Factors associated to hemoglobin decrease after percutaneous nephrolithotomy: a retrospective study.

OBJECTIVE: This study aims to determine the preoperative and perioperative risk parameters associated with a decrease in hemoglobin (Hb) in patients undergoing percutaneous nephrolithotomy (PCNL). METHODS: We collected prospective data of consecutive patients who underwent PCNL from January 2018 to December 2022. The median decrease in post-operative hemoglobin levels compared to pre-operative was found to be 1.5 g/dl. This value was the cut-off value that divided the sample into two groups. Group 1 has a decrease in Hb levels that is higher or equal to the cutoff, group 2 has a decrease in Hb levels that is lower than the cut-off. All preoperative, stone characteristics and perioperative factors were recorded. RESULTS: A total of 273 patients were included in the study, 141 in Group 1 and 132 in Group 2. The mean age of Group 1 was significantly higher (55.48 ± 8.73 vs 45.9 ± 10.75 years, p < 0.05). The mean bleeding of Group 1 was significantly higher (285.85 ± 113.68 vs 135 ± 77.54 ml, p < 0.05). There was a significant difference in mean operation time between groups (86.35 ± 32.05 vs 64.89 ± 27.83 min, p < 0.05). Multivariate analysis showed that the variables age, comorbid diabetes mellitus, intraoperative bleeding amount, and operation time had a significant relationship with Hb reduction in patients undergoing PCNL (p < 0.05). CONCLUSIONS: Older age, comorbid diabetes mellitus, large amounts of intraoperative bleeding, and longer operating time are factors associated with PCNL-related postoperative hemoglobin decrease.

What is the most dangerous sexual position that caused the penile fracture? A systematic review and meta-analysis.

PURPOSE: Penile fracture (PF) affects 1,14 to 10,48 men in every 100.000 men in East Asia, and the primary aetiology is sexual intercourse, but the knowledge regarding the most dangerous sexual position is not well explained. This study compares three sexual positions: man on top position (MTP), woman on top position (WTP), and doggy style position (DSP), leading to PF potential. MATERIALS AND METHODS: A search of sexual position-related PF in Google Scholar, PubMed, Cochrane, and PMC Europe was performed. Criteria inclusion was the full text of relevant articles which describ the number of sexual positions. It was analyzed by odds ratio, random model effect, and the OR and 95%CI were calculated. RESULTS: 12 relevant papers involving 490 patients comprised 169 MTP, 120 WTP, 158 DSP, and 43 no intercourse cases. Meta-analysis of all sexual positions was a MTP P= 0,04, WTP P=0,49, and DSP P=0,0005. CONCLUSION: The man-dominant positions (MTP and DSP) were significantly potential for PF, which speculated that when a man is dominant and very excited, intercourse may become highly vigorous and impact trauma. This study found that man's dominant position consists of DSP and the MTP significantly lead to PF.

What is the most dangerous sexual position that caused the penile fracture? A systematic review and meta-analysis

ABSTRACT Purpose: Penile fracture (PF) affects 1,14 to 10,48 men in every 100.000 men in East Asia, and the primary aetiology is sexual intercourse, but the knowledge regarding the most dangerous sexual position is not well explained. This study compares three sexual positions: man on top position (MTP), woman on top position (WTP), and doggy style position (DSP), leading to PF potential. Materials and methods: A search of sexual position-related PF in Google Scholar, PubMed, Cochrane, and PMC Europe was performed. Criteria inclusion was the full text of relevant articles which describ the number of sexual positions. It was analyzed by odds ratio, random model effect, and the OR and 95%CI were calculated. Results: Twelve relevant papers involving 490 patients comprised 169 MTP, 120 WTP, 158 DSP, and 43 no intercourse cases. Meta-analysis of all sexual positions was a MTP P= 0,04, WTP P=0,49, and DSP P=0,0005. Conclusions: The man-dominant positions (MTP and DSP) were significantly potential for PF, which speculated that when a man is dominant and very excited, intercourse may become highly vigorous and impact trauma. This study found that man's dominant position consists of DSP and the MTP significantly lead to PF.

