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Objective: This case report was aimed to present a lateral percutaneous nephrolitotomy (PCNL) approach for a patient with horseshoe kidney, few comorbidities, and the outcome of this procedure. Case(s) presentation: A 70 years old obese male came into our hospital with pain in the left flank. Upon CT scan examination, we found that the patient has Horseshoe kidney with left hydronephrosis. The hydronephrosis resulted from obstruction caused by left kidney pelvic stone with a size of 25 x 20 mm. We decided to do lateral PCNL for this case with an excellent result. Discussion: With newer advancements in urology, different minimally invasive treatment modalities are available to manage stone disease in HSKs. PCNL has shown the better result with fewer complications to remove calculi from HSKs and is accepted as a routine treatment of large calculi in HSK, showing a high SFR ranging from 71% to 88%. Lateral percutaneous access of the renal collecting system is safe, as it is gained on the opposite side to where the renal blood vessels enter the kidney. Conclusion: Stone management in patients with horseshoe kidneys is a challenging procedure in endourology, however percutaneous nephrolithotomy is considered a safe and effective treatment option in patients with renal stones in a horseshoe kidney with acceptable result. Keywords: Horseshoe kidney, percutaneous nephrolithotomy, lateral PCNL.

Introduction: The incidence of UTI after TURBT in the early stages can result in morbidity, increase the length of stay, and patient costs, even if not treated can be a risk factor for bladder tumor recurrence. The global incidence of post-TURBT UTI varies between 2-39%. This study aims to determine the incidence of UTI in post-TURBT patients. Materials and Methods: This study was a cross-sectional retrospective study. The research data was taken from the medical records of patients who underwent TURBT between 2017 - 2021 at a tertiary hospital. UTI after the TURBT was defined by symptoms of fever (≥ 38oC) and the results of urinalysis examination with positive bacteriuria. While asymptomatic bacteriuria (ABU) is defined by the results of a positive bacteriuria examination without symptoms of fever. The results of the study were processed with descriptive statistics and then presented in the form of tables and explanatory narratives. Statistical analysis was performed using SPSS version 26 with a p-value < 0.05 considered statistically significant. Results: 140 patients underwent the TURBT. The data collected were 92 patients. In the pre TURBT, 56 (60,9%) patients were positive for bacteriuria, but 55 (59,8%) patients did not have fever symptoms. There were 1(1.1%) patient who had UTI before the TURBT. This patient was treated first with an antibiotic before the TURBT procedure. After the TURBT, 9 (9,7%) patients underwent urinalysis. A total of 4 (4.3%) patients experienced UTI after the TURBT and 3 (3.3%) experienced ABU after the TURBT. The incidence of UTI after the TURBT increased the length of stay of the patient (p = 0,003). Conclusion: The incidence of post-TURBT UTI is 4.3%. Only 9,8% of patients underwent urinalysis after the TURBT.

Objective: This study aims to know the relationship between smoking and obesity as a risk factor among renal cell carcinoma histological subtypes. Material & Methods: This was a retrospective case-control study, with 67 patients with Renal Cell Carcinoma (RCC) at the Department of Urology, Hasan Sadikin Academic Medical Center Bandung from January 2012 to December 2021 as the case group, and 13 patients with benign tumors as the control group. The odds ratio and its significance were calculated. Results: In clear cell RCC, smokers (p-value=0.008), showed strong relationship to cigarette types (p-value=0.013), and obesity (p-value=0.042). In papillary RCC, smokers (p-value=0.035) showed a strong relationship to cigarette types (p-value=0.041). Cloves have a higher risk compared to filtered cigarettes (OR 2.25, 95% CI [0.54-9.25]). Conclusion: Clear cell RCC is most prevalent in smokers. Obesity is associated with clear cell RCC. Cloves pose the greatest risk of clear cell and papillary RCC. Keywords: Obesity, RCC, smoking, cigarette.

Objective: This study aims to assess the urologist role on tobacco screening and smoking cessation among bladder cancer patients in Indonesia. Material & Methods: A questionnaire regarding tobacco uses screening and smoking cessation recommendation practice patterns was sent to urologists in Indonesia via Ikatan Ahli Urologi Indonesia (IAUI) or Indonesian Urological Association (IUA). The survey was established by Google Form and was sent by email. Responses were automatically integrated to Google spreadsheet. Results: Total of 111 responses from 569 urologists in Indonesia were received, and of the respondents 96% were male and 4% were female. 70% urologists always educate their patients about smoking as one of risk factor for bladder cancer and only 4% never did it. Most common answer for the reason is patients never ask their urologists about it (7%). More than half (59%) of urologists sometimes discuss smoking cessation and 78% always recommend quitting smoking. The majority of responders have never smoked cigarettes (56%), 35% were former smokers, and 9% were current smokers. Conclusion: This study revealed that majority of urologists always educate that smoking is one of risk factor for bladder cancer and recommend to quit smoking. However, only 37% always discuss tobacco use cessation with their patients. Keywords: Tobacco use, smoking cessation, bladder cancer, urologist.

Purpose: This study aimed to determine survival rate and clinical characteristics of testicular tumor patients with a history of scrotal violation. Materials and Methods: This study was a retrospective cohort; we reviewed medical records from 2017 to 2021 with testicular tumors who had a history of scrotal violation. We evaluate clinical characteristics and survival up to 5 years. We used the KaplanMeier survival analysis and log-rank test. Results: There are 27 patients with testicular tumor who had a history of scrotal violation. Based on histopathological findings, the most common type was seminoma testis. While based on TNMS staging of the testicular tumor, the most common presentation is T2; Nx; Mx; and S3. Furthermore, based on the prognostic group for testicular tumor we found 5 patients with stage IB, 15 patients with stage IS, 2 patients with stage II, and 5 patients with stage III. Clinical manifestations of scrotal violation were residual tumor found in scrotal region in 2 patients, inguinal and abdominal region in 3 patients. Using the Kaplan-Meier survival curve, the 5-year survival rate was 44% from Statistical test in log-rank test, a significant result is obtained. Conclusion: Survival rate of testicular tumors who had a history of scrotal violation were lower and influenced by ECOG Performance Status Scale. Prognosis of a scrotal breach in the late stage may have a higher mortality rate. In contrast, there was a significant difference in outcome if the scrotal violation had been known at the early stages.

