Pediatric genitourinary injuries: 7-year experience at the largest tertiary referral hospital in Eastern part of Indonesia.

INTRODUCTION: The anatomical variations between children and adults render pediatric patients more prone to urogenital trauma. However, it is not known for certain whether children are more prone to genitourinary trauma than adults. The aim of the study is to scrutinize the characteristic of pediatric genitourinary trauma at, the largest tertiary hospital in Eastern part of Indonesia. STUDY DESIGN: The design of the study was analytic retrospective gathering medical records of all pediatric patients with urogenital trauma with total sampling. The number of patients, ages, genders, etiology, locations, and management were collected. Data was statistically analyzed using SPSS®, and p < 0.05 was considered statistically significant. RESULTS: We found 13.5 (10-15.5) years as the median age in our 60 samples. Boy (75.00%), renal trauma (56.67%), abdominal and pelvic trauma (96.67%), traffic accident (91.67%), suprapubic catheterization (52.17%), and hemodynamically stable (91.67) was among the majority. We also found that non-operative management was in majority. Statistical analysis demonstrated significant differences for management and grade of injury (p < 0.05). DISCUSSIONS: This is, to the best of our knowledge, the first study of genitourinary injuries in children who were treated at a tertiary hospital in Indonesia during the course of the 7-year research period. The limitations of this study are retrospective character and conducted in single institution. CONCLUSION: The highest incidence of pediatric urogenital trauma is renal trauma due to traffic accident, which often multitrauma. Future prospective multi-center studies should be done to corroborate the results.

Impact of statin on renal cell carcinoma patients undergoing nephrectomy. Does it affect cancer progression and improves survival? A Systematic Review and Meta-Analysis.

INTRODUCTION: Renal cell carcinoma (RCC) is regarded as one of the most common malignant tumors. Various concomitant medications in RCC patients undergoing surgery are investigated to explore the potential for improving survival and preventing disease recurrence, including statin. It has been observed that these drugs induce apoptosis, thereby inhibiting tumor growth and angiogenesis. We aimed to perform a systematic review and meta-analysis to enhance the level of evidence for statin in RCC. METHODS: A systematic literature search was conducted in several online databases, including PubMed, Scopus, and Sciencedirect, using terms relevant to the use of statins in RCC patients undergoing nephrectomy for publications published up to July 2023, according to a registered review procedure (CRD42023452318). The Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias of the included study. Review Manager 5.4 was used for all analyses. RESULTS: Seven articles was eligible for our study. The analysis revealed that patients receiving statin had a better overall survival compared to patients who does not receive statin (HR 0.71, 95% CI 0.51-0.97, p = 0.03, I2 = 76%). However, there was insignificant difference in terms of CSS, DFS, and PFS between RCC patients receiving statin and without statin. CONCLUSIONS: Statin has substantial benefits for improving OS. Even though the outcomes for CSS, DFS, and PFS were insignificant, the potential role of statins as a supplementary therapy in surgically treated RCC still requires further investigation.

Prolapsed ureterocele mimicking a vulval mass in young female with complete duplex system and ureteral stone: A case report.

INTRODUCTION AND IMPORTANCE: Ureterocele is a congenital malformation of the ureter with dilatation in the distal part of the ureter. In most cases, this condition was present in childhood. In cases involving adults, this condition is associated with prolapse as well as the formation of stones. Prolapsed ureterocele with stone is considered to be a very rare case. We report a complex case of prolapsed ureterocele in a young female with a protruding mass in the vagina with complete pyeloureteral duplication and stone in the left ureterovesical junction. CASE PRESENTATION: A 19-year-old female presented to the hospital with a complaint of protruding mass in the vagina. A Computed Tomography (CT) scan and Intravenous Urography (IVU) confirmed the presence of a left ureterocele with a complete duplex system and stone in the ureterovesical junction. An endoscopic resection of the ureterocele was performed. One year following surgery, the patient was asymptomatic without deterioration of renal function or urinary tract infection. DISCUSSION: Prolapsed ureterocele in adulthood mimicking the clinical appearance of vulvar mass is considered a very rare case. The imaging examination in this case can be identified through CT-Scan. Surgical treatment of ureterocele consisted of incision, multiple punctures, unroofing, or resection. Considering the complex presentation in this case, we decided to undergo endoscopic resection to prevent the incidence of re-prolapsed which later required a second procedure. CONCLUSION: In cases of prolapsed ureterocele associated with urethral stones, endoscopic treatment is a viable option for reducing the risk of recurrent ureterocele prolapse.

Silodosin as a medical expulsive therapy for distal ureteral stones: A systematic review and meta-analysis.

