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All Journal Paediatrica Indonesiana Jurnal Ilmu Medis Indonesia
Budiono, Nur
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Circumcision in subject with hemophilia: the Yogyakarta Method Widjajanto, Pudjo Hagung; Hadi, Nurul; Saputro, Ivan Onggo; Wibowo, Agus; Budiono, Nur; Tusino, Agus; Sutowo, David Wijaya
Paediatrica Indonesiana Vol. 64 No. 3 (2024): May 2024
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi64.3.2024.244-9

Abstract

Background Circumcision is one of the most common surgical procedures in boys in Indonesia. In cases patient with hemophilia (PWH), doctors tend to avoid this procedure due to increased bleeding tendency. In 2007, we developed a protocol for clotting factor concentrate (CFC) administration for circumcision in SWH, namely, the “Yogyakarta Method.” Objective To evaluate the outcomes of the Yogyakarta Method for circumcising PWH. Methods This descriptive study was based on medical records of PWH who underwent circumcision at Dr. Sardjito Hospital (DSH), Yogyakarta and 3 surrounding hospitals under DSH supervision from 2008-2017 and 2018-2022. Diagnoses of hemophilia were based on clinical findings and factor assays. Subjects with hemophilia A received factor VIII (25 IU/kg/dose) and those with hemophilia B received factor IX (50 IU/kg/dose) before, during and after the procedure. In addition, patients received tranexamic acid (15 mg/kg/dose). Circumcision was performed by a pediatric surgeon or urologist. Results From 2008-2017, 28 PWH underwent circumcision, 14/28 of whom were in DSH. Twenty-six patients had hemophilia A and 2 had hemophilia B. Their severities were mild (12 subjects), moderate (10), and severe (6). Subjects’ median age was 10.5 (5-19) years and their median CFC use was 8 (range 7-10) doses in hemophilia A and 4 (range 4-5) doses in hemophilia B patients. Three of 28 PWH had bleeding episodes after the procedure. Following the encouraging results from the initial 2008-2017 study period, most of PWH circumcised in 2018-2022 underwent the procedure in the same 3 district hospitals rather than at DSH (21/28 subjects), and had similar CFC consumption. Only 1 bleeding episode occurred after the procedure during the second study period. Conclusion The Yogyakarta method is safe and sufficient to control bleeding in circumcision of PWH. This method is also suitable in a district hospital setting.
HoLEP vs TURP in Benign Prostatic Hyperplasia: A Systematic Review Krista, Kevin Aldenio Hatma; Budiono, Nur
Jurnal Ilmu Medis Indonesia Vol 5 No 2 (2026): Maret
Publisher : Penerbit Goodwood

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35912/jimi.v5i2.6452

Abstract

Purpose: This review evaluates the efficacy, safety, and durability of HoLEP versus TURP, addressing the research gap concerning their comparative long-term stability and performance across varying prostate volumes. The study focuses on functional outcomes, complication profiles, and the scalability of each technique. Research Methodology: A systematic search (2020–2025) identified RCTs and meta-analyses comparing HoLEP and TURP in BPH patients. Parameters analyzed included IPSS, Qmax, PVR, perioperative outcomes, and reoperation rates. Results: Both procedures show comparable functional gains. However, HoLEP offers a superior perioperative profile, significantly lower bleeding risk, and higher long-term durability. Furthermore, HoLEP’s efficacy is independent of prostate size, whereas TURP efficiency diminishes in larger glands. Conclusions: Despite a steeper learning curve, HoLEP’s safety and versatility position it as the primary modern surgical standard. TURP remains a relevant alternative depending on institutional facilities. Conclusions: Despite having a longer learning curve, HoLEP is worthy of consideration as the primary choice in modern surgical management of BPH, while TURP remains relevant in certain conditions and facilities. Limitations: Limitations of this systematic review are the heterogeneity of study designs, populations, and follow-up durations, which may affect the comparability of results. Contributions: This review provides a contemporary evidence-based guide for clinicians in selecting optimal surgical interventions.
Co-Authors Agus Wibowo Krista, Kevin Aldenio Hatma Nurul Hadi, Nurul PUDJO HAGUNG WIDJAJANTO, PUDJO HAGUNG Saputro, Ivan Onggo Sutowo, David Wijaya Tusino, Agus