Bladder cancer is the 10th most common cancer in both males and females with a ratio of 3:1. About 75% of bladder cancers are non-muscle invasive bladder cancers (NMIBC). The aim of this study was to identify the characteristics of Non-Muscle Invasive Bladder Cancer (NMIBC) patients treated in Dr. Hasan Sadikin General Hospital as one of the tertiary hospitals in Indonesia. This was a retrospective descriptive study that involved reviewing the medical records of patients diagnosed with NMIBC between January 2008 and December 2019. Characteristics reviewed were age, gender, body mass index (BMI), smoking history, urinary tract infection and stone history, intravesical chemotherapy and its side effects, and urinary cytology results. All data were tabulated and charted. Fifty-one out of 773 bladder cancer patients were diagnosed with NMIBC (6.59%). The mean age was 62.94 years old, with the majority of patients were in the 60-69 age group (31.37%). Males constituted the majority of the patients (n=44, 86.27%), with most patients had ideal BMI (66.66%), smoking history (72.54%), urinary tract infection history (56,86%), and urolithiasis history (5.88%). Thirty patients were given intravesical chemotherapy (58.82%), three patients experienced hematuria (10%), and four patients had painful urination (13.33%). Urinary cytology showed atypical cells (92.16%) in the majority of patients. The incidence of NMIBC in bladder cancer patients in our study was 6.59%, which differs from the incidence in developed countries of 75%, as shown in previous literature.

Bladder cancer is the most common urinary tract malignancy. Radical cystectomy is preferred as gold standard therapy for non-metastatic SCC, reflected from better survival rates than other treatment options such as partial cystectomy, chemotherapy, and radiation. Several factors are associated with the occurrence of bladder cancer, including bladder stone and infection ; such conditions suggestively could cause chronic irritation on the bladder surface epithelial, causing cancerous lesion to arise. Several literatures have showed positive outcome of patients with bladder cancer that underwent radical cystectomy. Thus, it is recommended to be performed on bladder cancer cases. Hereby we present a case of a 50-years old male who underwent radical cystectomy and bilateral ureterocutaneoustomy after previous trans urethral resection of bladder tumor (TURB-T) due to squamous cell bladder cancer. At the time of admission, he had bladder stone that based on imaging result, has already penetrated adjacent tissues. We also conducted literature review to assess our case with the other reports regarding the outcome of radical cystectomy for bladder SCC.

Background: Bladder cancer is classified according to traditional American Joint Committee on Cancer TNM staging. In the absence of nodal (N stage) or distant metastases (M stage), the depth of tumor invasion (T stage) is the most important determination to be made: whether the tumor is invading into or beyond the lamina propria (muscle-invasive bladder cancer) or not (non-muscle-invasive bladder cancer). This study investigated the association between the cutoff value of tumor depth and width and survival rate in non-muscle-invasive (pT1) bladder cancer. Methods: This was a retrospective cohort design of randomly selected, single-centered study. The subjects were patients with pT1 urothelial carcinoma who were diagnosed on transurethral resection of bladder specimens at a tertiary hospital in West Java, Indonesia. The research sample was taken by consecutive sampling from 2015 to 2019. Results: Sixty-four patients from were included in this study. A tumor depth >2 mm resulted in a hazard ratio (HR) of 1.41 (95% confidence interval [CI], 1.27–3.94; p2.4 mm also increased HR significantly (3.27; 95% CI, 1.69–5.87; p

Renal cell carcinoma occurrence is increasing from time to time and known as one of the most common cancers worldwide. RCC usually found in older age and common acquired risk factors for RCC including obesity, hypertension, diabetes, smoking and long-term use of NSAIDs. As for genetic risk, it is noted that Von Hippel–Lindau gene involved in the pathogenesis of RCC. Many treatment strategies were developed for RCC with various outcome. Here, we present a sporadic clear cell renal carcinoma in young male without VHL gene mutation and survive for long term period despite progressivity of treatment.

Background: Bladder tumors are the most common neoplasm of the lower urinary tract. Bladder carcinoma arising from a suprapubic cystostomy tract is a relatively rare. Some patients with bladder tumors have difficult urethral access for urinary retention due to inaccessible urethra. Most people think cystostomy in patient with bladder cancer can cause seeding and upstaging to suprapubic cystostomy tract. This study aim of suprapubic cystostomy can cause seeding and upstaging of bladder cancer. Methods: Literature obtained from the search results of Pubmed, Medscape, Science Direct, Scopus, Cochrane Library, and Google Scholar electronic databases with the keywords used are “suprapubic catheter and bladder cancer”, “suprapubic catheter and bladder tumor”, “suprapubic catheter and bladder carcinoma”, “suprapubic cystotomy and bladder carcinoma”, and “suprapubic catheter and bladder cancer upstaging” with no time limits. Results: Eighty two articles were obtained from the electronic database. Following all the inclusion and exclusion criteria, the final selection considered 5 literature with 16 patient eligible for this literature review. The five literature involved a total of 16 bladder cancer patients with a suprapubic catheter. The duration of suprapubic catheter insertion was between 1 to 3 months. As long as it is within the specified time and from the location of cancer, literature result there will be no seeding and upgrading in the suprapubic cystostomy tract. In our case report we have patient with duration suprapubic cystostomy 1 months wih no seeding and upgrading cancer. Conclusion: Although SPC is an effective, inexpensive, easy mode of access for bladder tumors with difficult urethral access for urinary retention due to inaccessible urethra, it also presents a risk of SPC tract bladder cancer, mostly SCC and TCC. It is important to be aware of any suspicious signs and symptoms, duration time of use suprapubic cystostomy and location of the cancer.

Background: Urothelial carcinoma is the most widely recognized histologic type of bladder cancer. Smoking duration and intensity associated with tumour aggressiveness and recurrence. This study aims to examine smoking behavioural change in patients with bladder urothelial carcinoma who were given an intervention for smoking cessation. Methods: A cross-sectional study (2009 – 2019) was conducted. Subjects were divided into three groups: patients who had smoked 20 cigarettes per day for ≤30 years; and patients who had smoked for >40 years. General characteristics, educational level and quit levels are noted. These data were obtained from the medical record and anamnesis by telephone. Result: A total of 325 patients with urothelial cancer between 2009-2019 were involved. 273 (84%) patients were male, aged 58.71 ± 12.8 years. 40.9% had a history of smoking for >40 years, 66.5% of patients did not quit smoking at all. There was a significant difference in smoking cessation rates between groups with a history of different smoking intensities (p = 0.000). Mann-Whitney U test showed that there was a significant difference between the group who had a history of smoking 20 cigarettes per day for ≤30 years with the group who smoked for >40 years (p = 0.000 on both comparisons). 135 (41.5%) patients were in the lower education group. Conclusion: The patient’s history of heavy smoking intensity and lower educational level was associated with a lower likelihood of smoking cessation. Urologists must play an important role in the education and intervention process to support patients to quit smoking. A guide/guideline is needed and it could be through a special smoking clinic for counselling or treatment.

