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Meta analisis perbandingan luaran prosedur tubeless dan totally tubeless dibandingkan dengan prosedur nefrostomi pasca tindakan percutaneous nephrolithotomy Anak Agung Gde Oka
E-Jurnal Medika Udayana Vol 9 No 10 (2020): Vol 9 No 10(2020): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2020.V09.i10.P01

Percutaneous nephrolithotomy (PNL) with nephrostomy tube as a drainage has been considered the standard procedure. However, recently many literatures reporting the use of tubeless and totally tubeless as a drainage following PCNL with excellent results. This meta-analysis is aiming to evaluate the safety of tubeless PCNL and totally tubeless PCNL versus nephrostomy tube as a drainage following PNL. All eligible literatures were searched on MEDLINE and Cochrane Library database to identify all randomized controlled trials (RCTs) that compared tubeless and totally tubeless PNL versus nephrostomy tube following PNL. The analyzed outcomes were length of hospital stay, postoperative hemoglobin (Hb) drop, and postoperative analgesic requirements. Review Manager 5.0. was used to conduct the meta-analysis study. Eleven RCTs covering 806 subjects and consist of 9 RCTs for comparison I (tubeless PCNL vs nephrostomy tube PNL, 290 cases and 295 controls) and 2 RCTs for comparison II (totally tubeless PNL vs nephrostomy tube PNL, 113 cases and 108 controls) were identified. Tubeless PNL required significantly less analgesic and shorter length of hospital stay compared with nephrostomy tube PNL. Furthermore, there was shorter length of hospital stay in totally tubeless PNL compared with nephrostomy tube PNL. However, no significant difference was observed in the analyses concerning postoperative Hb decrease in both comparisons. Tubeless PNL and totally tubeless PNL are associated with shorter hospital stay compared with nephrostomy tube PNL. Tubeless PNL also associated with less analgesic requirement compared with nephrostomy tube PNL.

Usia dan obesitas berhubungan terhadap terjadinya penyakit benign prostatic hyperplasia di RSUP Sanglah Bali periode januari 2014 sampai desember 2014 Kadek Devi Ari Frasiska; Anak Agung Gde Oka
E-Jurnal Medika Udayana Vol 7 No 1 (2018): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (213.305 KB)

Benign protastic hyperlasia (BPH) is a disease affecting the prostate gland where the state of enlarged prostate will impede the flow of urine and cause symptoms. BPH is commonly suffered by middle aged to elderly men. There are many risk factors regarding to this disease, such as age and obesity. Therefore, the aims of this research to describe the relationship between age and obesity with the incidence of BPH. This research used descriptive analytic design and the samples were taken using consecutive sampling. Subject and place of research are men aged >40 who visited polyclinics urology department and were hospitalized in Sanglah Hospital during January until December 2014. Results of this research are from 138 samples in term of age, there were 65 elders, 66.2% suffered from BPH, while 33.8% did not. Out of 73 adults, 41.1 % suffered from BPH and 58.9% did not. After being analyzed using chi-square, the result showed that age had significant correlation to the occurrence of BPH with p=0.003. However, regarding to obesity factor, there were 98 persons with obesity, 49% suffered from BPH, and 51% did not. Meanwhile, 40 persons who were not obese, as many as 41.1% suffered from BPH, and 58.9% did not. After being tested using chi-square, the result showed that there was no significant correlation between obesity and BPH with p=0.184. Conclusion of this research are age is the risk factors of benign prostatic hyperplasia , whereas obesity is not a risk factor of BPH. Keywords: Benign prostatic hyperplasia, age, obesity

Procalcitonin and white blood cell as predictors of urosepsis in urinary tract obstruction patients at Sanglah Hospital Denpasar Gatot Triwono; Anak Agung Gde Oka; Desy Permatasari; Christopher Ryalino
Neurologico Spinale Medico Chirurgico Vol 2 No 2 (2019)
Publisher : Indoscholar

Introduction: Patients with urinary tract obstruction are often accompanied by urinary tract infections. In some cases, it develops into urosepsis that increases mortality. Early detection capability is essential. The purpose of this study was to determine the role of serum procalcitonin (PCT), nitrite urine (NU) and white blood cell (WBC) as urosepsis predictors in patients with urinary obstruction. Methods: This is a cross-sectional study involving 36 samples carried out at our hospital using consecutive sampling technique from December 2016 to February 2017. Statistical analyses used were a bivariate test and multivariate test using Poisson regression. Results: From the bivariate test analysis, serum PCT level of ≥0.25 ng/ml, positive result for NU, and a WBC amount of ≥12,000 cells/mm3 were predictors for urosepsis. In the multivariate test, we obtained a PCT serum level of ≥0.25 ng/ml, and WBC of ≥12,000 cells/mm3 were true predictors of urosepsis in patients with urinary tract obstructions with infections. Conclusion: Serum PCT and WBC can be used as a predictor of urosepsis in patients with urinary tract obstruction.

