Predicting Parameters of Renal Function Recoverability after Obstructive Uropathy Treatment in Adults.

Obstructive uropathy can have many causes and can manifest as supravesical, vesical, or infravesical levels of obstruction. Treatment of obstructive uropathy, whether definitive or temporary, has a risk of complications or could worsen the patient's quality of life. Thus, knowledge of the parameters that predict recoverability of renal function after obstructive uropathy treatment is essential for patients and their families. Several studies have evaluated many factors that might potentially predict recoverability of renal function after obstruction release and these essentially are divided into factors predicting unilateral or bilateral obstruction. Almost all unilateral obstruction studies used ureteropelvic junction obstruction cases as their subjects and utilized nuclear scan renography to evaluate kidney recoverability. Factors confirmed as predicting factors for recoverability of renal function were age, hemoglobin level, BUN-to-creatinine ratio, postoperative urine volume and sodium excretion, cortical thickness, type of renal pelvis, hydronephrosis grade, corticomedullary differentiation, parenchymal echogenicity, renal resistive index, and initial kidney function. Thus, these studies all had different criteria for defining the recovery of renal function, and this might explain the differences observed from study to study.

The Role of Docetaxel in Non-Castrate Resistant Metastatic Prostate Cancer: An Evidence-based Case Report.

AIM: to learn the role of docetaxel in non-castrate resistant prostate cancer patient. METHODS: literature search was conducted to find relevant study comparing the combination of docetaxel and androgen deprivation therapy (ADT) to ADT alone in non-castrate resistant prostate cancer using PubMed, Cohrane Library, Proquest, EBSCO, and Scopus database. Quality assessment of studies was done using Bond University Rapid Critical Appraisal of a Systematic Review. RESULTS: we found 494 studies from literature search, but only two studies were included in final selection. Based on validity assessment, we chose one study to be discussed further. This study showed that combination of docetaxel and ADT is better than ADT alone in regards of overall survival (HR 0.64; 95% CI 0.55, 0.75; p<0.0001; NNT=3), biochemical progression free survival (HR 0.63; 95% CI 0.57, 0.69; p<0.0001; NNT=2) and clinical progression free survival (HR 0.73; 95% CI 0.64, 0.84; p<0.0001; NNT=2). Benefit of docetaxel and ADT combination was especially seen in high volume disease (HR 0.67; 95% CI 0.54, 0.83; p=0.0003; NNT=3). CONCLUSION: addition of docetaxel into ADT has beneficial effects in terms of overall survival and progression free survival in patients with non-castrate resistant metastatic prostate cancer.

Metachronous bilateral testicular germ cell tumors with different histopathology: A case report.

Background: Testicular cancer is the most common solid tumor affecting men aged 20-39 years old. About 95% of all testicular tumor is testicular germ cell tumor. Bilateral testicular tumor is a rare incident and has similar histopathology only in less than 5% of all testicular cancer patients. Besides oncological issues, bilateral testicular tumors could lead to further consequences, such as psychosocial and hormonal issues. This article shows a case of different histopathology in the metachronous bilateral testicular tumors. Case presentation: A 34-years-old male came with right radical orchiectomy due to testicular pure seminoma pT1N0M0S0 three and half years ago. He underwent bleomycin, etoposide phosphate (BEP) chemotherapy for progressive multiple lymphadenopathies in paracaval and interaortacaval region from positron emission tomography (PET)/computerized tomography (CT) scan a year later. Sperm banking was done before initiated chemotherapy. High metabolic activity was detected in contralateral testis from follow up PET-scan. Left testicle enlargement with hard consistency was found on physical examination and there is an elevation of alpha-feto protein (AFP) and ß-hCG. Intraoperatively, the frozen section identified a malignant tumor and the patient was decided to undergo radical left orchiectomy. Postoperative pathological results showed a mixed germ cell tumor of 3.5 × 2.5 × 2 cm consisting of immature teratoma, yolk sac tumor and embryonic carcinoma without lympho-vascular invasion and involvement of the spermatic cord. Post-operative imaging and testicular tumor marker did not identify any metastases. BEP chemotherapy, testosterone replacement therapy was planned for further management in this patient with complete blood count, prostate serum antigen (PSA) and digital rectal examination should be measured three to six weeks after initiation. Conclusion: Metachronous bilateral TGCT with different histopathology is a rare disease. The treatment depends on histology of second tumor and its stage. TRT is mandatory for patient undergoing bilateral orchidectomy to address lack if testosterone.

Malignant solitary fibrous tumor of the penis: A case report of rare malignancy.

