Varicocele repair in improving spermatozoa, follicle-stimulating hormone, and luteinizing hormone parameters in infertile males with azoospermia: a systematic review and meta-analysis.

ABSTRACT: Patients with azoospermia show a prevalence of varicocele of 10.9% and a 14.8% contribution to male infertility. Patients with azoospermia are thought to produce high-quality semen following varicocele treatment. Advising varicocelectomy prior to sperm retrieval in a reproductive program is still debated. This study reviewed the impact of varicocele repair on male infertility using several factors. A literature search was conducted using Scopus, PubMed, Embase, the Wiley Online Library, and Cochrane databases. Sperm concentration, sperm progression, overall sperm motility, sperm morphology, and follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels were also compared. Outcomes were compared between those who received treatment for varicocele and those who did not. The data from the pooled analysis were presented as standardized mean difference (SMD) along with a 95% confidence interval (CI). Heterogeneity was evaluated using I2. Additionally, we conducted analyses for publication bias, sensitivity, and subgroup analysis as appropriate. Nine studies were included after screening relevant literature. Statistical analysis revealed a significant improvement in sperm concentration (SMD: 1.81, 95% CI: 0.84-2.77, P < 0.001), progressive sperm motility (SMD: 4.28, 95% CI: 2.34-6.22, P < 0.001), and sperm morphology (SMD: 3.59, 95% CI: 2.27-4.92, P < 0.001). Total sperm motility showed no significant difference following varicocele repair (SMD: 0.81, 95% CI: -0.61-2.22, P = 0.26). No significant differences were seen in serum FSH (SMD: 0.01, 95% CI: -0.16-0.19, P = 0.87) and LH (SMD: 0.19, 95% CI: -0.01-0.40, P = 0.07) levels as well. This study supports varicocele repair in infertile men with clinical varicocele, as reflected by the improvement in sperm parameters after varicocelectomy compared with no treatment. There were no significant improvements in serum FSH and LH levels.

A comparison between the efficacy and complication of laparoscopic and microsurgical varicocelectomy: Systematic review and meta-analysis.

Varicocele is the dilatation of the scrotal veins and may affect sperm count and infertility. It is caused by congenital vein insufficiency or absence of venous valve. The main treatment is by surgery, and currently, there are two minimally invasive choices: laparoscopic and microsurgical varicocelectomy. This systematic review aimed to record randomized clinical trials from various sources using all qualified studies up to June 2022. The assessed outcomes were operation time, hydrocele, hospital stay, change in semen parameter, recurrence rate, and pregnancy rate. The essential data extracted were Jadad score, publication year, age, and sample size. This systematic review consisted of 509 and 512 patients in the laparoscopic and microsurgery group, respectively, taken from 12 out of 281 studies. The result of this systematic review was significant difference in operation time between patients from two groups (weighted mean difference [WMD] -21.40, 95% confidence interval [CI]: -28.90--13.89); length of hospitalization (WMD: 0.38, 95% CI: 0.02-0.74); laparoscopic could significantly increase the risk of hydrocele by 3.30-fold (risk ratio [RR]: 3.30, 95% CI: 1.07-10.12); laparoscopic could significantly increase the recurrence rate by 6.98-fold (RR: 6.98, 95% CI: 3.46-14.08); no significant difference in spontaneous pregnancy between patients in both groups (RR: 0.81, 95% CI: 0.57-1.16); and laparoscopic surgery decreased the occurrence of sperm parameter changes by 40% (RR = 0.40, 95% CI: 0.25-0.62).

Role of ureteral stent material and coating to prevent ureteral stent related issue: A systematic review and meta analysis.

INTRODUCTION: Ureteral stents require materials that balance bulk and surface properties. Achieving both can be challenging, as ideal bulk properties may not align with optimal surface properties. Thus, researching coatings and biomanufacturing methods for ideal materials is essential. METHODS: A systematic review and meta-analysis, following PRISMA Guidelines, involved literature searches across five databases: PubMed, Scopus, Embase, ClinicalKey, and Cochrane. From 417 screened articles, eight studies were deemed eligible for qualitative and quantitative analysis. The selected articles underwent bias assessment using ROB Tools 2. RESULTS: The systematic review analyzed 1.356 participants. Findings revealed that firm ureteral stents significantly increased risk of infection, hematuria, and lower body pain. On the contrary, soft stents reduced infection (OR: 0.62; p=0.004), hematuria (OR: 0.60; p<0.001), and lower body pain (OR: 0.63; p=0.0002). However, infection reduction effect was uncertain due to heterogeneity. Coated vs non-coated material analysis found no difference in encrustation (OR: 1.26; p=0.52) or infection (OR: 1.67; p=0.99). Stent firmness did not affect encrustation on double J stent (OR: 0.97; p=0.17). CONCLUSIONS: Softer materials like silicone are preferred for ureteral stents to reduce symptoms like hematuria and lower body pain. Coatings like silver nanoparticles and triclosan, while enhancing antimicrobial properties, did not effectively lower infection risk.

