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Journal : Medical Scope Journal (MSJ)

Transurethral Vaporization of Bladder Neck Using Holmium Laser: First Experience in Manado Mahesa Krishna; Eko Arianto; Ari Astram; Frendy Wihono; Christof Toreh
Medical Scope Journal Vol. 6 No. 1 (2024): Medical Scope Journal
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/msj.v6i1.46491

Abstract

Abstract: Bladder neck contracture (BNC) is a potential complication after radical prostatectomy (RP). This may be a result of inadequate approximation at the time of surgery, urinary extravasation, or distraction of the bladder neck from a hematoma. Patients commonly complains of a poor urinary stream or prolonged unexplained incontinence. Treatment of BNC requires a tailored approach and can range from simple, office-based procedures to complex surgical reconstruction. We reported a case of 81-year-old male complaining urine retention for one month. The patient had previous open prostate procedure a year prior. On examination, neurogenic causes were excluded. Retrograde ureterocystography revealed bladder neck contracture. Patient was diagnosed as bladder neck contracture post open prostatectomy surgery. Transurethral holmium laser vaporization with 800 micrometre, 20 Hz frequency and 4,5 Joule of power. through a ureteroscope was performed. Two-way Folley catheter 18Fr was inserted without irrigation. Patient was discharged post-surgery two days after catheter removal and spontaneous micturition. Endoscopic balloon dilatation with incision appears to offers promising result in the management of BNC. The consideration of using transurethral vaporization with holmium laser modality was the first procedure ever done in Manado. In conclusion, TUVP is one of the alternatives, minimally invasive procedures to treat BNC. The use of holmium laser for the incision of bladder neck is another alternative to treat BNC with great outome proven by the length of stay (LOS) of two days after the procedure was done. Keywords: bladder neck contracture; transurethral vaporization; holmium laser; post prostatectomy
The Importance of Preoperative Evaluation to Predict the Outcome of Percutaneous Nephrostomy Ronald J. Datu; Eko Arianto; Ari Astram; Christof Toreh
Medical Scope Journal Vol. 6 No. 2 (2024): Medical Scope Journal
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/msj.v6i2.52858

Abstract

Abstract: Percutaneous nephrostomy (PCN) is an invasive procedure equal to a grade 4 penetrating kidney trauma. It should be carefully considered whether has a greater benefit or risk. There are currently no parameters or scores to predict the outcome of nephrostomy in our center. This study aimed to conduct a review to find out whether there were parameters or scores that could be used to predict the outcome of nephrostomy. This research used relevant studies obtained from Clinical Key, PubMed, Semantic Scholar, Dimensions, and Science Direct published in the last 10 years and written in English. Studies on children and transplant cases were excluded. Studies that met the PICO criteria were selected. The results showed that of the 141 articles collected, and filtered with inclusion criteria, exclusion criteria, and PICO criteria, finally the remaining were three studies selected. The studies discussed about classification, SFU grading system, and complication of nephrostomy; significant variables affecting recoverability of renal function; patients’ characteristics and outcomes of double J ureteral stenting (DJS) and PCN; and 12-month-post-operative creatinine level change. Most patients who failed DJS had increased creatinine level. However, one of the indications for a nephrostomy was stenting failure. In conclusion, predictor factors that can affect the renal recovery after nephrostomy include kidney shape and size, pre-nephrostomy creatinine levels, urine output, state of infection, and degree of hydronephrosis. However, the evidence is still not enough. Further research is needed on the predictor factors for renal recovery after nephrostomy. Keywords:  percutaneous nephrostomy; hydronephrosis; kidney function; predictors