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All Journal e-CliniC JURNAL BIOMEDIK Indonesian Journal of Urology Medical Scope Journal (MSJ) International Journal of Health and Pharmaceutical (IJHP)
Ari Astram, Ari
Department of Urology, Faculty of Medicine/Indonesia University, Cipto Mangunkusumo General Hospital, Jakarta.
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Nursing Public Health

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Karakteristik dan Motivasi Augmentasi Penis dengan Komplikasinya di RSUP Prof. Dr. R. D. Kandou dan RS Jejaring Purba, Adrian; Astram, Ari; Monoarfa, Richard
Jurnal Biomedik : JBM Vol 10, No 2 (2018): JURNAL BIOMEDIK : JBM
Publisher : UNIVERSITAS SAM RATULANGI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/jbm.10.2.2018.20091

Abstract

Abstract: Penile augmentation is an individual effort to enlarge one’s penile size for his sexual satisfaction and his mate without functional alteration. This study was aimed to obtain the profile of motivation, sexual satisfaction, mental distortion, and complications in patients with penile augmentation. This was a descriptive categorical study with a retrospective approach. This study was conducted at Prof. Dr. R. D. Kandou Hospital and its link hospitals for 10 months involving 23 patients; most of them (34.78%) were 26-35 years old. Most patients (61%) had internal motivation based on NSSS scale >30. Based on ulcer free period, 3 patients had free period of ulcer I; no patient had free period of ulcer II. Based on pain scale, 14 patients (60.87%) had pain scale of <5 and 9 patients (39.13%) had pain scale of >5. Most complications were in the form of ulcers located in preputium (56.52%). The relationships between motivation and NSSS scale before and after penile augmentation were analyzed using Fisher exact test which obtained P = 0.000 for relationship between motivation and NSSS scale (sexual satisfaction) before and after penile augmentation and P = 0.360 between post augmentation (with its complications) and sexual satisfaction. Conclusion: Patients with penile augmentation were internally and externally motivated without any mental distortion. There was a significant relationship between internal motivation and penile augmentation as well as between motivation and sexual satisfaction. Albeit, there was no significant relationship bewteen complications of penile augmentation and sexual satisfaction. Most patients suffered complications.Keywords: penile augmentation, NSSSAbstrak: Augmentasi penis merupakan usaha individu untuk membesarkan ukuran penis demi memenuhi hasrat seksual dan pasangannya tanpa perubahan fungsi. Penelitian ini bertujuan untuk mendapatkan gambaran motivasi, kepuasan seksual, adanya gangguan jiwa, dan komplikasi pada pasien yang melakukan augmentasi penis. Jenis penelitian ialah deskriptif kategorik dengan pendekatan retrospektif. Penelitian ini dilakukan di RSUP Prof. Dr. R. D. Kandou dan RS jejaring selama 10 bulan yang melibatkan 23 pasien. Rentang usia pasien 16-59 tahun, terbanyak pada usia 26-35 tahun (34,78%). Sebagian besar pasien (61%) dengan motivasi secara internal berdasarkan skala NSSS>30. Berdasarkan periode bebas ulkus didapatkan 3 pasien dengan periode bebas ulkus I; tidak didapatkan pasien dengan periode bebas ulkus II. Berdasarkan skala nyeri didapatkan 14 pasien (60,87%) dengan skala nyeri <5 dan 9 pasien (39,13%) dengan skala nyeri >5. Lokasi komplikasi terbanyak berupa ulkus di preputium (56,52%). Analisis menggunakan Fisher exact terhadap hubungan motivasi dan skala NSSS sebelum dan sesudah augmentasi penis memper-lihatkan hubungan antara motivasi dan kepuasan seksual dengan nilai P = 0,000 (<0,05) serta hubungan antara pasca augmentasi (beserta komplikasi) dan kepuasaan seksual dengan nilai P = 0,360 (>0,05). Simpulan: Pasien yang melakukan augmentasi penis termotivasi secara internal dan eksternal tanpa adanya distorsi gangguan psikiatrik. Terdapat hubungan bermakna antara motivasi internal dan augmentasi penis serta antara motivasi melakukan augmentasi penis dan kepuasan seksual. Tidak terdapat hubungan bermakna antara komplikasi augmentasi penis dan kepuasaan seksual. Hampir seluruh pasien disertai komplikasi.Kata kunci: augmentasi penis, NSSS
SUCCESS OF PERCUTANEOUS NEPHROLITHOTOMY: COMPARING SPINAL ANESTHESIA WITH GENERAL ANESTHESIA Astram, Ari; Birowo, Ponco; Rasyid, Nur; Pryambodho, P; Susilo, C
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.v22i2.104