Comparison of Early Inguinal Lymph Node Dissection and Neoadjuvant Chemotherapy in Penile Cancer Patient with Bulky Nodal Metastasis: A Cohort Study.

PURPOSE: Penile cancer is a rare malignancy, where extranodal extension in inguinal or pelvic lymph nodes is associated with decreased 5-year cancer-survival rate in this study, we try to assess survival and quality of life in a penile cancer patient with bulky lymph node. METHODS: We retrospectively reviewed data from penile cancer patients with bulky lymph nodes who underwent treatment between July 2016 and July 2021 at tertiary referral hospital care. The inclusion criteria (age >18 yr, histologically proven penile cancer, and completion of last treatment 6 months prior to this study) yielded a cohort of 20 eligible penile cancer patients with bulky lymph nodes (> 4 cm/bilateral mobile/unilateral fixed). Only patients who had completed therapy at least 6 months prior to the study were included. After obtaining consent, they were asked to complete the EORTC QLQ-C30 questionnaire to evaluate the patient's quality of life. RESULTS: Out of 20 patients, 5 patients underwent direct ILND and 15 patients underwent chemotherapy. Median follow-up after primary diagnosis was 114+32 months in patients with early ILND and 52+11 months in patients who underwent delayed lymph node dissection. Out of 5 patients who underwent early ILND, all of them survived during follow-up, and achieved cancer-free status without residual tumor and with excellent functional outcomes (Karnofsky 90). There was no significant difference in social function (p-value = 0.551), physical function (p-value = 0.272), role function (p-value = 0.546), emotional function (p-value = 0.551), cognitive function (p-value = 0.453), and global health status (p-value = 0.893) between patient which treated with early ILND and Neoadjuvant Chemotherapy. However, patients who underwent early ILND showed a relatively better clinical outcome. CONCLUSION: Early ILND followed by adjuvant chemotherapy for penile cancer with palpable lymph nodes is more favourable than neoadjuvant TIP chemotherapy.

The difference between cytokeratin 20 expression in high- and low-grade urothelial bladder carcinomas: A cross-sectional study.

Background: Bladder cancer is one of the most common cancers worldwide. Expression of cytokeratin 20 (CK 20) could be used as a biomarker in different epithelia to determine malignancy, especially in gastrointestinal, urinary tract, and Merkel cells. CK 20 could be detected in several urothelial carcinomas and was associated with bladder cancer recurrence. The study aimed to assess the utility of CK 20 expression for bladder cancer grading. Materials and Methods: This was a retrospective study assessing CK 20 expression in 73 bladder cancer patients who had transurethral resection of bladder tumor or cystectomy. The data were then collected and analyzed with SPSS Statistics version 20.0. Results: Fifty-six (76.7%) cases of high- and 17 (23.3%) cases of low-grade urothelial bladder cancer were examined for CK 20 expression. Positive expression was present in 57 (78.1%) samples. A significant difference (P = 0.034) in CK 20 expression was observed between low-grade and high-grade urothelial carcinomas. Positive expression was seen in 44 (77.2%) high-grade cases and only 13 (22.8%) low-grade cases. Conclusion: The difference in the CK 20 expression was found to be statistically significant among different grades of bladder cancer but not to metastatic bladder cancer. Further, studies are required to establish CK 20 as a diagnostic tool. We suggest a combination with several markers to compare which is superior.