A randomized controlled trial study on effectiveness between tadalafil versus combination mirabegron and solifenacin on treatment of ureteral stent-related symptoms.

Introduction: ureteral stents have common complications like ureteral stent-related symptoms (SRSs). This study investigated the effectiveness of tadalafil compared to mirabegron and solifenacin combination therapy in patients with ureteral SRSs after double-J (DJ) stent insertion. Methods: this double-blind, randomized clinical trial used consecutive random sampling in participants with SRSs after double-J stent insertion. The study was conducted at four different hospitals in Makassar, Indonesia, from July to December 2020. Ureteral stent-related morbidity indices which analyzed include urinary symptoms, pain, general health, quality of work, and sex scores. All of the indices were measured by ureteral symptom score questionnaire for the first, second, third, and fourth weeks after drug consumption, either tadalafil 10 mg/day (group A, n=25) and a combination of mirabegron 25 mg/day and solifenacin 5 mg/day (group B, n=28). Results: before the treatment procedure, the groups were comparable in age, gender, body mass index, DJ stent procedures, type, and indication. In general, the score in all parameters declined over the follow-up time for both groups. Group A had a lower urinary symptom score than group B at week III and week IV (all p-value < 0.001). In addition, group A had a lower pain score, general condition, work activity, and other complaints than group B at week II, week III, and week IV (all p-value <0.001). The sexual activity score is comparable between the group, except in week I. Conclusion: according to our results, we suggest tadalafil to minimize stent-related urinary symptoms and improve general health in patients with double J stent.

Giant stone in a urinary bladder diverticulum in a 69-year-old male: a case report.

The stone formation could occur due to urine stasis in the bladder diverticulum. However, the stones are usually smaller in size and can pass spontaneously. However, a giant stone inside vesical diverticulum is considered a rare entity. We report a 69-year-old male, with a two-year history of lower urinary tract symptoms along with a recurrence of urinary tract infection. An abdominal computed tomography scan revealed the presence of a giant bladder diverticulum and a large bladder stone. The patient underwent a transurethral bladder neck incision followed by diverticulectomy with stone extraction. The diverticulum size measures 6x4x3.8 cm and diverticulum stone size of 4x3x3 cm. Fortunately, the patient recovered well after the operation. In conclusion, giant stones inside large vesical diverticulum are a rare occurrence and should be considered in patients with lower urinary tract symptoms. Early diagnosis and optimal management of the obstruction are the principles to prevent long-term complications.

Intrauterine device (IUD) migration into the bladder with stone formation: A case report.

Intrauterine device (IUD) is one of the most effective and standard contraception methods worldwide, including in Indonesia. A 54-year-old woman with frequent urination, pain in urination, and intermittency. History of using IUD 19 years ago. Urinalysis revealed there are pyuria and positive occult blood urine exam. Urinary sediment evaluation revealed some erythrocytes, leukocytes, and epithelial cells. Abdominal non-contrast CT scan revealed a stone with IUD. Stone and IUD were extracted via cystolithotomy. IUD complications may develop into bladder stone formation caused by IUD migration to the bladder. Stone extraction relieves symptoms and gives a good prognosis.

A rare Prostatic Stromal Tumor - Stromal Tumor of Uncertain Malignant Potential (STUMP) and Prostatic Stromal Sarcomas (PSS) as cultural sexual health problem in a young adult: A case report.

Stromal prostatic tumors, which consist of Stromal Tumors of Uncertain Malignant Potential (STUMP) and Prostatic Stromal Sarcomas (PSS), are rare diagnoses, especially in young adults, and influence culture sexual health, such as Erectile Dysfunction (ED). A 29-year-old man complained of a urinary emptying disorder and hematuria. The imaging test referred to a prostatic tumor. The first histopathologic review showed STUMP, and twice transurethral resection prostate (TURP) was found in some areas with infiltration, which leads to PSS, and others consisted of STUMP. The Erection Hardness Score (EHS) was four points before intervention and two points post-surgery.

