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Safendra Siregar, Bambang Sasongko Noegroho, Ricky Adriansjah, Akhmad Mustafa, Ananta Bonar Department of Urology, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, IndonesiaCorrespondence: Safendra SiregarDepartment of Urology, Faculty of Medicine Universitas Padjadjaran, General Hospital Hasan Sadikin Bandung, Jl. Makmur No. 16, Bandung, IndonesiaTel +62811227180Email safendra.sir@yahoo.co.idIntroduction: Varicocele is the predominant cause of male infertility. Reactive oxygen species was found in varicocele which induce the lipid peroxidation process in the plasma membrane of spermatozoa and may cause damage to spermatozoa in semen and seminiferous tubules, disrupting spermatogenesis. Human adipose derived stem cells (hADSC) can suppress oxidative stress in some oxidative injury model. This study investigate the effect of intratesticular hADSC injection on malondialdehyde (MDA) level and spermatogenesis process by histopathological examination in the varicocele rat model.Methods: This is an experimental study. A total sampling of 9 male Wistar rats were divided into three groups. Group I consist of 1 Wistar rats without any treatment or model (sham group), group II consist of 4 Wistar rats with varicocele model without hADSC therapy (control group), and group III consist of 4 Wistar rats with varicocele model and were given injections of 1.0× 106 hADSC cells intratesticularly 30 days after model was made (therapy group). Testicular tissue was harvested for evaluation.Results: In all varicocele model rats (group II and III), the result of MDA level in therapy group (2.53 mol/liter) was significantly lower than the MDA level in control group (4.43 mol/liter) (p = 0.01). On histopathological examination, the average Johnson’s Score in the therapy and control group was 9.77 and 9.18, respectively. The analysis showed Johnson’s score in the intervention group was significantly higher (p = 0.018).Conclusion: Intratesticular injection of hADSC can help reduce MDA levels and improve spermatogenesis process, which is damaged by varicoceles.Keywords: human adipose-derived stem cell, varicocele, spermatogenesis, infertility, malondialdehyde, MDA

Bambang Sasongko Noegroho, Safendra Siregar, Akhmad Mustafa, Muhammad Aldito Rivaldi Urology Department, Hasan Sadikin Academic Medical Center, Universitas Padjajaran Bandung, Barat, IndonesiaCorrespondence: Bambang Sasongko NoegrohoUrology Department, Hasan Sadikin Academic Medical Center, Universitas Padjajaran Bandung, Jl. Pasteur No. 38 Bandung Jawa, Barat, 40161, IndonesiaTel +022 2034953/55Fax +022 2032216Email bsn.urologi@gmail.comBackground and Aim: Fournier gangrene (FG) is a necrotizing fasciitis of perineal and/or genital regions that may progressively spread; necrotic tissue may cause morbidity and mortality related to sepsis and multi-organ dysfunction. Surgical intervention required for patients with Fournier gangrene may vary according to the severity of the infection. A Fournier Gangrene Severity Index (FGSI) has been devised to assess the risk of mortality in patients with Fournier gangrene. The aim of this study was to validate the implementation of the FGSI in predicting mortality of FG patients in our hospital.Methods: A retrospective study was performed on all patients with Fournier gangrene admitted and treated in Hasan Sadikin General Hospital during 2015– 2019. Data were collected from the medical records of the emergency room and outpatient clinics. Sociodemographic variables, preexisting comorbidities, outcome, management, and FGSI score were included as variables.Results: In this study, 83 patients were included from the period 2015– 2019, divided into two groups. From the Charlson Comorbidity Index, we found the first group average score was 2.5 (0– 9), and the second group this was 2 (1– 8). From the FGSI, in the first group, we found the average score was 5.5 (2– 15), and the average was 14 (10– 19) in the second group, which is significantly higher than the first group (p = 0.001).Conclusion: We find that the FGSI score system is a good tool for predicting severity of the disease and mortality risk of the patients, which is consistent with findings in other studies.Keywords: FGSI scores, Fournier gangrene, prognosis