Introduction: Tamsulosin is the most commonly used medical expulsive therapy (MET). However, it does not alleviate ureteral colic. It is important to develop MET that can reduce ureteral colic while maintaining a high stone clearance rate. Silodosin is an α1A adrenoceptor with high affinity and selectivity for the distal ureter, which may reduce ureteral colic and enable stone expulsion for distal ureteral stones. Therefore, we performed this systematic review and meta-analysis to evaluate the efficacy of silodosin as MET and its role in reducing ureteral colic among patients with distal ureteral stones. Materials and Methods: This research was conducted in accordance with the Cochrane Handbook for Systematic Review and Intervention, in adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, and was registered in the International Prospective Register of Systematic Reviews (PROSPERO CRD42021249003). A comprehensive literature search was performed in several databases including Medline, EMBASE, and Scopus up to July 2021 for randomized trials comparing silodosin with placebo for MET. RevMan 5.4 was used for data analysis. Results: A total of six randomized controlled trials were included in this analysis with a total of 907 patients. Our analysis revealed that the patients who received silodosin had significantly higher stone expulsion rate (SER) (odds ratio [OR] 3.33, 95% confidence interval [CI] 2.34, 4.76, P < 0.01), significantly shorter stone expulsion time (SET) (mean difference -3.79, 95% CI -4.51, -3.06, P < 0.01), and lower analgesic use (OR 0.4, 95% CI 0.23, 0.69, P < 0.01) compared to the group receiving placebo. Conclusion: Silodosin showed significantly higher SER, lower SET and lower analgesic use in patients with distal ureteral stones as compared to a placebo.

Factors for In-Hospital Mortality in 145 Male Patients with Fournier's Gangrene: A 10-Year Observational Study from a Single Tertiary Referral Center in Indonesia.

BACKGROUND Fournier's gangrene (FG) is a potentially fatal necrotizing infection. Due to the rapid progression of the disease, the fatality rate remains high despite advances in therapy. This 10-year observational study from a single tertiary referral center in Indonesia aimed to identify the risk factors for in-hospital mortality from 145 male patients diagnosed with FG. MATERIAL AND METHODS This retrospective cohort study was conducted at one of Indonesia's largest tertiary referral hospitals. The risk factors of in-hospital mortality were analysed using data collected through hospital medical records. All patients diagnosed with FG from January 2012 until December 2021 were included. Outcome measured was sociodemographic factors, comorbidities, laboratory findings, length of stay, culture results, and disease outcome. The microbiological culture was performed on FG lesions isolates. The statistical analysis was conducted using SPSS version 26.0. RESULTS The analysis included 145 male patients with a median age of 52 (IQR, 43-61) years. Of them, 38 (26.20%) patients died. There were more patients with diabetes mellitus (DM) in non-survivor groups compared to survivor groups (76.3% vs 57%, p=0.035). On multivariate analysis, DM and Clostridium perfringens infection were found to be independent factors of in-hospital mortality [adjusted odds ratio (aOR)2.583, 95% confidence interval (CI)=1.061-6.289, aOR 5.982,95% CI=1.241-28.828, respectively]. CONCLUSIONS The mortality rate for FG was considerably high. DM and Clostridium perfringens infection were shown to be independent risk factors for mortality among men.

The role of tranexamic acid in reducing bleeding during transurethral resection of the prostate: An updated systematic review and meta-analysis of randomized controlled trials.

Introduction: Transurethral resection of the prostate (TURP) is regarded as the current gold standard surgical intervention for benign prostatic hyperplasia (BPH). However, this procedure is associated with significant chances of intraoperative and postoperative bleeding. Several studies have reported the role of tranexamic acid in prostatic surgeries, but, its role in TURP is still unclear. This review aims to evaluate the role of tranexamic acid in reducing the blood loss during TURP. Materials and Methods: A systematic search was performed on Medline, Scopus, Embase, and Cochrane, up to December 2021. Relevant randomized controlled trials (RCTs) evaluating the role of tranexamic acid in TURP were screened using our predefined eligibility criteria. Data were expressed as odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CIs). All analyses were performed using RevMan 5.4 (Cochrane Collaboration, UK). Results: Six trials were included in this meta-analysis, comprising of 582 patients with BPH who underwent TURP. The meta-analysis revealed an insignificant difference in the rate of blood transfusion (OR 0.68, 95% CI 0.34, 1.34, P = 0.27) but, a significantly lower amount of blood loss and a lower reduction in the hemoglobin (Hb) levels in the patients receiving tranexamic acid as compared to the control group (MD - 127.03, 95% CI - 233.11, -20.95, P = 0.02; MD - 0.53, 95% CI - 0.84, -0.22, P < 0.01; respectively). Also, the operative time (P = 0.12) and the length of hospitalization (P = 0.59) were similar between the two groups. Conclusion: The administration of tranexamic acid was not found to be effective in reducing the need for blood transfusion, the operative time, and the length of hospitalization during the TURP. However, it could reduce the amount of blood loss and the fall in the Hb levels.