The Efficacy and Safety of Avanafil During a Treatment of Male Erectile Dysfunction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Purpose: Erectile dysfunction (ED) contributes to a large burden and impairs the quality of life among males. Avanafil appears to be a promising treatment for ED; however, its efficacy and safety profile remain unclear. This study aimed to evaluate the efficacy and safety of avanafil for the treatment of ED. Patients and Methods: An extensive search of PubMed, ScienceDirect, Web of Science, and Embase databases with 11 publications was performed, with outcomes evaluated are International Index of Erectile Function - Erectile Function (IIEF-EF), Sexual Encounter Profile (SEP), and Treatment-Emergent Adverse Events (TEAE). Statistical parameter Mean Difference (MD) and Risk Ratio (RR) with 95% Confidence Interval (CI) were used to measure effect size. Results: The pooled estimates demonstrated that changes in IIEF-EF function (MD=4.39, 95% CI [3.41, 5.37], p<0.001), SEP-2 (RR=3.43, 95% CI [2.79, 4.22], p<0.001), SEP-3 (RR=2.30, 95% CI [2.01, 2.62], p<0.001), and TEAE (RR=1.49, 95% CI [1.12, 1.96], p=0.005) were significantly higher in the avanafil group than in the placebo group. Moreover, 200 mg avanafil was superior to that mg 100 mg-avanafil, indicated by the IIEF-EF score (MD=-1.15, 95% CI [-1.40, -0.89], p<0.001). In contrary, there were no significant differences in SEP-2 (RR=0.90, 95% CI [0.75, 1.08], p=0.26), SEP-3 (RR=0.92, 95% CI [0.81, 1.05], p=0.21) and TEAE (RR=1.00, 95% CI [0.87, 1.15], p=0.99) for both 100 mg and 200 mg doses. Conclusion: This review highlights the potential use of this drug in ED treatment. Further large-scale Randomized Controlled Trials investigations involving various racial groups are required to confirm these findings.

The Assessment of Male Erectile Dysfunction Characteristics in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis and Hemodialysis Using the International Index of Erectile Function (IIEF-5) Combined with Hospital Anxiety and Depression Scales.

Purpose: To determine the differences in mean scores of erectile dysfunctions (EDs) assessed by the International Index of Erectile Function (IIEF-5) questionnaire between patients with chronic kidney disease (CKD) undergoing hemodialysis and patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Patients and Methods: This is an analytic observational study with a cross-sectional design that was conducted from June to December 2022 at the Urology Center of Haji Adam Malik General Hospital and Rasyida Kidney Specialized Hospital. The sample of this study were male CKD-patients who underwent regular hemodialysis (HD) and who underwent CAPD, and met the inclusion and exclusion criteria. Psychological disorders experienced during therapy session are considered as risk factors and assessed via the Hospital Anxiety and Depression Scale (HADS). These disorders assessment was used to evaluate the severity of the patients' anxiety and depressive symptoms. Statistical data analysis was carried out. Results: Both groups had HADS-A and HADS-D scores with an average <7, classified as normal anxiety and depression. Most of the patients in the HD group had mild-to-moderate ED (28.6%), while in the CAPD group had mild severity of ED (38.1%). There were no significant differences in severity of ED between patients undergoing HD and CAPD (p > 0.05). However, there was a significant difference in ED scores (IIEF-5) between patients undergoing HD and those with CAPD (p < 0.05), in which patients in the CAPD group had a higher IIEF-5 score. In addition, there was a significant positive correlation with moderate strength (p<0.001; r=0.494) between anxiety disorders and ED disorders in patients undergoing HD and CAPD, whereas there is no significant correlation between depressive disorders and ED conditions (p > 0.05). Conclusion: There was a significant difference in IIEF-5 scores between patients undergoing HD and CAPD.

The association between serum hypoxia inducible factor-1α level and urothelial bladder cancer: A preliminary study.

INTRODUCTION: We aim to evaluate the association between serum hypoxia inducible factor (HIF)-1α level and stage and grade of urothelial bladder cancer (UBC). METHODS: A case-control study was conducted at Haji Adam Malik Hospital Medan, Indonesia. Inclusion criteria for case group was subject aged 18 years or older and diagnosed with UBC based on histopathological examination. Control group consisted of gender and age matched healthy subjects. Serum HIF-1α level was determined using ELISA method. Data was analyzed with chi square, Mann Whitney, and independent T tests. RESULTS: A total of 80 subjects were enrolled and divided into case and control groups equally. Most subjects were males with mean age of 69.65 years for case group and 68.25 years for control group. Most subjects had advanced primary tumor and lymph node stages. Only 30% subjects had metastasized UBC. Higher serum HIF-1α level was observed in case group (p < 0.001). Serum HIF-1α level was strongly associated with metastasis stage (p < 0.001), followed by lymph node (p = 0.005) and primary tumor (p = 0. 013) stages. Serum HIF-1α level was not associated with grading (p = 0.134). CONCLUSIONS: Serum HIF-1α level is associated with staging but not grading of UBC.

Evaluation of Health-Related Quality of Life in Patients Receiving Treatment for Penile Cancer: A Single-Center Cross- Sectional Study.