Correlation of total ischemic time to creatinine serum level and resistive index value in kidney transplant Putu Astri Novianti; Gede Wirya Kusuma Duarsa; Gede Andi Aditya; Anak Agung Gde Oka; Kadek Budi Santosa; I Wayan Yudiana; Pande Made Wisnu Tirtayasa; Ida Bagus Putra Pramana; Yenny Kandarini; Wayan Sudana; Djodi Sidartha; Raka Widiana
Neurologico Spinale Medico Chirurgico Vol 3 No 2 (2020)
Publisher : Indoscholar

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36444/nsmc.v3i2.109

Background: The transient period when the kidney donor was extracted until being anastomosed (total ischemic time) will aggravate many putative molecular ischemic-reperfusion injury mechanisms. Several studies have reported the risk of delayed graft function development, which can be reflected by creatinine serum (Cr) level and resistive index (RI) value. This study aims to determine the correlation of total ischemic time to Cr levels reduction in one-month post-transplantation and RI value. Methods: This was a cross-sectional retrospective study involving subjects who underwent kidney transplantation in Sanglah General Hospital. In this study, the primary parameters were total ischemic time, Cr level, and RI value. The total ischemic time is calculated using a stopwatch intraoperatively. Cr level was obtained from blood examination, and RI value was obtained from the ultrasonography test. Data analysis was analyzed statistically using SPSS 24.0, and p < 0.05 was considered significant. Results: About 17 kidney transplant subjects were included in this study. The mean total ischemic time was 105 minutes and 43 seconds. There was an insignificant negative correlation between Cr level reduction and total ischemia time (r = -0.36; p = 0.89). An analysis of the correlation of total ischemic time and RI value, there was a linear correlation, but statistically insignificant (r = 0.11; p = 0.66). Conclusion: Total ischemic time has a negative correlation with post-transplant creatinine serum level and a positive correlation with the post-transplant resistive index value, but these results are not statistically significant.

Usia dan obesitas berhubungan terhadap penyakit batu saluran kemih di RSUP Sanglah Denpasar periode Januari 2014 sampai Desember 2014 Nurfitriani Nurfitriani; Anak Agung Gde Oka
Intisari Sains Medis Vol. 10 No. 2 (2019): (Available online: 1 August 2019)
Publisher : DiscoverSys Inc.

Introduction: Urinary Stone Disease is the process of forming stones caused by the deposition of a substance with excess amounts of urinary or due to other factors that affect the solvency of substance. Urinary Stone Disease is frequently Â Â found on adults between 15-59 years old. Total patient who diagnosed by Urinary Stone Disease in Indonesia is too high. Many things associated against the onset of this disease, such as age and obesity. Therefore the research to examine which factors cause the occurrence of Urinary Stone Disease is necessary in order to raise the early prevention.Method: Research design is descriptive analytic. Using consecutive sampling method. Data will be analyzed in univariate and bivariate using statistical test of chi-square with a level of significance of Î± < 0.05. Place of research in Sanglah Denpasar Bali Subject of research are men and women above 15 years old, diagnosed with Urinary Stone Disease. Subject research are urology unit visiting patient also patient being hospitalized at Sanglah General Hospital.Result: The research results showed that the age has become risk factors which closely related with Urinary Stone Disease, value of p = 0.002. Obesity does not have significant relations against the occurrence of Urinary Stone Disease with value of p = 0,564.Concluison: Age has close relation with the occurrence of Urinary Stone Disease, while obesity has no relation towards the occurrence of Urinary Stone Disease diseases.

Perbandingan efektivitas teknik modifikasi dan konvensional pada operasi open pyelolithotomy batu staghorn I Gede Hendra Sucipta; Anak Agung Gde Oka; I Gede Raka Widiana
Intisari Sains Medis Vol. 10 No. 1 (2019): (Available online 1 April 2019)
Publisher : DiscoverSys Inc.

