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All Journal Medical Journal of Indonesia Indonesian Journal of Urology Proceedings Book of International Conference and Exhibition on The Indonesian Medical Education and Research Institute
Raharja, Putu Angga Risky
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Health Professions Medicine & Pharmacology Neuroscience Public Health

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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.
Rare nephrostomy complication mimicking rupture of abdominal aortic aneurysm: a case report Bangsawan, Kiwah Andanni; Irdam, Gampo Alam; Raharja, Putu Angga Risky; Darwis, Patrianef; Fachriza, Ihza; Rahman, Fakhri
Medical Journal of Indonesia Vol. 33 No. 3 (2024): September
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.cr.247245

Abstract

Percutaneous nephrostomy (PCN) is a routine procedure in urology with up to 99% success rate and less than 6% of total complications dominated by minor cases. This was a case report of a 59-year-old male patient with an unusual major bleeding complication after PCN that mimicked a ruptured abdominal aortic aneurysm. The laparotomy exploration identified the bleeding source from the right lobar artery, thus renorrhaphy was performed. Proper visualization of anatomic layout, color Doppler imaging, and selecting a guiding method and technique could reduce bleeding complications following PCN.
Comprehensive Histopathological Properties of Dartos Tissue Associated with Hypospadias Severity and Chordee: A Prospective Study Raharja, Putu Angga Risky; Birowo, Ponco; Rachmadi, Lisnawati; Wibowo, Heri; Kekalih, Aria; Duarsa, Gede Wirya Kusuma; Wahyudi, Irfan
Proceedings Book of International Conference and Exhibition on The Indonesian Medical Education Research Institute Vol. 8 No. - (2024): Proceedings Book of International Conference and Exhibition on The Indonesian M
Publisher : Writing Center IMERI FMUI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69951/proceedingsbookoficeonimeri.v8i-.243

Abstract

Background: The cause of chordee in hypospadias is not fully understood. Dartos fascia resection has been shown to correct penile curvature, suggesting its potential involvement. This study aimed to evaluate the histopathological properties of dartos tissue and their association with hypospadias severity and chordee.Methods and Materials: Dartos tissue samples were collected from 37 children with hypospadias and ten controls undergoing circumcision between March and October 2024. Histopathological analysis using hematoxylin-eosin and Masson’s trichrome staining assessed for collagen, smooth muscle, and vascular density. Assessment and quantification of all histopathological components were blinded. Results: The hypospadias group showed lower collagen density (60.85±6.75% vs. 67.31±4.61%; p=0.003) and higher smooth muscle density (7.34±4.92% vs. 2.51±2.24%; p<0.001) compared to controls, with no significant difference in vessel density. Sub-analysis showed severe chordee was linked to lower collagen density compared to mild (Mean Difference [MD] -6.24±2.41%; p=0.014) and moderate chordee (MD -5.73±2.54%; p=0.031). Conclusions: The dartos tissue in hypospadias patients exhibited lower collagen density and higher smooth muscle density, with chordee severity specifically linked to decreased collagen density.
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 Online First
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.
Co-Authors Alfarissi, Fekhaza Aria Kekalih Arry Rodjani Bangsawan, Kiwah Andanni Darwis, Patrianef Fachriza, Ihza Fakhri Rahman, Fakhri GAMPO ALAM IRDAM, GAMPO ALAM Gede Wirya Kusuma Duarsa Gerhard Reinaldi Situmorang, Gerhard Reinaldi Heri Wibowo Irfan Wahyudi Lisnawati Rachmadi Nainggolan, Ebram Ponco Birowo