INTRODUCTION: Penile cancer is one of the uncommon types of cancer in men. The treatment could significantly impact a patient's quality of life (QOL), leading to difficulties in fulfilling life functions. METHODS: This descriptive observational study aimed to describe a situation using a cross-sectional design objectively. The population of this study was all patients with a diagnosis of penile cancer who underwent therapy at the Haji Adam Malik Hospital from September 2020 to September 2021. Quality of life was assessed using EORTC QLQ-C30. RESULTS: The respondents' mean age and standard deviation were 54.44 and 8.647 years, respectively. The youngest was 38 years, while the oldest age was 64 years. Most respondents had no history of circumcision (55.6%). All respondents had a poor QOL based on the 28 components in the questionnaire. This study showed that erectile function, changes in sexual function, and overall sexual function were correlated with health-related quality of life (HRQoL) post-treatment. In general, lack of sexual activity is the primary factor responsible for decreasing HRQoL in penile cancer patients. It has been reported that 70% of patients experienced a negative impact on sexuality post-treatment. CONCLUSION: The quality of life in patients receiving treatment for penile cancer at RSUP H. Adam Malik, Medan, was poor. It is associated with a lack of sexual activity.

Nephrolithiasis-Associated Renal Cell Carcinoma in Patients Who Underwent Nephrectomy: A Single-Center Experience.

Background: Kidney stones (nephrolithiasis) affect around 5% of the world's population. Some medical disorders, like obesity or diabetes, have increased the incidence and prevalence of nephrolithiasis. In addition, chronic inflammation and infection are frequently linked to kidney stone formation. Urothelial cell proliferation may change as a result of chronic inflammation, tumors will therefore develop as a result of this. The correlation between nephrolithiasis and renal cell cancer can also be explained by shared risk factors. At Adam Malik General Hospital, we strive to identify the risk factor for stone-induced renal cell cancer. Methods: This study was carried out at Adam Malik General Hospital by collecting medical record reports from patients who had nephrectomy for nephrolithiasis between July 2014 and August 2020. A variety of information was obtained, including identification, smoking status, body mass index (BMI), hypertension, diabetes mellitus, and nephrolithiasis history. The histopathological examination of cancer patients was used to determine adjusted odds ratios (ORs) both separately and in combination with other variables. Age, smoking status, BMI, hypertension, and diabetes mellitus all influenced the OR. The single variable was examined using Chi-square test, and the multivariate analysis was carried out using linear regression. Results: A total of 84 patients who underwent nephrectomy due to nephrolithiasis were included in the study, with an average age of 48.77 ± 7.23 years old; 48 (60%) of those were aged < 55 years old. In this study, 52 male patients (63.4%) and 16 patients (20%) were found to have renal cell carcinoma. Univariate analysis showed that the OR of patients with familial history of cancer was 4.5 (95% confidence interval (CI) 2.17 - 19.8), and the OR for smokers was 1.54 (95% CI 1.42 - 1.68). Similar results were shown in patients with hypertension and urinary tract infections due to stones. Nephrolithiasis patients with hypertension were 2.56 (95% CI 1.075 - 6.106) times more likely to develop a malignancy, while patients who had an infection due to a urinary tract stone were 2.85 (95% CI 1.37 - 5.92) times more likely to develop renal cell carcinoma compared to its counterpart. Both have a P-value of less than 0.05. Contrarily, alcoholism and frequent nonsteroidal anti-inflammatory drugs (NSAIDs) user results were different. Both have a P-value of 0.264 and 0.07, respectively. Furthermore, diabetes mellitus type 2 and BMI over 25 are not statistically significant, with a P-value of 0.341 and 0.12, respectively. In multivariable-adjusted analyses, participants with a family history of cancer and recurrent urinary tract infection due to urinary tract stones had a statistically significant increase in overall renal cell carcinoma risk (hazard ratio (HR): 1.39, 95% CI 1.05 - 1.84 and HR: 1.12, 95% CI 1.05 - 1.34). Conclusion: Kidney stone and renal cell carcinoma are significantly correlated due to recurrent urinary tract infection and familial history of cancer, which increases renal cell carcinoma risk.

Bilateral synchronous testicular cancer: A case report.