Safendra Siregar,1 Jupiter Sibarani,1 Bambang Sasongko Noegroho,1 Irfan Firmansyah,1 Ani Melani Maskoen2 1Department of Urology, Faculty of Medicine Universitas Padjadjaran, General Hospital Hasan Sadikin Bandung, Indonesia; 2Department of Molecular Genetic Laboratory Universitas Padjadjaran, Bandung City, West Java Province, IndonesiaCorrespondence: Safendra Siregar; Bambang Sasongko NoegrohoDepartment of Urology, Faculty of Medicine Universitas Padjadjaran, General Hospital Hasan Sadikin, Jl. Pasteur No. 38, Bandung, IndonesiaTel +62811227180; +62811215058Email safendra.sir@yahoo.co.id; basanoe@yahoo.comIntroduction: The prevalence of hypospadias ranges between 1: 250 to 300 per live birth. Estrogen exposure has been associated with the increasing incidence of hypospadias in humans and a significant relationship between Estrogen Receptor 1 (ESR1) polymorphisms and hypospadias was determined from the previous study. This study aims to determine the proportion of ESR1 polymorphism.Methods: This was a descriptive study aimed to find the incidence of ESR1 gene polymorphism in hypospadias patients visiting the Urology Outpatient Unit of the Hasan Sadikin Bandung Hospital who will undergo hypospadias surgery. Deoxyribonucleic acid (DNA) was performed using foreskin of hypospadias patient during the surgery then being extracted and will be analyzed using polymerase chain reaction (PCR) sequencing.Results: Thirty eight samples of hypospadias were identified, 5 samples were unable to sequence and 33 samples were successfully sequenced using the PCR method. The Pvull ESR1 gene was dominated by the T allele which is a wild-type allele and the genotype containing the T allele, namely TT + TC (57,2%). Normal genotype (TT) were more frequent in distal hypospadias, and Heterozygous polymorphisms (TC) was higher in proximal hypospadias. The ESR1 Xba1 gene polymorphism was dominated by the A allele which is a wild-type allele and the AA + AG genotype (76,1%). Normal genotype (AA) was more frequent in distal hypospadias, and both heterozygous hypospadias (AG) and homozygous hypospadias (GG) were found only in proximal hypospadias. The ESR1 SNP 12 gene polymorphisms were found in the combination of genotypes that played a role, namely GA + AA (81%) and the G allele which is a wild-type allele. Heterozygous polymorphisms (GA) was the most finding genotype and more frequent in proximal hypospadias.Conclusion: ESR1 gene polymorphisms (PvuII, XbaI, and SNP 12) were found in hypospadias patients. ESR1 polymorphisms may correlate with the severity of hypospadias. Further research with a larger sample and better hypospadias grouping is needed to confirm.Keywords: estrogen receptor 1, hypospadias, polymorphism

Purpose: Non-obstructive azoospermia (NOA) is a common, but complex problem, with multiple therapeutic options and a lack of clear guidelines. Hence, there is considerable controversy and marked variation in the management of NOA. This survey evaluates contemporary global practices related to medical and surgical management for patients with NOA., Materials and Methods: A 56-question online survey covering various aspects of the evaluation and management of NOA was sent to specialists around the globe. This paper analyzes the results of the second half of the survey dealing with the management of NOA. Results have been compared to current guidelines, and expert recommendations have been provided using a Delphi process., Results: Participants from 49 countries submitted 336 valid responses. Hormonal therapy for 3 to 6 months was suggested before surgical sperm retrieval (SSR) by 29.6% and 23.6% of participants for normogonadotropic hypogonadism and hypergonadotropic hypogonadism respectively. The SSR rate was reported as 50.0% by 26.0% to 50.0% of participants. Interestingly, 46.0% reported successful SSR in <10% of men with Klinefelter syndrome and 41.3% routinely recommended preimplantation genetic testing. Varicocele repair prior to SSR is recommended by 57.7%. Half of the respondents (57.4%) reported using ultrasound to identify the most vascularized areas in the testis for SSR. One-third proceed directly to microdissection testicular sperm extraction (mTESE) in every case of NOA while others use a staged approach. After a failed conventional TESE, 23.8% wait for 3 months, while 33.1% wait for 6 months before proceeding to mTESE. The cut-off of follicle-stimulating hormone for positive SSR was reported to be 12-19 IU/mL by 22.5% of participants and 20-40 IU/mL by 27.8%, while 31.8% reported no upper limit., Conclusions: This is the largest survey to date on the real-world medical and surgical management of NOA by reproductive experts. It demonstrates a diverse practice pattern and highlights the need for evidence-based international consensus guidelines., Competing Interests: The authors have nothing to disclose., (Copyright © 2025 Korean Society for Sexual Medicine and Andrology.)