Malignant Solitary fibrous tumor (SFT) is a rare mesenchymal tumor that consists of spindle cell components. The occurrence of SFT in the genitourinary tract is extremely rare. So, there is no clear algorithm for the management of this case. We report A 33-year-old male who complained of recurrent penile swelling in the last 7 months after underwent surgery 3 months earlier. The tumor re-enlarged from the surgical wound's previous sutures. Total penectomy was performed followed by bilateral inguinal lymphadenectomy. Perineostomy was performed for urinary diversion. Long-term follow-up after surgery is suggested due to the risk of recurrences and metastasis.

Daily activities and training experiences of urology residents during the coronavirus disease 2019 pandemic in Indonesia: A nationwide survey.

Objective: To explore the impact of the coronavirus disease 2019 (COVID-19) pandemic on the training experiences of urology residents in Indonesia. Methods: A cross-sectional study using a web-based questionnaire (SurveyMonkey) involved all registered urology residents in Indonesia. The questionnaire was structured in Bahasa Indonesia, composed of 28 questions, and divided into three sections: demographic characteristics, current daily activities, and opinions regarding training experiences during the COVID-19 outbreak. The survey was distributed to all respondents via chief of residents in each urology center from May 26, 2020 to Jun 2, 2020. Results: Of the total 247 registered urology residents, 243 were eligible for the study. The response and completeness rate for this study were 243/243 (100%). The median age of respondents was 30 (range: 24-38) years old, and 92.2% of them were male. Among them, 6 (2.5%) respondents were confirmed as COVID-19 positive. A decrease in residents' involvement in clinical and surgical activities was distinguishable in endourological and open procedures. Most educational activities were switched to web-based video conferences, while others opted for the in-person method. Smart learning methods, such as joining a national or international speaker webinar or watching a recorded video, were used by 93.8% and 80.7% of the respondents, respectively. The respondents thought that educational activities using web-based video conferences and smart learning methods were effective methods of learning. Overall, the respondents felt unsure whether training experiences during the COVID-19 pandemic were comparable to the respective period before. Conclusion: The COVID-19 pandemic negatively affected urology residents' training experiences. However, it also opened up new possibilities for incorporating new learning methodologies in the future.

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.

The Impact of the COVID-19 Pandemic on Urology Practice in Indonesia: A Nationwide Survey.

PURPOSE: This study aimed to investigate the impact of COVID-19 on urology practice in Indonesia. MATERIAL AND METHODS: This was a cross-sectional study using web-based questionnaire (Survey Monkey), which was distributed and collected within a period of three weeks. All practicing urologists in Indonesia were sent an e-questionnaire link via E-mail, WhatsApp Messenger application, and/or short message service, and the chief of residents in each urology centre distributed the e-questionnaire to urology residents. RESULTS: The response rate was 369/485 (76%) among urologists and 220/220 (100%) among urology residents. Less than 10 percent of the responses in each section were incomplete. There are 35/369 (9.5%) of urologists and 59/220 (26.8%) of urology residents had been suspected as COVID-19 patients, of whom seven of them were confirmed to be COVID-19 positive. The majority of urologists (66%) preferred to continue face-to-face consultations with a limited number of patients, and more than 60% of urologists preferred to postpone the majority (66%) or all elective surgery. Most urologists also chose to postpone elective surgery in patient with COVID-19-related symptoms and patient who required post-operative ICU-care. Urologist and urology residents reported high rates of using personal protective equipment, except for medical gowns and N95 masks, which were in short supply. Several uro-oncology surgeries were considered to be the top priority for Indonesian urologist during COVID-19 epidemic period. CONCLUSION: The COVID-19 pandemic has caused a decline in urology service in both outpatient clinic and surgery services with uro-oncological procedure as a priority to conduct.

Adherence of Indonesian urologists to practice guidelines for the management of benign prostatic hyperplasia.

