Comparison of scrotal and inguinal orchiopexy for palpable undescended testis: a meta-analysis of randomized controlled trials.

INTRODUCTION: Scrotal and inguinal orchiopexy are two commonly used surgical approaches for palpable undescended testis (UDT), each with distinct advantages. However, the optimal approach remains a matter of debate, warranting a comprehensive meta-analysis of randomized controlled trials (RCTs) to guide clinical decision-making. MATERIALS AND METHODS: A comprehensive literature search was conducted, adhering to PRISMA guidelines, to select RCTs comparing scrotal and inguinal orchiopexy for palpable UDT. Eight RCTs were selected for meta-analysis. Outcome measures included operative time, hospitalization duration, total complications, wound infection or dehiscence, testicular atrophy or hypotrophy, and testicular re-ascent rate. The evaluation of the study's quality was conducted by utilizing the revised Cochrane risk-of-bias tool. RESULTS: Scrotal orchiopexy showed significantly shorter operative time compared to the inguinal approach (WMD: - 15.06 min; 95% CI: - 21.04 to - 9.08). However, there was no significant difference in hospitalization duration (WMD: - 0.72 days; 95% CI: - 1.89-0.45), total complications (OR: 1.08; 95% CI: 0.70-1.66), wound infection or dehiscence (OR: 0.73; 95% CI: 0.27-1.99), testicular atrophy or hypotrophy (OR: 1.03; 95% CI: 0.38-2.78), and testicular re-ascent (OR: 1.43; 95% CI: 0.67-3.06) between the two approaches. A small proportion of cases (7.3%) required conversion from scrotal to inguinal orchiopexy due to specific anatomical challenges. CONCLUSION: Both scrotal and inguinal orchiopexy are safe and effective for palpable UDT, with comparable outcomes in terms of hospitalization and complications. Scrotal orchiopexy offers the advantage of shorter operative time. Clinicians can use this evidence to make informed decisions on the surgical approach for palpable UDT.

A Mixed Gonadal Dysgenesis in an 19 Year Old Girl with Ambigous Genitalia: A Case Report.

A 19-year-old girl was referred with delayed puberty and ambiguous genitalia. She had short stature with high blood pressure and Turner's stigmata with external genitalia Prader Score 4. Ultrasound revealed hypoplastic uterus with no gonad. Follicle stimulating hormone, luteinizing hormone and testosterone level were increased (51.29 mIU/mL, 23.66 mIU/mL and 742 ng/dl). Karyotyping revealed 46 XY with Fluorescence in situ hybridization cytogenetic study based on 300 cells showed mosaic chromosome, monosomy X (17%) and XY (83%). Laparascopic gonadectomy was done and showed that testes were only in the right inguinal canal. Then patient had external genitalia reconstruction and received estrogen replacement therapy.

TUR-P phantom for resident surgical training: food-based design as a human mimicking model of the prostate.

PURPOSE: This study would like to develop a novel model similar to human prostate in terms of its texture profile, sensation upon resection, and anatomical hallmarks for resident transurethral resection of the prostate (TUR-P) training. METHODS: Ten phantom designs were proposed, using broadly available ingredients and a homemade protocol. Three steps of evaluation and development were done: objective measurement measuring texture profile (e.g. hardness, elasticity, cohesiveness/consistency, and adhesiveness/stickiness) using TA-XT2i Texture Analyzer (Llyod Instruments, Ametek Inc) to compare the designs with human prostate, finding the most similar design to prostate; expert consensus by a panel of urologist/senior residents comparing the simulation of TUR-P on the selected design with pre-existing control phantom; and anatomical design development using 3D printing for molding. RESULTS: Texture profile analysis for mean hardness, elasticity, cohesiveness/consistency, and adhesiveness/stickiness of human prostate was 3753.4 ± 673.4, 85 ± 1.9, 0.7 ± 0.03, and 0, respectively, and design IX was the most similar to human prostate (3660.7 ± 465.6, 87.0 ± 2.5, 0.6 ± 0.05, 0). Furthermore, expert consensus showed superiority of design IX compared with pre-existing control phantom (16.95 ± 1.36 vs 8.86 ± 3.10; P < 0.001). Most of the respondents agreed that the texture, consistency, and phantom ability to mimic human prostate upon resection were similar with human prostate, though hallmarks of the prostate e.g. veromontanum, and lobes were lacking. We used these feedbacks to develop a mold, designed to produce these important anatomical hallmarks. CONCLUSION: This study developed a cost-effective prostate model from a food-based design that is similar to human prostate in terms of its texture and sensation upon TUR-P resection provided with important anatomical hallmarks.