Purpose: Non-obstructive azoospermia (NOA) represents the persistent absence of sperm in ejaculate without obstruction, stemming from diverse disease processes. This survey explores global practices in NOA diagnosis, comparing them with guidelines and offering expert recommendations., Materials and Methods: A 56-item questionnaire survey on NOA diagnosis and management was conducted globally from July to September 2022. This paper focuses on part 1, evaluating NOA diagnosis. Data from 367 participants across 49 countries were analyzed descriptively, with a Delphi process used for expert recommendations., Results: Of 336 eligible responses, most participants were experienced attending physicians (70.93%). To diagnose azoospermia definitively, 81.7% requested two semen samples. Commonly ordered hormone tests included serum follicle-stimulating hormone (FSH) (97.0%), total testosterone (92.9%), and luteinizing hormone (86.9%). Genetic testing was requested by 66.6%, with karyotype analysis (86.2%) and Y chromosome microdeletions (88.3%) prevalent. Diagnostic testicular biopsy, distinguishing obstructive azoospermia (OA) from NOA, was not performed by 45.1%, while 34.6% did it selectively. Differentiation relied on physical examination (76.1%), serum hormone profiles (69.6%), and semen tests (68.1%). Expectations of finding sperm surgically were higher in men with normal FSH, larger testes, and a history of sperm in ejaculate., Conclusions: This expert survey, encompassing 367 participants from 49 countries, unveils congruence with recommended guidelines in NOA diagnosis. However, noteworthy disparities in practices suggest a need for evidence-based, international consensus guidelines to standardize NOA evaluation, addressing existing gaps in professional recommendations., Competing Interests: The authors have nothing to disclose., (Copyright © 2024 Korean Society for Sexual Medicine and Andrology.)

Introduction: We aim to evaluate the association between serum hypoxia inducible factor (HIF)-1α level and stage and grade of urothelial bladder cancer (UBC)., Methods: A case-control study was conducted at Haji Adam Malik Hospital Medan, Indonesia. Inclusion criteria for case group was subject aged 18 years or older and diagnosed with UBC based on histopathological examination. Control group consisted of gender and age matched healthy subjects. Serum HIF-1α level was determined using ELISA method. Data was analyzed with chi square, Mann Whitney, and independent T tests., Results: A total of 80 subjects were enrolled and divided into case and control groups equally. Most subjects were males with mean age of 69.65 years for case group and 68.25 years for control group. Most subjects had advanced primary tumor and lymph node stages. Only 30% subjects had metastasized UBC. Higher serum HIF-1α level was observed in case group (p < 0.001). Serum HIF-1α level was strongly associated with metastasis stage (p < 0.001), followed by lymph node (p = 0.005) and primary tumor (p = 0. 013) stages. Serum HIF-1α level was not associated with grading (p = 0.134)., Conclusions: Serum HIF-1α level is associated with staging but not grading of UBC.

