Big bladder stone accompanied by big posterior urethral stone: A management of rare case report.

INTRODUCTION AND IMPORTANCE: Urinary tract stones are a common disease, but concurrent large-size stones in the bladder and urethra are rare. This phenomenon can lead to obstruction, infection, and other complications. We reported the management of a rare case of a giant bladder stone accompanied by a big posterior urethral stone. CASE PRESENTATION: A 36-year-old man with a chief complaint of not being able to have spontaneous micturition, frequent expulsion of stones from the penis, and a history of hematuria. Bladder examination revealed a giant bladder stone of 1278 Hounsfield Unit (HU) with a size of 4.1 × 7.2 cm, and urethral examination revealed a stone of 1275 Hounsfield Unit (HU) with a length of 4.3 × 4.2 cm, without mass. This patient underwent vesicolithotomy and urethrotomy. The evaluation showed spontaneous micturition and dissolved hydronephrosis. CLINICAL DISCUSSION: Urinary tract stone management primarily involves endourology or open surgery. For smaller stones (<5-6 mm), medication is sufficient, as they often pass spontaneously. Larger stones may require interventions like vesicolithotomy or urethrotomy. Vesicolithotomy is preferred for complex or large bladder stones, while urethrotomy is performed if the stone location is palpable or seen on imaging. These procedures are practical options for general surgeons in first-level hospitals. CONCLUSION: Concurrent large bladder and urethral stones are uncommon. Endourology or open surgery is typically employed. Treatment selection should be personalized to individual patient assessment to mitigate potential complications effectively.

Evaluating prognostic indicators for in-hospital mortality in Fournier's gangrene: a 7-year study in a tertiary hospital.

BACKGROUND: Fournier's Gangrene Scoring Index (FGSI), Simplified FGSI (SFGSI), Uludag FGSI (UFGSI), Laboratory Risk Indicator for Necrotizing (LRINEC), Neutrophil-Lymphocyte ratio (NLR), and Platelet-lymphocyte ratio (PLR) have been devised to assess the risk of mortality in Fournier's Gangrene (FG) patients. However, the effectiveness of these indicators in predicting mortality at the time of admission remains uncertain. The aim of this study is to assess the prognostic efficacy of FG's various indicators on in-hospital mortality. METHODS: This study analyzed 123 patients from Dr. Soetomo General Hospital's emergency department in Indonesia from 2014 to 2020. Data included demographics, wound cultures, and parameters like FGSI, UFGSI, SFGSI, NLR, PLR, and LRINEC. In-hospital mortality status was also recorded. The data was subjected to comparative, sensitivity, specificity and regression analyses. RESULTS: In our study of 123 patients, the median age was 52, with a mortality rate of 17.9%. The majority of patients were male (91.1%) and the most common location was scrotal (54.5%). Non-survivors had a shorter median stay (6.5 days) compared to survivors (14 days). Diabetes was the most prevalent comorbidity (61.8%). The highest sensitivity and specificity were found in FGSI and UFGSI indicators. Multivariate logistic regression identified LoS and FGSI as independent predictors of mortality. CONCLUSIONS: FGSI and UFGSI, upon admission, demonstrated the highest sensitivity and specificity, with hospital stay duration and FGSI as key mortality determinants.

Ex Vivo-Generated Tolerogenic Dendritic Cells: Hope for a Definitive Therapy of Autoimmune Diseases.

Current therapies for autoimmune diseases are immunosuppressant agents, which have many debilitating side effects. However, dendritic cells (DCs) can induce antigen-specific tolerance. Tolerance restoration mediated by ex vivo-generated DCs can be a therapeutic approach. Therefore, in this review, we summarize the conceptual framework for developing ex vivo-generated DC strategies for autoimmune diseases. First, we will discuss the role of DCs in developing immune tolerance as a foundation for developing dendritic cell-based immunotherapy for autoimmune diseases. Then, we also discuss relevant findings from pre-clinical and clinical studies of ex vivo-generated DCs for therapy of autoimmune diseases. Finally, we discuss problems and challenges in dendritic cell therapy in autoimmune diseases. Throughout the article, we discuss autoimmune diseases, emphasizing SLE.

