Prahara Yuri

Association between tumor-associated macrophages and microvessel density on prostate cancer progression

Background To evaluate tumor-associated macrophages (TAMs) infiltration and microvessel density as possible prognostic factors related to prostate cancer (PCa) progression. Methods Immunostaining of TAMs in prostate biopsy specimens was performed using a monoclonal antibody CD68 and microvessel density (MVD) using von Willebrand factor (vWF) from 25 specimens with high-grade prostatic intraepithelial neoplasia (HGPIN) and 25 specimens with PCa after transurethral resection of the prostate (TURP). Six microscopic (×200) fields were selected for TAM counting and six microscopic (×100) fields were selected for MVD counting around the cancer foci. Association between age, preoperative prostate-specific antigen (PSA), pathologic Gleason sum (GS), TAM, MVD, extracapsular extension, and metastasis were assessed using Pearson/Spearman, Student t test/Mann-Whitney U test and one-way analysis of variance/Kruskal-Wallis test. Results The mean of age, PSA, TAMs, and MVD were 69.1 ± 9.9, 67.1 ± 92.4, 26.2 ± 11.9, and 31.4 ± 14.0, respectively, from 50 specimens with PCa and HGPIN. Increasing TAMs number was not correlated with increasing MVD number and there was no significant mean difference statistically (P > 0.05) in TAMs and MVD although the mean of TAMs number was higher in PCa versus HGPIN but significant in PSA level (P < 0.001). In PCa specimens, age, PSA, TAMs, and MVD number were higher in patients with metastatic and extracapsular extension, but not significant statistically (P > 0.005). There was no correlation between TAMs and MVD (P > 0.001). Conclusions TAMs and MVD had increased PCa but did not provide independent prognostic value. Increasing numbers of TAMs was not always followed by an increase in MVD. HGPIN is the most likely precursor for PCa.

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.

Laparoscopic repair of vesicovaginal fistulae with a transperitoneal approach at Universitas Gadjah Mada Urological Institute: a case report

BackgroundA vesicovaginal fistula is an abnormal fistulous tract extending between the bladder and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault. In addition, the sequelae from these fistulae have a profound effect on the patients in view of their physical, psychological, and social dimensions. The treatment of vesicovaginal fistula is surgical in most cases and the choice of the repair technique is controversial. We evaluated the benefits of a laparoscopic approach in a patient with vesicovaginal fistulae. Here, we present our first experience using a simplified laparoscopic approach technique to repair vesicovaginal fistulae in our country.Case presentationA 46-year-old Javanese woman presented with urinary incontinence following an abdominal hysterectomy 3 months earlier and received laparoscopic repair. A cystoscopy was performed to confirm the fistula orifice and a stent was inserted into the fistula tract from her bladder to her vagina. A tamponade was inserted into her vagina up to the vaginal apex, to be able to identify the vagina. She had adhesions; therefore, adhesiolysis was performed using a combination of sharp and blunt dissection to expose the vaginal stump and the superior aspect of her bladder. A simple cystotomy was performed and extended to include the fistulae site, and then the defect was repaired by using a running stitch. A second layer of closure was performed in an imbricating fashion with the same suture. The vagina defect was not closed separately but covered with an omental flap. This procedure takes approximately 2.5 hours; estimated blood loss was minimal and there were no intraoperative complications. She had no recurrent symptoms 6 months after surgery.ConclusionOur case report concludes that the simplified laparoscopic approach to vesicovaginal fistulae is a viable option for successful repair and that it reduces the size of bladder opening, causes minimal bleeding, and gives successful relief.

Intracorporeal Dilatation Plus Al-Ghorab Corporoglandular Shunt for Salvage Management of Prolonged Ischemic Priapism

Ischemic priapism (IP) is a urological emergency that requires early intervention in order to prevent irreversible structural and functional changes. The purpose of penile shunt surgery is to passage out ischemic blood in the corpus cavernosum (CC), restoring the normal circulation within these structures. Here, we present our first experience using modification of Al-Ghorab shunt procedure to treat severe and prolonged IP. The Al-Ghorab shunt procedure was modified by the retrograde insertion of a 7/8 Hegar dilator into the opening of the distal cavernous tissue via the original Al-Ghorab incision. Priapism was successfully relieved, and no recurrent IP was reported.