Objective: This study was aimed to know the complication and safety of TPPB-VY in clinical practice. Material & Methods: TPPB were performed in 34 patients between January 2019 and Juni 2021. Ethical approval of this study was sought from the hospital authorities (IRB number: LB.02.01/X.6.5/ 55/2020). Patients underwent systematic 10-12 core TPPB depend on the prostate volume with intravenous light sedation. The patient was included to the study if PSA ≥ 4 ng/ml and/or Digital Rectal Examination (DRE) results suggestive of prostate cancer. Procedures were performed without any antibiotic prophylaxis or an enema before the procedure and post procedure the patients just get an oral fluoroquinolones and low potent analgetics (if needed). The complication include pain level post procedure (using VAS), perineal hematoma, fever and retention post biopsy were recorded. Results: In all, 34 patients were included in the study. The result showed that perineal pain perceived by patients post procedure were 76.47% (26 out of 34 patients) but the VAS score just mild around 0-2. There were 23.53% (8 out of 34 patients) hematuria, 5.88% (2 out of 34 patients) acute urinary retention and 2.9 % (1 out of 34 patients) perineal hematoma. No fever or clinical infection was observed and 82.35% (28 out of 34 patients) patients presented with minor complications (ClavienDindo I). Only one of the patients were hospitalized due to the post-biopsy complication that need intervention. Conclusion: This is the first study TPPB using Novel Affordable VY probe. The results show clinically insignificant complication without infection. TPPB using Novel Affordable VY probe is feasible and safe.

Purpose: Around 75% of all bladder cancers are classified into nonmuscle invasive bladder cancer (NMIBC). The NMIBC's high recurrence and progressivity rate are most commonly found in tumors invading the lamina propria (LP), classified as staged pT1 when it extended to the LP with a heterogeneous recurrence and progression. This study aimed to correlate the measurement of tumor depth and width to lymphovascular invasion (LVI) in NMIBC. Materials and Methods: A 5-year retrospective analytical study (2015–2019) was conducted in a tertiary hospital in Indonesia. We reassessed and analyzed the tumor depth and width of 64 patients with pT1 bladder cancer based on histopathological reports and analyzed the correlation of tumors and LVI. The depth was reassessed by measuring the transitional urothelium with the LP as an initial marking point, up to the tumor's edge in the LP, and tumor's width by measuring the largest width of one tumor focus in the LP, along with the presence of LVI by histopathological exams. Data were analyzed using the Mann − Whitney test. Results: The participants were 64 patients with pT1 bladder cancer. The mean tumor pT1 invasion depth was 2.03 ± 0.918 mm. The non-LVI group's mean tumor invasion depth was 1.72 ± 0.721 mm, whereas the LVI group was 2.21 ± 0.980 mm. The tumor invasion depth was a significant factor for LVI, whereas the tumor maximum diameter was not. Conclusion: The tumor invasion's depth was significantly associated with the LVI. The pT1 tumor invasion depth measurement might serve as a predictive variable of tumor recurrence and progressivity.

One of the most prevalent and deadly cancers in men is bladder cancer. To achieve the best possible outcome, physicians need to diagnose it promptly. The gold standard for diagnosis is tissue biopsy, but this method is invasive. There is another option for non-invasive diagnostic using urine cytology. The purpose of this study was to measure the accuracy of urine cytology in diagnosed bladder cancer patients. This study extracted data from patients medical records in a tertiary hospital in Indonesia from 2009–2019. The diagnostic accuracy was then compared between urine cytology and biopsy as the gold standard. Data on subjects’ baseline characteristics and diagnostic accuracy (sensitivity, specificity, PPV, and NPV) were collected. Results were then stratified according to the American Joint Committee on Cancer pathology staging for bladder cancer. Of 124 study subjects, male was more dominant (male,88% versus female, 12%) Seventy-five patients had a T1-tumor stage. Overall, the diagnostic accuracy was as follows:sensitivity, 47.8%; specificity, 90.9%; PPV, 98.2%; and NPV, 14.5%. High-grade tumors were shown to have a higher sensitivity. The highest accuracy was found in the MIBC grade T3, which was 90.68%. For diagnostic accuracy, urine cytology offered high specificity, but low sensitivity. The exploration of other markers is needed to establish a non-invasive but accurate method to diagnose bladder cancer.

Giant renal cell carcinoma is a rare case. We reported six cases of giant renal cell carcinoma, which required surgical resection of the tumor, including a 9.900 cm3 of encapsulated neoplasm removal. To our knowledge, this is the largest giant clear cell RCC ever reported in Asia. Cytoreductive nephrectomy without targeted therapy was performed in all cases. The most common type in all cases was clear cell carcinoma. From six cases, four patients died during follow-up of more than 6 months. The number of cases that died in our case was related to poor preoperative status performance, while one of the patients had a histopathological sarcomatoid cell result with a poor prognosis. We should consider performing cytoreductive nephrectomy in younger patients, clear-cell histology, good performance status, limited metastatic burden, 3 or less International Metastatic RCC Database Consortium (IMDC) risk factors, responding to presurgical therapy, preferably in high-volume centers. Cytoreductive nephrectomy is not for every patient, and it’s associated with longer survival in well-selected patients.

Prostate cancer is a malignant disease of the urogenital system, which is the second most common cancer in men and one of the leading causes of death in male population. In Bandung City, Indonesia, no data are available regarding the profile of prostate cancer patients. This study aimed to determine the profile of prostate cancer patients treated at Dr. Hasan Sadikin General Hospital Bandung, Indonesia, which is the tertiary hospital in the most populated province in Indonesia, during the period of 2015-2019. This was a a retrospective descriptive study on secondary data from medical records. Results showed that most prostate carcinoma patients were was 67.95 ± 8.946 years old with most of them (n=92, 81.4%) had a history of hypertension and 62 patients (54.9%) did not have any history of smoking. Most patients had 20-40 cc prostate volume with hard consistency and without nodules; a PSA level of > 20 ng/ml; and a gleason score of 8-10 or poorly differentitated. Age affected increased incidence of prostate carcinoma with the highes prostate volume (20-40cc). The average PSA was 504.66 ± 10.26 and the median gleason score was 8 (6-10). The highest prostate volume is 20-40cc with hard consistency without nodule and the highest PSA value is > 20 ng/ml with a Gleason score of 8-10, showing a poorly differentiated condition.

Hem-o-lok clips (HOLC) migration after laparoscopic surgery may cause delayed postoperative issues. We present a delayed lower urinary tract symptoms (LUTS) and urinary stones due to HOLC migration from previous radical prostatectomy approximately 10 years ago. A 88-year-old man presenting clinic with LUTS; previously received robotic-assisted laparoscopic radical prostatectomy (RALP) 10 years ago. HOLC and stones from the bladder were extracted with cystoscopy lithotripsy. Latest follow-up noted complete resolution of symptoms. RALP may cause HOLC migration with variable duration of LUTS symptoms occurring, reaching up to 10 years.