Experience of the first 6 years of pediatric kidney transplantation in Indonesia: A multicenter retrospective study.

BACKGROUND: Pediatric kidney transplantation was only introduced in Indonesia in 2013. We therefore aimed to assess the characteristics and outcomes of transplants performed from its inception to January 2019. METHOD: The study had a dual-center retrospective design. We examined the records of kidney transplant recipients and then calculated patient and graft survival rates by Kaplan-Meier survival analysis with 95% confidence intervals (95% CI). RESULTS: In total, 12 kidney transplantations were performed in eleven children during the study period; among these, ten were boys, and nine had renal failure caused by congenital anomaly of the kidney or urinary tract. All donors were living, and all recipients were on dialysis at the time of transplantation, when their median age was 14.5 years (range, 8-19 years). Three patients died of infection in the first year of follow-up and two lost their allograft by the time of their last follow-up (median, 13 months; range, 4-69 months). The 1-year patient survival rate was therefore 68.18% (95% CI, 29.72%-88.61%), which remained unchanged at 3 and 5 years. However, the non-death-censored graft survival rates at 1, 3, and 5 years were 68.18% (95% CI, 29.72%-88.61%), 51.14% (95% CI, 14.5%-79.46%), and 25.57% (95% CI, 1.38%-64.78%), respectively. CONCLUSION: Patient and graft survival rates after pediatric kidney transplantation in Indonesia are lower than those reported in other countries. Closer patient follow-up and stricter adherence to guidelines could improve transplant outcomes, but we must seek to improve the balance between infection and rejection.

Comparison Between End-to-end Anastomosis and Buccal Mucosa Graft in Short Segment Bulbar Urethral Stricture: a Meta-analysis Study.

AIM: to compare long term follow-up between end-to-end urethroplasty and bucal mucosal graft for the management of patients with short bulbar urethral stricture. METHODS: we conducted a meta-analysis of cohort studies. Literature research was performed on the MEDLINE, Science Direct, and EMBASE database including studies from 1980 through 2014. The inclusion criteria were patients with short bulbar urethral strictrure (sized 3 cm) undergoing end-to-end anastomosis (EE) and buccal mucosa graft (BMG) with the complication of voiding symptoms and sexual dysfunction 12 months. Pooled risk ratio (RRs) and 95% confidence interval (CIs) were calculated using Mantzel-Haenzel method, while the heterogeneity were determined through I2 value. Data analysis were done using Stata software version 10.0 (StataCorp). RESULTS: We analyze 10 studies in this meta-analysis. Sexual dysfunction following EE and BMG were found in 24.6% (45/183) patients and 9.1% (11/122) patients, respectively (overall RR 2.54; 95% CI: 1,44-4,47; p=0.001). Voiding symptoms following EE and BMG were found in 14% (8/57) patients and 12.5% (7/56) patients, respectively (overall RR 0.77; 95% CI: 0.3-2.0; p=0.591). Furthermore, stricture recurrent following EE and BMG were 8.4% (8/107) and 30% (14/46), respectively (overall RR 0.38; 95% CI: 0.17-0.84; p=0.016). The effectiveness of EE and BMG were found to be equal as both demonstrated few complications. BMG were found to be superior than EE terms of minimal sexual dysfunction complication. On the contrary, EE were found to be superior than BMG in terms of stricture recurence following short bulbar urethral stricture surgery. CONCLUSION: BMG can be considered as the primary treatment rather than EE for managing short urethral stricture cases.

Early Realignment Versus Delayed Urethroplasty in Management of Pelvic Fracture Urethral Injury: A Meta-analysis.