Prognostic Value of PCO2 Gap in Adult Septic Shock Patients: A Systematic Review and Meta-Analysis.

Sepsis cases caused substantial mortality and a significant burden on healthcare costs and resources. To tackle this problem, there has been discussion surrounding O2 parameters as it has a distinct outcome in septic patients. This review aimed to evaluate the prognostic value of the central venous-arterial carbon dioxide difference (PCO2) gap in patients with septic shock. A comprehensive systematic search was performed through electronic databases including Pubmed, Scopus, and Embase for studies focusing on the use of PCO2 gap as a mortality predictor in septic shock patients. Other secondary outcomes such as mean arterial pressure, lactate clearance, the acute physiology and chronic health evaluation II score, and intensive care unit length of stay were also measured. The Newcastle-Ottawa Scale tool was used to assess the risk of bias. A total of 8 studies were analysed. The mortality rate (odds ratio=0.50, 95% CI=0.28-0.87, P < .01) and lactate levels (mean difference [MD] = -0.98; 95% CI=-1.62 to -0.35; P=.001) of the low PCO2 gap group were significantly lower than the high gap group. The low gap group had a significantly higher mean arterial pressure compared to the high gap group (MD=4.54; 95% CI=2.14 to 6.95; P=.001). There were no pronounced outcomes in acute physiology and chronic health evaluation score and intensive care unit length of stay. PCO2 gap can potentially be used as a marker for mortality rate in septic shock patients. It is also significantly associated with other predictors, such as mean arterial pressure and lactate clearance.

Comparative efficacy and safety between Micro-Percutaneous Nephrolithotomy (Micro-PCNL) and retrograde intrarenal surgery (RIRS) for the management of 10-20 mm kidney stones in children: A systematic review and meta-analysis.

Objectives: Kidney stone in children is a recurring problem that requires multiple interventions over time. Minimally-invasive approach, such as Extracorporeal Shockwave Lithotripsy (ESWL) is recommended for moderately-sized stones. However, since ESWL is associated with multiple interventions, Micro-Percutaneous Nephrolithotomy (Micro-PCNL) and Retrograde Intrarenal Surgery (RIRS) can also be considered to treat kidney stones in pediatric patients. Both approaches have their respective advantages and disadvantages. In this study, we aimed to compare the efficacy and safety of Micro-PCNL and RIRS in pediatric patients with kidney stones. Methods: This systematic review and meta-analysis adhered to the PRISMA guideline and Cochrane Handbook of intervention. The included studies were obtained from the PubMed and ScienceDirect databases. The protocol of this review has been registered in PROSPERO (CRD42021265894). The quality of the studies was assessed using the Newcastle-Ottawa Scale, outcomes were analyzed using STATA®16, and certainty of evidence was evaluated using GRADE. Results: A total of 239 participants were included in this study, divided into the Micro-PCNL (n = 112) and RIRS (n = 127) procedure groups. Statistical analysis revealed a significantly lower requirement of postoperative stenting procedure in Micro-PCNL compared to RIRS (OR 0.09; 95%CI 0.02, 0.47; p < 0.01). However, no significant difference was found in stone-free rate (p = 0.86), operative time (p = 0.09), UTI incidence (p = 0.67), blood transfusion requirement (p = 0.95), and length of stay (p = 0.77). Conclusion: Micro-PCNL is superior to RIRS in managing pediatric kidney stones,10-20 mm in size based on their comparable SFR and fewer requirements of additional stenting procedures.

Comparative efficacy and safety of holmium laser enucleation of the prostate (HoLEP) using moses technology and standard HoLEP: A systematic review, meta-analysis, and meta-regression.

