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What Is The Comparative Effectiveness Of Radical Prostatectomy, Radiation Therapy, And Androgen Deprivation Therapy In Patients With Biochemically Recurrent Prostate Cancer After Initial Treatment? : A Systematic Review and Metaanalysist Studies Tegar Pamungkas; John M.Sangkai
The Indonesian Journal of General Medicine Vol. 14 No. 3 (2025): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/q303zb82

Introduction: Biochemically recurrent prostate cancer (BCRPC) after initial treatment poses a significant clinical challenge. This systematic review and meta-analysis aimed to evaluate the comparative effectiveness of radical prostatectomy, radiation therapy, and androgen deprivation therapy (ADT), including novel antiandrogens, in patients with BCRPC without metastatic disease. Methods: Following PRISMA 2020 guidelines, 40 studies published within the last 10 years were included, comprising mostly randomized controlled trials and prospective cohorts. Eligible studies compared at least two interventions among radical prostatectomy, radiation therapy, and ADT in adult patients with biochemical recurrence after primary treatment. Primary outcomes included progression-free survival, metastasis-free survival (MFS), overall survival (OS), and treatment-related complications. Data extraction and quality assessment were performed independently by multiple reviewers. Results: The addition of ADT to salvage radiotherapy (SRT) significantly improved PSA progression-free survival (HR 0.63; 95% CI 0.53–0.74) and metastasis-free survival (HR 0.67; 95% CI 0.55–0.82). Longer ADT duration (24 months) was superior to shorter duration (6 months) in improving MFS (HR 0.77; 95% CI 0.61–0.97). Novel hormonal agents combined with ADT, such as apalutamide, abiraterone, and enzalutamide, further enhanced biochemical control (HRs ranging 0.48–0.72). No consistent overall survival benefit was observed across studies (HR 0.85; 95% CI 0.42–1.69). PSMA PET/CT-guided SRT improved biochemical progression-free survival compared to conventional imaging. Treatment-related toxicities increased with dose-intensified radiotherapy and intensified hormonal therapies but were generally manageable. Discussion: Combining ADT with SRT improves biochemical and metastasis-free outcomes in BCRPC patients. Extended ADT duration and novel antiandrogen additions show further benefit, though optimal timing and duration remain uncertain. Advanced imaging enhances treatment precision. Balancing efficacy with toxicity and quality of life is essential. Conclusion: Multimodal treatment involving salvage radiotherapy and ADT, especially with novel hormonal agents, improves disease control in biochemically recurrent prostate cancer. Personalized treatment decisions based on patient risk and PSA kinetics are crucial. Further research is needed to clarify overall survival benefits and optimize therapy duration.

Analysis Study of Outcomes Robotic-Assisted Surgery is Compared to Minimally Invasive Surgery in Pediatric Urology: A Comprehensive Systematic Review and Metaanalysis Study Tegar Pamungkas; John M.Sangkai
The International Journal of Medical Science and Health Research Vol. 4 No. 5 (2024): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/y68aeb30

Background: The use of robotic-assisted surgery (RAS) has increased more slowly in pediatrics than in the adult population. Despite the many advantages of robotic instruments, such as the ability to mimic the movements of the human wrist, highly magnified 3D visualization, and tremor filtration, the da Vinci Surgical System still presents some limitations for use in pediatric surgery. Method: This systematic review and meta-analysis, conducted following PRISMA guidelines and employing the PICO format, aim to explore about the analysis study of outcomes robotic-assisted surgery is compared to minimally invasive surgery in pediatric urology. Inclusion criteria encompass diverse study designs (RCTs, observational, quasi-experimental, and case-control studies) investigating the analysis study of outcomes robotic-assisted surgery is compared to minimally invasive surgery in pediatric urology, while exclusion criteria filter out studies lacking relevance to the analysis study of outcomes robotic-assisted surgery is compared to minimally invasive surgery in pediatric urology. Result: The selected articles, demonstrate a recent publication trend, with 2 are articles published in PubMed journal, 5 were published in Sage Journal, 1 were published in Lancet, 4 were published in Science Direct from 2014 – 2024. Based on the Z value of 12.79 and P value <0.00001, there is a significant comparison between robotic-assisted surgery and minimally invasive surgery. The fixed random value is 0.37, where the value here is positive. Conclusion: Robotic procedures in paediatric surgery are increasingly reported. Financial restrictions in many public health markets will likely demonstrate a reduced growth. Over the next decade, the introduction of new, more affordable robotic platforms is likely to alter this.

A Comprehensive Systematic Review of Comparative Outcomes Following Laparoscopic Versus Open Cholecystectomy for Gallbladder Disease: Evidence Synthesis from Randomized Controlled Trials and High-Quality Comparative Studies Afdhona Wiranata; John M.Sangkai
The International Journal of Medical Science and Health Research Vol. 19 No. 3 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/gypwxh67

