Nur Rasyid

Safety of tubeless or totally tubeless drainage and nephrostomy tube as a drainage following percutaneous nephrolithotomy: A comprehensive review

Percutaneous nephrolithotomy (PCNL) using a nephrostomy tube as a drainage has been considered the standard procedure. However, recently many literatures have reported the use of tubeless and totally tubeless drainage following PCNL with excellent results. A literature search was conducted using MEDLINE databases to review each drainage technique following PCNL (tubeless, totally tubeless, or nephrostomy tube) and also to assess the most recent evidence that compare the safety of these drainage procedures with a clear-cut clinical parameter imposed. Tubeless or totally tubeless PCNL is significantly superior to standard PCNL in terms of length of hospital stay, postoperative pain (visual analog scale) score, demands or dosage of analgesics required, as well as faster return to activity for the patients. However, despite the many advantages of tubeless or totally tubeless PCNL over standard PCNL, there are a number of situations requiring the consideration of nephrostomy tube placement. Nonetheless, decision to use or not to use nephrostomy tube after PCNL depends on the surgeons experience and clinical judgment.

Comparison of Visual Prostate Symptom Score with the International Prostate Symptom Score and uroflowmetry parameters in assessing men with lower urinary tract symptoms in Dr. Cipto Mangunkusumo National General Hospital, Indonesia

Background The complexity of International Prostate Symptom Score (IPSS) as an objective questionnaire for lower urinary tract symptoms might be overcome with alternative questionnaire such as the Visual Prostate Symptom Score (VPSS) which uses pictograms instead of questions to illustrate some of the questions addressed in IPSS. Methods Male patients older than 45 years with lower urinary tract symptoms were evaluated with Indonesian version of the IPSS and VPSS, for uroflowmetry parameters using a transabdominal ultrasound. Appropriate statistical analysis was used. Results Of all participants, 24.2% and 11.1% require assistance when answering IPSS and VPSS questionnaires, respectively. The mean age, IPSS total score, VPSS total score, Qmax, voided volume, and postvoid residual volume were 67.4 ± 8.9 years, 13.4 ± 7.8, 10.8 ± 2.7, 13.6 ± 8.6 mL/sec, 248 ± 136 mL, and 54.9 ± 68.3 mL, respectively. Total IPSS, IPSS quality of life (QoL), IPSS question (Q) 2, IPSS Q7, and IPSS Q5 were significantly correlated with total VPSS, VPSS QoL, VPSS Q1, VPSS Q2, and VPSS Q3 [correlation coefficient (r) P value: 0.57, <0.001; 0.76, <0.001; 0.39, <0.001; 0.72, <0.001; 0.50, <0.001, respectively]. VPSS Q3 was significantly correlated with Qmax (r, P value: −0.26, <0.001). There was a significant relationship between the level of education and the ability to complete IPSS questionnaire (P < 0.001). There was no significant relationship between the level of education and the ability to complete VPSS questionnaire (P = 0.649). Conclusion The VPSS was significantly correlated with IPSS and Qmax. The novel questionnaire proved useful as an alternative tool for IPSS for assessing men with lower urinary tract symptoms, especially for those with lower level of education.

Efficacy Quotient Tindakan ESWL Piezolith Richard Wolf 3000 pada Penderita Batu Ureter di RSUPN Dr. Cipto Mangunkusumo, 2008–2011

Extracorporeal shockwave lithotripsy (ESWL) is the most common method of ureteral stone management. Since 2008, RSCM has ben using ESWL piezolith 3000 richard wolf and efficacy quotient (EQ) value have not yet studied. The study aims was to determine the efficacy quotient (EQ) of ESWL using piezolith richard wolf 3000 machine for ureteral stone by analyzing free-stone rate with location of stones, number of stones, stone burden, stone opacity, obstruction and kidney function. This cross sectional study was carried out in January 2008-December 2011, with multivariate analytical study. Ninety five percent (n=113) of 119 patients were declared stone free after the first ESWL. EQ value was 0.89. Stone size was the correlated with stone free rate (p<0.05). It is concluded that ESWL procedure using richard wolf piezolith 3000 machine patients had better EQ and better stone-free rate than previous reports using similar machines.

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.

Factors affecting stone free rate of primary percutaneous nephrolithotomy on staghorn calculi: a single center experience of 15 years

Objectives: Percutaneous nephrolithotomy on staghorn calculi is challenging for urologists because it is difficult to remove all of the stones. The purpose of this study was to evaluate the associated factors of stone-free rate after primary percutaneous nephrolithotomy on staghorn calculi in a large series of patients at a single, tertiary referral, endourologic stone center. Methods: We collected data from medical record between January 2000 and December 2015. A total of 345 primary percutaneous nephrolithotomy procedures were performed for patients with staghorn calculi. This study included both and made no distinction between partial and complete staghorn calculi. Stone-free is defined as the absence of residual stones after undergoing percutaneous nephrolithotomy for the first time. Significant factors from univariate analysis that correlated with stone-free rate after primary percutaneous nephrolithotomy of staghorn stone were further analyzed using multivariate regression analysis. Results: The mean patient age was 52.23±10.38 years. The stone-free rate of percutaneous nephrolithotomy monotherapy was 62.6%. The mean operating time was 79.55±34.46 minutes. The mean length of stay in hospital was 4.29±3.00 days. Using the chi-square test, history of ipsilateral open renal stone surgery ( p = 0.01), stone burden ( p = < 0.001), and type of anesthesia ( p = 0.04) had a significant impact on the stone-free. From multivariate analysis, the history of ipsilateral open renal stone surgery [OR 0.48; 95% CI 0.28-0.81; p 0.01] and the stone burden [OR 0.28; 95% CI 0.18-0.45; p 0.00] were significant independent risk factors for stone-free.