Abstract

Objective: The purpose of this study compared the outcome of PCNL under general and spinal anesthesia for the outcome. Material & Methods: PCNL had been performed from 2000 until 2011 with total 760 PCNL divided into 220 PCNL using general anesthesia (Group A) and the remaining 540 PCNL using spinal anesthesia (Group B) The data of both groups were evaluated with Chi square test, and Mann-Whitney test. Result: Stone free rate in Group A was 71.37% similar with Group B 72.97% (p > 0.05). Spinal anesthesia was used more often in patient who had previous surgery 65.5% compared with general anesthesia 36.82% (p < 0.05). The average surgery duration in Group A was longer than group B (77.10 ± 35.59 minutes vs 68.42 ± 30.55 minutes) (p < 0.05). The average length of hospital stay in Group B was shorter than Group A (3.90 ± 2.72 days vs 5.47 ± 4.25 days) (p < 0.05). There was no difference between Group A and Group B in complication and the needs of tranfusion. Conclusion: PCNL under spinal anesthsia was feasible and safe even better in the shorter surgery duration and the length of hospital stay.
PATIENT PERCEPTION RELATED TO URODYNAMIC TESTING: A QUESTIONNAIRE BASED STUDY Astram, Ari; Rahardjo, Harrina Erlianti
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.v25i2.405

Abstract

Objective: Urodynamic test is a series of test to evaluate the bladder function including voiding and storage physiology. Several previous studies have found that urodynamic testing had association with physical and emotional discomfort. The primary goal of this study was to determine the parameters of anxiety, pain, and shame related to urodynamic testing. Material & Method: From June 2014 to June 2015, a total of 57 consecutive patients who underwent urodynamic study were included in the present study, consisting of 20 men and 37 women. They have completed the questionnaire before and after urodynamic study. Patients were requested to answer four questions related to pain, embarrassment, anxiety, and knowledge related to urodynamic test. Results: Overall, most of the patients felt not at all and nearly not anxious before urodynamic study. Thirty percent of patient thought that there would be moderate pain when the urodynamic test is performed. Majority of patients (68% of patients) felt no embarrassment prior to the test. Overall, patients felt better after urodynamic study in terms of anxiety and pain. Parameter of embarrassment significantly increased after the test. Patient perception of anxiety and pain before urodynamic test are not significantly different with perception after urodynamic test. Conclusion: Urodynamic tests are very well tolerated by men and women. Majority of patients felt better after urodynamic test according to pain and anxiety score. No statistical difference in level of pain and anxiety between before and after the procedure, while parameter of embarrassment was significantly higher after the test was done.
Relation of Pre-operative Ureteral Catheter Use and Complications of Intraoperative Ureteral and Bladder Trauma in Gynecologic Oncology Patients Undergoing Major Surgical Procedures Sinurat, Bintang; Toreh, Christof; Astram, Ari; Arianto, Eko; Langi, Fima
Medical Scope Journal Vol. 7 No. 1 (2025): Medical Scope Journal
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/msj.v7i1.56265