Background: Open pyelolithotomy for staghorn stone patient management has a high stone-free rate. The disadvantages of open pyelolithotomy include aesthetics and postoperative complications, so a breakthrough to reduce these complications is needed, which can be achieved by doing modified open pyelolithotomy.Objective: To compare the modified and conventional open pyelolithotomy techniques according to the duration of operation, the volume of surgical bleeding, pain, and post-operative drop in hemoglobin (Hb).Method: A quasi-experimental study with twenty-two samples of staghorn stone patients was collected from October 2016 to October 2017. Parametric tests were used as data were normally distributed and homogeneous. The independent t-test was used to compare each measured parameter according to the type of operation. Analysis of covariance (ANCOVA) was used to control the variables of age, gender, and body mass index (BMI).Result: The modified technique had a shorter operating duration than the conventional method (p < .05). The volume of surgical bleeding in the modified technique was lower compared to the conventional technique (p < .05). Pain scores in the modified technique were lower than the conventional technique (p <Â .05). The drop in Hb levels in the modified technique was lower than the conventional technique (p < .05). Analysis using ANCOVA found that the type of operation has a direct effect on the duration of operation, volume of surgical bleeding, and post-operative pain.Conclusion: The modified open pyelolithotomy technique was more effective than the conventional open pyelolithotomy technique based on the duration of operation, the volume of surgical bleeding, and post-operative pain scale. In this study, it was found that the drop in Hb levels was not directly affected by the type of surgery.

Karakteristik pasien batu ginjal dengan tatalaksana retrograde intra-renal surgery di Rumah Sakit Umum Pusat Sanglah dan Rumah Sakit Surya Husada: initial report tahun 2017-2019 I Made Nugraha Gunamanta Sabudi; Gede Wirya Kusuma Duarsa; Kadek Budi Santosa; I Wayan Yudiana; Pande Made Wisnu Tirtayasa; Ida Bagus Putra Pramana; Anak Agung Gde Oka
Intisari Sains Medis Vol. 11 No. 2 (2020): (Available online: 1 August 2020)
Publisher : DiscoverSys Inc.

Background: Renal stone is frequent cases that happened in the community. There are a lot of options to treat renal stone; one of them is RIRS. RIRS is an alternative procedure after ESWL and PNL for renal stone.Method: Twenty-seven samples as total sampling of all patients that were done with RIRS in Sanglah Hospital and Surya Husada Hospital from January 2017 until June 2019 retrospectively. Data were collected secondary from Medical Reports of the patients and showed a descriptive study depict how the RIRS patient characteristic in Sanglah Hospital and Surya Husada Hospital. All RIRS patients showed that the RIRS procedure is secondary due to history of ESWL, PNL, URS with insertion of DJ Stent, and or Nephrolithotomy.Results and Conclusion:Characteristic of age in this study was 52,41 years old in mean value, with male and female per cent, respectively 62,96% and 37,04%. Stone size of the study was classified to 4 cluster which are: (1) 37,04% cluster with stone size <1 cm, (2) 33,33% cluster with stone size â‰¥1cm to <2cm, (3) 3,70% cluster with stone size â‰¥2 cm, and (4) 25,93% cluster that with stone size unknown. This study also showed some similarity with two other studies about patient characteristic of RIRS treatment.Â Latar Belakang: Batu ginjal adalah kasus yang sering terjadi di masyarakat. Terdapat banyak pilihan tindakan untuk mengambil batu ginjal salah satunya adalah dengan tindakan RIRS. Tindakan RIRS masih menjadi alternatif tindakan setelah pilihan pertama PNL dan ESWL untuk batu ginjal.Metode: Penelitian ini mengambil 27 sampel pasien dari total sampling seluruh pasien yang dilakukan RIRS di Rumah Sakit Umum Pusat (RSUP) Sanglah dan Rumah Sakit (RS) Surya Husada selama Januari 2017 hingga Juni 2019 secara retrospektif. Data didapatkan dari data sekunder rekam medis pasien. Penelitian disajikan secara deskriptif memberikan gambaran karakteristik pasien yang mendapatkan tindakan RIRS. Seluruh pasien yang dilakukan RIRS di RSUP Sanglah dan RS Surya Husada merupakan pasien dengan mendapat RIRS Sekunder setelah sebelumnya memiliki riwayat pernah ESWL, PNL, URS dengan pemasangan DJ-stent, dan atau nefrolitotomi.Hasil dan Simpulan: Karakteristik usia rata-rata pada penelitian ini adalah 52,41 tahun dengan perbandingan persentase laki-laki perempuan berturut-turut 62,96% dan 37,04%. Ukuran batu pada penelitian dikelompokkan menjadi 4 kelompok dengan masing-masing kelompok: (1) 37,04% kelompok dengan ukuran batu <1 cm, (2) 33,33% kelompok dengan ukuran batu â‰¥1cm s/d <2cm, (3) 3,70% kelompok dengan ukuran batu â‰¥2 cm, (4) 25,93% kelompok yang ukuran batunya tidak tercantum.