A giant intra-abdominal right testicular seminoma in a bilateral undescended testicle: a case report.

Cryptorchidism is the most common congenital malformation of the male genitourinary tract. An undescended testicle has a 10% chance of developing cancer, with an intra-abdominal testicle having the highest risk. We present a 24-year-old man with a history of bilateral cryptorchidism, complaining of lower abdominal mass for two months. An abdominal computed tomography scan showed an intra-abdominal mass lesion measuring 13 x 9 cm and displacing the bladder caudally. Exploratory laparotomy revealed a right intra-abdominal testicular tumor. A right orchiectomy and left orchidopexy was performed. Histopathological examination revealed a testicular seminoma. The patient was discharged without complications and was referred to the oncology department for chemotherapy and further management. Our findings support the early treatment and close monitoring of cases of cryptorchidism due to the risk of malignancy as well as the necessity of routine scrotal examinations in all males presenting with an abdominal mass.

Percutaneous nephrolithotomy for management neglected encrusted ureteral stent in a transplanted kidney: a case report.

Retrieving these forgotten encrusted double j (DJ) stents could be challenging and require multimodal urological interventions, especially in a single-functioning transplanted kidney. Only a few cases of mini-percutaneous nephrolithotomy (mini-PCNL) via ultrasonography (US) guidance in transplanted kidneys have been published. We report a 47-year-old man; a case of a transplanted kidney, with a complaint of abdominal pain and dysuria for two weeks. The patient had a forgotten DJ stent for more than a year due to a lack of post-procedural follow-up information. An abdominal computed tomography scan showed a 20 x 13mm stone in the proximal tip of the DJ stent. Ultrasonography-guided mini-PCNL with a 19-fr rigid nephroscope was performed without complications. In conclusion, we emphasize the importance of patient education regarding the indwelling DJ stent. This case also provides that if an experienced urologist performs it, the US-guided mini-PCNL is safe and effective in transplanted kidney patients.

Ureteral avulsion caused by through and through penetrating injury of the pelvis.

Ureteral avulsion is one of the rare cases in urology considering that this structure is well-protected in retroperitoneal location. However, the presence of penetrating pelvis injury should raise high clinical suspicion that ureteral avulsion may present in this case. We report the case of ureteral avulsion in patients caused by through and through penetrating injury of the pelvis. We managed ureteral avulsion by performing end-to-end anastomosis along with ureteral stenting. A multidisciplinary approach was performed to treat other structural damages. Finally, after two months, ureteral stent was removed and ileal-re-anastomosis was performed.

Malignant renal hemangiopericytoma: a case report.

Malignant hemangiopericytoma (HPC) is an uncommon disease first described by Stout and Murray in 1942. Patients with suspected renal HPC on admission sometimes complain of low back pain, hematuria, or hypertension. A combination of histochemical and anatomo-pathologic examinations is necessary to confirm the diagnosis of renal HPC. We report the case of a 41-year-old female patient who had persistent painful nodular lesion at the right lower back and gross hematuria. Based on analyses of clinical symptoms and signs plus radiological a laboratory examination, she was diagnosed with renal cell carcinoma of the right kidney. She subsequently underwent open right radical nephrectomy via transperitoneal approach. The patient was discharged from hospital in good condition on Day 5 of care after surgical intervention. Malignant HPC of the kidney is an uncommon disease that can be diagnosed based on multislice computerized tomography angiography plus histopathological examination using the periodic acid shift method. Management of malignant renal HPC requires radical nephrectomy followed by chemotherapy. This case study provides important preliminary data for further studies of patients with renal HPC in Indonesia.

Priapism due to chronic myelocytic leukemia.