BACKGROUND: Clinical guideline is built to provide consistent, efficient, and high quality of medical care based on recent evidence. This study aimed to investigate the adherence of Indonesian urologists to clinical guidelines for the management of benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: This was a cross-sectional study using questionnaire conducted between January and June 2017. Respondents were Indonesian urologists registered as members of Indonesia Urological Association and had already practice in urology for at least 6 months. Questionnaires were sent via e-mail and Google Form. The level of adherence was measured using scoring system decided by authors' agreement. All data were processed using SPSS, version 23, and presented in descriptive fashion. RESULTS: Of 352 urologists who fulfilled inclusion and exclusion criteria, 209 (59.4%) respondents returned the questionnaire. Most of respondents (95.2%) used Indonesia Urological Association BPH guidelines as their clinical practice guidance. Routinely performed recommended examination, such as symptom scoring system, digital rectal examination, urinalysis, uroflowmetry, postvoid residual urine, and prostate imaging were used by 89.9%, 92.5%, 70.4%, 50.8%, 53.3%, and 98.6% respondents, respectively. After patient is diagnosed with BPH, most of respondents considered medical therapy (99%), surgical therapy (93%), and watchful waiting (78.4), with alpha-blocker as the drugs most preferred by respondents. For indication to perform surgery for BPH, only bladder stones, decreased renal function, and trial without catheter failure were considered by more than 85% of respondents. Open prostate surgery was performed by 54.8% respondents for the following reasons: large prostate volume, presence of bladder stone, unavailability of endourology equipments, abnormality of bladder, and residency training program. At last, this study found median (minimum-maximum) of Indonesian urologists adherence level toward BPH guidelines is 78.5% (28.6%-100%). CONCLUSIONS: In general, Indonesian urologists have a good adherence toward guidelines. However, there is still wide variation of their adherence to it.

Extrarenal calyces mimicking retroperitoneal cystic mass with concomitant ureteropelvic junction obstruction: renal pelvis reconstruction using calyx unification.

Extrarenal calyces (ERCs) are a very rare urological anomaly, especially when concomitantly presenting with ureteropelvic junction obstruction (UPJO). Surgical intervention is often necessary in ERCs associated with UPJO, with dismembered pyeloplasty being the most commonly utilized technique. We present a case of UPJO-associated ERCs in which renal pelvis reconstruction using calyx unification was selected as the treatment technique. An 11-year-old boy was referred to our center due to bilateral hydronephrosis and left multicystic kidney disease. Magnetic resonance imaging showed severe left hydronephrosis with concomitant left cystic mass and left UPJO. A 99mTc diethylenetriaminepentaacetic diuretic renal scan showed residual renal function of 25.9% split function and 26.8 mL/minute glomerular filtration rate. Intraoperatively, we found ERCs with severely dilated renal pelvis. The renal pelvis was excised. Major calyces protruding from the kidney were unified using side-to-side anastomosis to form a new structure resembling a renal pelvis, which was further anastomosed to the ureter. Temporary urinary drainage from the affected kidney was achieved using a double-J (DJ) stent and nephrostomy. Pathological examination revealed atrophic transitional epithelial cells. There was no intra- or postoperative complication reported. The nephrostomy tube and DJ stent were removed 2 weeks and 3 months after surgery, respectively. Ultrasonography examination performed at 1 and 9 months after DJ-stent removal showed no hydronephrosis. We conclude that renal pelvis reconstruction using calyx unification can be performed safely and is effective in treating patients with ERCs associated with PUJO. This technique should be considered especially in cases where excision of the renal pelvis cannot be avoided.

Effect of citrus-based products on urine profile: A systematic review and meta-analysis.

Background. Urolithiasis is a disease with high recurrence rate, 30-50% within 5 years. The aim of the present study was to learn the effects of citrus-based products on the urine profile in healthy persons and people with urolithiasis compared to control diet and potassium citrate.  Methods. A systematic review was performed, which included interventional, prospective observational and retrospective studies, comparing citrus-based therapy with standard diet therapy, mineral water, or potassium citrate. A literature search was conducted using PUBMED, COCHRANE, and Google Scholar with "citrus or lemonade or orange or grapefruit or lime or juice" and "urolithiasis" as search terms. For statistical analysis, a fixed-effects model was conducted when p > 0.05, and random-effects model was conducted when p < 0.05.  Results. In total, 135 citations were found through database searching with 10 studies found to be consistent with our selection criteria. However, only 8 studies were included in quantitative analysis, due to data availability. The present study showed a higher increased in urine pH for citrus-based products (mean difference, 0.16; 95% CI 0.01-0.32) and urinary citrate (mean difference, 124.49; 95% CI 80.24-168.74) compared with a control group. However, no differences were found in urine volume, urinary calcium, urinary oxalate, and urinary uric acid. From subgroup analysis, we found that citrus-based products consistently increased urinary citrate level higher than controls in both healthy and urolithiasis populations. Furthermore, there was lower urinary calcium level among people with urolithiasis.  Conclusions. Citrus-based products could increase urinary citrate level significantly higher than control. These results should encourage further research to explore citrus-based products as a urolithiasis treatment.