AIM: this meta-analysis study will evaluate the incidence of urethral stricture as a successfull parameter in the management of PFUI through early realignment, compared with delayed urethroplasty. Long-term complications such as erectile dysfunction and incontinence on both methods will also be evaluated. METHODS: online literature was sourced from Pubmed, Embase, Cochrane, and Google Scholar. The incidence of stricture was evaluated from the entire study group of ER and DU. Stricture of the urethra is diagnosed by the symptoms such as the obstruction that felt by the patient, uroflowmetry examination, and urine residual post micturition that supported by urethrography examination at regular interval. In some cases the incidence of stricture also diagnosed by urethroscopy. The patient is assessed as not having stricture when it is no longer needed to do urethral dilatation or advanced urethrotomy. The rate of incontinence was assessed subjectively from the patient's complaints. The erectile function assessed subjectively; decreased of tumesen's degree, reduced the duration of erection, and penetration failure diagnosed as erection dysfunction. The data were processed as dichotomy data to calculate the risk ratio using Review Manager 5.1. RESULTS: five relevant literatures reviewed in this study. The incidence of urethral strictures are statistically significant lower in early realignment group (RR=0.70, 95% CI 0.50-0.99, P<0.05). There were no statistically significant differences between both treatment groups on the incidence of erectile dysfunction (RR=0.72, 95% CI 0.39-1.34) nor the incidence of incontinence (RR=0.74, 95% CI 0.36-1.51). CONCLUSION: early realignment decrease the occurrence of stricture on PFUI treatment compared to delayed urethroplasty method. Between the two methos, the complications such as erectile dysfunction and incontinence; however, there was no significant difference.

Challenges in the diagnosis of delayed presentation of intraperitoneal Iatrogenic bladder trauma post Caesarean delivery: A case report.

Iatrogenic bladder trauma (IBT), a rare complication of Caesarean delivery (CD), can present with delayed symptoms, posing diagnostic challenges. A case study reports IBT presenting six days post-CD, initially undetected by retrograde cystography and CT urography. Subsequent surgical exploration revealed an 8-cm wound in the bladder dome, concealed by a hematoma and enlarged uterus. While retrograde cystography is typically accurate, false negatives may occur. CT cystography offers higher sensitivity but may still miss small perforations. Delayed IBT can manifest with abdominal pain, hematuria, and elevated renal function tests, warranting clinical suspicion and consideration of surgical exploration despite negative imaging.

Detection of Molecular Variations at Androgen Receptor Gene in 46,XY Differences in Sex Development Cases.

Introduction: One of the common causes of 46,XY differences in sex development (DSD) cases is androgen insensitivity syndrome. This X-linked recessive inherited condition is associated with pathological variations of the AR gene, leading to defects in androgen action. Affected 46,XY infants or individuals experience variable degrees of undervirilization and those with severe form will have female-like external genitalia. Therefore, they were more likely assigned and reared as females. The confirmatory molecular test is often needed due to similar clinical manifestations with other conditions causing 46,XY DSD. Since in our country, the molecular test for the AR gene is lacking, the study is conducted as a preliminary study to elaborate on the possibility of developing a molecular test for the AR gene in 46,XY DSD cases. Methods: Archived DNAs of 13 46,XY DSD cases were analyzed using polymerase chain reaction and direct sequencing for molecular defects in the AR gene. Clinical and hormonal data were collected and analyzed. Results: The study successfully amplified and visualized the eight exons of the AR gene and revealed two subjects carrying AR gene variants at exon 7. In the first case, 1.2-year-old boy carried heterozygous p.Gln825Arg, which has never been reported elsewhere, and the second subject, a 2.1-year-old girl with heterozygous p.Arg841His. Both subjects presented with severe undervirilization of external genitalia with external genitalia masculinization scores (EMS) of 1.5 and 3. Conclusion: In this series, two of 13 46,XY DSD cases carried variants at the AR gene, resulting in complete androgen insensitivity syndrome.

Hypospadias risk associated with chronic hypertension during pregnancy: A systematic review and meta-analysis.

