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All Journal Medical Journal of Indonesia Indonesian Journal of Urology Indonesian Journal of Cancer Indonesian Journal of Cancer
Gerhard Reinaldi Situmorang, Gerhard Reinaldi
Department Of Urology, Faculty Of Medicine/Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta.
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Internal Genital Organ-preserving Radical Cystectomy: A Case Report WIDIA, FINA; SITUMORANG, GERHARD R; HAMID, AGUS RIZAL A.H; MOCHTAR, CHAIDIR A
Indonesian Journal of Cancer Vol 10, No 2 (2016): April - June 2016
Publisher : Indonesian Journal of Cancer

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (465.53 KB)

Abstract

ABSTRACTAdenocarcinoma of the bladder is usually managed by radical cystectomy. However, recent literature shows that internal genital organ-preserving radical cystectomy is feasible in selected cases in order to get a better impact on patient’s psychology, sexuality and potential fertility. Here, we report a 32-year-old woman with adenocarcinoma of the bladder who was managed with internal genital organ-preserving radical cystectomy. The patient was never had any child and the radiologic examination (MRI) showed no involvement of internal genitalia organ. This procedure aims to maintain fertility potential of the patient. Intraoperatively, no adhesion was found between the tumor and internal genitalia organ. The internal genitalia organ was successfully preserved during the radical cystectomy. ABSTRAKTata laksana adenokarsinoma kandung kemih umumnya berupa sistektomi radikal. Akan tetapi, penelitian terbaru menunjukkan bahwa preservasi organ internal genitalia dapat diterapkan pada kasus-kasus tertentu dengan tujuan untuk mempertahankan potensi seksual dan fertilitas pasien. Saat ini kami melaporkan seorang perempuan berusia 32 tahun dengan adenokarsinoma kandung kemih yang menjalani sistektomi radikal dengan tetap mempertahankan organ genitalia interna. Pasien merupakan nulipara dan pada pemeriksaan radiologi MRI tidak didapatkan infiltrasi tumor pada organ genitalia interna. Prosedur operasi dilakukan dengan tujuan mempertahankan potensi fertilitas. Intraoperatif, tidak didapatkan perlengketan antara tumor dan organ genitalia interna. Organ genitalia interna berhasil dipreservasi selama prosedur sistektomi radikal.
RETROPERITONEOSCOPIC HEMINEPHRECTOMY: INITIAL EXPERIENCE IN CIPTO MANGUNKUSUMO HOSPITAL JAKARTA Irdam, Gampo Alam; Wahyudi, Irfan; Rodjani, Arry; Situmorang, Gerhard Reinaldi
Indonesian Journal of Urology Vol 22 No 2 (2015)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v22i2.174

Abstract

Objective: To explain efficacy and feasibility of heminephrectomy laparoscopic with retroperitoneal approach in double collecting system patients with non-functional upper moiety. Material & methods: Three cases in Cipto Mangunkusumo Hospital’s urology outpatient clinic from July 2013 - January 2014 with double collecting system and non-functional upper moiety. Laparoscopic heminephrectomy with retroperitoneal approach were done to these patients. Results: Surgery was done within 200 - 240 minutes with minimal bleeding and no significant complication. There was no significant hemodynamic disturbance observed during surgery. Patients were able to mobilize and to get immediate oral intake. Pains were minimal and can be treated with first-line analgesics. The patients were discharged on the fourth and fifth day of hospitalization. Conclusion: We are reporting our initial experience doing retroperitoneoscopic heminephrectomy in double collecting system patient. This procedure was feasible and produced good outcomes for the patients.
DELAYED GRAFT FUNCTION FOLLOWING LAPAROSCOPIC LIVE DONOR NEPHRECTOMY: A MULTIVARIATE ANALYSIS Tirtayasa, Pande Made Wisnu; Situmorang, Gerhard Reinaldi; Rodjani, Arry; Rasyid, Nur
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.v23i2.208

