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Introduction: The clinical usage of the ureteral stent caused several stent-related symptoms (SRSs), including lower urinary tract symptoms, pain, general health, work performance, sexual matter and additional problems. This study aims to evaluate the effectiveness between tamsulosin and solifenacin combined with tamsulosin for SRSs.Methods: This double blind randomized controlled trial used 50 patients. Between September 2020 and February 2021, patients underwent double-J stenting after retrograde ureteroscopy were analyzed. All patients would be randomized in a 1:1 ratio in a 1:1 ratio to receive either tamsulosin 0,4 mg (Group A: 25 participants) or tamsulosin 0,4 mg & solifenacin 5 mg combination (group B: 25 participants).We used the Ureteral Symptoms Score Questionnaire (USSQ) as an outcome measure at 1s, 2nd, 3rd and 4th weeks after stent insertion. Results: Group A was found more in women, while in group B was more in men. The highest age in group A and group B was 50-60 years old (36% and 64%). The location of stenting in group A was found more in left (60%), while the group B in the right (52%). Both groups had more patients who were normal nutritional status (60%). There was an improvement in pain and work performance after treatment in both groups, meanwhile group B showed better improvement than group A at all weeks. in addition, there was an improvement in urinary symptoms and sexual matter in group B better than in group A at 2nd to 4th week. Furthermore, group B showed better improvement in general health and additional problem only at 4th week. Conclusions: Combination therapy with tamsulosin and solifenacin improved USSQ score more than the monotherapy group. This implied that combination therapy is optimal for improving SRSs.

Introduction Traumatic kidney injuries are the most common urinary tract injuries. Pediatric patients are more susceptible to renal injury from blunt trauma than adults because of anatomic factors. The aim of this publication was to provide a reference for traumatic kidney injury in the pediatric group based on the study in our center. Methods A retrospective study was conducted from January 2014 to December 2019 to review medical records of children admitted with renal trauma. Relevant findings, including demographics, mechanisms and grades of injury, clinical parameters, interventions, and outcomes were recorded. Results Thirty-three pediatric patients were investigated. Males experienced traumatic kidney injury more often than the female with a ratio of 10:1. Most cases occurred during the adolescent (12–18) years (81.82%). Left side kidney injury (63.64%) was more frequent than right side (36.36%). Most cases (96.97%) were caused by blunt trauma, mainly traffic accidents (81.82%). Most patients (90.91%) had stable hemodynamics. Grade IV kidney injury was the most frequently found injury (39.39%). The cause of renal function disturbance was based on the blood urea nitrogen/creatinine (BUN/Cr) ratio with 21.87% of patients suffering from intra-renal causes and 12.5% from pre-renal causes. No significant association between different grades and BUN/creatinine ratio was found. Isolated renal injuries were found in 54.54% of patients. Most patients were treated conservatively (87.88%), and survival was 96.97%. Conclusion Non-operative management is safe and and yields good outcomes in kidney trauma patients with stable hemodynamics. Renal trauma severity is not associated with the BUN/Cr ratio.

Lower urinary tract symptoms (LUTS) and ureteral-stent-related symp-toms (uSRS) are similar to those of lower urinary tract symptoms caused by benign prostatic hypertrophy (BPH), and complaints about urgency and frequency of urination are the same as in patients with overactive bladder syndrome (OAB). β₃-adrenoceptor agonist (Mirabegron) and anti-muscarinic (Solifenacin) therapies used for LUTS and OAB therapy can also be used to reduce SRS complaints. This study aimed to determine the effectiveness of using Solifenacin as a treatment for uSRS as compared to Mirabegron. This study used a double-blinded experimental design. Samples were taken randomly (consecutive random sampling) from fifty patients with uSRS. Data was collected using the Ureteral Symptoms Score Questionnaire (USSQ) as a measuring instrument. Data was analyzed using the mean, t-Test, and Chi-square tests. P values of [J Med Allied Sci 2020; 10(2.000): 115-120]

Background Penile curvature in men with Peyronie’s disease (PD)—caused by tunica anchoring plaques with loss of focal fiber elasticity—theoretically increases the risk of penile fracture during sexual activity. Penile fracture is the result of tearing of the tunica albuginea of one or both corpora cavernosa, usually during sexual intercourse, and is among the most serious urological emergencies. Generally, a patient presented to a surgical emergency within 48 h of injury can be handled successfully with minimum complications. Immediate surgical treatment is the current standard of care and has a relatively low risk of late complications. Case presentation We present a case of penile fracture in a male with a history of PD referred to the emergency department with severe pain. Clinical history assessment and physical examination revealed a penile fracture with underlying PD. He underwent emergency surgical exploration via subcoronal incision. Penile plication was not necessary for our case because the angulation of the penis was less than 15° after examination of artificial erection. Conclusion Penile fracture in a patient with underlying PD is a rare urological emergency that should be treated surgically with fracture repair as early as possible. Penile plication might be necessary in severe cases (angulation > 60°).

