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All Journal Jurnal Kedokteran Brawijaya
Pradana Nurhadi
Urology Department, Faculty Of Medicine, Universitas Brawijaya, Malang, Indonesia
Medicine & Pharmacology

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Predictor Factor for Severity Degree of Pediatric Hydronephrosis in Tertiary Hospital Hamdan Yuwafi Naim; Besut Daryanto; Pradana Nurhadi
Jurnal Kedokteran Brawijaya Vol. 32 No. 2 (2022)
Publisher : Fakultas Kedokteran Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jkb.2022.032.02.6

Abstract

Pediatric hydronephrosis is often hideous, and its severity highly correlates with a significantly increased incidence of pathological condition and outcome. The management of this disease is based on the severity level by identifying the clinical manifestation, so performing an early detection is crucial to prevent the disease progression. This research aimed to determine the predictor factors for the severity degree of pediatric hydronephrosis to give better treatments for patients. This study retrospectively reported 51 data of hydronephrosis cases that were collected from January 2012 to August 2019. Severity degree was evaluated using SFU (Society of Fetal Urology) scoring system and divided into two groups, mild-moderate (first and second degree) and moderate-severe (third and fourth degree). Data including age, gender, number of kidneys affected, etiology, and antenatal care were collected and statistically analyzed using Pearson's Chi-square and Fischer Exact test. The research result from 51 pediatric patients, 72.55% were categorized as moderate-severe hydronephrosis while the remaining 27.45% were categorized ad mild-moderate hydronephrosis. Ureteropelvic junction (UPJ) stenosis (37.25%) is the most common cause of pediatric hydronephrosis. Significant correlations are noted among severity degree and gender, the number of kidneys affected, etiology, and chosen antenatal care between obstetrician-gynecologist and midwife (p<0.05). In short, gender, number of kidneys affected, etiology, patient's choice on antenatal care can be the predictor factors for pediatric hydronephrosis. Thus, these findings are essential for urologists in pediatric hydronephrosis management.
46 XX Congenital Adrenal Hyperplasia (CAH) after Clitoroplasty, Labioplasty, and Vaginoplasty Rahmat Husein; Besut Daryanto; Paksi Satyagraha; Pradana Nurhadi
Jurnal Kedokteran Brawijaya Vol. 32 No. 2 (2022)
Publisher : Fakultas Kedokteran Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jkb.2022.032.02.9

Abstract

Congenital adrenal hyperplasia (CAH) is the most common cause (60%) of Disorder of Sex Development (DSD), which causes three problems: symptoms and conditions arising due to adrenal endocrine disorders, long-term treatment, and quality of life due to genital ambiguity. An 18-year-old female patient was diagnosed with simple virilizing CAH and had genital ambiguity from birth. The patient was raised as a male. Overall, the examination results indicated a female. Physical examination before surgery showed virilization, such as external genital pigmentation, precocious pubic hair, and bilateral impalpable testis. The karyotype genetic examination confirmed female: 46, XX. Eventually, the patient decided as a female and underwent surgical management consisting of clitoroplasty, labioplasty, and vaginoplasty, followed by long-term corticosteroid therapy. Observations were made for three years after surgery to see the progress of the patient's condition. After undergoing glucocorticoid therapy and surgery, the patient had not experienced menstruation. Her breasts did not enlarge, and mustache and beard were still growing on her face. The patient was concerned about her condition, especially about the risk of infertility and inappropriate physical changes. The management of virilization in CAH with genital ambiguity should be seen from psychological and surgical perspectives. Understanding the disease, the goals of surgery, long-term treatment, and social adaptation help improve quality of life and reduce negative stigma.
A Two-Year-Old Boy with Diphallia and Multiple Congenital Anomalies Rizal Trianto; Pradana Nurhadi; Besut Daryanto
Jurnal Kedokteran Brawijaya Vol. 32 No. 2 (2022)
Publisher : Fakultas Kedokteran Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jkb.2022.032.02.10

Abstract

Diphallia is a rare urogenital defect and varies from a small accessory penis or duplication of the glans to complete penile duplication. Its incidence is 1 in 5.5 million live births. Only 100 cases were reported from 1609 until 2021. A two-year-old boy with diphallia and multiple congenital anomalies had an uncircumcised penis with two glans penis and two complete urethral orifices, accompanied by scrotum bifidum, asymmetric right buttock, with normal anorectal position. Spina bifida with lipomyelocele, tethered cord at the level of vertebra lumbar 3-4, scrotum bifidum, and left mild hydronephrosis were observed using Magnetic Resonance Imaging (MRI). Urethrocystoscopy of both complete urethra revealed meatal stenosis and bulbar urethral stricture, normal posterior urethral, and no verumontanum in the right urethral orifice and did dilatation. Whereas normal urethral orifice, anterior urethra, posterior urethra and verumontanum were found in the left side. Management for diphallia must consider associated anomalies and the goal of patient satisfaction. In this case, conservative treatment is the best choice.
Co-Authors Hamdan Yuwafi Naim Paksi Satyagraha Rahmat Husein Rizal Trianto