Abstract

Iatrogenic injury to the urinary tract is a potential complication of all surgical procedures performed in or retroperitoneum and pelvis. Gynecological surgery in particular has a risk of urinary tract injury due to the close anatomy of the urinary tract and the reproductive system in women. This study aimed to evaluate the relation between pre-operative ureteral catheter use and complications of intraoperative ureteral and bladder trauma in gynaecologic oncology patients undergoing major surgical procedures. This study used cohort data of patients undergoing major surgical procedures at Prof. Dr. R. D. Kandou Hospital, Manado, recorded in medical records from January 1, 2023 to June 30, 2023. The bivariate test showed that patients who received pre-operative ureteral catheter insertion had fewer urological trauma events (4.5%) compared to patients who did not get pre-operative ureteral catheter (95.5%). The relations between pre-operative ureteral catheters and the incidence of urological trauma was found to be statistically significant with a p-value of 0.019 and the history of chemotherapy had a p-value of 0.036, meanwhile the relations with other variables showed p-values of >0.05. Therefore, the use of pre-operative catheters could not significantly eliminate the occurrence of ureteral trauma because many of the confounding factors were accompanied by several other conditions that were also studied in the multivariate analysis. In conclusion, there is no association between the use of pre-operative ureteral catheters and complications of intraoperative ureteral trauma in gynecologic oncology patients undergoing major surgical procedures. Future studies using samples from more sources are expected to assess the relation between pre-operative ureteral catheter use and the incidence of urological trauma more accurately, and to assess the ease of use of pre-operative ureteral catheter. Keywords: ureteral catheter; ureteral trauma; gynaecologic oncology patients
Comparison of Scoring Systems in Predicting Stone-Free Rate in Flourless Retrograde Intrarenal Surgery Arianto, Eko; Astram, Ari; Toreh, Christof; Wihono, Frendy; Krishna, Mahesa
Medical Scope Journal Vol. 7 No. 1 (2025): Medical Scope Journal
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/msj.v7i1.57388

Abstract

Abstract: Thus far, there is no standardised method for predicting outcomes from fluoro-less retrograde intrarenal surgery (RIRS) procedure. This study aimed to compare scoring systems in predicting stone-free rate (SFR) in RIRS patients This was an observational and analytical study with a retrospective cohort design. Samples were obtained from medical records of  Dr. J. H. Awaloei Hospital from March 2022 to October 2023. This study only analyzed three scoring systems: Guy's Stone Score (GSS), Resorlu-Unsal Stone Score (RUSS), and Seoul National University Renal Stone Complexity Score (S-ReSC). The results obtained 219 patients with an average age of 55 years, GSS grade I in 108 patients, and grade II in 50 patients. Related to RUSS score, 43 patients got a score of 1, 108 got a score of 2, and 60 got a score of 60. Meanwhile, S-ReSC score was at a high level with a percentage of 65.3%, 20.4% at the medium level, and 14.4% at the low level. Moreover, GSS sensitivity 76%, specificity 75%, PPV 93.2%, NPV 41.1%, AUC 75%; RUSS score sensitivity 75.4%, specificity 62.2%, PPV 90%, NPV 36.2%, AUC 70%; S-ReSC score sensitivity 71%, specificity 77.5%, PPV 93.4%, NPV 37.3%, AUC 72%. In conclusion, Guy's Stone Score, Resorlu-Unsal Stone Score, and Seoul National University Renal Stone Complexity Score have similar abilities in predicting stone-free rate. Further research is needed with a larger sample size or population to confirm the findings of this study. Keywords: nephrolithiasis; stone-free rate; scoring system; retrograde intrarenal surgery
First Endoscopic-Guided Percutaneous Nephrolithotomy (ePSL) with Prone Split-Leg Position in Manado Phoebus, Andrien; Astram, Ari; Toreh, Christof; Arianto, Eko; Wihono, Frendy
e-CliniC Vol. 13 No. 1 (2025): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v13i1.59320