Highlights • Preputial stones are a very rare form of urinary tract stone. • Almost all the cases happen in a male in uncircumcised males, poor genital hygiene, low socioeconomic status, and phimosis. • The symptoms and signs are due to phimosis. • Neglected preputial stones can cause serious morbidities, such as hydronephrosis and renal failure., Introduction Preputial stones are a very rare form of urinary tract stone, and only small number cases have been reported in the literature, and tend to occur in uncircumcised males with poor genital hygiene, low socioeconomic status, and phimosis. Presentation of case Here, we report a case in a male who presented with more than 100 preputial stones. The stones were evident on clinical examination by palpation on the preputial. The patient was treated by dorsal slit circumcision. Discussion Preputial stones can occur at any age but are far more common in adult males. All cases of preputial stone are associated with severe phimosis in uncircumcised males. The symptoms and signs are due to phimosis, like in these patients, which causes urinary stasis beneath the foreskin. The stone is often palpable on examination of the prepuce, and a plain radiograph can confirm this. Neglected preputial stones can cause serious morbidities. Treatment involves the removal of stone and elimination of the predisposing cause. Conclusions This case reminds us of the necessity of circumcision for adult uncircumcised males.

Highlights • The existence of bladder stones is an uncommon condition that can cause vesico-vaginal fistulas (VVF). • Almost all the cases resulted in giant bladder stones. • Here, we report the uncommon case of a giant bladder stone causing VVF., Introduction The presentation of bladder stones is the most common manifestation of a lower urinary tract stone. In severe cases, it can cause pressure necrosis and lead to vesico-vaginal fistula (VVF). This case reports a female patient diagnosed with a bladder stone accompanied by VVF. Presentation of case A 56-year-old female came to the hospital with complaints of dysuria accompanied by continual urinary incontinence symptoms dating back about a month. During vaginal examination, we found a fistula and a stone. An ultrasound (US) showed a hyperechoic shadow measuring 1.27 × 1.36 cm in the vesica urinary and plain kidney, ureter, and bladder (KUB) x-ray showed the presence of a radiopaque shadow of about 7.5 × 5 cm in the pelvic area. This stone was removed through an open cystolithotomy. Intraoperatively, a fistula of about 1 cm in diameter was found in the trigonum close to the internal meatus. A fistula repair was performed immediately without complications, and the follow-up results were satisfactory. Conclusion The presentation of a bladder stone is an uncommon condition that can cause VVF. Therefore, it is important to pay attention to its clinical signs.

Highlights • Traumatic penile amputation is a rare surgical emergency that requires immediate care. • Most reported cases involve genital self-mutilation induced by psychiatric disorders. • We report a successful proximal penile shaft amputation via macrosurgical techniques., Introduction Traumatic penile amputation is a highly uncommon surgical emergency that requires immediate intervention. Most reported cases involve genital self-mutilation induced by underlying psychiatric disorder, especially schizophrenia. The self-mutilation of external genitals in psychiatric patients, also known as Klingsor syndrome, is a rare form of urotrauma. Presentation of case We present a case of partial penile amputation in a 46-year-old male with Klingsor syndrome admitted to the hospital 3 days after the incident. Urological examination revealed a subtotal cut of the penis, including the distal part of the mons pubis, dorsal and lateral parts of the penile skin, corpus cavernosum, and corpus spongiosum, as well as a partial bulbous urethra rupture. The penis remained suspended by only a thin ventral part of the penile skin. After macroscopic surgical replantation, the patient recovered well and could urinate without any symptoms of urethral stricture. The entire penis remained viable with minimal scarring at the surgical site, and penile erection could be achieved and maintained. Conclusion The case demonstrates a rare instance of the successful proximal penile shaft amputation via macrosurgical techniques by an experienced urologic surgeon.

