Irfan Wahyudi

Obese Kidney Donors in the Laparoscopic Living Nephrectomy Era: How Safe?

BACKGROUND Obesity is a major worldwide health problem, causing up to 3.4 million deaths per year. It is considered to be a relative contraindication for laparoscopic surgery. Laparoscopic living donor nephrectomy is the criterion standard procedure for kidney procurement in many transplant centers. However, the selection of the obese donors undergoing laparoscopic nephrectomies is still debatable. The objective of this study was to compare short-term results of obese donors and non-obese donors undergoing laparoscopic living donor nephrectomies. MATERIAL AND METHODS A retrospective analysis of 259 live donors between November 2011 and August 2015 was performed. Body mass index equal to or more than 30 kg/m2 was categorized as obese. Twenty subjects were categorized as obese donors. We randomly assigned for 30 non-obese donors to the control group. Intra-operative and post-operative data were compared between these 2 groups. A p-value ≤0.05 was considered a significant difference. RESULTS Donor characteristics were the same in the 2 groups. No significant differences were found in the first warm ischemic time, estimated blood loss, or postoperative pain. The operative time in the obese group was significantly longer than in the control group (270 vs. 245 min, p≤0.05). The hospital stay was also significantly longer in the obese group (4 vs. 3 days, p≤0.05). CONCLUSIONS At our hospital, obese donors had short-term results comparable to those of non-obese donors in laparoscopic living nephrectomy. While longer operative time and length of stay were found, there were no significant complications observed. Long-term outcomes should be evaluated to justify use of obese donors.

Zero ischaemia open partial nephrectomy using Thulium laser in pediatric renal tumor: A first experience

The management of localized kidney tumors has changed, resulting in a shift from radical nephrectomy toward more frequent use of partial nephrectomy (PN). For many patients with small clinical T1 renal tumors (< 7 cm) who are candidates for nephron-sparing surgery, PN is now the reference standard treatment. Laser technology, such as diode laser and holmium laser, has been reported in very selected series for PN since 1985. Thulium laser utilization in pediatrics partial nephrectomy has not been significantly evaluated. Therefore, we reported this study to know its affectivity and efficacy in open PN especially in pediatric patient.

Neo-glans reconstruction after glans amputation during circumcision using autologous buccal mucosal graft

Genitourinary trauma comprises 2e10% of all hospital admission, which external genitalia trauma is involved in 33e36% of the cases. Amongst external genitalia traumas, penile or glans amputation is very rare case.1 During circumcision, glans injury is mostly due to glans trapped in the circumcision clamp or while performing guillotine technique, which usually results in partial or total amputation of glans penis. After 24 hour of injury, it is not recommended to reattached the glans, penile lengthening can be performed using proximal lengthening using gracilis muscle, scrotal flap or distal lengthening using rectus abdominis fascial island flap covered by skin graft or scrotal flap. A few studies has report the use of buccal mucosal graft in glans reconstruction.2,3 In this study we describe this novel technique of neoglans reconstruction using autologous buccal mucosal graft in paediatric iatrogenic amputation during circumcision.

Abnormal dartos fascia in buried penis and hypospadias: Evidence from histopathology

INTRODUCTIONnThe importance of the pathology of the dartos fascia in hypospadias and buried penis is still debatable. Understanding the properties of connective tissue of dartos fascia in hypospadias and buried penis may give a clue to the underlying mechanism.nnnOBJECTIVEnThis study aimed to compare connective tissue and vascularization of dartos fascia between normal penis, buried penis, and hypospadias.nnnSTUDY DESIGNnWe conducted this prospective study from May 2013 to November 2016. We collected dartos fascia specimens from three groups: buried penis, hypospadias, and normal penis as control. All of the patients underwent primary surgery in all groups. Patients with penile abnormalities, such as phimosis or Balanitis Xerotica Obliterans (BXO) were excluded from the normal penis group. We compared the fibers between these groups using Masson trichrome histochemical staining, Gomoris silver impregnation staining, Weigert resorcin-fuchsin staining, and CD31 immunohistochemistry staining for evaluation of collagen fibers, reticulin fibers, elastin fibers, and endothelial cells of blood vessels, respectively. The collagen fibers, reticular fibers, elastic fibers, and vascular vessels were counted with ImageJ and manually calibrated and counted and were analyzed using the one-way ANOVA test. The assessment conducted by two pathologists was blinded, without knowing the clinical diagnosis of patients.nnnRESULTSnThere was a total of 60 patients with 20 patients in each group. Collagen fibers for most cases of buried penis and hypospadias showed thicker but fewer collagen fibers than the normal penis. There was a reduction of total collagen and elastin of dartos fascia in hypospadias and buried penis cases. On the other hand, the ratio of reticulin fibers, which represents collagen type III to total collagen, was increased compared to normal penis.nnnDISCUSSIONnAlthough the dartos fascia in buried penis and hypospadias is thick and inelastic when palpated or during traction/counter traction, it is well-vascularized tissue. This inelastic dartos fascia tissue is an abnormal tissue, but its characteristics are not similar to fibrotic tissue. However, further study with a larger sample is warranted and should differentiate the degree of chordee in patients with hypospadias and buried penis.nnnCONCLUSIONSnThere was a difference between connective the tissue of dartos fascia in buried penis and patients with hypospadias compared with normal penis. Inelastic dartos fascia tissue in patients diagnosed with buried penis and hypospadias is an abnormal tissue. Therefore, it is suggested that this tissue is excised during reconstructive surgery. Further research is needed to unveil the pathophysiology of the condition.