Abstract

Objective: This study was performed to define and investigate the incidence, risk factors, and clinical characteristics of delayed graft function (DGF) in laparoscopic live donor nephrectomy (LDN). Material & methods: We retrospectively analyzed the medical records of donor and recipient from our first 100 cases of laparoscopic LDN in Cipto Mangunkusumo General Hospital Jakarta, from November 2011 to February 2014. The criteria used to define DGF were the requirement for dialysis in postoperative week 1 and/or serum creatinine greater than 2.5 mg/dl at postoperative day 7. Patients who did not match any of these criteria were define as having normal renal allograft function. Results: The overall prevalence of DGF was 14%. Recipients body mass index, cold ischemia time, vascular anastomosis time, and total ischemia time were higher among the delayed graft function group, but no risk factors for DGF were significantly associated after multivariate analysis. Conclusion: The incidence of DGF in our study was in the range of that observed in previous studies. The factors that previously reported and believed as risk factors of DGF in laparoscopic LDN were not significantly associated with the development of DGF in our study.
Internal Genital Organ-preserving Radical Cystectomy: A Case Report FINA WIDIA; GERHARD R SITUMORANG; AGUS RIZAL A.H HAMID; CHAIDIR A MOCHTAR
Indonesian Journal of Cancer Vol 10, No 2 (2016): April - June 2016
Publisher : National Cancer Center - Dharmais Cancer Hospital

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (465.53 KB) | DOI: 10.33371/ijoc.v10i2.429

Abstract

ABSTRACTAdenocarcinoma of the bladder is usually managed by radical cystectomy. However, recent literature shows that internal genital organ-preserving radical cystectomy is feasible in selected cases in order to get a better impact on patient’s psychology, sexuality and potential fertility. Here, we report a 32-year-old woman with adenocarcinoma of the bladder who was managed with internal genital organ-preserving radical cystectomy. The patient was never had any child and the radiologic examination (MRI) showed no involvement of internal genitalia organ. This procedure aims to maintain fertility potential of the patient. Intraoperatively, no adhesion was found between the tumor and internal genitalia organ. The internal genitalia organ was successfully preserved during the radical cystectomy. ABSTRAKTata laksana adenokarsinoma kandung kemih umumnya berupa sistektomi radikal. Akan tetapi, penelitian terbaru menunjukkan bahwa preservasi organ internal genitalia dapat diterapkan pada kasus-kasus tertentu dengan tujuan untuk mempertahankan potensi seksual dan fertilitas pasien. Saat ini kami melaporkan seorang perempuan berusia 32 tahun dengan adenokarsinoma kandung kemih yang menjalani sistektomi radikal dengan tetap mempertahankan organ genitalia interna. Pasien merupakan nulipara dan pada pemeriksaan radiologi MRI tidak didapatkan infiltrasi tumor pada organ genitalia interna. Prosedur operasi dilakukan dengan tujuan mempertahankan potensi fertilitas. Intraoperatif, tidak didapatkan perlengketan antara tumor dan organ genitalia interna. Organ genitalia interna berhasil dipreservasi selama prosedur sistektomi radikal.
CYSTOSTOMY DIVERSION REDUCED COMPLICATIONS FOLLOWING HYPOSPADIAS REPAIR: A SYSTEMATIC REVIEW AND META-ANALYSIS Wahyudi, Irfan; Raharja, Putu Angga Risky; Situmorang, Gerhard Reinaldi; Rodjani, Arry
Indonesian Journal of Urology Vol 31 No 3 (2024)
Publisher : Indonesian Urological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32421/juri.v31i3.883

Abstract

Objective: This study aims to investigate the associations between the use of cystostomy diversion and the incidence of complications following hypospadias repair. Material & Methods: An extensive search of PubMed, ScienceDirect, Embase, and the Cochrane Library, was performed to identify studies that assessed the impact of cystostomy diversion on complication rates after hypospadias repair. To evaluate potential biases, the RoB 2 tool was applied for randomized controlled trials (RCTs), while the ROBINS-I tool was used for observational studies. Data analysis was conducted using Review Manager 5.4. Results: This review included ten studies involving 1.120 patients who underwent hypospadias repair. The overall complication was 16.9%. The meta-analysis revealed that opting against cystostomy diversion after hypospadias repair led to a notably increased risk of complications, as evidenced by a pooled odds ratio (OR) of 1.48 (95% confidence interval (CI) 1.07–2.03). The significant negative effect of not performing cystostomy on the risk of complications was consistent in sub-analysis of distal hypospadias (OR 1.97; 95% CI 1.11–3.51) and primary hypospadias repair (OR 1.80; 95% CI 1.19–2.73). In the funnel plot, there was no significant publication bias identified. Conclusion: Our meta-analysis demonstrated that cystostomy diversion reduces the incidence of complications following hypospadias repair. The positive effects were consistent in both distal hypospadias and primary hypospadias repair. Keywords: Complications, cystostomy, hypospadias.
Comparing anastomosis techniques on ischemia time in multi-arterial kidney grafts: a systematic review and meta-analysis Hernawan Rahmat Muharia, Bayu; Situmorang, Gerhard Reinaldi; Rasyid, Nur; Rodjani, Arry; Birowo, Ponco
Medical Journal of Indonesia Vol. 34 No. 1 (2025): March
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.oa.257527