INTRODUCTION AND IMPORTANCE: Testicular cancer is the most common type of malignancy in young adult males, accounting for 1 % of all cancer diagnosis in men and 5 % of all urologic tumors. It is one of the malignancies with the highest cure rate. Bilateral germ cell tumor of the testicles is rare, representing only 1 % of all new cases of testicular cancer, around 30 % of which occur synchronously. Interestingly, there is not yet an occurrence where the bilateral synchronous testicular cancer has different histopathological type. CASE PRESENTATION: In this paper, we performed bilateral radical orchiectomy in different occasion, followed by adjuvant chemotherapy (BEP regiment). CLINICAL DISCUSSION: Since the clinical result is excellent, this finding could be a breakthrough in testicular cancer study. A cellular communication between different cancer cell type through chemokine which could affect response to chemotherapy. CONCLUSION: Treatment with surgery and chemotherapy is well tolerated and received. A further specific clinical study needs to be performed to investigate this finding in the future.

Poor prognosis of urothelial carcinoma in patients presented with persistent paraneoplastic leukocytosis with anemia.

Introduction: Paraneoplastic leukocytosis is a rare manifestation of urological cancer. This condition is well associated with the poor prognosis in other solid tumors. Anemia is the most common hematological manifestation of cancer, affecting 40%-64% of patients with cancer. This condition is also well associated with a poor prognosis. The goal of this research is to determine the clinical presentation and fate of individuals with urothelial carcinoma who have persistent paraneoplastic leukocytosis and anemia. Methods: From January 2014 to December 2020, a retrospective cohort of patients with a histological result of urothelial carcinoma was collected. Data were extracted from a single National Cancer Center Hospital in Indonesia. Persistent leukocytosis is defined as a leukocyte count ≥20,000/mL on at least two occasions with a minimum interval of 30 days. Anemia is defined using the WHO definition of anemia. Urinalysis, chest X-ray, and other blood tests were performed to exclude other probable causes of leukocytosis. Results: Thirteen of 123 patients screened presented with persistent paraneoplastic leukocytosis and anemia. All patients presented with bladder cancer, with two patients (15.4%) presented with a mixed histological urothelial carcinoma. During the trial, all of the patients died, with a median survival of 20 days after the beginning of paraneoplastic leukocytosis with anemia. Conclusions: Persistent paraneoplastic leukocytosis and anemia in a patient with urothelial carcinoma are a rare condition that is associated to a poor prognosis and a lower median overall survival time.

Correlation between neutrophil-to-lymphocyte ratio with Gleason score in patients with prostate cancer at Adam Malik Hospital Medan 2013 - 2015.

CONTEXT: A grading system was created by Donald F. Gleason for prostate cancer as prognostic indicators. The neutrophil-to-lymphocyte ratio (NLR) was found that it could be a prognostic factor in solid tumors. AIMS: This study aims to assess whether there is a correlation between NLR with the results of the Gleason score of patients with prostate adenocarcinoma biopsy at Haji Adam Malik Hospital Medan. SETTINGS AND DESIGN: A total of 121 patients underwent a prostate biopsy from early January 2013 to December 2015 at Adam Malik Hospital. SUBJECTS AND METHODS: Of the 121 patients, thirty were not included in the study because of incomplete baseline data and a history of hematological abnormalities. Data from 91 patients were then taken, including age, hematologic data prebiopsy, prostate-specific antigen (PSA) on initial examination, prostate weight estimation, and Gleason scores from biopsy results. STATISTICAL ANALYSIS USED: The data are processed with SPSS version 22. RESULTS: A significant moderate strength correlation was found between NLR and Gleason Score (r = 0.572; P = 0.001). However, no statistically significant correlation found between NLR and prostate weight estimation (r = 0.077; P = 0.469) and NLR with PSA (r = 0.072; P = 0.496). CONCLUSIONS: A significant correlation between the neutrophil-to-lymphocyte ratio and the Gleason score was noted. Further studies are needed to confirm these findings.

Systemic Inflammatory Response in Predicting Prostate Cancer: The Diagnostic Value of Neutrophil-To-Lymphocyte Ratio.