Introduction Laparoscopic Cholecystectomy (LC) has become the global standard for symptomatic gallbladder disease, replacing Open Cholecystectomy (OC). However, the critical need for continuous, rigorous systematic evaluation across a broad spectrum of clinical, safety, and socioeconomic outcomes persists to validate modern surgical policy, especially for high-risk and complex patients. This review provides a definitive, quantitative synthesis comparing LC and OC. Methods Following PRISMA guidelines, a systematic search identified over 15 high-quality comparative studies, primarily Randomized Controlled Trials (RCTs), published through 2025. Data were extracted for 17 specific outcomes spanning efficiency, safety, morbidity, and cost. Methodological integrity was assessed using the Cochrane Risk of Bias tool (RoB 2.0). Meta-analytical synthesis employed random-effects models to pool comparable outcomes, calculating Risk Ratios (RR) or Odds Ratios (OR) and Weighted Mean Differences (WMD) with 95% Confidence Intervals (CI). Results Laparoscopic Cholecystectomy demonstrated overwhelming superiority in recovery and systemic safety. Key findings include a substantial reduction in Length of Hospital Stay (LOHS) (WMD \approx -3 days) and accelerated Time to Return to Normal Activity (WMD \approx -22.5 days) (Cochrane Review, 2007). LC significantly reduced overall morbidity (12% vs 22%) (Kamal, 2025) and provided robust protection against systemic complications, including respiratory (OR 0.55, P < 0.00001) and cardiac events (OR 0.55, P = 0.002), particularly in the elderly (Wang et al., 2014). Economically, LC resulted in lower projected 5-year cumulative charges (Cost-Effectiveness Study, 1993) and markedly fewer sick leaves (OR 0.34, P = 0.01). Discussion The synthesized evidence firmly establishes LC as the standard of care due to its superior short-term clinical benefits, reduced systemic inflammatory stress, and demonstrable economic advantages. The consistent reduction in LOHS and convalescence time translates directly into greater societal productivity. While conversion rates exist (2–10%), they serve as a critical safety valve, preserving the overall low morbidity profile of the laparoscopic approach. Conclusion Laparoscopic Cholecystectomy offers superior clinical outcomes, enhanced patient safety, and a lower overall socioeconomic burden compared to Open Cholecystectomy. LC should be maintained as the primary operative modality for the management of gallbladder disease.

ROBOTIC FLEXIBLE URETEROSCOPY VERSUS CONVENTIONAL FLEXIBLE URETEROSCOPY FOR THE MANAGEMENT OF RENAL CALCULI: EFFICACY, SAFETY, AND COST EFFICIENCY A SYSTEMATIC REVIEW Anita Arum Wijayatri; John M.Sangkai
The Indonesian Journal of General Medicine Vol. 37 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/fge2ym11

Introduction: Robotic flexible ureteroscopy (R-fURS) has been developed to overcome ergonomic and technical limitations of conventional flexible ureteroscopy (C-fURS) for renal calculi. This systematic review compares the efficacy, safety, and cost efficiency of R-fURS versus C-fURS. Methods: A systematic search of PubMed, Scopus, Cochrane Library, Web of Science, and ClinicalTrials.gov (up to April 2026) was conducted following PRISMA 2020 guidelines. Risk of bias was assessed using RoB 2 (RCT) and ROBINS-I (observational studies). Certainty of evidence was evaluated using GRADE. Meta-analysis was not performed due to clinical and methodological heterogeneity. Results: Four studies comprising 518 patients were included: one head-to-head RCT (Geavlete 2016, N=132) and three single-arm R-fURS studies (Salah 2024, Kim 2025, Klein 2021). R-fURS stone-free rates ranged 73–92.4%, comparable to C-fURS (89.4% in direct comparison). Major complications (Clavien-Dindo ≥III) were 0–1%. Operative time ranged 51–116 minutes; length of stay was 9.3 hours–1.5 days. No study reported explicit cost data. Consistent advantages of R-fURS included improved surgeon ergonomics and reduced radiation exposure. Overall GRADE certainty: Very Low to Low. Discussion: R-fURS achieves comparable stone-free rates and safety to C-fURS, with superior ergonomics and radiation protection as its most robust benefits. However, evidence is limited by heterogeneity in stone-free rate definitions, lack of direct comparative data, and absence of cost-effectiveness analyses. Conclusion: R-fURS is a feasible alternative to C-fURS with acceptable efficacy and safety. Large-scale multicentre RCTs with standardised outcomes and formal cost analyses are required before strong clinical recommendations can be made.

Orthotopic Neobladder vs. Ileal Conduit after Radical Cystectomy: A Systematic Review on Functional Outcomes and Quality of Life Anita Arum Wijayatri; John M.Sangkai
The International Journal of Medical Science and Health Research Vol. 45 No. 2 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/8apnrw20

Introduction: Radical cystectomy (RC) for bladder cancer necessitates urinary diversion, with orthotopic neobladder (ONB) and ileal conduit (IC) being the main options. This review aims to identify and synthesize the statistically significant positive functional outcomes and quality of life (QoL) advantages of ONB compared to IC. Methods: A systematic review of 80 studies (RCT, etc) was conducted. Significant positive outcomes favoring ONB were extracted for global QoL, physical function, body image, sexual function, and specific QoL domains. Results: Meta-analyses demonstrated ONB significantly outperforms IC in global health status (WMD +9.13, p=0.004), physical functioning (WMD +11.57, p=0.0001), role functioning (WMD +9.64, p=0.002), and social functioning (WMD +6.81, p=0.03) (1,2). ONB showed superior body image (p=0.001) (12) and sexual function in males (p<0.001) (13,14). At 24 months, ONB achieved higher general HRQoL (73.6 vs. 60.5, p=0.013) and a greater proportion of "good" HRQoL (61.1% vs. 32.4%, p=0.019) (8). In women, ONB provided better emotional (p=0.02), physical (p=0.05), and role functioning (p=0.03) at 6 months (29). ONB also preserved better renal function compared to IC in some metabolic studies (39). Discussion: The positive significant effects of ONB are domain-specific and time-dependent. The advantage in global and physical functioning is most pronounced at 12-24 months post-surgery, corresponding to the stabilization of continence and anatomical preservation. Superior body image and male sexual function represent key psychosocial benefits not achievable with IC. However, these positive findings must be contextualized within significant selection bias favoring younger, healthier patients for ONB. Conclusion: ONB provides statistically significant and clinically meaningful advantages in global QoL, physical and social functioning, body image, and male sexual function. These positive outcomes support ONB as the preferred diversion for appropriately selected patients, particularly younger, motivated males without significant comorbidity.

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