Abstract

Abstract: Literature has not yet defined the best position for percutaneous nephrolithotomy (PCNL) based on the complexity of the stone burden. This case of left-sided complex kidney stones underwent endoscopic-guided PCNL in an PSL (prone split-leg position). A 61-year-old woman with a chief complaint of right pelvic pain. Standard prone PCNL was planned for this patient, however, due to so much debris in the pelviocalyceal system during URS evaluation and ureter catheter insertion, we decided to puncture with ultrasound guidance rather than fluoroscopy. Intraoperatively there was residual superior calyx stone that was beyond the reach of nephroscope. We decided not to do a double puncture because of poor vision due to the floating debris. In the second procedure, the ePSL method was utilized. A C-arm and nephroscope examination revealed no active bleeding, no infundibulum laceration, and no remaining stones. The primary goals of this method were to remove stones from the urinary tract throughout the entire tract using a one-step, one-access procedure that made the most of the full range of endourologic equipment. There were a number of reasons why the prone split-leg position was chosen, including operator preference, familiarity with the position, and the inability to make a direct puncture in the upper pole. The main drawback was that patient would not be able to see how well and safely this method worked over time. In conclusion, complex kidney stones can be treated with ePSL performed in the prone split-leg position, which is a safe procedure with a low risk of complications. Keywords: percutaneous nephrolithotomy; prone split-leg position; complex kidney stones
Long-Term Follow-up after Kidney Trauma at Prof. Dr. R. D. Kandou General Hospital Manado Arianto, Eko; Panelewen, Bryan P.; Astram, Ari; Toreh, Christof; Wihono, Frendy
e-CliniC Vol. 13 No. 2 (2025): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v13i2.59605

Abstract

Abstract: Renal trauma, caused by blunt or penetrating injuries, is associated with severe complications such as hypertension, chronic kidney disease (CKD), and pyelonephritis, especially in high-grade renal trauma. The study aimed to evaluate the complications and management of renal trauma patients at Prof. Dr. R. D. Kandou Hospital Manado from January 2022 to October 2024. This was an observational study with a cross-sectional design involving 17 patients that met the inclusion criteria. Data included types of trauma, severity level, management approaches, and post-trauma complications. Trauma severity was classified using the American Association for Surgery of Trauma (AAST) grading system. The results showed that 58.8% of patients had penetrating trauma, while 41.2% experienced blunt trauma. The highest percentages were found in grade II severity (29.4%). Operative management was the most common approach (58.8%). Post-trauma complications included CKD (70.5%), hypertension (29.4%), and pyelonephritis (29.4%). In conclusion, renal trauma, whether blunt or penetrating, often leads to significant complications such as CKD and hypertension. Proper long-term management and monitoring of kidney function and blood pressure are crucial to minimize the complications. This study highlights the need for early and effective intervention in high-grade renal trauma cases. Keywords: renal trauma; hypertension; acute kidney injury (AKI); chronic kidney disease (CKD); post-trauma complications
Validation of Guy’s Stone Score, RUSS, S-RESC SCORE, and S.T.O.N.E Score for Predicting Stone Free Rate in Percutaneous Nephrolithotomy in a Residency Teaching Hospital Panelewen, Bryan P.; Arianto, Eko; Astram, Ari; Toreh, Christof; Wihono, Frendy
Medical Scope Journal Vol. 7 No. 2 (2025): Medical Scope Journal
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/msj.v7i2.61296