INTRODUCTION: Previous studies have suggested that hypertensive disorders of pregnancy increase risk of hypospadias, but so far none have focused on the influence of maternal chronic hypertension (CH). This study aimed to conduct a systematic review and meta-analysis of currently available observational data to assess the association of maternal CH with hypospadias risk. METHODS: Literature searches were performed using EMBASE, SCOPUS, Pubmed, and manual methods according to PRISMA 2020 guidelines and MOOSE checklist. Eligible articles were included in the study and assessed for quality using the Newcastle-Ottawa Scale (NOS). Extracted data were presented in review tables. Pooled analysis for unadjusted and adjusted effect sizes was used to determine OR and 95%CI using DerSimonian and Laird model. Heterogeneity was tested using I2 test, and publication bias was examined using funnel plots. Sensitivity analyses are done to address uncertainties. RESULTS: Searches yielded a total of 1130 publications with six eligible studies and high NOS quality score (6-9) were selected as depicted in extended summary figure. There were 519 hypospadias patients with maternal CH among those six eligible studies for analysis. After sensitivity analysis, there is one study that is excluded due to different hypospadias definition. Among the 5 remaining studies, it is found that there is an elevated risk of hypospadias in the context of maternal CH as determined by pooled unadjusted and adjusted OR (OR 1.50 95%CI 1.17-1.93; aOR 1.77 95%CI 1.54-2.04 respectively). Heterogeneity was high in unadjusted pooled analysis (I2 = 73% P = 0.005) and low in adjusted analysis (I2 = 0% P = 0.40)). Funnel plots were symmetrical in both analyses indicating a lack of publication bias. CONCLUSIONS: This meta-analysis indicates that maternal CH increases risk of hypospadias in male offspring. Future studies should weigh in biological mechanisms and pharmacological effects to elaborate the pathogenesis of this association.

Circumcision reduces urinary tract infection in children with antenatal hydronephrosis: Systematic review and meta-analysis.

INTRODUCTION: Urinary tract infection (UTI) is more prevalent in boys with antenatal hydronephrosis (ANH). Circumcision is known to lessen the risk of UTI. This study was performed to examine the associations between circumcision and UTI among patients with ANH. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards were followed for conducting this systematic review and meta-analysis. PubMed, ScienceDirect, EMBASE, and Cochrane Library databases were searched through August 4th, 2022 to identify eligible studies. The risk of bias was measured using the Newcastle-Ottawa Scale (NOS). Review manager 5.4 was used for all analysis. RESULTS: A total of 21 studies involving 8,968 patients with ANH were included in the meta-analysis. The incidences of UTI were 18.1% in the uncircumcised group and 4.9% in the circumcised group. From analysis, circumcision had significant protective effect against UTI with pooled OR of 0.28 (95% CI 0.23-0.32). The significant protective effects were also found in subgroup analysis of hydronephrosis etiology, including vesicoureteral reflux (pooled OR of 0.24; 95% CI 0.17-0.32), obstructive hydronephrosis (pooled OR of 0.34; 95% CI 0.21-0.53), and posterior urethral valve (pooled OR of 0.28; 95% CI 0.16-0.52). CONCLUSION: Our meta-analysis showed that circumcision was associated with a decreased incidence of UTI in children with ANH. This benefit was consistent irrespective of the underlying cause of hydronephrosis.

Bilateral single system ectopic ureters with bilateral urethral insertion and horseshoes kidneys in a female child.

A 14-months old female child was diagnosed with bilateral single system ectopic ureters opening into the urethra, with small bladder capacity, horseshoes kidneys, and bilateral hydronephrosis, presenting recurrent febrile UTI accompanied by continuous incontinence and elevated renal function. Early bilateral re-implantation of the ureters (modified Lich-Gregoir) was done in one setting, resulting jn no recurring febrile UTIs and continuous wetting, improving renal function parameter, competent bladder neck, and 10 folds increased in bladder capacity after 1-year follow up. We showed that earlier treatment enables patient to preserve both renal and bladder function without involving complex reconstructive surgery.

Associations of ureteroceles location and system anatomy with outcomes of endoscopic treatment: A systematic review and meta-analysis.