Testicular torsion is a common urological emergency among children, peaking in neonates and pubertal age with an incidence rate of 3.8 in 100.000 (0.004%) annually. This study aimed to explore the characteristics of testicular torsion cases and risk factors for orchiectomy in testicular torsion patients. This was a retrospective study on medical records of patients diagnosed with testicular torsion underwent surgery at the urology department of Dr. Hasan Sadikin General Hospital Bandung, Indonesia, from January 2009 to August 2019. Patient characteristics including age, duration of symptom, location, etiology, and degree of torsion were analyzed. A total of 86 cases of testicular torsion were identified, with most cases (54 cases, 62.8%) occured at the mean age 14.67 ± 2.4 years old. Most patients (69 patients, 80.2 %) arrived more than six hours after the onset, and 65 (75.5%) and 4 (4.6%) of them underwent orchiectomy and orchidopexy, respectively. The remaining patients (17 patients, 19.8%) came less than 6 hours after the onset and only 8 (9.3%) and 9 (10.4%) underwent orchiectomy and orchidopexy, respectively. Both duration of torsion (p = 0.000, P

Objective: This study aims to compare outcomes of supine percutaneous nephrolithotomy to prone percutaneous nephrolithotomy as a traditional approach in Hasan Sadikin Hospital Bandung. Material & Methods: Data was taken from urology’s database between 2003-2012, which contain data of prone position (2003-2007), and supine position (2008-2012). Three hundred forty-nine patients were included in this study. We reviewed data on demography, stone burden, operating time, stone-free rate, transfusion rate, hospital stay, and major complications. Results: Of 174 patients underwent prone position, and 175 patients were part of the supine position. Age means of prone position was 51.0 years old, the supine position was 50.5 years old. The number of male patients was 65.5% for prone, and 66.1% for supine. The mean stone's largest diameter of prone was 23.87 mm, supine was 22.36 mm. The operating time of prone was 107 minutes; supine was 90 minutes. The stone-free rate of prone was 94.7%; supine was 91.3%. The mean hospital stays of prone was 14.3 days; supine was 9.6 days. The transfusion rate of prone position was 8.9%, supine was 7.2%. No major complications were recorded. Conclusion: Higher stone-free rates are achieved with patients in the prone position during PCNL. Supine position has shorter operating time, and hospital stay, lower blood transfusion rates. The complication rate is not different between the two positions.

Epidermal inclusion cyst is a benign lesion that can originate in all parts of the human body. However, the penile location is quite rare. We reported a 24-years old man with a painless, soft, progressive-growing mass at the distal part of the penis with a history of ectopic undescended testis. Complete resection was performed, and further histopathologic study revealed an epidermal inclusion cyst of the penis. This report would like to present a rare case of a penile epidermal inclusion cyst mimicking an ectopic testis mass at our institution.

Introduction: Polyorchidism is a rare condition with a total number of approximately 190 cases. Malignancy was found in 6,4% of cases. Case presentation: A 57 years old man came with a sudden and persistent painful mass in right inguinal region. The patient decided to undergo surgery with diagnosis of incarserated lateral hernia inguinal and obtained a testicular-like lump in the right inguinal canal, then the patient underwent orchiectomy. Histopathological examination revealed a soft tissue tumor with microscopic characteristic of seminoma. CT-Scan revealed metastasis to lung and liver. Conclusion: Attention must be given to detect malignancy in polyorchidism.

Early diagnosis of undescended testis (UDT) in patients under 2 years old plays a vital role in therapy success. However, in developing countries, UDT is often diagnosed in over 2 years. This case report described unilateral UDT in a patient aged 19 years accompanied by testicular torsion, which was found intraoperatively and not vital. Thus, the operator decided to do an orchiectomy. The operation was successful, and the patient was discharged the day after the surgery.

A 55-years-old man presented with the chief complaint of right flank mass and hematuria. CT scan revealed clinical T4 RCC. Cytoreductive nephrectomy (CN) was performed with histopathology result of Papillary renal cell carcinoma. A month later, the patient was admitted to the emergency room with severe dyspnea suggesting intrapulmonary metastases. Here we present an unusual case with a new pulmonary metastasis lesion rapidly appear a month after cytoreductive nephrectomy.

Pleomorphic retroperitoneal liposarcoma are uncommon malignant tumor which hard to treat condition for its local aggressiveness and clinical specificity. A 84 years-old male patient complained with an abdominal mass and left flank pain without hematuria. The patient also complained of shortness of breath due to left pleural effusion. Contrast CT Scan revealed left renal hematoma with suggestive of renal trauma. Left flank exploration and tumor excision was performed to the patient. Histopathological examination showed pleomorphic retroperitoneal liposarcoma. In seventh day post-operative, the condition was fully recovered. This is an unusual presentation retroperitoneal mass. Pleomorphic retroperitoneal liposarcoma can provide atypical imaging.

Percutaneous nephrostomy (PN) is a urine diversion procedure using a tube, stent, or catheter. Knowledge of bacterial sensitivity to antibiotics can guide the establishment of an appropriate and safe treatment to reduce the incidence of percutaneous nephrostomy-related infection (PNCI). The purpose of this study was to determine the suitability of antibiotics medication based on the results of bacterial culture and bacterial sensitivity test. This study was a retrospective descriptive observational study on medical records of patient diagnosed with obstructive uropathy who underwent PN in the period January 2017 to December 2019. A total of 20 bacterial isolates were classified as gram-positive bacteria isolates (16.53%) and 101 isolates presented gram-negative bacteria (83.47%). The most frequent gram-negative bacteria identified in these isolates were E. coli (n=42), Pseudomonas aeruginosa (n=22), and Klebsiella pneumonia (n=20). Meanwhile, Staphylococcus aureus was seen in ten isolates with gram-positive bacteria. Vancomycin antibiotics had the best sensitivity to gram-positive bacteria based on the antibiotic sensitivity tests. On the other hand, meropenem and amikacin had the best sensitivity to gram-negative bacteria (83.2%). This study showed that the most common bacteria identified from nephrostomy patients is E. coli with meropenem and amikacin as the most sensitive antibiotic for these patients. Thus, antibiotic therapy before and after PN procedure should be considered wisely to prevent resistant PNCI.

Objective: To evaluate hypoechoic lesion in transrectal ultrasonography of prostate (TRUS-P) predictive value on prostate cancer based on PSA Interval and Gleason Group. Material & Methods: An observational analytic study with a cross-sectional design take place from January 2015 to December 2018 analyzing patients who had undergone TRUS-P Biopsy at Hasan Sadikin Hospital. Patients are divided into several subgroups according to different PSA levels. A p-value < 0.05 was considered statistically significant. PPV, NPV, and Youden’s index were all indexes reflecting the performance of a diagnostic test. Results: There were 35 cases (49.3%) with a visible hypoechoic lesion in TRUS and 36 cases (41.7%) without a visible hypoechoic lesion. In our study, 23.9% of the patients with hypoechoic lesions were diagnosed with prostate cancer on TRUSP-Biopsy. The results of the analysis with Youden’s index show that PSA at intervals of 10-20 is the best predictor of diagnostic values. Then we analyzed the overall detection rate based on PSA interval. Patients with PSA > 20 ng/ml, hypoechoic lesions were significantly associated with Gleason Group. Conclusion: We concluded in our study that the hypoechoic lesion in transurethral ultrasonography of prostate could improve the predictive efficacy for diagnosing prostate cancer.