Purpose: The use of HoLEP was associated with steep learning curve thus prolonging operative procedure. The problem of learning curve could be solved with the invention of Moses HoLEP. This study aimed to evaluate the comparison of efficacy and safety between Moses HoLEP and standard HoLEP in BPH patient. Materials and methods: Systematic search was carried out using PRISMA guideline. Pubmed, Scopus and Embase were searched to collect randomized controlled trials and observational studies. Quantitative analysis was performed to evaluate the comparison in intraoperative, postoperative and complications characteristics. RevMan 5.4 and STATA were used in data analysis. Results: Total of 7 studies (1226 patients) were included. Regarding intraoperative characteristics, Moses HoLEP provided significantly shorter enucleation time (MD: 3.00, 95% CI: 5.57 to -0.43, p = 0.02), shorter hemostasis time (MD: 3.79, 95% CI: 5.23 to -2.34, p < 0.00001), and shorter laser use time (MD: 2.79, 95% CI: 5.03 to -0.55, p = 0.01). For postoperative characteristics, Moses HoLEP possessed significantly lower PVR (MD -34.57, 95% CI -56.85 to -12.30, p = 0.002). Overall complication was higher in standard HoLEP although the result was not significant (MD 0.68, 95%CI: 0.38 to 1.21, p = 0.19). Moses HoLEP possessed more superiority over standard HoLEP regarding shorter hemostasis time with the increasing of prostate size (coefficient -0.894, p = 0.044). Conclusion: Moses HoLEP demonstrated shorter enucleation time, shorter hemostasis time and shorter laser use time. Moses HoLEP also possessed lower PVR. There were no safety issues in Moses HoLEP compared with standard HoLEP.

The efficacy of tissue glue in pediatric circumcision wound approximation: A meta-analysis of randomized controlled trial.

INTRODUCTION: Tissue glue has been examined extensively for its effectiveness in pediatrics, and the findings are good. The purpose of this research was to examine the effectiveness of tissue glue compared to absorbable sutures for wound approximation in pediatric circumcision. METHODS: A systematic review and meta-analysis on children who had circumcision using tissue glue and absorbable suture were done in line with the PRISMA criteria. RevMan 5.4 was used to perform the meta-analysis. The mean differences for continuous and dichotomous data are determined using inverse variance, and the odds ratio is calculated using the Mantel-Haenszel technique. RESULTS: The inclusion criteria were met by six trials containing a total of 817 patients. According to the analysis, tissue glue significantly reduces the duration of the operation (MD - 7.98; 95% CI -12.35, -3.62; p = 0.0003), pain severity (SMD -0.57; 95%CI -0.80, -0.32; p < 0.00001) and the duration of pain (MD - 2.33; 95% CI -2.57, -2.08; p < 0.00001) compared to absorbable suture. However, we found that there was no significant difference in the incidence of postoperative bleeding, infection, dehiscence, or overall complication when comparing tissue glue to traditional suture. CONCLUSION: Our systematic review and meta-analysis using the most recent data suggest that tissue glue usage might reduce the operation time, as well as the intensity and duration of postoperative pain.

The role of preoperative dutasteride in reducing bleeding during transurethral resection of the prostate: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: Bleeding is one of the most common complications of transurethral resection of the prostate (TURP). Several previous studies reported that administering dutasteride before surgery could reduce perioperative bleeding. We aimed to evaluate the efficacy of preoperative dutasteride treatment in benign prostatic hyperplasia patients undergoing TURP by performing a meta-analysis of relevant randomized controlled trials (RCTs). METHODS: A comprehensive literature search was performed through the electronic databases including Medline, Cochrane Library, Google Scholar, and ClinicalTrial.gov in October 2020. RCTs evaluating the role of dutasteride for TURP were screened using the eligibility criteria and the quality of RCTs was assessed using the Cochrane Risk of Bias Tool. The heterogeneity was assessed using I 2 statistic. The measured outcomes were hemoglobin (Hb) levels, perioperative blood loss, blood transfusion, microvessel density (MVD), and operation time. Data were pooled as mean difference (MD) and odds ratio (OR). RESULTS: A total of 11 RCTs consisting of 627 samples from the treatment group and 615 samples from the placebo group were analyzed. Patients that received dutasteride had less reduction in Hb levels (MD -1.10, 95% confidence interval [CI] -1.39 to -0.81, p<0.00001). Dutasteride also significantly reduced the operation time (MD -1.79, 95% CI -2.97 to -0.61, p=0.003) and transfusion rate after surgery (OR 0.34, 95% CI 0.15 to 0.77, p=0.009) compared to the control group. However, the MVD (MD -3.60, 95% CI -8.04 to 0.84, p=0.11) and perioperative blood loss in dutasteride administration for less than 4 weeks (MD 46.90, 95% CI -144.60 to 238.41, p=0.63) and more than 4 weeks (MD -190.13, 95% CI -378.05 to -2.21, p=0.05) differences were insignificant. CONCLUSION: Preoperative administration of dutasteride is able to reduce bleeding during TURP, as indicated by less reduction in Hb level, lower transfusion rate, and less operation time.