Massive subcutaneous abscess: A case report of management and source control.

INTRODUCTION AND IMPORTANCE: Postoperative peritoneal infection, a common complication, remains prevalent despite surgical advancements. Acute abdomen necessitates rapid treatment, often presenting with abdominal pain and systemic inflammation. Bladder injuries, potentially leading to sepsis, require immediate surgical intervention. CASE PRESENTATION: We report a case of a 60-year-old man who came with the main complaint of feeling full in his stomach for 7 days, accompanied by non-radiating right lower abdominal pain since one day before hospital admission and a lethargy condition. There are complaints of seepage from the stitch marks on the right stomach, such as yellow urine. Laboratory and physical examination showed the patient in sepsis condition. CT Cystography showed a defect of 0.4 cm on the bladder dome, the contrast leakage into extraperitoneal and intraperitoneal, and tunneling to the right abdominal subcutaneous. The patient underwent subcutaneous abscess, bladder repair, and cystostomy. One month after surgery, the patient had normal micturition. CLINICAL DISCUSSION: Acute abdominal pain is one sign of emergency surgery. It can be caused by infection, inflammation, vascular occlusion, or obstruction. Physical and laboratory examination of the patient showed a sepsis condition. CT Cystography showed the presence of bladder rupture and subcutaneous abscess. The only management is surgical exploration for infection source control. CONCLUSIONS: This case underscores the importance of prompt diagnosis and comprehensive management, involving surgical intervention and targeted antibiotics, for sepsis-related complications post-TURP and bladder repair, necessitating a multidisciplinary approach for optimal outcomes and complication prevention.

Management of high-grade pediatric renal trauma in tertiary referral hospital in Indonesia: A case series and literature review.

INTRODUCTION AND IMPORTANCE: Genitourinary tract injuries constitute 10 % of all traumas, with renal injuries being common in pediatric cases due to reduced perirenal fat and abdominal wall muscle development. However, very few reports of pediatric renal trauma in Indonesia have been reported. In this case series, We present a case series of high-grade renal injury and review the literature on pediatric renal trauma in Indonesia. CASE PRESENTATION: We present four cases with renal trauma as the subjects of this case study. The 13-year-old boy, who was the initial patient, complained of hematuria and abdominal pain after falling from a tree. The second patient, the 13-year-old boy, presented with left lower back pain and hematuria after being elbowed in the left waist. The third patient, a 14-year-old boy, had been in a motorcycle accident and got grade 5 renal injury according to AAST classification. The final case involved a 4-year-old boy who experienced recurrent hematuria caused by a pseudoaneurysm following blunt renal trauma. DISCUSSION: Trauma is the leading cause of morbidity and mortality in children, with approximately 3 % of children assessed in pediatric hospital trauma departments having had trauma. With appropriate management according to guidelines, mortality can be avoided. CONCLUSION: The case series highlights the significance of treating pediatric renal trauma patients individually according to their hemodynamic state and degree of impairment.

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.

Efficacy and complications of hyaluronic acid and polylactic acid for penile augmentation: a systematic review and meta-analysis.

Background: Penile size is considered a symbol of manhood and is a subjective problem for men, especially those with small penis syndrome. Penile augmentation was introduced to correct penile size problems from a medical, psychological, or esthetic point of view. Hyaluronic acid (HA) and polylactic acid (PLA) are two types of augmentation agents that are popularly used today. However, no systematic studies and meta-analyses have compared these two modalities as penile augmentation agents. This study aimed to analyze the efficacy and safety of penile filler injections with HA compared to PLA. Methods: This study was based on the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Articles examining the differences in efficacy and adverse events of the administration of HA and PLA in patients undergoing penile augmentation were systematically reviewed from the PubMed, Proquest, Web of Science, and Scopus databases. An odds ratio with a 95% CI was applied to measure the study outcome. The analysis was performed with RevMan 5.4 software. The risk of bias for each study was evaluated using the Risk of Bias v2 instrument from Cochrane. This research protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO) registry. Result: Four articles consisting of 283 research subjects were included in this study. The meta-analysis for penile girth enhancement after penile augmentation found significant results in the HA group compared to the PLA group (P=0.01). There was no difference in the level of satisfaction with penile appearance 4 weeks after penile augmentation in the HA group compared to the PLA group (P=0.79). HA was significantly superior in sexual satisfaction 12 weeks postpenile augmentation (P=0.0004). There was no difference in the incidence of pain after penile augmentation in the HA group compared to the PLA group (P=0.33). In the postaugmentation penile inflammation, there was no difference (P=0.98) in the HA group compared to the PLA group. Conclusion: There are differences in the efficacy of penile augmentation with the superiority of HA in increasing penile diameter and postaugmentation sexual satisfaction compared to PLA. There was no difference in the incidence of complications between using HA and PLA.