Prostate cancer (PCa) is the most frequent malignancy in men worldwide after lung cancer. The gold standard for diagnosing prostate cancer is prostate biopsy. There are two main approaches for diagnosing PCa: transrectal biopsy and transperineal biopsy. In Indonesia, transperineal approach is rarely done as a part of diagnostic work up.The most known method of transperineal biopsy is the fan technique, which is a difficult technique to perform, particularly when directing the needle to the target accurately. For this reason, we develop an affordable bioplastic VY probe mounted needle guide device ($10) to provide precise needle insertion during the biopsy. In this study, we assessed the objective and subjective factors of the newly developed VY device. • Basic knowledge and operation technique were equalized by holding a prostate biopsy training using fan technique and VY device to 20 first-year Residents • Participants were randomized and devided into two groups to perform fan technique and VY technique based on the training given • Subjective factors (usefulness, the easiness, and preference) and objective factors (duration of puncture to needle visualization on USG, biopsy duration time, and the ability to reach the target tissue) were evaluated.

Spontaneous perirenal hemorrhage is bleeding in perirenal space with no associated trauma or iatrogenic manipulation. It is a rare condition, prevalence of renal arteriovenous malformation (AVMs) was

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.

Introduction: Giant renal cell carcinoma (volume more than 1000 cc) is a rare case. Management included surgical resection combined with targeted therapy. Case presentation: We reported a case of giant clear cell renal carcinoma with 9.900 cm3 of total volume, that required surgical resection of the tumor. This is the largest giant clear cell RCC reported in Asia. Discussion: Giant renal cell carcinoma management without targeted therapy was not optimal. Multimodal therapy was recommended for better outcome. Conclusion: Surgical resection of Giant RCC is challenging, for that reason targeted therapy is recommended to be the alternative regardless the outcome.

Introduction: Bladder leiomyoma is a rare, benign tumor of the bladder. We present the first large endovesical leiomyoma case report in Indonesia and the largest bladder leiomyoma without any post-operation symptoms. Case presentation: A 42-year-old female came with painless hematuria and irritative symptoms in the past year. Cystoscopy and open excision of the tumor showed well-encapsulated papillary solid mass at trigone (7 x 6.5 × 4 cm with a weight of 800 g). Postoperative histopathology confirmed the diagnosis of endovesical leiomyoma of the urinary bladder. Conclusion: Open excision of bladder leiomyoma had good outcomes on large endovesical mass patients.

Objective: To assess the difference in the administration of 0.2 mg and 0.4 mg tamsulosin to the patient's complaint with DJ stent based on USSQ parameters. Material & Methods: This was a prospective study conducted in Hasan Sadikin Hospital Bandung from October to December 2017. A total of 60 patients with indwelling DJ stents randomly divided into 2 groups (n=30). The first group was given tamsulosin 0.2mg daily and the second group was given tamsulosin 0.4 mg daily. LUTSs before and after tamsulosin administration for a week were evaluated in both groups using USSQ. Percentage decreases in USSQ score in both groups were then compared using Mann Whitney Test. Results: In group I, USSQ score means were 31.9 (20.0-40.0; SD 31.9) before tamsulosin 0.2 mg administration and 26.1 (15.0-35.0; SD 5.6) after tamsulosin 0.2 mg administration. Comparison test before and after tamsulosin 0.2 mg administration showed significant decrease in USSQ score. In group II, USSQ score means were 38.9 (31.0-44.0; SD 2.9) before tamsulosin 0.4 mg administration and 16.7 (13.0-21.0; SD 1.8) after tamsulosin 0.4 mg administration. Comparison test before and after tamsulosin 0.4 mg administration showed significant decrease in USSQ score. The percentage decreases in USSQ score were 18.7% in group I and 56.9% in group II. Different test score before and after treatment for both groups showed p-value

Leiomyoma is a benign tumor of smooth muscle origin. Primary leiomyoma of the adrenal gland is very rare. Adrenal tumors are often diagnosed during the ultrasound or computerized tomography (CT) study as incidentaloma. According to the literature review, up to 2018, the largest size of adrenal leiomyoma which had ever been reported was 12 × 10 × 8 cm in dimension (Maher et al.). Herein, we report the largest adrenal leiomyoma with the tumor mass of 600 g (14,1x11,4x10,1 cm) from a female patient admitted to our hospital. Keywords: Adrenal leiomyoma, Adrenal tumor, Leiomyoma, Incidentaloma

Objective: To validate the Indonesian version of the ureteral stent symptoms questionnaire (USSQ) for patients with indwelling ureteral stents. Material & Methods: The Indonesian version of the USSQ was developed following a well-established multistep process by two urologists and two independent translators. A total of 38 patients with indwelling temporary unilateral ureteral stents completed the Indonesian USSQ. Patients completed questionnaires at 1 week after stent insertion and 1 week after stent removal. The reliability of the Indonesian version was evaluated for internal consistency using Cronbach’s alpha test. Domain structures were examined by interdomain (section) associations using Spearman’s correlation coefficient (r). Sensitivity to change of each domain was assessed using Wilcoxon test. Results: Urinary, pain, general health, work performance and additional problem showed good internal consistency whereas sexual problem and global quality of life displayed low consistency. There were strong correlations of urinary symptoms with body pain (r=0.633) and general health (r=0.686), moderate correlation with work performance. In addition there was also strong correlation between body pain and general health (r=0.723). Sensitivity to change were significant to all domain except sexual matters domain. (p

Objective: Penile cancer are the rarest carcinoma of the genitourinary system that are often devastating for the patient and frequently diagnostically and therapeutically challenging for the Urologist. In view of this, it would be interesting to study the incidence, demographics, presentation, and treatment of the patients. The aim of this study was to report the status of penile cancer at Hasan Sadikin Hospital Bandung. Material & Methods: This was a retrospective study of 9 patients. We study the incidence, demographics, presentation, and treatment of the patients at Hasan Sadikin Hospital Bandung between January 2010 and December 2015. Results: The mean age of the patients was 50.44 ± 12.09 years old. All patients had squamous cell carcinoma. Five patients underwent partial penectomy, 4 patients underwent total penectomy and perineostomy for urinary diversion. Four patients had lymph node localization. A Superficial lymph node dissection was performed in two patients. One of our patient was referred to hemato-oncologist for chemotherapy. Conclusion: Penile cancer seems rare in our hospital. General public should be educated about genital hygiene and early circumcision in male infant as a prophylactic measure. An understanding of the various operative procedures for treatment of the primary tumor and regional lymph nodes is therefore critical in the successful management of this condition.