Priapism is defined as a whole or partial penile erection that persists for more than 4 hours without stimulation. Hematologic disorders are a significant risk factor for ischemic priapism. Here, we report a case of priapism due to chronic myelocytic leukemia. This is rare considering that the epidemiology of priapism in hematologic malignancies includes only 1% of patients with chronic myelocytic leukemia. Priapism has a relatively high complication rate, and management generally focuses on prompt treatment. Hematologic screening should be performed to rule out the possibility of these disorders that could underlie priapism.

Neglected double-J stent with giant bladder stone: a case report.

Double-J (DJ) stents have been widely utilized in urological practice. They are commonly used to relieve ureteral obstruction. Serious complications may occur when stents are left in place for long periods of time. In the present paper, we report a patient with a neglected DJ stent that had been inserted for five years after uterus-tumor surgery and led to a bladder stone. We report a case of a female who presented a bladder stone with a right DJ stent in the pelvic cavity. The stone was evident in radiological examination in an incidental finding. The treatment was transurethral cystolithotripsy. This case reminds us of the necessity of providing enough information and appropriate knowledge pertaining to the insertion of a ureteral stent. Transurethral cystolithotripsy is one of the treatment methods and can be suggested as a definitive method in consideration that it is a clinically effective and safe intervention.

Detection of Cryptic taxa in the genus Leptophryne (Fitzinger, 1843) (Amphibia; Bufonidae) and the description of a new species from Java, Indonesia.

We investigated phylogenetic relationships among populations of two species within the genus Leptophryne, L. cruentata and L. borbonica, using the mitochondrial 16S rRNA gene. As a result, we identified two distinct lineages within populations currently considered Leptophryne cruentata: 1) a lineage containing L. cruentata from the type locality, and 2) a lineage from Mt. Slamet and Mt. Ciremai. On the basis of genetic and morphological differences, we describe the Mt. Slamet and Mt. Ciremai populations as a new species, L. javanica sp. nov. The new species is distinguished from L. cruentata and L. borbonica by the following combination of morphological characters: the presence of distinct yellow mottling on the dorsum; relatively small body size (SVL male 22.2-24.0 mm, female 29.6 mm); relatively short hindlimbs (HLL 37.0-40.9 mm); relatively short fourth toe (4ToeL 4.3-6.0 mm); basal webbing on the hands, but well developed on toes; very protruding snout and an indistinct tympanum. In our preliminary phylogenetic analysis, we also detected four distinct lineages within Leptophryne borbonica: 1) a lineage containing true L. borbonica from west Java, 2) a lineage from Lampung (Sumatra I), 3) a lineage from northern Borneo, and 4) a lineage from Bengkulu (Sumatra II). Further studies are needed to determine taxonomic status of these lineages.

Note-, phrase- and song-specific acoustic variables contributing to the individuality of male duet song in the Bornean southern gibbon (Hylobates albibarbis).

In this study, we examine acoustic individuality in male duet songs of wild, non-habituated Bornean southern gibbons (Hylobates albibarbis) and identify contributing acoustic variables. We recorded 174 male duet songs from nine groups in a rainforest in Central Kalimantan, Indonesia. Each male portion of the duet was analysed for 14 acoustic variables at three levels of variation, including six note-specific variables (start frequency, end frequency, minimum frequency, maximum frequency, average frequency and duration), four phrase-specific variables (minimum frequency, maximum frequency, duration and number of syllables) and four song-specific variables (minimum frequency, maximum frequency, duration and number of syllables). Principal component analysis was performed to summarise each of these sets of variables into a total of six principal components (PCs). Strong acoustic individuality was found in all PCs and at all three levels: note, phrase and song (all p < 0.001). Furthermore, a particularly high magnitude of individuality was found in PC 1 of the song-specific analysis, defined by the acoustic variables of duration and number of syllables. Due to the high levels of individuality, we suggest that these acoustic variables may be used by Bornean southern gibbons for individual discrimination. As well as furthering our biological understanding of male gibbon song with regards to individuality and associated conspecific recognition, these findings also have the potential to help improve population survey methods, such as the acoustic sampling method using listening points, by offering a more accurate method of individual recognition.