Survival and clinical outcomes of kidney transplant recipients with coronavirus disease infection: An updated systematic review and meta-analysis.

The recent outbreak of the 2019 novel coronavirus disease (COVID-19) has raised a tremendous global concern among people, especially those with pre-existing comorbidities. Kidney transplant (KT) recipients represent a susceptible category of patients due to the long-term administration of immunosuppressive therapy. However, data on how COVID-19 is affecting these patients are scarce. We aim to systematically review the current findings regarding survival and clinical outcomes of KT recipients with COVID-19 infection. A comprehensive literature search was conducted from PubMed and Embase published up to May 2021. Studies reporting data on the incidence of COVID-19 infection among KT recipients were included. The primary outcomes analyzed in this study, including mortality rate, mechanical ventilation requirement, intensive care unit (ICU) admission, and acute kidney injury (AKI) occurrence, were measured as a pooled prevalence rate (PR) with 95% confidence intervals (CIs). All analyses were performed using STATAVR 16. A total of 30 studies comprising 3,146 KT recipients with COVID-19 infections were included. The pooled PR of mortality among KT recipients with COVID-19 infection was 21% (95% CI, 18% to 25%), ICU admission, 24% (95% CI, 20% to 28%), mechanical ventilation, 18% (95% CI, 15% to 21%), and AKI, 48% (95% CI, 42% to 53%). Meta-regression analysis showed that age was significantly associated with a higher mortality rate (P < .01). Mortality rate associated with age and relatively poor clinical outcomes were high among KT recipients with COVID-19 infection. Further studies addressing preventive measures for this at-risk population should be encouraged.

Methylene blue for vasoplegic syndrome in cardiopulmonary bypass surgery: A systematic review and meta-analysis.

BACKGROUND: To evaluate the benefit of methylene blue as an adjunct treatment by assessing hemodynamic, morbidity rate, intensive care unit length of stay, and mortality rate outcomes in adult patients with vasoplegic syndrome. METHODS: A systematic search through electronic databases including Pubmed, Embase, Scopus, and Medline for studies assessing the use of methylene blue in patients with vasoplegic syndrome compared to control treatments. The Newcastle-Ottawa Scale tool was used for observational studies, and Jadad Scale was used for controlled trials to assess the risk of bias. RESULTS: This systematic review included six studies for qualitative synthesis and five studies for quantitative synthesis. Pooled analysis revealed that mean arterial pressure, systemic vascular resistance, heart rate, and hospital stay were not statistically significant in methylene blue administration compared to control. However, administration of methylene blue in vasoplegic syndrome patients significantly reduces renal failure (OR = 0.25; 95% CI = 0.08-0.75), development of multiple organ failure (OR = 0.09; 95% CI = 0.02-0.51), and mortality rate (OR = 0.12; 95% CI = 0.03-0.46). CONCLUSION: Adjunct administration of methylene blue for vasoplegic syndrome patients significantly reduces renal failure, multiple organ failure, and mortality.

Effects of vitamin D supplementation on 25(OH)D concentrations and blood pressure in the elderly: a systematic review and meta-analysis.

Background: Hypertension and vitamin D deficiency are prevalent among the elderly. This study evaluated the effects of vitamin D supplementation on changes in serum 25-hydroxyvitamin D (25(OH)D) levels and blood pressure (BP) in the elderly (age > 60 years). Methods: Randomized controlled trials from electronic databases on the elderly taking oral vitamin D, until the end of March 2019, were selected. Two reviewers independently screened the literature on the basis of specific inclusion criteria. The primary outcomes were serum 25(OH)D level, systolic BP (SBP), and diastolic BP (DBP) changes. Results: Our analysis revealed significant differences in serum 25(OH)D level changes between the vitamin D and control groups (mean difference [MD] = 13.84; 95% confidence interval [CI] = 10.21-17.47; P < 0.000). There were no significant differences in SBP and DBP changes between the vitamin D and control groups. Subgroup analysis revealed significant differences in SBP changes between the hypertensive and vitamin D-deficient subgroups (MD = -4.01; 95% CI = -7.45 to -0.57; P = 0.02 and MD = -1.91; 95% CI = -3.48 to -0.34; P = 0.02, respectively), and DBP changes only in the hypertensive subgroup (MD = -2.22; 95% CI = -4.1 to -0.34; P = 0.02). Conclusions: Vitamin D supplementation significantly increases 25(OH)D levels and seems beneficial in lowering BP, specifically in the elderly with elevated BP and vitamin D deficiency.