INTRODUCTION: Ureteroceles are a congenital abnormality of the ureter that can cause significant complications. Endoscopic treatment is a commonly used treatment approach. The aim of this review is to assess the results of endoscopic treatment for ureteroceles with consideration to their location and system anatomy. METHODS: A meta-analysis was conducted by searching electronic databases for studies comparing outcomes of endoscopic treatment for ureteroceles. Newcastle-Ottawa Scale (NOS) was employed to evaluate the potential for bias. The primary outcome was the rate of secondary procedures required following endoscopic treatment. Secondary outcomes were inadequate drainage and post-operative vesicoureteral reflux (VUR) rates. A subgroup analysis was performed to investigate possible causes of heterogeneity in the primary outcome. The statistical analysis was conducted using Review Manager 5.4. RESULTS: There were 28 retrospective observational studies, published between 1993 and 2022, including 1044 patients with primary outcomes in this meta-analysis. The quantitative synthesis showed that ectopic and duplex system ureteroceles were significantly associated with higher rate of secondary operation compared to intravesical and single system ureteroceles, respectively (OR: 5.42, 95% CI: 3.93-7.47; and OR: 5.10, 95% CI: 3.31-7.87). The associations were still significant in subgroup analysis based on follow up duration, average age at surgery, and duplex system only. For secondary outcomes, incidence of inadequate drainage were significantly higher in ectopic (OR: 2,01, 95% CI: 1.18-3.43), but not in duplex system ureteroceles (OR: 1.94, 95% CI: 0,97-3.86). Post-operative VUR rates were higher in both ectopic (OR: 1.79, 95% CI: 1.29-2.47) and duplex system ureteroceles group (OR: 1.88, 95% CI: 1.15-3.08). CONCLUSION: Ectopic ureteroceles and duplex system ureteroceles were associated with worse outcomes following endoscopic treatment compared to intravesical and single system ureteroceles, respectively. It is recommended to carefully select patients, conduct pre-operative evaluations, and closely monitor patients with ectopic and duplex system ureteroceles.

Staghorn stones in a congenital malrotation double collecting kidney managed by laparoscopy.

Kidney stones presenting with abnormal renal anatomy offer a unique challenge to the urologist. The position, calyceal orientation, relationships of the calices to the renal pelvis, renal vasculature, relationships with other intraabdominal organs, and abnormal ureteral insertion of these kidneys vary significantly. We reported a rare case of staghorn stones in congenital malrotation double collecting kidney managed by laparoscopic extended pyelolithotomy. The procedure successfully achieved stone-free status without any complications. To summarize, laparoscopy is considered effective for complex renal stones with unusual anatomy, including double collecting systems and renal malrotation when percutaneous approach cannot be performed.

Degree of kidney injury due to artificial pelvic-ureteric junction obstruction with level of neutrophil gelatinase-associated lipocalin, interleukin 18, and histopathological descriptions in Wistar: experimental research.

Pelvic-ureteric junction obstruction (PUJO) is considered the most common pathology for hydronephrosis in neonates. Full recovery of kidney impairment due to PUJO is possible, especially when pyeloplasty is indicated as surgery is mostly conducted when deterioration is identified, early detection should be considered to prevent further complications. Commonly used kidney damage biomarkers are not sensitive enough to predict kidney damage. Neutrophil gelatinase-associated lipocalin (NGAL) and urinary interleukin 18 (IL-18) are markers of early kidney damage with different characteristics. This study aimed to evaluate the relationship between these two markers with the degree of histopathological kidney damage in Wistar rats induced by PUJO. Methods: A total of thirty male Wistar rats, 200-250 g, were divided into three groups: (1) control, (2) sham, (3) PUJO (4th, 7th, 14th, and 21st days). Urine NGAL, IL-18 levels, and renal histopathology were observed on day 0, 4, 7, 14, and 21. Statistical analysis was performed using the Kruskal-Wallis and Mann-Whitney test with P less than 0.05 considered significant. Results: There was no significant difference in urine NGAL levels between groups, while IL-18 levels were significantly different based on the Kruskal-Wallis test (P 0.031). The results of the Mann-Whitney test showed a significant difference in IL-18 levels between the control group and the PUJO group on day 4 (P=0.028); the Sham surgery group with the PUJO group on day 4 (P=0.014); the PUJO group on day 4 with the PUJO group on the 7th day (P=0.008); and the PUJO group on the 7th day with the PUJO group on the 14th day (P=0.033). Conclusion: Urinary IL-18 levels can be used as a predictor of kidney damage in acute-subacute PUJO cases.

Single-stage repair for female epispadias with urinary incontinence: A case report and literature review.