Abstract

Abstract: Kidney stones represent a significant health burden globally, with a high risk of recurrence. Percutaneous nephrolithotomy (PCNL) is the primary treatment option for kidney stones larger than 20 mm, offering superior outcomes compared to open surgery. Several scoring systems, including Guy’s Stone Score (GSS), S.T.O.N.E. Nephrolithometry Score, Resorlu Unsal Stone Score (RUSS), and Seoul Renal Stone Complexity (S-ReSC), have been developed to predict the Stone-Free Rate (SFR) following PCNL. However, the comparative effectiveness of these scoring systems remains unclear. This study aimed to evaluate and compare the predictive accuracy of GSS, S.T.O.N.E., RUSS, and S-ReSC scoring systems in determining SFR after PCNL. This was an analytical and retrospective study. Data were collected from 60 patients with kidney stones treated at Prof. Dr. R. D. Kandou Hospital Manado from January to December 2023. Patients underwent PCNL, and preoperative non-contrast CT scans and postoperative plain abdominal X-rays were used for evaluation. Statistical analyses included univariate, bivariate, and multivariate tests, as well as ROC curve analysis. The results showed that all four scoring systems were statistically significant in predicting SFR (p<0.005). The RUSS score demonstrated the highest predictive value, with an odds ratio 20 times higher than without scoring. The ROC analysis showed AUC values of 0.792 for GSS, 0.913 for RUSS, 0.694 for S-ReSC, and 0.945 for S.T.O.N.E. These findings highlight significant relationships between stone complexity scores and SFR, emphasizing their utility in surgical planning. In conclusion, each scoring system has significant predictive value for SFR following PCNL. Among them, RUSS showed the highest reliability, followed by S.T.O.N.E. and GSS. Despite differences in focus, all scores contribute to treatment planning and patient management. Further research is needed to optimize these tools and integrate them with advanced imaging and minimally invasive techniques for personalized patient care. Keywords:  percutaneous nephrolithotomy; kidney stones; Stone-Free Rate; Guy’s Stone Score; S.T.O.N.E Nephrolithometry Score; Resorlu Unsal Stone Score; Seoul Renal Stone Complexity
Mitroanoff Appendicovesicostomy Procedure On Bladder Neck Stenosis: A Case Report Arianto, Eko; Hardianti Kusanto, Putri; Astram, Ari; Toreh, Christof; Wihono, Frendy; R. Torry, Stivano
International Journal of Health and Pharmaceutical (IJHP) Vol. 5 No. 2 (2025): May 2025 ( Indonesia - Iraq - Malaysia)
Publisher : CV. Inara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51601/ijhp.v5i2.411

Abstract

The Mitrofanoff Appendicovesicostomy (MAC) procedure is a significant surgical intervention for patients with bladder neck stenosis, particularly in cases of severe urological dysfunction. This case report presents a 34-year-old female with a history of urinary incontinence and vesicovaginal fistula (VVF) following a cesarean section. The patient underwent the MAC procedure to address her bladder neck stenosis and restore urinary continence. Preoperative assessments, surgical techniques, and postoperative outcomes are discussed, highlighting the effectiveness of the MAC procedure in providing a new pathway for urine flow and improving the patient's quality of life. This report emphasizes the importance of a multidisciplinary approach in managing urinary incontinence, considering both physical and psychological factors. It also underscores the need for timely diagnosis and tailored surgical interventions to enhance patient outcomes. Future research should focus on identifying risk factors and developing personalized treatment strategies to mitigate urinary incontinence and related complications in postpartum patients. By integrating clinical evidence and holistic care, healthcare providers can better navigate the complexities of urinary incontinence and improve the quality of life for affected individuals.
Co-Authors Adianti Khadijah, Adianti Agus Rizal Ardy Hariandy Hamid, Agus Rizal Ardy Hariandy Ahmad Zulfan, Ahmad ARIANTO, EKO C Susilo, C CHAIDIR A MOCHTAR, CHAIDIR A Hardianti Kusanto, Putri Harrina Erlianti Rahardjo, Harrina Erlianti Krishna, Mahesa Langi, Fima Nur Rasyid P Pryambodho, P Panelewen, Bryan P. Phoebus, Andrien Ponco Birowo Prahara Yuri Purba, Adrian R. Danarto, R. R. Torry, Stivano Rainy Umbas Richard Monoarfa Sinurat, Bintang Toreh, Christof Wihono, Frendy