Blood loss predictive factors and transfusion practice during percutaneous nephrolithotomy of kidney stones: a prospective study.

Objectives Bleeding is the most common complication of percutaneous nephrolithotomy (PCNL). Injudicious transfusion is frequently performed in current practice, even though it is not always needed. This study aimed to identify the predictive factors of blood loss in the PCNL procedure and evaluate the perioperative transfusion practice. Methods A prospective study of PCNL was randomly performed by two consultants of endo-urology at our institution. The inclusion criteria were adults with kidney pelvic stones >20 mm or stone in inferior calyx >10 mm or staghorn stone. Those with coagulopathy, under anti-coagulant treatment or open conversion were excluded. A full blood count was taken at baseline and during 12, 24, 36, 72-hours post-operatively. Factors such as stone burden, sex, body surface area, shifting of hematocrit level and amount of blood transfused were analyzed statistically using line regression to identify the predictive factors of total blood loss (TBL). Results Eighty-five patients were enrolled in this study. Mean TBL was 560.92 ± 428.43 mL for both endo-urology surgeons. Stone burden was the most influential factor for TBL (p=0.037). Our results revealed that TBL (mL) = -153.379 + 0.229 × stone burden (mm2) + 0.203 x baseline serum hematocrit (%); thus considerably predicted the need for blood transfusion. A total of 87.1% patients did not receive perioperative transfusion, 3.5% received intra-operative transfusion, 7.1% received post-operative transfusion, 23% had both intra and post-operative transfusion, resulting in a cross-matched transfusion ratio of 7.72. Mean perioperative blood transfused was 356.00 ± 145.88 mL.

Fibrous Pseudotumor of the Tunica Vaginalis Associated With Hydrocele and Testicular Atrophy.

Fibrous pseudotumors of the testicular tunics and paratesticular tissue are uncommon lesions. They typically arise as painless scrotal masses that may be associated with hydrocele or history of surgery, trauma, or infection. Although benign, these lesions often clinically indicate malignancy and usually remain undiagnosed preoperatively. Here, we report on a 59-year-old man with fibrous pseudotumor of the tunica vaginalis associated with hydrocele and testicular atrophy.

Multimodality Treatment of Bile Duct Stone

Gallstone and bile duct stone is a common disease and affects people from every society, race, age and gender. Advance in medicine has led us to a new paradigm of bile duct stone treatment. Endoscopic procedures for bile duct stone by means of Endoscopy Retrograde Cholangio-pancreatography (ERCP), sphincterotomy, balloon dilation, basket extraction, and lithotripsy, and even using laser as well as the shockwave-has brought a lot of novel innovation with high success rate. Appropriate indication and the ability to recognize various risk factors of complication are the keys to successful treatment, in order to decrease morbidity and mortality rate. Multimodality treatment of bile duct stone includes endoscopy, surgery, and drugs are a treatment approach which has always to be carried out in bile duct stone management. Difficult bile duct stone cases such as large stone, impacted stone, biliary stone in pregnancy, and recurrent stone can be treated by endoscopy with excellent success rate particularly if it is accomplished using multimodality treatment. Keywords: bile duct stone, endoscopy, ERCP, sphincterotomy, mechanical lithotripsy, laser lithotripsy, shockwave, cholecystectomy laparoscopy, precut sphincerotomy

Serial Cases of Combining ESWL and ERCP Procedures in Management Chronic Pancreatitis and Difficult Bile Duct Stones

E x t ra c orpor e al sho c k w a v e lit ho t r i psy ( ES W L ) has an e s t ab li sh e d ro l e i n t he m anag e m e nt of pan c r e a ti cdu c t al c a l c u l iandas f ur t h e r t r e a t m e nt m oda lit y f o r l a rgeor d iffi c u l t c o m p li c a t e d c o mm on b il e du c t ( C B D ) s t on e s. C o m b i n e d w it h m i n i m a ll y i n v as i v e e ndos c op i c pro ce dure su c has e ndos c op i c r e t rograde c ho l ang i o - pan c r e a t o g raphy ( ER C P ) , i t h as r e p l a ce d op e n surg e ryas t he i n i t i al f o rm of t h e rap y . ES W L has a l so p ro ve d t o bean e ff ec ti v e t h e rapy i n t r e a ti ng i n t rah e pa ti cs t on e s t h a t are r e f ra c t ory t orou ti ne e ndos c op i c ex t ra c ti on. I n t h e se s e r i al c as e s w e pr e s e nt t hr e e c as e s w h i c hus i n g c o m b i n e dES W La n dER C P pro ce dur e s t o t r e at c hron i cpan c r e a titi spa i nand g i ant C BD s t one t hat pr e s e n ti nggoodresultson f o ll owup w it houtany c o m p l i c a ti on. Keyw ords: E S W L , ER C P , c hron i cpan c r e a ti t i s, C BDs t one