Objective: Fournier's gangrene is a rare but life-threatening infection disease with high mortality rate. The quick Sepsis-related Organ Failure Assessment (qSOFA) is a new and simpler scoring system that may identify patients with suspected infection who are at greater risk for a poor outcome. The purpose of this study was to find out role of qSOFA in determining prognosis of Fournier's gangrene patients., Methods: This study is a case control with retrospective review of Fournier's gangrene patients treated at Hasan Sadikin Hospital from January 2013 to December 2017 who met inclusion criteria. Participants were divided into two groups according to qSOFA score as high qSOFA (2-3) and low qSOFA (0-1)., Results: From 69 patients, the mortality rate was 24.6%. The sensitivity of qSOFA score to predict mortality was 88.2%; the specificity was 94.2%; positive predictive value was 83.3%; negative predictive value was 96.1%; positive likelihood ratio was 15.2; negative likelihood ratio was 0.12; and the area under the receiver operating characteristic curve of qSOFA was 94.2%. There was significant association between qSOFA scale and mortality with p -value of 0.0001. The qSOFA score has strong positive correlation with Fournier's Gangrene Severity Index ( p <0.0001, r =0.704)., Conclusion: qSOFA scoring system has a high prognostic value and can be used to determine prognosis of Fournier's gangrene patients., Competing Interests: The authors declare no conflict of interest., (© 2022 Editorial Office of Asian Journal of Urology. Production and hosting by Elsevier B.V.)

Objective: To explore the impact of the coronavirus disease 2019 (COVID-19) pandemic on the training experiences of urology residents in Indonesia., Methods: A cross-sectional study using a web-based questionnaire (SurveyMonkey) involved all registered urology residents in Indonesia. The questionnaire was structured in Bahasa Indonesia, composed of 28 questions, and divided into three sections: demographic characteristics, current daily activities, and opinions regarding training experiences during the COVID-19 outbreak. The survey was distributed to all respondents via chief of residents in each urology center from May 26, 2020 to Jun 2, 2020., Results: Of the total 247 registered urology residents, 243 were eligible for the study. The response and completeness rate for this study were 243/243 (100%). The median age of respondents was 30 (range: 24-38) years old, and 92.2% of them were male. Among them, 6 (2.5%) respondents were confirmed as COVID-19 positive. A decrease in residents' involvement in clinical and surgical activities was distinguishable in endourological and open procedures. Most educational activities were switched to web-based video conferences, while others opted for the in-person method. Smart learning methods, such as joining a national or international speaker webinar or watching a recorded video, were used by 93.8% and 80.7% of the respondents, respectively. The respondents thought that educational activities using web-based video conferences and smart learning methods were effective methods of learning. Overall, the respondents felt unsure whether training experiences during the COVID-19 pandemic were comparable to the respective period before., Conclusion: The COVID-19 pandemic negatively affected urology residents' training experiences. However, it also opened up new possibilities for incorporating new learning methodologies in the future., Competing Interests: All authors declare no conflict of interest., (© 2021 Editorial Office of Asian Journal of Urology. Production and hosting by Elsevier B.V.)

Objective: Erectile dysfunction is a condition in which the patient is unable to achieve or maintain a sufficient erection for sexual intercourse. Transportation usage was believed to have a higher risk of erectile dysfunction. This study aimed to assess the correlation between activity and severity of erectile dysfunction among online motorcycle taxi drivers who use motorbikes., Materials and Methods: This research uses an observational analytic method with a cross-sectional approach with primary data collection from the respondents who work as online motorcycle drivers from January 2021 to March 2021. Data analyses were conducted using Mann-Whitney and Spearman statistical test., Results: A total of 149 respondents met the inclusion and exclusion criteria contained in this study. It was found that the prevalence of erectile dysfunction in this study was 57.7%. There was a significant difference in the distance covered (km) by online motorcycle taxi drivers who experienced erectile dysfunction compared to those who did not have erectile dysfunction (P=.050). In addition, there was a significant difference in length of work (year) among online motorcycle taxi drivers who experienced erectile dysfunction (P=.045)., Conclusion: There was a significant difference in erectile dysfunction incidence based on the distance covered per day and length of work in online motorcycle taxi driver. No significant difference was found in the incidence of erectile dysfunction based on the length of motorbike drive per day. The more distance covered (km) and length of work (year) and the more severe the erectile dysfunction are based on international index of erectile function-5 score.