Objective: The aim of this study is to provide database about local invasion and metastasis pattern, as well as the disease characteristics of bladder cancer in Hasan Sadikin Hospital, Bandung. Material & Methods: Between January 2011 and December 2016 there were 321 cases of bladder cancer recorded in our hospital. Of all cases, 106 patients included in this study, with evident of local invasion or distant metastasis either radiologically (contrast abdominal pelvic CT scan) or pathologically. Results: The study group consist of 106 patients (86 men [81.7%], 20 women [28.3%]); with mean age of 56.78 ± 13.19 (4-76) years old. Histopathology findings of transitional cell carcinoma (TCC) consist of 82 (77.3%) patients and the atypical histology features group of 24 (22.7%) patients. Local invasion was found in 99 patients of 321 (30.8%), with the most common organ invasion to the prostate in male (n=38 [35.8%]). Lymph node metastasis were found in 47 patients (44.3%), with the most common nodal metastasis to obturator lymph nodes (n=21 [19.8%]). Distant metastasis was found in 24 patients (22.6%) with the most common site for distant metastasis was the liver (n=12 [11.3%]). In TCC group, 12 patients (63.1%) had a distant organ metastasis with nodal metastasis, whereas in atypical group, majority of the patients with distant organ metastasis (n=5 [83.3%]) had no lymph node involvement. Moreover, in transitional cell group, not all patient (n=17 [73.1%]) had local invasion of the tumor, while all patients with distant organ metastasis in atypical group (n=6 [100%]) had abdominal or pelvic wall invasion (cT4b). Conclusion: TCC is the most common pathology findings and with Prostate is the most common site for local tumor invasion. Obturator lymph nodes is the most common nodal metastasis and liver is the most common site for distant metastasis in bladder cancer.

Objective: To compare the validated calculators of Indonesian Prostate Cancer Risk Calculator (IPCRC) vs Korean Prostate Cancer Risk Calculator (KPCRC) vs Prostate Cancer Prevention Trial Risk Calculator (PCPT-RC) vs European Randomized Study of Screening for Prostate Cancer Risk Calculator (ERSPC-RC) in predicting prostate cancer in our patients at Hasan Sadikin Hospital Bandung. Material & methods: This study is a prospective study conducted from August 2014 – December 2015 at Urology Clinic at Hasan Sadikin Hospital that included all patients with BPH or suspected PCa who have been undergoing prostate biopsy. Variables such as age, PSA level, prostate volume (transabdominal or transrectal ultrasound) and digital rectal examination (DRE) finding were recorded. Risk calculation was generated using each risk calculator. Data were analyzed using Chi-square analysis, Kolmogorov-Smirnov, and finally receiver operating characterisitic (ROC) curve. All statistical analyses were performed with SPSS version 20. Results: There were 89 BPH and 43 PCa patients between August 2014 – December 2015. The mean age, PSA and prostate volume are 65.78 ± 8.33 years; 121.16 ± 375.76ng/ml; 55.86 ± 31.9ml respectively. Abnormal DRE was found in 27 PCas and 4 BPHs. Receiver operator curve analysis of IPCRC showed AUC 0.861 vs KPCRC (AUC=0.779) vs ERSPC-RC (AUC=0.745) vs PCPT-RC (AUC=0.794) vs PSA (AUC 0.794), sensitivity 81.4% and specificity 71.9% with cut-off point 19.67 for the IPCRC in predicting the prostate cancer in our center. Conclusion: IPCRC is better than KPCRC, PCPT-RC and ERSPC-RC in predicting prostate cancer in our center.

Objective: To evaluate the Primary Care Physician’s (PCPs) knowledge, attitude and clinical behavior in managing patients with BPH, as an input in the review of BPH guideline of Indonesian Urology Association. Material & method: The mailing included a cover letter, questioner consist of 10 questions survey, survey instrument and a post-paid envelope. A 10-questions survey were validated according to BPH guideline by Indonesian Urology Association (IUA). PCPs who work in district health offices and registered in district health office of Indonesian Health Ministry in Bandung, were selected as respondents. Results: 75% of sampled primary care physician working in 71 district health offices responded. 83% of respondent did not know the BPH guideline that had been published by Indonesian Urology Association. Although 88% of PCP’s knew about the symptoms of BPH, only 32% heard about of International Prostate Symptoms score. However, only 13 % were reported applying the symptoms score. Regarding to mandatory examination by the guideline, 64% of PCPs reported performing digital rectal examination, and 47% reported ordering urinalysis test. The recommended test such as PSA and serum creatinine level only asked 24% and 60% by PCPs. Only 21% of PCPs knew about the uroflowmetry but never ordering the test. 47% of PCPs reported using α blockers and 2% using finasteride for treating BPH. The referral was conducted by PCPs mostly due to urinary retention and hematuria. 70% of PCPs would refer the patients to urologist and the others to general surgeon and general internist. Conclusion: Although PCPs play role up to certain extent in diagnosing and managing of BPH, most of them are not interested in looking for reference.

Objective: To assess the efficacy of pulsed holmium:YAG laser lithotripsy for ureteral stone therapy. Material and method: Ninety-one patients (70 males and 21 females) with age range 20 – 76 years underwent 93 ureteroscopic procedures for 101 ureteral stones. A preoperative diagnosis was established by ultrasound scanning and intravenous urography. An 8 F rigid Karl-Storz ureteroscope was used for a holmium:YAG laser (OmniPulse MaxTM 80 watt Holmium Laser System Model 1210-VHP, Trimedyne,Inc. Irvine CA, USA) as energy source for laser lithotripsy. The stone localization was mostly at the lower third of the ureter. The mean stone size was 9,6 mm, mean duration of procedure was 48,1 minutes, and the mean hospital stay was 2,1 days. Results: The overall stone clearance rate was 95,6% with the best results for stones in the middle third of the ureter (100%). At follow up we noted two patients with residual stones and two patients with a perforation of the ureteral wall. Conclusion: The Holmium:YAG laser is effective for ureteral stone treatment with a high success rate. Special attention and care should be afforded in impacted ureteral stones.

Objective: To evaluate the sensitivity and the specificity of the ultrasound in predicting renal parenchyma laceration and perirenal hematoma in patients with abdominal blunt trauma with suspicion of renal trauma, as confirmed by operative findings in the explorative laparotomy. Material & methods: From March 2005 to March 2006, we found 28 patients admitted to the emergency department with abdominal blunt trauma with suspicion of renal trauma. Every patient was scanned sonografically to detect the presence of the renal parenchyma laceration and perirenal hematoma. All those patients underwent laparotomy for any certain indication, but not because of ultrasound findings. The ultrasound findings then were checked with the operative findings. Results: The sensitivity of the ultrasound in predicting renal parenchyma laceration is 53.8%, while its sensitivity in predicting perirenal hematoma is 75%. The specificity of ultrasound in predicting both renal parenchyma laceration and perirenal hematoma is 100%. Conclusion: Ultrasound for kidney trauma is sensitive in predicting the presence of perirenal hematoma, but not sensitive in predicting the presence of a renal parenchyma laceration. Ultrasound is very specific in predicting if both perirenal hematoma and renal parenchyma laceration are present.