BACKGROUND: Over the past decades, the study of the microenvironment of cancer has supported the hypothesis between inflammation and cancer. Previous studies have demonstrated a promising value of platelet-to-lymphocyte (PLR) and neutrophil-to-lymphocyte ratio (NLR) as a systemic inflammatory response in prostate cancer. AIM: To evaluate their pre-biopsy values of PLR and NLR in predicting prostate cancer. MATERIAL AND METHODS: This is a diagnostic study with retrospective design. We included all benign prostatic hyperplasia (BPH) and prostate cancer (PCa) patients who underwent prostate biopsy in Adam Malik Hospital between August 2011 and August 2015. We used PSA value above 4 ng/dL as the threshold for the biopsy candidates. The relationship between pre-biopsy variables affecting the percentage of prostate cancer risk was evaluated, including age, prostate-specific antigen (PSA) level, and estimated prostate volume (EPV). The PLR and NLR were calculated from the ratio of related platelets or absolute neutrophil counts with their absolute lymphocyte counts. The values then analysed to evaluate their associations with the diagnosis of BPH and PCa. RESULTS: Out of 298 patients included in this study, we defined two groups consist of 126 (42.3%) BPH and 172 PCa (57.7%) patients. Mean age for both groups are 66.36 ± 7.53 and 67.99 ± 7.48 years old (p = 0.64), respectively. There are statistically significant differences noted from both BPH and PCa groups in terms of PSA (19.28 ± 27.11 ng/dL vs 40.19 ± 49.39 ng/dL), EPV (49.39 ± 23.51 cc vs 58.10 ± 30.54 cc), PLR (160.27 ± 98.96 vs 169.55 ± 78.07), and NLR (3.57 ± 3.23 vs 4.22 ± 2.59) features of both BPH and PCa groups respectively (p < 0.05). A Receiver Operating Characteristics (ROC) analysis was performed for PLR and NLR in analysing their value in predicting prostate cancer. The Area Under the Curve (AUC) of PLR is 57.9% with a sensitivity of 56.4% and specificity of 55.6% in the cut-off point of 143 (p = 0.02). The NLR cut-off point of 3.08 gives 62.8% AUC with 64.5% sensitivity and 63.5% specificity. These AUCs were comparable with the AUC of PSA alone (68.5%). We performed logistic regression between PSA, PLR, and NLR with result in the exclusion of PLR if calculated conjunctively. Therefore, NLR has a promising performance in predicting PCa in patients with PSA above 4 ng/dL (OR = 3.2; 95%CI: 1.96-5.11). We found as many as 80 (63.5%) patients with benign biopsy results with negative NLR value in this study. CONCLUSION: NLR has promising value in predicting prostate cancer. A further prospective study in validating its diagnostic value was needed.

Management of Severe Acute Pancreatitis.

Acute pancreatitis is one of the most common causes of hospitalisation from gastrointestinal diseases. The causes of pancreatitis vary between countries. Acute pancreatitis is classified based on Revised Atlanta classification 2013 as mild, moderately severe and severe acute pancreatitis. Acute pancreatic severity can be stratified by scoring systems such as Ranson's score, BISAP score, APACHE-II score, SOFA score. In severe acute pancreatitis, to diagnose, abdominal pain raised amylase or lipase, supported imaging finding and organ failure. Organ failure can be diagnosed by using Modified Marshall Scoring System. Management is started conservatively, which are fluid resuscitation, enteral nutrition, analgesics, and antibiotics. Surgical management is indicated when infected pancreas necrosis is detected. In this review, we will discuss the current management based on recent research.

Ki-67 Expression as a Predictive Factor of Muscle Invasion in Bladder Cancer.

BACKGROUND: Bladder cancer is the 9th most frequent cancer worldwide. Ki-67 is immunohistochemistry marker that is predictive of cancer cell proliferation. The expression of Ki-67 is associated with poor prognosis in several types of malignancy, yet the value of Ki-67 as the prognostic factor in bladder cancer remains controversial. AIM: This study is aimed to investigate the association between Ki-67 expression with muscle-invasive bladder cancer (MIBC) and non-muscle invasive bladder cancer (NMIBC). METHODS: This was a case-control study with a retrospective design. The study was conducted at the Department of Pathology, University of Sumatera Utara, Indonesia. Samples were paraffin blocks from patients diagnosed with bladder cancer and agreed to be put in the study. The samples were stained with Immunohistochemistry Staining (IHC), and then we quantitatively counted the number of the Ki-67 stained nucleus on a microscope. RESULTS: A total of 54 samples were obtained in this study. Samples consisted of 27 samples with NMIBC and 27 samples with MIBC. The cut-off point was 20%, we found 17 patients with MIBC and 14 patients with NMIBC presented with biomarker > 20%. Biomarker ≤ 20% was found in 10 patients with MIBC and 13 patients with NMIBC. On statistical analysis with Chi-Square test, no significant association found (p = 0.583) between KI-67 and muscle - invasiveness with OR of 1.579, 95% CI (0.533-4.678). CONCLUSION: There is no association between expression of Ki-67 and muscle invasiveness in bladder cancer.