Background: Varicocele is known to have impacts in infertility cases and sperm quality. This review aimed to evaluate the effects of microsurgical varicocelectomy on sperm DNA fragmentation index (DFI) and sperm parameters., Methods: Open full English text articles from January 2017 to October 2021 were searched from online database including PubMed, EMBASE, Scopus, Cochrane Library and Google Scholar., Results: Systematic search resulted in 277 potential papers. After throughout paper analysis, 5 studies were included in this review. From all five analyzed studies, microsurgical varicocelectomy was statistically proven to reduce DNA fragmentation index by 5.46% (mean difference -5.46; 95% CI: -4.79, -6.13; p < 0.00001). Moreover, the procedure also significantly improved other sperm parameters (sperm concentration +8.23%, sperm motility +7.17%, sperm progressive motility +2.77%, sperm morphology +0.64%)., Conclusion: Microsurgical varicocelectomy significantly improves spermatogenesis as reflected by biomarkers of infertile men including semen parameters and sperm DNA fragmentation (SDF).

Objective: Infertility affects about 15% of couples in reproductive age worldwide. Male factors are the main causes for this condition. Antioxidants have long been used for infertility treatment as they are easily available with a low cost. In this systematic review, we focused on the relation between antioxidant supplementation and sperm DNA fragmentation and other sperm parameters., Material and Methods: An online search from PubMed and ScienceDirect databases was conducted by 2 reviewers. We reviewed full-text articles to obtain detailed information., Results: Nine articles were included in this study. Four studies revealed a statistically significant reduction of sperm DNA fragmentation and five studies revealed an insignificant decrease of sperm DNA fragmentation. Sperm concentration, sperm motility, and morphology were also increased after antioxidant supplementation. Pregnancy rates were reported in 3 studies; the rates increased in 2 studies, and similar rate to placebo group was observed in 1 study., Conclusion: Antioxidant supplementation can counteract against oxidative stress and improve spermatogenesis process reflected by decrease of DNA Fragmentation Index (DFI), improvement of sperm parameters, and elevation of pregnancy rates confirmed by those included studies.

Introduction: Renal cell carcinoma (RCC) is well known for its ability to metastasize into different organs. However, the management of metachronous RCC is still not yet standardized., Case Presentation: A 62 years old man was presented with haematuria for the last 2 months. CT scan revealed bladder mass with a size of 2,5 cm and underwent en-bloc resection of bladder mass. The histopathological result showed non-muscle-invasive bladder clear cell renal carcinoma. The patient had a history of left nephrectomy in 2017 and meningioma mass metastasectomy in 2020 with the same histopathological origin., Conclusion: Bladder metastasis of RCC can be treated by endoscopic surgical intervention., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Herlyn-Werner-Wunderlich (HWW) syndrome is difficult to diagnose. We report our first experience of fistula repair in HWW syndrome in Hasan Sadikin General Hospital Indonesia. A 12 years old girl presented with urinary retention, and was consulted to urology because the urethral meatus could not be found. MRI showed two separate uteri, cervices, and vaginas. Complete separation of vagina and urethra was done. After 2 years follow up, the patient had no complaint. HWW syndrome should be suspected in cases with pelvic pain or urinary retention during menarche period among teenagers and neonatal cases with any renal malformation., Competing Interests: The authors declare that they have no financial connections with any companies of relevance for this article., (© 2021 The Authors. Published by Elsevier Inc.)