Laparoscopic procurement of single versus multiple artery kidney allografts: Meta-analysis of comparative studies

Laparoscopic donor nephrectomy has become the standard procedure to procure kidney graft. Transplantation using multiple arteries allograft is technically more challenging and still controversial with respect to renal transplantation outcomes. The objective of this study was to examine the transplantation outcome in both donor and recipient outcome of multiple arteries allograft kidney compared with single renal artery kidney. Eligible studies were identified from electronic databases: PubMed, Cochrane CENTRAL, Science Direct, and CINAHL as of October 2016. Relevant parameters explored using Review Manager V5.2 included donor and recipient outcomes. Twenty-four studies were included in this meta-analysis. Compared with SA, MA kidneys were associated with a longer donor operative time. There was no difference between donor length of stay, intraoperative blood loss, hospital stay, first warm ischemic time (WIT-I), and donor surgical complications in donors with multiple arteries compared with single. There was an increased risk of one-year graft loss (OR 1.57, 95% CI 1.09 to 2.26, pxa0=xa00.016), recipient vascular complications and recipient ureteral complications in multiple arteries compared with single artery allografts. Kidney transplantation with multiple arteries is relatively as safe as single artery in terms of donor outcomes. However, transplantation with multiple arteries allograft had several potential negative impacts on the recipient outcomes.

Kidney transplantation: A new era of laparoscopic living donor nephrectomy in Indonesia

BACKGROUNDnSince its introduction in 1995, laparoscopic living donor nephrectomy (LLDN) has been a standard procedure in many transplantation centers worldwide. In 2011, LLDN was performed for the first time in Indonesia and became a standard procedure at our institution. The aim of this study is to evaluate the first 250 cases of LLDN at our institution.nnnMETHODSnRetrospective analyses were conducted of the first 250 cases of LLDN. All operations were performed between November 2011 and July 2015 at Cipto Mangunkusumo Hospital, Jakarta. We grouped each 100 consecutive cases and the last 50 cases (three groups) to evaluate operation-related parameters, and complications.nnnRESULTSnSignificant decreases in the first warm ischemic time, blood loss, length of stay, and number of complications were observed among the three groups. There was only one conversion to open case during LLDN surgery and no mortality case observed.nnnCONCLUSIONnLaparoscopic living donor nephrectomies had been performed successfully with improvement of surgical parameter in due time. Thus, laparoscopic approach has entered a new era for kidney procurement in Indonesia.

Safety of clean urologic operations without prophylaxis antibiotic therapy in Cipto Mangunkusumo Hospital, Jakarta: A double-blind randomized controlled trial study.

OBJECTIVEnThis study was conducted to identify the safety measures of performing clean urologic operations without administration of prophylaxis antibiotics.nnnMETHODSnWe conducted a double-blind randomized controlled trial with patients who underwent clean urologic operations in Cipto Mangunkusumo Hospital, Jakarta, Indonesia, from April 2013 to January 2014. The local and systemic infection states were compared between the prophylaxis and placebo groups. Local infection was identified as surgical site infection and systemic infection as fever and leukocytosis.nnnRESULTSnA total of 42 patients participated in the study (21 patients in each group), comprising 14 (33.3%) children and 28 (66.7%) adults. The most frequently performed operation was surgical sperm retrieval. No patients in either group were found to have local or systemic infection. However, there was a statistical difference in the white blood cell counts between the two groups (pxa0=xa00.003), although there was no sign of local or systemic infection in any of the patients.nnnCONCLUSIONnClean urologic operations without prophylaxis antibiotic therapy can be safely applied to urologic patients.