Abstract

BACKGROUND Kidney transplants with multiple renal arteries (MRAs) address donor shortages but carry higher vascular risks than single renal arteries. This study aimed to evaluate how different anastomosis techniques affect outcomes in kidney transplants with MRAs through meta-analysis and systematic review, concluding the continuous discussion about the best reconstructive strategy. METHODS A comprehensive search across 5 databases (PubMed, ScienceDirect, Cochrane Library, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature) was conducted until December 17, 2024, to find studies comparing anastomoses technique in MRA grafts. Meta-analysis was performed using Review Manager software version 5.4, generating pooled effect estimates for mean difference (MD) and risk ratio (RR), two-sided p-values, and 95% confidence intervals (CIs). RESULTS Two retrospective cohort studies were included in the meta-analysis. There was no significant difference between end-to-side and side-to-side anastomosis in warm ischemia time (MD = 15.64, 95% CI: −6.82−38.10, p = 0.17) or cold ischemia time (MD = −16.74, 95% CI: −105.61−72.14, p = 0.71). The complication rate showed no significant variation between side-to-side and end-to-side anastomosis (RR = 2.38, 95% CI: 0.41−13.70, p = 0.33). Meta-analysis on graft function and rejection was impossible due to differences in measurements and the small number of studies. CONCLUSIONS Different anastomosis techniques for MRA grafts did not result in longer ischemia times or higher complication rates. Graft function and rejection rates were comparable between side-to-side and end-to-side anastomosis, suggesting both were equally feasible for renal transplants with MRAs. Further studies are required to verify these findings.
Laparoscopic Tenckhoff catheter insertion technique with Alken telescopic metal dilator in pediatric population Situmorang, Gerhard Reinaldi; Alfarissi, Fekhaza; Raharja, Putu Angga Risky; Rodjani, Arry; Wahyudi, Irfan
Medical Journal of Indonesia Vol. 34 No. 2 (2025): June
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.oa.257670

Abstract

BACKGROUND End-stage renal disease (ESRD) is a major public health concern worldwide, with peritoneal dialysis (PD) offering a key alternative to hemodialysis. Flow restriction due to catheter migration is a common complication, affecting 7–26% of patients with PD. This study aimed to reduce complications in pediatric patients by examining a novel laparoscopic Tenckhoff catheter insertion technique using an Alken telescopic metal dilator. METHODS In a prospective observational study conducted between September 2018 and October 2022, 33 pediatric patients with ESRD underwent laparoscopic Tenckhoff catheter insertion using a combination of laparoscopic and Seldinger techniques with Alken dilators. This approach involves rectus sheath tunneling using a nephrostomy puncture needle, wire insertion, and dilatation of up to 15 Fr using Alken telescopic metal dilators under laparoscopic guidance. Survival analysis was used to assess catheter survival and complication rates. RESULTS The mean (standard deviation [SD]) patient age was 11.92 (3.7) years, with a median follow-up of 21.3 months. Catheter survival was 84.8%, with 5 catheter withdrawals due to infections (4 cases) or obstruction (1 case). Early and late complications, including exit-site infection, peritonitis, and catheter obstruction, occurred annually at rates of 0.10, 0.03, and 0.02 episodes per patient, respectively. No pericatheter leakage occurred. CONCLUSIONS This novel laparoscopic Tenckhoff catheter insertion technique using an Alken telescopic metal dilator become a simple and minimally invasive method, and associated with high catheter survival and low complication rates. Therefore, further comparative studies are recommended.
Comparing suturing techniques and materials in hypospadias repair: a prospective cohort study Nainggolan, Ebram; Raharja, Putu Angga Risky; Situmorang, Gerhard Reinaldi; Rodjani, Arry; Wahyudi, Irfan
Medical Journal of Indonesia Vol. 34 No. 4 (2025): December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.oa.257921

