Intravesical Prostatic Protrusion (IPP) and Prostate Uretral Angle (PUA) in Benign Prostatic Hyperplasia (BPH) patient with Lower Urinary Tract Symptoms (LUTS) on International Prostatic Symptoms Score (IPSS) and uroflowmetry.Methods: A cross sectional study was done to 71 BPH patients with LUTS who attended Urologic Clinic in Dr. Hasan Sadikin General Hospital and matched the inclusion and exclusion criterias. The Intravesical Prostatic Protrusion and PUA were measured using transrectal ultrasound and the degree of LUTS was measured using IPSS and uroflowmetry. Patients were classified based on PUA (<350 dan â‰¥350) and degree of IPP (grade 1< 5mm;II 5-10mm;III >10mm). Data were analyzed using Spearman correlation test. Results: Prostatic-Urethral Angle has a strong correlation with IPSS total and voiding (0.670 and 0.715) but the correlation was weak with IPPS storage (0.381). Furthermore, PUA has a strong negative correlation with Qmax dan Qave values. The bigger the PUA, the smaller Qmax dan Qave values. IPP has a strong correlation with IPSS total and voiding (0.645 and 0.662), but has moderate correlation with IPSS storage (0.442). Furthermore, IPP has no correlation with the values of Qmax, Qave, Voided volume and PVR.Conclusions: Prostatic-Urethral Angle and Intravesical Prostatic Protrusion have a strong correlation with the occurence of LUTS in BPH patients. Keywords: Benign prostatic hyperplasia, intravesical prostatic protrusion, lower urinary tract symptoms, prostate-urethral angleÂ DOI:Â 10.15850/ijihs.v3n2.583

THE ROLE OF BEDSIDE BLADDER SONOGRAPHY FOR DETECTION OF BLADDER TRAUMA Santoso, Jumadi; Adi, Kuncoro
Indonesian Journal of Urology Vol 23 No 1 (2016)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v23i1.80

Objective: To evaluate the role of bedside bladder sonography along with retrograde instilation of saline as a novel diagnostic procedure for suspected bladder trauma. Material & methods: Prospective evaluation of all patients with suspected bladder injuries admitted to the Emergency Department of Hasan Sadikin General Hospital, Bandung, Indonesia, from 2010–2013. Suspected urethral injury patients were excluded. Along with routine Focused Assessment Sonography for Trauma (FAST) procedure, bedside bladder sonography was performed concurrently with retrograde instillation of normal saline 350cc through a Foley catheter. The objective of real-time bladder sonogram was to examine the presence of peri-vesical free fluid turbulence and accumulation during saline instillation, which subsequently indicated a suspected bladder perforation. The accuracy of sonographic results were compared with computerized tomography (CT), cystogram or intraoperative findings. Time to diagnosis was recorded. Statistical analysis was performed to evaluate the sensitivity, specificity, positive predictive value (PPV), negative predictive value(NPV) and diagnostic accuracy. Results: 23 patients met the inclusion criteria. The mean age was 27.21 years old, 87% were males. Based on cystogram or intraoperative finding there are 21 patients have bladder rupture. Among these patients, 14 patients had positive result onbladder sonogram, and all confirmed positive on cystogram and operative finding. Nine patients had negative result on bladder sonogram. While 7 among them have positive result on cystogram or intraoperative finding. Analysis revealed 67% sensitivity, 100% specificity, 100% PPV, and 22.2% NPV. Overall diagnostic accuracy of bladder sonogram was 83.5%. Time to diagnosis were significantly shorter in bedside bladder sonogram compared to CT or cystogram (11.82 ± 2.99 min vs 181.30 ± 88.89 min; p < 0.05). Conclusion: Bedside bladder sonogram is a useful adjunct procedure for diagnosis of bladder trauma. It is time and cost effective, and can be performed in bed-side emergency setting with acceptable accuracy.

Laparoscopic transperitoneal approach for vesicovaginal repair : The first experience in Hasan Sadikin Hospital Santoso, Jumadi; Pramod, Sawkar Vijay
Indonesian Journal of Urology Vol 22 No 1 (2015)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v22i1.82

Introduction : 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 gynaecologic surgery, with transperitoneal hysterectomy 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. Objective : To report our first experience in transperitoneal laparoscopic repair of vesicovaginal fistula in Hasan Sadikin Hospital. Patient and Method : A 31-year-old female presented with vesicovaginal fistula after sectio caersaeran. 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 bilateral 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. Result : Total operative time was 270 min. Normal diet was resumed on day 1, drain was removed on post operatif day 1 and patient was discharged on the second day with an indwelling catheter. Good 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. Keywords : Fistula vesico vaginal, laparoscopic.

THE EFFICACY OF NASOGASTRIC TUBE IN A LARGE BLOOD CLOT EVACUATION DURING CYSTOSCOPY Wallad, Caesar Khairul; Santoso, Jumadi; Adi, Kuncoro
Indonesian Journal of Urology Vol 23 No 2 (2016)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v23i2.224

Objective: In this study we introduce using nasogatric tube as an alternative to procure a safe and efficient way to remove large troublesome blood clots during cystoscopy procedure. Material & methods: We prospectively perform blood clot evacuation using nasogastric tube suction (NGT) on 21 patients in Hasan Sadikin GeneralHospital Bandung,within 6 months period. A 24 fr sheath and 16 fr NGT connected to suction unit with a 300 mmhg negative pressure was set. A repetitive back and forth technique was set in motion during the procedure. Cystoscopy time and NGT suction time was documented. Results: All patients were successfully managed with this method without complication during the procedure. The average time for clot removal was 5 minutes 8 seconds with average cystoscopy time was 20 minutes 12 seconds and average estimated blood clots volume was 483 grams. Conclusion: Evacuation using NGT suction is effective, safe and an efficient way to remove a large bothersome clots.

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