BACKGROUND: Epispadias is a rare condition. Epispadias in females is two times less common than in males. Female epispadias range from 1 in 160,000 to 480,000 live births. Epispadias can be diagnosed through careful physical examination of the genital. Surgery is the management of epispadias. Surgical management of epispadias is quite tricky and requires expertise. The literature that discusses female epispadias is challenging to be found. In this paper, we would like to report surgical management of isolated female epispadias in Cipto Mangunkusumo Hospital, Jakarta. CASE PRESENTATION: A 7-year-old girl was admitted with a chief complaint of urinary incontinence since birth, during daytime and nighttime. Urinary incontinence was not induced by activities nor worsened by eating/drinking. Physical examination showed that the patient's external genitalia has underdeveloped labia minora, patulous urethra, bifid clitoris, and multiple hypopigmentation lesions. Laboratory results were in the normal range. The voiding cystourethrography (VCU) result revealed urine leaks during the filling phase. The bladder wall was normal, and no vesicoureteral reflux (VUR) appeared. The urethrocystoscopy shows a more vertical OUE, a wide-open bladder neck, and a urethral length of 1.5 cm. The patient underwent single-stage surgical procedures that consist of epispadias repair and bladder neck reconstruction through a subsymphyseal perineal approach. No complications occurred intra-operative and post-operative. At the 1-week and 6-months follow-up, the patient achieved urinary continence, and the surgical wound healed normally. DISCUSSION: Epispadias is a rare condition that could occur in various degrees, from mild to severe degrees. To a severe degree, there is a split at the entire urethral and involves the bladder neck causing constant incontinence for the patient. Epispadias cases are quite challenging to diagnose. The physician needs to separate the labia majora and perform the physical examination carefully. The objective goals of surgical management of epispadias are to achieve urinary continence, restoration of anatomy, function, and cosmetic appearance of urethra and genitalia. Single-stage reconstruction is the current surgical method used to repair isolated female epispadias. CONCLUSION: Females epispadias is a rare congenital anomaly that is quite often to miss diagnosed. The single-stage technique is the recommended surgical technique for isolated female epispadias. This patient has achieved urinary continence, and no complications occurred during and post-surgery.

Risk factors for surgical complications and short-term outcomes evaluation after novel method of buried penis correction: A single-center experience.

INTRODUCTION: Buried penis is a condition that causes the penis to appear entrapped in the subcutaneous fatty tissues. Its significant impact on quality of life affects children as well as adults. This study aims to determine the risk factors for short-term surgical complications and assess patient and surgeon satisfaction after buried penis reconstruction using complete degloving and excision of dartos tissue technique without penile anchoring suture. METHODS: A retrospective review was performed on all buried penis patients who underwent complete degloving and excision of dartos tissue by 3 different pediatric urologists at a single institution from July 2010-July 2020. The observation time point was taken from the last evaluation in the first 1 year postoperatively. Data were collected from questionnaires distributed to patients and surgeons. Patient demographics and perioperative data were extracted. Bivariate analyses were performed to identify the risk factors for short-term surgical complications. Patients' and surgeons' postoperative satisfaction was likewise assessed based on penis size, morphology, and voiding function. RESULTS: One hundred and thirty-three patients of median age 12 (2-35) years with median follow-up of 6 (1-12) months were included. The median penis length were 2 (1-3.5) cm before surgery with 3 (0.5-7) cm postoperative penile length enhancement. The postoperative penis size were reported as "satisfied" or "very satisfied" by 99% of involved surgeons and 92% of patients. The morphology were reported as "satisfied" or "very satisfied" by 99% of involved surgeons and 88% of patients. Voiding function were reported as "satisfied" or "very satisfied" by 100% of involved surgeons and 99% of patients. Prolonged edema (19.5%) was reported as the most frequent complication. Poor skin gliding occurred in 10.5% of patients. Subjective penis pain was reported in 6% of patients. Five (3.8%) patients who reported being unsatisfied with their penis size had postoperative penile length enhancement of 2 (0.5-2.5) cm (p = 0.04). Trapped penis, uncorrected penile curvature, and dissatisfaction with the morphology were reported by one patient each. The uncorrected penile curvature has a correlation with the preoperative penile curvature (p = 0.02). CONCLUSION: Buried penis reconstruction using complete dartos excision without penile anchoring suture is regarded safe and effective by both patients and surgeons. Prolonged edema is a reversible complication that can occur during early postoperative follow up (≤3 months) and obesity can be considered as one of the independent predictors for prolonged edema occurrence.

Rare cases of vesicouterine fistula.