Objective: The aim of the study was to detect the differences in number and the distribution of angiotensin II type-1 receptor (AT1R) in BPH, high grade PIN, and adenocarcinoma of the prostate. Material & method: A prospective study was performed in RSHS, in collaboration with the Department of Anatomical Pathology. Prostate samples were taken by TUR of the prostate, and then divided into 5 groups. They were BPH, high grade PIN, adenocarcinoma of the prostate in 3 difference grades (well, moderate, and poorly differentiated). Kidney tissue for control. Immunohistochemical staining was done to determine the angiotensin II type-1 (AT1R) receptor distribution as primary antibody used was mouse monoclonal antibody AT1 (TONI-1): sc-57036, Santa Cruz Biotechnology Inc., CA. Results: Angiotensin II type-1 receptor was found in material of BPH, high grade PIN and adenocarcinoma of the prostate. The number and distribution of the receptors were not different. Conclusion: There are no significant differences in number and distribution of angiotensin II type-1 receptor on BPH, high grade PIN, and adenocarcinoma of the prostate.

Objective: To evaluate the effect of estrogen on wistar’s vaginal epithelium. Material & method: We divided 30 female wistars into three groups, ten wistars underwent bilateral ovariectomy, 10 wistars underwent bilateral ovariectomy, and estrogen replacement and 10 wistars as control. The second group received estradiol 1 mg/kg/day, directly after ovariectomy. After 4 weeks the vagina was then harvested and stained with hematoxylin-eosin to evaluate the thickness of epithelial layer of vagina. A pair T-test was use for statistical analysis. Results: Estrogen ablation decreased the thickness of epithelial layer in wistar’s vagina. The mean thickness of epithelial layer in vagina were 3, 5, and 10 for each group respectively. The mean epithelial layer of the first group as well as the second group showed significant difference compared to control group (p>0,05), while the first group showed insignificant difference compared to the second group. Conclusion: Estrogen ablation seems to decrease the thickness of vaginal epithelium, while estrogen replacement revealed insignificant effect.

Objective:We reported a case of mature (benign) cystic retrovesical teratoma. Retrovesical teratoma is a very rare extragonadal tumour, especially in adults, moreover in male patients. Grading and classification of teratoma is important for management and prognosis.Material & method:The patient in this study was a 49-year-old male who had chief complaints of abdominal mass and difficulty in urination. We performed Ultrasonography (USG) and Abdominal Multislice Computed Tomography (MSCT) scan on the patient. Results: USG showed a large mass in the pelvic region demonstrating a well-defined hypoechoic mass with septations at posterior of vesica urinaria. MSCT scan showed a large inhomogeneous hypodense mass with thin septations as well as multiple areas of fatty collections and coarse calcifications in pelvic region. We performed complete surgical resection per laparotomy. Grossly, the mass measured 12 x 10 x 5 cm and had rubbery consistency. Cut section of the mass revealed multilocular cystic spaces, whitish-gray walls, scattered yellowish adipose tissue collection, mucus secretions, and areas of calcifications. Pathological diagnosis of the resected tumour was a matured teratoma. The diagnosis was made because the tumour showed signs of a mature teratoma such as lined by stratified squamous and respiratory columnar eptithelium, fat and muscle tissue, nerve tissue, and calcifications. Conclusion: There were no neuroepithelium appearance. To our knowledge, this is the first retrovesical teratoma case being reported in Indonesia.

Objective: To describe our experience about laparoscopic partial nephrectomy to treat localized renal tumour patients in Urology Department Hasan Sadikin General Hospital Bandung. Material & method: In 2014, there were 6 female patients that underwent laparoscopic partial nephrectomy in Hasan Sadikin General Hospital Bandung. In one case, there were tumours on both kidneys. Five patients were underwent transperitoneal approach and 1 patient were undergo retroperitoneal approach. All patients were examined with ultrasonography and Abdominal CT scan with contrast. We also calculate RENAL nephrometry score. Results: There were 6 female patients with left flank pain that undergo laparoscopic partial nephrectomy. In one case, there are tumours on both kidneys. In RENAL nephrometry score calculation, there were 3 patients with 10x score, 1 patient with 11x score, 1 patient with 7x score, and 1 patient with 6p score. From all of them, 4 patients were successfully performed laparoscopic partial nephrectomy, 1 patients was undergo laparoscopic nephrectomyand 1 patient is converted to open partial nephrectomy. Five patients were undergo transperitoneal approach and 1 patient was undergo retroperitoneal approach. Surgery ranged from 180-240 minutes. Intra operative bleeding was ranged from 50-200 cc. Tramadol intravenous was used for post operative pain control. With VAS score in first post operative day was 6, and 2 at the time of discharge. Hospitalized time was ranged from 4-6 days. Conclusion: Laparoscopic partial nephrectomy is an alternative treatment that safe for localized renal tumour. This procedure is depend on the technique and approach from each Urologist. Our limitations are we didn’t have laparoscopic ultrasonography and the tumour close to pelvocalyces system.

Objective: In Hasan Sadikin General Hospital Bandung prostate biopsy is recommended for patients with prostate specific antigen (PSA) levels above 10 ng/mL or PSA density (PSAD) above 0.15 if PSA in between 4–10 ng/mL. However, there were other factors beside of prostate cancer (PCa) that could influence PSA value, such as racial differences and prostatitis. Thus, the optimal cut-off point for PSA is still debatable in national level. This research aimed to determine PSA and PSAD cut-off point for patient suspected of PCa in Hasan Sadikin Hospital Bandung. Material & Methods: A total of 502 patients underwent prostate biopsy for suspicion PCa from 2010–2014. The cut-off point of PSA and PSAD is generated from receiver operating characteristic (ROC) curve. Results: The cut-off point for PSA was 14.6 ng/mL (sensitivity 81.4%, specificity 29.8%). The cut-off point for PSAD was 0.23 (sensitivity 81.4%, specificity 34.8%). Positive predictive value (PPV) for this new cut-off point of PSA and PSAD were 41.1% and 37.6% respectively. Conclusion: PSA and PSAD cut-off point for patients in our center was 14.6 ng/mL and 0.23 respectively. This value is relatively higher compared to the Indonesian consensus. The difference might occur due to high rate of urinary tract infection in patients attending Hasan Sadikin General Hospital Bandung.