Malignant hemangiopericytoma (HPC) is an uncommon disease first described by Stout and Murray in 1942. Patients with suspected renal HPC on admission sometimes complain of low back pain, hematuria, or hypertension. A combination of histochemical and anatomo-pathologic examinations is necessary to confirm the diagnosis of renal HPC. We report the case of a 41-year-old female patient who had persistent painful nodular lesion at the right lower back and gross hematuria. Based on analyses of clinical symptoms and signs plus radiological a laboratory examination, she was diagnosed with renal cell carcinoma of the right kidney. She subsequently underwent open right radical nephrectomy via transperitoneal approach. The patient was discharged from hospital in good condition on Day 5 of care after surgical intervention. Malignant HPC of the kidney is an uncommon disease that can be diagnosed based on multislice computerized tomography angiography plus histopathological examination using the periodic acid shift method. Management of malignant renal HPC requires radical nephrectomy followed by chemotherapy. This case study provides important preliminary data for further studies of patients with renal HPC in Indonesia.

Double-J (DJ) stents have been widely utilized in urological practice. They are commonly used to relieve ureteral obstruction. Serious complications may occur when stents are left in place for long periods of time. In the present paper, we report a patient with a neglected DJ stent that had been inserted for five years after uterus-tumor surgery and led to a bladder stone. We report a case of a female who presented a bladder stone with a right DJ stent in the pelvic cavity. The stone was evident in radiological examination in an incidental finding. The treatment was transurethral cystolithotripsy. This case reminds us of the necessity of providing enough information and appropriate knowledge pertaining to the insertion of a ureteral stent. Transurethral cystolithotripsy is one of the treatment methods and can be suggested as a definitive method in consideration that it is a clinically effective and safe intervention.

BACKGROUND: Hypospadias is the second most common congenital anomalies among human congenital disabilities. There are over 300 surgery techniques being introduced to treat hypospadias. The successful of hypospadias repair is assessed by several outcomes as well as complications following surgery. AIM: This study aims to show the multicenter hypospadias data in Indonesia descriptively. METHODS: All the data were compiled based on questionnaires, which were distributed to Indonesian pediatric urologists. The questionnaire includes several questions containing demographic aspect, preferred techniques being used, and complications being found regarding hypospadias repair. RESULTS: Eighteen Indonesian pediatric urologists from 12 centres involved in this study. The data were collected from June – September 2018 based on the surgeon’s experience throughout 2017. From 591 cases based on the returned questionnaire, penile-type hypospadias was the most common type of hypospadias being treated (35.7%) followed by penoscrotal (28.9%) and scrotal-type (12.9%). Moderate severity of chordee was mostly seen among all cases (40.6%). Tubularised incised plate (TIP), + Thiersch Duplay, was the most common technique being used to treat hypospadias (44.3%), followed by onlay island preputial flap (14.9%) and two-stage technique (14%). The incidence of urethrocutaneous fistulae in this study was 13.9%. CONCLUSION: This study showed how Indonesian pediatric urologists dealt with hypospadias cases. TIP + Thiersch Duplay procedure being the preferred technique used by most participants and the rate of urethrocutaneous fistulae as one of the complications was comparable with previous studies.

Highlights • About 10% of traumatic injury patients have genitourinary involvement. • Immediate exploration and urethral reconstruction is indicated in urethral trauma. • Urethra rupture with anorectal laceration can be treated with primary anastomosis., Introduction The initial management of urethral trauma remains disputed, and there are several suitable techniques, including delayed repair and suprapubic urinary diversion as well as primary endoscopic or open alignments. The treatment choice used depends on the rupture’s location and length as well as the accompanying trauma. Case presentation A 33-year-old male patient was referred to the department of emergency, with the chief complaint of inability to void experienced 1 day before being admitted, after falling from a height of approximately three meters. There was a laceration to the perineum 3 cm long to the rectum, with no active bleeding. After the incident, the patient could not void, but the lower abdomen was not painful. Upon retrograde urethrography examination, contrast extravasation of the bulbous urethra was seen through the anorectal laceration. Immediate debridement and repair for the anorectal wound, then primary anastomosis for the bulbous urethra, was performed. Discussion The likelihood of an injury to the anterior urethra increases with certain clinical features, including blood in the urethral meatus, palpable bladder distention, and a butterfly appearance on the perineum. Immediate exploration and reconstruction of the urethra is recommended in urethral traumas associated with penile fractures and non-life-threatening penetrating injuries. Furthermore, small lacerations are repaired primarily, while total ruptures are treated with anastomosis. Conclusion Proper identification and management of urethral rupture determines the outcome. Initial urethral trauma management is disputed; however, a bulbous urethra rupture with anorectal lacerations can be treated safely and effectively with primary anastomosis.