CASE: Vesicouterine fistula (VUF) is the rarest form of genitourinary fistulas. As lower-segment cesarean section becomes a more common mode of delivery, they have become the leading cause of VUF formation. We present four VUF patients with varied symptoms such as menouria, amenorrhea, with or without urinary incontinence. We diagnosed all of our cases through cystoscopy in conjunction with methylene blue dye test or hysteroscopy. OUTCOME: We successfully repaired VUF in three open surgery instances and one laparoscopic case. To diagnose VUF, cystoscopy and hysteroscopy are still the gold standard. An expert surgeon's open or laparoscopic repair is effective and safe. The patients no longer experienced incontinence, cyclical hematuria (menouria), discomfort, or sexual dysfunction. CONCLUSION: Cystoscopy and hysteroscopy remain the gold standard tool in diagnosing VUF. Open or laparoscopic repair performed by an experienced surgeon is an effective and safe technique with a successful outcome.

Complications of ovarian cancer surgery in Dr. Cipto Mangunkusumo National Referral Hospital, Jakarta: A cross-sectional study.

Background: Ovarian cancer remains as one of the deadliest gynecologic problems globally. Often appears in advanced state, its surgery proves to be a challenge for clinicians. This study aim to present complications surrounding ovarian cancer surgery. Materials and methods: This study was a cross-sectional study to analyze reports of intraoperative and postoperative complications in ovarian cancer patients undergoing laparotomy in Dr. Cipto Mangunkusumo National General Hospital, Jakarta from January 2018 to December 2019. Ovarian cancer patients undergoing laparotomy surgery were included in the study. Patients with a history of other cancers or having incomplete data were excluded from the study. Intraoperative complications included intestinal, ureter, bladder injury, and postoperative complications included paralytic ileus, surgical wound infection and sepsis were documented. Results: A total of 78 subjects were included in the study. The total proportion of complications was 19.2%. The most prevalent intraoperative complications were intestinal injury (12.8%), bladder injury (2.6%), and ureter injury (1.3%). Most prevalent postoperative complications reported were surgical wound infection (5.2%), sepsis (3.9%), while none of the patients had paralytic ileus. Conclusion: The proportion of intraoperative and postoperative complications in ovarian cancer surgery was still at alarming level (19.2%). Further steps are needed to ameliorate the rate of complications surrounding ovarian cancer surgery.

Digital Pattern Recognition for the Identification of Various Hypospadias Parameters via an Artificial Neural Network: Protocol for the Development and Validation of a System and Mobile App.

BACKGROUND: Hypospadias remains the most prevalent congenital abnormality in boys worldwide. However, the limited infrastructure and number of pediatric urologists capable of diagnosing and managing the condition hinder the management of hypospadias in Indonesia. The use of artificial intelligence and image recognition is thought to be beneficial in improving the management of hypospadias cases in Indonesia. OBJECTIVE: We aim to develop and validate a digital pattern recognition system and a mobile app based on an artificial neural network to determine various parameters of hypospadias. METHODS: Hypospadias and normal penis images from an age-matched database will be used to train the artificial neural network. Images of 3 aspects of the penis (ventral, dorsal, and lateral aspects, which include the glans, shaft, and scrotum) will be taken from each participant. The images will be labeled with the following hypospadias parameters: hypospadias status, meatal location, meatal shape, the quality of the urethral plate, glans diameter, and glans shape. The data will be uploaded to train the image recognition model. Intrarater and interrater analyses will be performed, using the test images provided to the algorithm. RESULTS: Our study is at the protocol development stage. A preliminary study regarding the system's development and feasibility will start in December 2022. The results of our study are expected to be available by the end of 2023. CONCLUSIONS: A digital pattern recognition system using an artificial neural network will be developed and designed to improve the diagnosis and management of patients with hypospadias, especially those residing in regions with limited infrastructure and health personnel. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/42853.

Minimal Invasive Treatment in Pelvic-Ureteric Junction Obstruction: A Comprehensive Review.

Pelvic-ureteric junction obstruction (PUJO) is a common condition, and one of the lead causes of hydronephrosis in children. Currently, the gold standard treatment of PUJO is open surgery using the Anderson-Hynes-modified dismembered pyeloplasty technique. However, with the advancement of medical technology, several minimal invasive approaches were developed, including endoscopic, laparoscopic, and robotic approach, from which the best choice of surgical technique was yet to be determined. Considering the advantages and disadvantages of these methods, the recommended option is to tailor the best surgical approach to each individual patient, and to the surgeons' preference and experience. Considering these recent advances, a new algorithm is proposed to choose the best minimal invasive modalities invasive treatment to treat PUJO.