Comparison of different scoring systems for predicting in-hospital mortality for patients with Fournier gangrene.

PURPOSE: To compare different scoring systems for predicting in-hospital mortality in patients with Fournier gangrene (FG). METHODS: A comprehensive literature search was performed to find all scoring systems that have been proposed previously as a predictor for in-hospital mortality in patients with FG. Data of all patients with FG who were hospitalized in one of Indonesia's largest tertiary referral hospitals between 2012 and 2022 were used. The receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of the scoring systems. RESULTS: Ten scoring systems were found, i.e., Fournier's Gangrene Severity Index (FGSI), Uludag FGSI, simplified FGSI, NUMUNE Fournier score (NFS), Laboratory Risk Indicator for Necrotizing Fasciitis, age-adjusted Charlson comorbidity index, sequential organ failure assessment (SOFA), quick SOFA, acute physiology and chronic health evaluation II, and surgery APGAR score (SAS). Of 164 FG patients included in the analyses, 26.4% died during hospitalization. All scoring systems except SAS could predict in-hospital mortality of patients with FG. Three scoring systems had areas under the ROC curve (AUROC) higher than 0.8, i.e., FGSI (AUROC 0.905, 95% confidence interval (CI) 0.860-0.950), SOFA (AUROC 0.830, 95% CI 0.815-0.921), and NFS (AUROC 0.823, 95% CI 0.739-0.906). Both FGSI and SOFA had sensitivity and NPV of 1.0, whereas NFS had a sensitivity of 0.74 and an NPV of 0.91. CONCLUSION: This study shows that FGSI and SOFA are the most reliable scoring systems to predict in-hospital mortality in FG, as indicated by the high AUROC and perfect sensitivity and NPV.

Comparison between neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as predictors of mortality on Fournier's gangrene cases.

Introduction: Fournier's gangrene (FG) is an infection of the subcutaneous tissue and fascia that progresses quickly and leads to necrosis. It is more prevalent in male patients and immunocompromised individuals, such as those suffering from uncontrolled diabetes. It has a high mortality rate, which makes its early identification and clinical suspicion critical. This study aimed to compare two laboratory parameters, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), and to predict the mortality of FG in a tertiary care hospital. Methods: In a retrospective study, data was retrieved from medical records for the period from January 2014 to December 2020, of patients diagnosed with FG. Recorded data that is age, sex, comorbidities, mortality, and laboratory results (PLR and NLR) were used to assess determinants of survival. Results: There were 23 (17.04%) nonsurvivors among the 135 subjects studied. The mean age was 50.9 ± 14.9 years and men were 103 (83%) patients. Among the participants, diabetes mellitus was the most frequent comorbidity at 74 (54.81%) patients. NLR ≥8 was statistically significant (P = 0.013) for identifying mortality, while PLR >140 was not. In multivariate analysis, NLR ≥8 was found to be a reliable predictor of the FG mortality rate (adjusted odds ratio 12.062, confidence interval 95% 2.115-68.778, P = 0.005). Conclusion: NLR had prognosis predictive value for FG, whereas PLR did not.

Severe obstructive symptoms and urinary bladder mass due to cystitis glandularis: A very rare case report in children.