Metanephric Adenoma is a rare benign renal epithelial tumor, only a few reports are found in the literature. Reported a 48-year-old female with a palpable mass at left flank, pain and microscopic haematuria. Radiological imaging shows a mass on left Kidney suspected of Renal Cell Carcinoma. Transperitoneal left radical nephrectomy was done. Histopathological results revealed a Metanephric adenoma. The patient is repatriated from the hospital four days after surgery. The patient is in good health, and there is no sign of recurrence on 48 months follow up after surgery.

Teratoma is an embryonal tumor composed several types of foreign cells from the lace of origin, it can be benign or malignant, and can be grown in various parts of the body. Based on the consistency, teratoma can be a cystic, solid, and mixed component. Teratoma of the kidney is very rare cases, only 19 cases in adult and 17 cases in child reported in the world. The intra-renal teratoma first described by McCurdy, he reported a six-week-old baby boy had abdominal mass in the left hypochondrium with prune belly syndromes on 1934. The first case of adult reported by Kojiro on 1976 in a 40-year-old male with abdominal pain. Present a 30-year-old male with chief complaints protruded mass in the left flank since a year after a history stabbing of the wound. Lumbotomy eleventh rib trans-costal incision for a nephrectomy suspected teratoma by radiological finding was done, and obtained masses is shaped like fetal malformation with size 13.5x14.5x20 cms. Histopathological results mature teratoma with interstitial nephritis.

Incident of bladder carcinoma synchronous with CML was about 0.45% and its treatment became a challenge. We reported a case of invasive urothelial cell carcinoma with chronic myeloid leukemia (CML) in a 55-years-old man. The patient suffered painless gross hematuria from the first time. Patient complained of weight drop drastically and often accompanied by intermittent fever. The result of bone marrow biopsy was chronic phase CML, while the results of abdominal ultrasound and abdominal Multislice Computerized Tomography without contrast were a bladder mass. The patient underwent TUR-BT and therapy with imatinib. The pathology result showed that an Invasive Urothelial Cell Carcinoma of bladder. Our report concluded an uncommon case of Invasive Urothelial Cell Carcinoma of bladder and CML.

Renal-type clear cell carcinoma (RTCCC) of the prostate is a rare form of kidney cancer that is infrequently reported in the literature. Here we describe the case of an 81-year-old male patient with a hard, immovable mass on his enlarged prostate, which was discovered through a digital rectal examination. His prostate-specific antigen (PSA) level was 23.01 ng/ml, and bone multi-slice computed tomography scans revealed several osteoblastic lesions on the inferior ramus of his bilateral pubic bone. Tissue recovered during the trans urethral resection of the prostate was indicative of RTCCC with typical prostatic adenocarcinoma (Gleason score 3 + 4 = 7). Concerning treatment course, bilateral subcapsular orchiectomy was chosen over medical hormonal therapy. Upon follow-up 12 months post-surgery, his lower urinary tract symptoms were nearly resolved and his serum PSA level had decreased to 3.2 ng/ml. Accurate RTCCC diagnosis remains a pressing concern that warrants further investigation to optimize treatment selection and patient outcome.

Introduction Lower Urinary Tract Symptoms (LUTS) can be a complication of ureteral stent insertion. Clinically, PDE5 inhibitors (Tadalafil) and alpha blockers (Tamsulosin) are the preferred drugs for treating lower urinary tract symptoms after ureteral stent insertion, also called ureteral stents-related symptoms (uSRS). This study aims to compare the effectiveness of 0.4 mg/day Tamsulosin and 10 mg/day Tadalafil for treating uSRS. Methods This study used a double-blinded experimental design. Fifty patients with uSRS were randomly assigned to one of 2 groups; group I (n = 25) received 10 mg/day Tadalafil, while group II (n = 25) received 0.4 mg/day Tamsulosin. The Ureteral Symptoms Score Questionnaire (USSQ) was administered on the 7th, 14th, 21st, and 28th day after insertion of the ureteral stent. p values of Results The administration of 10 mg/day Tadalafil had a good effect in reducing the LUTS score: mean scores were VS = 11.03, p = 4.21, GC = 3.8, WA = 1.29, SA = 1.94, and AS = 3.21. The administration of 0.4 mg/day Tamsulosin also had a good effect in reducing the LUTS score: mean scores were VS = 13.73, p = 9.89, GC = 3.85, WA = 4.31, SA = 0.59, and AS = 4.69. Conclusion Administration of 10 mg/day Tadalafil had significantly better results compared to 0.4 mg/day Tamsulosin in improving uSRS, except in VS week 2 and in GC weeks 2 and 4.