Testicular infarction and ischemia are rare complications of acute epididymitis. The condition is difficult to differentiate with testicular torsion clinically and radiologically. There are only a few cases that have been reported. In this study, we presented a case in a 45 years old male with acute pain in the left testicular. Left orchidectomy had been performed on the patient. Arterial thrombus and ischemia of the left testis were found by pathology examination. Although it is an uncommon case, it has been reported as a potentially serious complication of epididymitis and should be considered when acute scrotal pain is encountered., Competing Interests: None., (© 2021 Published by Elsevier Inc.)

Introduction: Cervical cancer is the 3rd most common cancer in women. In late stages, obstructive uropathy due to mass infiltration is common and the mainstay of treatment for this condition is palliative urinary diversion through percutaneous nephrostomy. Nevertheless, complications due to nephrostomy may have adverse effects on some patients. Further study is necessary to determine whether nephrostomy is suitable for all cervical cancer patients with obstructive uropathy. This study aims to identify the determinants of survival rate of cervical cancer patients undergoing nephrostomy for obstructive uropathy and determine the group of cervical cancer patients that would benefit the most from nephrostomy., Methods: Data were obtained from medical records of cervical cancer patients in Hasan Sadikin Central Public Hospital from January 2018 to December 2019. Log-rank analysis was performed to assess the survival rate of patients based on clinical conditions (age, metastasis, and ECOG performance status) and initial laboratory results (hemoglobin, leukocyte, thrombocyte and blood acidity)., Results: A total of 163 cases were identified from the medical records, with a median survival of 5(1-17) months. The results of the analysis showed that the survival rates of cervical cancer patients undergoing nephrostomy were significantly affected by age (p = 0.0001), metastasis (p = 0.0001), and ECOG performance status (p = 0.0001), while laboratory findings were not significant factors affecting survival (pHb=0.501; pLeu=0.634; pTr=0.077; pBGA=0.687)., Conclusion: The survival after nephrostomy in advanced cervical cancer patients is largely affected by age, metastasis, and performance status. The choices of doing nephrostomy in those patients should be considering those factors to maximize the benefit over the risk of complications., .

Penile strangulation by metallic ring is an emergency situation which requires urgent management. Strangulation of the penis usually performed in order to increase sexual performance or because underlying mental disorder or paraphilia. It is an uncommon urological emergency, if not treated as soon as possible it can lead to complications such as gangrene and amputation of the penis. There is no standard of care that has been found to be superior, with each case managed individually according to its clinical findings and operative settings. In this study, we present four cases of penile strangulation in last two years in a tertiary care hospital., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: The prevalence of hypospadias ranges between 1: 250 to 300 per live birth. Estrogen exposure has been associated with the increasing incidence of hypospadias in humans and a significant relationship between Estrogen Receptor 1 (ESR1) polymorphisms and hypospadias was determined from the previous study. This study aims to determine the proportion of ESR1 polymorphism., Methods: This was a descriptive study aimed to find the incidence of ESR1 gene polymorphism in hypospadias patients visiting the Urology Outpatient Unit of the Hasan Sadikin Bandung Hospital who will undergo hypospadias surgery. Deoxyribonucleic acid (DNA) was performed using foreskin of hypospadias patient during the surgery then being extracted and will be analyzed using polymerase chain reaction (PCR) sequencing., Results: Thirty eight samples of hypospadias were identified, 5 samples were unable to sequence and 33 samples were successfully sequenced using the PCR method. The Pvull ESR1 gene was dominated by the T allele which is a wild-type allele and the genotype containing the T allele, namely TT + TC (57,2%). Normal genotype (TT) were more frequent in distal hypospadias, and Heterozygous polymorphisms (TC) was higher in proximal hypospadias. The ESR1 Xba1 gene polymorphism was dominated by the A allele which is a wild-type allele and the AA + AG genotype (76,1%). Normal genotype (AA) was more frequent in distal hypospadias, and both heterozygous hypospadias (AG) and homozygous hypospadias (GG) were found only in proximal hypospadias. The ESR1 SNP 12 gene polymorphisms were found in the combination of genotypes that played a role, namely GA + AA (81%) and the G allele which is a wild-type allele. Heterozygous polymorphisms (GA) was the most finding genotype and more frequent in proximal hypospadias., Conclusion: ESR1 gene polymorphisms (PvuII, XbaI, and SNP 12) were found in hypospadias patients. ESR1 polymorphisms may correlate with the severity of hypospadias. Further research with a larger sample and better hypospadias grouping is needed to confirm., Competing Interests: The authors report no conflicts of interest in this work., (© 2021 Siregar et al.)