Cystitis Glandularis (CG) is an unusual proliferative disease of the bladder. This condition was associated with chronic inflammation or chronic obstruction. This condition usually presents as microscopic finding and the presence of large macroscopic lesion is a rare feature. Until now, the course of disease from transitional to cystitis glandularis is still unclear and the uncertainty of CG to potentially develop into adenocarcinoma has once been documented. Herewith, we report our experience with 2 years old boy with cystitis glandularis presenting with LUTS obstructive symptoms, hematuria and bladder mass. Ultrasound examination revealed bilateral hydronephrosis with hydroureter and bladder wall thickness suggesting the sign of obstruction and chronic inflammation. Cystoscopy examination was performed to ensure the diagnosis with the result revealing protruding mass partially obstructing the bladder trigone, both ureteral orifice and posterior urethra. Transurethral resection was performed and the administration of COX-2 inhibitor and oral steroid therapy were given. Post-operative course was uneventful with the improvement in symptom and uroflowmetry revealed promising result. This case represented an entity of rare and interesting case of cystitis glandularis causing severe obstructive symptoms and urinary bladder mass which appropriate therapy of endoscopic intervention, COX-2 inhibitor and oral steroid resulted in promising outcome. Follow up of 1 year resulted in reduced LUTS symptoms such as straining and difficulty of urination.

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.

Outcome management of Fournier's gangrene cases at tertiary hospital: 7 Years experience.

OBJECTIVE: This study aims to describe the condition of Fournier's gangrene in Dr. Soetomo General Hospital from January 2014 to December 2020. MATERIAL AND METHODS: This study used a retrospective analytic design, by taking data through medical records at Dr. Soetomo General Hospital from January 2014 to December 2020. This study used total sampling with recorded data: age, gender, length of stay, outcome, location, comorbidities, causes, management, culture results, and Fournier's gangrene severity index (FGSI) score. RESULT: Of the 135 subjects collected, it was found that 55.56% were individuals over 50 years of age. About 91.11% were male patients, with some sites being in the scrotum 50.37%. Only 25.19% of patients had no comorbids, while the rest had a history of CKD, hypertension, diabetes, or a combination of these diseases. Bacterial cultures obtained were mostly caused by the Enterobacteriaceae bacteria group (32.59%). Of the subjects we studied who experienced mortality, it was found that all were from the group with FGSI >9. CONCLUSION: From the results of our descriptive study, at a glance, it appears that there is a tendency for the incidence of Fournier's gangrene in the elderly and individuals with comorbidities. And the mortality rate increases with a high FGSI value. So that FGSI could be used as a predictor of mortality in patients with FG.

Local anesthetics versus systemic analgesics for reducing pain during Extracorporeal Shock Wave Lithotripsy (ESWL): A systematic review and meta-analysis.

Extracorporeal Shock Wave Lithotripsy (ESWL) is one of the treatment options for patients with renal and ureteral calculi. Even though the procedure is less invasive compared to others, pain caused by the procedure is a major concern. Several studies recommended the use of either local or systemic analgesia with varying results. We aimed to compare the use of local anesthetics and systemic analgesics from randomized controlled trials evaluating pain management during ESWL. A systematic search adhering to the Preferred Reporting Items for Systematic Review and Meta-Analysis protocol was performed in theMedline, ScienceDirect, and Cochrane library databases. The bias was evaluated using the Cochrane risk of bias tool. Mean difference (MD) was used to analyze continuous outcomes. A total of seven studies were obtained. The topical anesthesia used was eutectic mixture of local anesthetic cream and xylocaine gel. In contrast, the local injection anesthesia used was subcutaneous prilocaine and intracutaneous sterile water injection. The systemic analgesics used were intramuscular and oral forms of sodium diclofenac. There is no significant difference between the visual analogue scale results between the local and systemic groups (P> .05). The differences in ESWL frequency were also insignificant (P > .05). Additional analgesics supplementation (MD 8.44, 95% CI 2.28-14.61, P» .007) and the duration of the procedure (MD 1.39, 95% CI 0.21-2.56, P» .02) were significantly lower in the local group. Local anesthesia in ESWL shows a similar degree of pain and frequency but has a shorter duration and fewer analgesics supplementation than systemic analgesics.