Abstract

BACKGROUND Various techniques are available for hypospadias surgery, but the most effective suturing techniques and suture materials remain debated. This study aimed to evaluate the outcomes of hypospadias repair using various suturing techniques and materials. METHODS This prospective cohort study was conducted from August 2023 to August 2024 and included all patients who underwent hypospadias surgery at Cipto Mangunkusumo Hospital. We compared the outcomes of 2 suturing techniques (interrupted versus continuous) and 2 suture materials (6-0 polydioxanone [PDS] versus poliglecaprone 25) used for neourethra suturing. Follow-up assessments were conducted at 1, 2, and 4 weeks postoperatively, and subsequently every 3 to 6 months, focusing on complications. RESULTS 162 participants were included, with a mean age of 6.27 (3.99) years and a mean follow-up period of 20.39 (14.25) weeks. Complications occurred in 31 patients (19.1%), with a significant association between hypospadias type and complication occurrence (p = 0.039). Complication rates were 9.4% in distal, 12.5% in midshaft, and 26.8% in proximal cases. No significant differences were found between suturing techniques (interrupted: 19% versus continuous: 12%, p = 0.429) or suture materials (6-0 PDS: 22% versus 6-0 poliglecaprone 25: 9%, p = 0.998). Subgroup analyses by hypospadias type also showed no significant differences by suture type or technique (all p>0.05), although a trend toward significance was noted in proximal cases (p = 0.062). CONCLUSIONS The choice of suturing techniques and suture materials does not affect complication rates in hypospadias repair, allowing surgeons to decide based on personal expertise and preference.
Economic burden and healthcare costs of congenital anomalies of the kidney and urinary tract: a systematic review Alvarino, Akbar Muzakki; Pahlevi, Reza; Situmorang, Gerhard Renaldi; Wahyudi, Irfan; Rodjani, Arry; Raharja, Putu Angga Risky
Medical Journal of Indonesia Vol. 35 No. 1 (2026): March
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.oa.258074

Abstract

BACKGROUND Congenital anomalies of the kidney and urinary tract (CAKUT) cause significant morbidity and economic burden worldwide, highlighting the needs to understand its associated costs. This study aimed to assess the economic burden of CAKUT management. METHODS A systematic review was conducted across 5 databases, including PubMed, ScienceDirect, ProQuest, Nature, and Google Scholar, for studies published up to September 11, 2024, focusing on both direct (e.g., hospitalizations, surgeries, and treatments) and indirect (e.g., lost work time and complications management) healthcare costs related to CAKUT and published in English. Non-economic studies, reviews, editorials, abstracts, animal/in vitro studies, and duplicates were excluded. Methodological quality was assessed using the Risk Of Bias In Non-randomized Studies - of Interventions tool. Narrative synthesis and descriptive statistics were applied. Cost-effectiveness analysis followed Joanna Briggs Institute guidelines. RESULTS 8 studies met the inclusion criteria, revealing wide variations in CAKUT-related healthcare costs across countries and interventions. These studies focused on reviewing both direct and indirect costs, along with interventions that reduce overall healthcare expenditure. Key findings include: (1) In the USA, bilateral renal agenesis costs averaged USD 26,032; (2) In Australia, early whole exome sequencing reduced diagnostic costs by 20% in genetic kidney disease cases; (3) Robotic surgery demonstrated long-term cost-effectiveness despite higher inpatient costs; (4) Other cost-saving strategies include the early renal ultrasound algorithm and genomic testing for CAKUT. CONCLUSIONS CAKUT imposes a significant and variable economic burden globally. Identifying cost-effective interventions is crucial for optimizing care and reducing the financial impact. Further research on cost management strategies is needed to improve outcomes and efficiency.
Co-Authors AGUS RIZAL A.H HAMID Agus Rizal Ardy Hariandy Hamid, Agus Rizal Ardy Hariandy Alfarissi, Fekhaza Alvarino, Akbar Muzakki Arry Rodjani CHAIDIR A MOCHTAR CHAIDIR A MOCHTAR, CHAIDIR A FINA WIDIA GAMPO ALAM IRDAM, GAMPO ALAM Hernawan Rahmat Muharia, Bayu Irfan Wahyudi Nainggolan, Ebram Nur Rasyid Pande Made Wisnu Tirtayasa Ponco Birowo Raharja, Putu Angga Risky REZA PAHLEVI WIDIA, FINA