Introduction and objective: Penile paraffinoma or an old term is sclerosing lipogranuloma of male genitalia, are injected mineral oils, like paraffin, or other materials have been used more often in Eastern Europe and Asia, to increase the circumferential of the penis. This study aims to know the distribution and management of the Penile paraffinoma. Materials and methods: This is a single center retrospective descriptive study from January 2009 to December 2016. The data was collected from the personal interview and medical record of the patients who treated in our institution in Makassar. We collect the age of patients, a reason to injected foreign bodies, the person who injected, satisfied status after injected, site of inflammation, a reason to operate, type of operation procedure, and complications after the operation. Results: a Total Fifty-seven patient who came to our institution. Age range 25-47 years old, 56% injected to enlarged the size of the penis, 86% injected by a nonmedical person. 87% not satisfied with the results after injection, 51% inflammation less than a half of shaft penis. 49% want to operate to release the pain, and 51% of the patients we treated only with partial excision and primary closure and the rest dealt with by one step radical excision and skin graft/flap or by two-step cutaneous plasty of the penile shaft with scrotal skin. Two patients need second radical excision. Conclusion: Penile paraffinoma is an entity product that occurs by injected foreign material for penile augmentation. The treatment often requires extensive penile reconstruction surgery involve complete excision of foreign bodies along with associated reaction followed by primary closure if possible.

We present a case of Fournier gangrene (FG) in a two-month-old male infant which admitted to the hospital with chief complaining of progressive scrotal swelling for two weeks. Scrotal ultrasonography showed a free fluid on right hemiscrotal and normal testicles size. Debridement was conducted to remove devitalized tissue. Forty days after the surgery, the patient remained well without any complication.

Purpose: Compare the pain of the kocher incision and midline incision in postoperative patients with cholecystectomy laparotomy. Methods: Observational randomized controlled double sampling trial study Results: Pain that was felt by patients after 24 hours postoperatively with the kocher incision technique, most showed a score of 3, which was 12 patients (60%), whereas pain felt by patients with a midline incision technique mostly showed a score of 2 ie there were 10 patients (50 %). Overall, the midline incision showed lower VAS results when compared to the kocher incision, where most of the VAS in the midline incision showed a score of 2, whereas the kocher incision showed a score of 3. The results of the mann whitney statistical test showed a value of p = 0.192 (p> 0 , 05), which means that there is no significant difference between the pain level of the kocher group and the midline group. Conclusions: There was no significant difference between the level of pain in the group of patients who received the treatment with the kocher technique and the group with the midline technique.

Background: Urinary tract stone disease (urolithiasis) is still a significant health issue throughout the world. In Asia, regions with very high urolithiasis incidence stretch from Sudan, Saudi Arabia, United Arab Emirates, Pakistan, India, Myanmar, Thailand, Indonesia, and Philippines. Demographic and regional variations in cases of urolithiasis may provide clues to their etiology and prevalence. The aim of this study was to determine the characteristics of urolithiasis patients and their management in Makassar.Methods: This was a single centre retrospective descriptive study using data from patient medical records at Dr. Wahidin Sudirohusodo Hospital Makassar in 2015-2017. Patients’ demographic, clinical, and management characteristics were recorded.Results: From 1,166 urolithiasis patients, author found men were more dominant than women with ratio of 2.2: 1. Age distribution were more common in the range of 40-60 years (58.32%). The distribution of patients with high Body Mass Index (BMI) were relatively common included overweight 20.5% and obese 13.81%. The majority of cases were unilateral urolithiasis (89.28%), with stones were largely found in kidney (59.41%). Extracorporeal Shock Wave Lithotripsy (ESWL) was the method more commonly performed (48.13%) followed by lithotripsy.Conclusions: This study showed that urolithiasis were commonly found in the age group of 40-60 years, predominantly male, and high BMI were relatively common. The majority of cases were unilateral urolithiasis, mostly located in kidney. Urolithiasis were mostly managed by ESWL and lithotripsy.