The short-term disadvantageous of tension-suture and spica cast application in exstrophy-epispadias complex reconstruction: a case report Ida Bagus Putra Pramana; Anak Agung Gde Oka; Gede Wirya Kusuma Duarsa; Kadek Budi Santosa; I Wayan Yudiana; Pande Made Wisnu Tirtayasa
Intisari Sains Medis Vol. 10 No. 3 (2019): (Available online: 1 December 2019)
Publisher : DiscoverSys Inc.

Background: Exstrophy-epispadias complex (EEC) represents a spectrum of genitourinary malformations and associated with another congenital anomaly. EEC is a rare congenital disability. EEC affects the genitourinary system, anterior abdominal wall, musculoskeletal system, spine and anus. The surgical outcome has a lot of potential complications in patient with EEC. The decision to first approach is important for the next step. Herein, we reported a case of EEC with several anomalies. Case Description: A new-born male was born with section cesarean at 38 weeks of gestation from 34-year-old mother, and this is from the second pregnancy. The weight was 3300 grams, and the height was 48 centimetres. There was an abdominal wall defect with an exposed evaginated bladder plate with urine draining from the defect. A complete dorsally opened urethral plate was seen from the bladder neck down to the glandular grove. The patient was diagnosed with Exstrophy-epispadias complex (EEC). A 2 stage repair was conducted in this patient. After 10 days post-operation, the wound became dehiscence and got sepsis postoperatively as well as lead to die in the day 20.Conclusion: Wound dehiscence following reconstruction is very critical inpatient with EEC. Tension suture and spica cast application can be disadvantageous inpatient with EEC.

The relationship between urine specific gravity, urine pH, and blood uric acid levels to the type of urinary stones of patients with urolithiasis at Sanglah Hospital, Bali, Indonesia Jetty Kalembang; Anak Agung Gde Oka; I Gede Raka Widiana
Intisari Sains Medis Vol. 11 No. 2 (2020): (Available online: 1 August 2020)
Publisher : DiscoverSys Inc.

Background: Urine specific gravity, urine pH, and blood uric acid levels are risk factors for urinary tract stones. The urinary tract stones are formed due to the concentration of a solute exceeds its ability to remain in solution, resulting in supersaturation and crystallization. This study aims to determine the relationship between urine specific gravity, urine pH, and blood uric acid levels to the urinary stone's types in patients with urolithiasis at Sanglah HospitalMethods: A retrospective cross-sectional study was conducted among 95 subjects by using secondary data from the medical records in the period June 2017-2018 at Sanglah Hospital. The urolithiasis patient who met the inclusion and exclusion criteria were enrolled in this study. Data were analyzed by the Mann-Whitney Test and Kruskal-Wallis Test using SPSS version 17 for Windows.Results: The average age was 55Â±11 years old. Most of respondents were male (70.5%), normal Body Mass Index (BMI) (89.5%), urine pH <7 (75.7%), and mixed type of urinary stones (48.4%). There was a statistically significant relationship between the type of uric acid stone (p=0.029), blood uric acid levels (p=0.003), phosphate stone type (p=0.026), and magnesium stone (p=0.010) with urine pH. Besides, there was a statistically significant relationship between ammonium stone and blood uric acid levels types (p=0.022). A statistically significant difference was also found between stone types based on urine pH (p=0.013) in multivariate analysis.Conclusion: There is a significant relationship between urine pH and stone type on the incidence of urolithiasis in Sanglah Hospital in June 2017-2018, thereby increasing the incidence of urolithiasis.