Objective: To compare retroperitoneal versus transperitoneal laparoscopic ureterolithotomy in effectivity, pain scale and early complications. Material & methods: In this prospective comparison study from January 2013 to June 2014, 32 patients with proximal and mid ureteral stones underwent retroperitoneal laparoscopic ureterolithotomy or transperitoneal laparoscopic ureterolithotomy. The randomization occured on consecutive sampling on a 1 : 1 basis. Group 1 and 2 consisted of patients who underwent retroperitoneal laparoscopic ureterolithotomy and transperitoneal laparoscopic ureterolithotomy, respectively. Demographic and clinical variable, operative time, length of stay, ureteral suturing, pain scale according to visual analog scale (VAS) and early complications data were collected and analyzed. Statistical analysis was performed with SPSS® version 17.0 using student T-test and Mann-Whitney U tests with p value < 0.05 considered statistically significant. Results:VAS on day 1 between the 2 groups was statistically significant, and was higher in group 2 (p < 0.05). According to the Clavien-Dindo classification of surgical complication all the patients were in grade 1 classification. The differences in operative time, length of stay, ureteral suturing, visual pain analog score on day 3, and early complications between the 2 groups were not statistically significant.Conclusion: Transperitoneal laparoscopic ureterolithotomy is significantly associated with pain than retroperitoneal laparoscopic ureterolithotomy in first day after surgery. Successful stone removal remains the same in both groups.

Objective: To determine the incidence of squamous cell carcinoma (SCC) in patients with large bladder stone (> 40 mm). Material & method: This is a descriptive retrospective cross-sectional study, data was collected from medical record on patients with a diagnosis of large bladder stone (> 40 mm) that have been performed surgical removal of stone (vesicolithotomy) and bladder mucosa biopsy in Hasan Sadikin Hospital Bandung during 2006-2010. Furthermore, the data are classified according to pathology. Results: This study found cases of large bladder stone (> 40 mm) of 47 cases during the period 2006-2010, and of these 47 cases, there were 76.7% and 23.3% non-malignancy of a malignancy in 2 cases (4.3%) with anatomical pathology picture of SCC. Based on the age group of patients aged 31-40 years obtained 25.5%, 41-50 years 21.3%, 51-60 years 21.3% and > 60 years 23.4%, whereas for ages below 30 years 8.5%. Based on sex, male 95.7% and 4.3% of women. Based on the size, found a stone the size of 40 mm (48.9%), stone size of 50 mm (10.6%), stone size 60 mm and 70 mm respectively (8.5%), stone size 80 mm (12.8%), stone size > 80 mm (4.3%) and 6.4% with multiple bladder stones. Conclusion: There were only two cases of bladder SCC from 47 cases patients with large bladder stone (> 40 mm) in Hasan Sadikin Hospital Bandung during 2006-2010. Keywords: Bladder Stone, bladder carcinoma, squamous cell carcinoma.

Objective: To compare the sensitivity and specificity of both types of prostate biopsies, between 6 core biopsy/sextant biopsy with volume based biopsy prostate. Material & method: The subjects were patients that have been performed prostate biopsy in Hasan Sadikin Hospital in 2006 – 2010. The data was divided into two groups, the group A (before 2009) 327 patients had performed 6 cores biopsy, group B (after 2009), the biopsy was performed based on prostate volume (volume < 40 cc : 8 cores, volume 40-60 cc : 10 coresand volume > 60 cc : 12 cores). Biopsy results confirmed by definitive results from surgery, then analyzed specificity and sensitivity between two groups. The analytical statistic test using unpaired T test and Levene’s test. Results: There were 654 patients divided in two groups. The data in both groups were similar based on analytical statistic test using unpaired t test (p = 0.28) and the data was in normal distribution (Levene’s test = p > 0.05). The group A, mean age 67.4 years, mean prostate volume 32.53 cc and mean PSA levels 29.89 ng/dl and at group B, mean age 66.7 years, mean prostate volume 30.89 cc and mean PSA levels 16.92 ng/dl. Volume based cores method in prostate biopsy have higher sensitivity and specificity compared with 6 core biopsy (97.5% vs 94.0%) and (92.2% vs 77.8%). Conclusion: The sensitivity and specificity of prostate biopsy was increased in volume based cores compared to 6 cores biopsy. Keywords: Prostate biopsy, volume based.

Objective: This study is aimed to determine the effectiveness and complications of periprostatic block and intraprostatic infiltration anesthesia for transrectal prostate biopsy. Material & Method: Two consecutive group of patients, periprostatic block (group A) and intraprostatic infiltration (group B), underwent transrectal ultrasound (TRUS) guided prostate biopsy were entered into the study. Exclusion criteria were severe systemic infection, local infection (prostatitis, proctitis, anorectal abscess, and fissure), hemorrhoid (external and/or internal), and chronic pelvic pain (bladder pain syndrome (BPS) or other pelvic disease. Each group enrolled 58 patients. The patients were requested to choose indicate degree of pain on visual analog score (VAS) 3 times, during probe insertion (VAS1), during anesthesia (VAS2), and during the biopsy (VAS3). Complications from the procedures were recorded. The data were analyzed using Mann-Whitney and independent t-test. Results: There were no significant difference in average age of groups, 65,69 ± 7,019 years for group A and 65,34 ± 7,633 years for group B (p = 0,647). The VAS3 score of group B 5,17 ± 0,653 was significantly lower than group A 5,9 ± 0,612 (p < 0,001). The change in VAS score (VAS3-VAS2) in group B 0,55 ± 0,535 also significantly lower than group A 1,00 ± 0,530 (p = 0,004). The average days with pain were not significant on both group, group A 1,16 ± 0,362 day and group B 1,12 ± 0,329 day (p = 0,594). The duration of bleeding was significantly higher on group B 1,32 ± 0,562 day than group A 1,10 ± 0,307 day (p = 0,026). Conclusion: Intraprostatic infiltration resulted in less pain during prostate biopsy, but also reported more bleeding after the procedure than the periprostatic block. Keywords: Intraprostatic infiltration, periprostatic nerve block, transrectal ultrasound guided prostate biopsy.

Objective: To evaluate the improvement of Lower Urinary Tract Symptoms (LUTS) in males treated with terazosin based on sub scoring ratio of the International Prostatic Symptoms Score (IPSS). Material & Method: Sixty eight male with LUTS subjected to terazosin 1 mg daily and divided into two groups based on IPSS sub scoring ratio. After 3 months improvement of the symptoms were evaluated using the IPSS. Data analysis was done using paired T-test. The conclusion was based on significance level p1) and failure to store group (IPSS- v/s ≤1) after 3 months of Terazosin therapy (mean= 9,56 versus 6,94). Statistically superior improvement was observed on failure to voiding group (p=0,0003) (95CI:1,30-3,93). Conclusion: Terazosin is best given to male LUTS with IPSS- v/s >1 although both groups respond well. Keywords:International prostatic symptoms score, sub score, failure to voiding, failure to storage, male, lower urinary tract symptoms.