An avulsion is very rare and the most serious complication that may occur during ureteroscopy in 0.06-0.45% of patients during the ureteral stone procedure. A sixty years-old female with a small stone in the upper third of the right ureter with high-grade hydronephrosis and underwent a ureteroscopy procedure. During withdrawal of the scope, the ureter was brought out in urethral meatus, with inverted fashion, nearly the whole length of the ureter was avulsed out. A nephrectomy of the right kidney was then performed. Knowledge about signs of the ureteral avulsion, pitfalls when to stop, and treatments is really important., Competing Interests: The author declare that they have no financial connection with any companies of relevance for this article., (© 2021 The Authors.)

Renoduodenal fistula is a rare condition where a pathological tract is formed between the kidney and duodenum. This condition is caused by various etiologies, such as tuberculosis, malignancy, percutaneous nephrostomy procedure, cryoablation procedure in malignancy, and chronic infection. In this case, we report a case renoduodenal fistula caused by large staghorn calculus, precipitated by a previous history of trauma. Renoduodenal fistula is a rare condition that often presents without symptoms. This condition can be caused by chronic infection of the kidney, and one of the etiology is an infected large staghorn calculus., (© 2020 The Authors. Published by Elsevier Inc.)

Case Presentation: A case of a 57 years old woman came with the chief complaint of urinary incontinence since 20 years ago. After labor, she complained of urinary incontinence and left untreated. Physical examination and urethrocystoscopy revealed vaginal stone sized 90 × 70 mm and urethrovaginal fistula. We performed hysterectomy and vaginal stone removal, continued with fistula closure and vaginal repair. Up to 2 months follow up, no sign of urinary leakage and incontinence was found., Conclusion: Vaginal stone is a rare Case that might be present in a case of long term urethrovaginal fistula with neglected contraceptive device., (© 2020 Published by Elsevier Inc.)

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., Competing Interests: There are no conflicts of interest., (© 2020 The Authors.)

Objective: The fibrotic process of kidney resulting in glomerulosclerosis was found in patients with ureteropelvic junction obstruction (UPJO) who underwent renal biopsy during pyeloplasty. Transforming growth factor β1 (TGF-β1) plays a role in collagen accumulation, resulting in fibrosis. Adipose tissue-derived stem cells (ADSCs) have an anti-apoptotic effect on target cells and enhance the kidney function recovery. We will further investigate the use of ADSC in the prevention of kidney fibrosis in the unilateral UPJO model of Wistar rats., Material and Methods: A total of twenty-two 12-week-old Wistar rats were divided into three groups. We made the UPJO models using nylon 6-0 inside the left ureter and tied the ureter with nylon 6-0, creating partial ureteral obstruction. The treatment group was then injected with 1.0 × 10 6 cells of human ADSC via the tail vein of rats. All rats were euthanized after 2 and 4 weeks of treatment. The left kidney used hematoxylin-eosin for histopathological examination. Statistical analysis using one-way analysis of variance (ANOVA) was done with SPSS version 21.0., Results: TGF-β1 concentration in the treatment group was significantly lower in the 4 th week of observation (p4=0.0001), as well as collagen type 1, which was also significantly lower in the 4 th week (p4=0.0001). There was a significant difference in the glomerulus count between the control group and the human ADSC (hADSC) group therapy in week 2 and week 4 (p2=0.0001 and p4=0.026)., Conclusion: Administration of hADSC therapy reduces TGF-β1 and collagen type 1 levels and then improves the histopathological features in the process of renal fibrosis in the UPJO model.