The role of quick Sepsis-related Organ Failure Assessment score as simple scoring system to predict Fournier gangrene mortality and the correlation with Fournier's Gangrene Severity Index: Analysis of 69 patients.

Objective: Fournier's gangrene is a rare but life-threatening infection disease with high mortality rate. The quick Sepsis-related Organ Failure Assessment (qSOFA) is a new and simpler scoring system that may identify patients with suspected infection who are at greater risk for a poor outcome. The purpose of this study was to find out role of qSOFA in determining prognosis of Fournier's gangrene patients. Methods: This study is a case control with retrospective review of Fournier's gangrene patients treated at Hasan Sadikin Hospital from January 2013 to December 2017 who met inclusion criteria. Participants were divided into two groups according to qSOFA score as high qSOFA (2-3) and low qSOFA (0-1). Results: From 69 patients, the mortality rate was 24.6%. The sensitivity of qSOFA score to predict mortality was 88.2%; the specificity was 94.2%; positive predictive value was 83.3%; negative predictive value was 96.1%; positive likelihood ratio was 15.2; negative likelihood ratio was 0.12; and the area under the receiver operating characteristic curve of qSOFA was 94.2%. There was significant association between qSOFA scale and mortality with p-value of 0.0001. The qSOFA score has strong positive correlation with Fournier's Gangrene Severity Index (p<0.0001, r=0.704). Conclusion: qSOFA scoring system has a high prognostic value and can be used to determine prognosis of Fournier's gangrene patients.

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.

Herlyn-Werner-Wunderlich syndrome with urethrovaginal fistula: A rare case report.

Herlyn-Werner-Wunderlich (HWW) syndrome is difficult to diagnose. We report our first experience of fistula repair in HWW syndrome in Hasan Sadikin General Hospital Indonesia. A 12 years old girl presented with urinary retention, and was consulted to urology because the urethral meatus could not be found. MRI showed two separate uteri, cervices, and vaginas. Complete separation of vagina and urethra was done. After 2 years follow up, the patient had no complaint. HWW syndrome should be suspected in cases with pelvic pain or urinary retention during menarche period among teenagers and neonatal cases with any renal malformation.

Papillary renal cell carcinoma with testicular and penile metastases: A case report and literature review.

The most common site of Metastatic Renal Cell Carcinoma (mRCC) are lung, bone, liver, and brain. We report an extremely rare case of a 69-year-old man who presented mRCC to testicle and penis. He had a left-sided testicular mass in addition to left-sided abdominal fullness. He underwent a percutaneous renal biopsy with pathologic result was papillary RCC. The patient started on targeted therapy with Lenvatinib. Because there was no progress in this treatment, the patient came to our clinic. Subsequently, we performed left cytoreductive nephrectomy and radical left orchiectomy, and total penectomy. The definitive pathologic result confirmed papillary RCC.