Hubungan antara densitas mikrovaskular dan limfoplasmasitik dengan metastasis kelenjar getah bening inguinal pada pasien karsinoma penis di RSUP Sanglah, Bali, Indonesia Silvester Kristian Taopan; Anak Agung Gde Oka; I Gde Raka Widiana; I Wayan Juli Sumadi
Intisari Sains Medis Vol. 12 No. 1 (2021): (Available online : 1 April 2021)
Publisher : DiscoverSys Inc.

Background: Carcinoma is the most common malignancy that occurs in penile tissue. Most of the metastasis of penile carcinoma is lymphogenic to the nearest lymph node. Metastasis is a significant prognosis factor in reflecting the outcome of penile carcinoma patients. To begin a process of metastasis requires the formation of new blood vessels (angiogenesis) and infiltration of mononuclear cells. Both of these can be assessed through micro vessel density and lymphoplasmacytic. This study aims to determine the relationship between microvascular and lymphoplasmic density with inguinal lymph node metastases in penile carcinoma patients at Sanglah General Hospital, Bali, Indonesia.Methods: This research is an analytic cross-sectional study. Data collection was carried out from the patient's Medical Record during January 2014 - December 2018. From 40 samples of penectomy surgery the micro vessel Density and lymphoplasmacytic readings were first stained with staining of hematoxylin eosin by anatomic pathologist. Cut-off point microvessel density and lymphoplasmacytic is taken by calculating the mean and standard deviation. Bivariate analysis with Chi Square Test and multivariate analysis using logistic regression tests were used for statistical analysis. Data were analyzed using SPSS version 20 for Windows.Results: From the Bivariate Analysis it was found that there was a significant relationship between Micro-vessel Density and Metastasis to the inguinal lymph node (P=0.019) and there was a significant relationship between lymphoplasmacytic and metastasis to the inguinal lymph node (P=0.005). The Multivariate Analysis confirms that microvessel density, lymphoplasmacytic and history of phimosis are significantly related to the occurrence of metastasis to inguinal lymph node in penile carcinoma patients (p=0.040).Conclusion: There were significant relationships between Micro vessel Density and Lymphoplasmacytic density with metastasis to inguinal lymph nodes in patients with penile SCC. A history of phimosis was proved to be a dominant risk factor. Latar Belakang: Karsinoma merupakan keganasan tersering yang terjadi pada jaringan penis. Sebagian besar metastasis karsinoma penis bersifat limfogen menuju Kelenjar Getah Bening (KGB) terdekat. Untuk memulai suatu proses metastasis diperlukan pembentukan pembuluh darah baru (angiogenesis) dan infiltrasi sel mononuklear. Kedua hal tersebut bisa dinilai melalui densitas mikrovaskuler dan limfoplasmositik. Penelitian ini bertujuan untuk mengetahui hubungan antara densitas mikrovaskular dan limfoplasmositik dengan metastasis kelenjar getah bening inguinal pada pasien karsinoma penis di RSUP Sanglah, Bali, Indonesia Metode: Penelitian ini merupakan penelitian potong lintang analitik. Pengambilan data dilaksanakan dari Rekam Medis pasien selama Januari 2014 – Desember 2018. Dari 40 sampel Operasi Penektomi dilakukan pembacaan densitas mikrovaskuler dan limfoplasmositik yang telah lebih dulu diberikan pewarnaan Hematoxylin Eosin oleh ahli patologi anatomi. Titik potong densitas mikrovaskuler dan limfoplasmositik diambil dengan cara menghitung rerata dan standar deviasi. Analisis bivariat dengan Uji Chi-Square dan analisis multivariat dengan menggunakan uji regresi logistik digunakan untuk analisis statistik. Data dianalisis dengan SPSS versi 20 untuk Windows.Hasil: Analisis bivariat didapatkan hubungan yang bermakna antara Densitas Mikrovaskuler dengan metastasis ke KGB Inguinal (p=0,019) dan terdapat hubungan yang bermakna antara limfoplasmositik dengan metastasis ke KGB inguinal (p=0,005). Analisis multivariat menegaskan bahwa densitas mikrovaskuler, limfoplasmositik dan riwayat fimosis berhubungan secara bermakna dengan terjadinya metastasis ke KGB Inguinal pada pasien karsinoma penis (p=0,040).Simpulan: Adanya hubungan antara Densitas Mikrovaskular dan Limfoplasmositik dengan metastasis ke KGB inguinal pada pasien dengan KSS penis. Riwayat fimosis merupakan faktor resiko dominan.

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