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Objective: This study aims to comprehensively assess TRT's cardiovascular safety in males with hypogonadism, providing valuable insights for treatment decisions. Material & Methods: Adhering to PRISMA guidelines, we registered our PROSPERO protocol and analyzed relevant English-language randomized clinical trials published from 2008 to 2023. Results: Among 1187 initial papers, 7 studies met inclusion criteria, with 6 in quantitative analysis and all 7 in qualitative assessment. Our findings indicate that TRT does not significantly increase the risk of cardiovascular events compared to placebo. Specifically, the analysis of major adverse cardiac events (MACE) yielded an OR of 0.90 (95% CI: 0.74, 1.10; I² = 26%; p = 0.25), while the evaluation of all cardiovascular adverse events revealed an OR of 1.37 (95% CI: 0.73, 2.55; I² = 75%; p = 0.001). Conclusion: This study offers reassurance for clinical decision-making by suggesting that TRT is not significantly associated with an elevated cardiovascular risk in hypogonadal men, addressing the ongoing debates on this issue. Keywords: Cardiovascular safety, hypogonadism, testosterone replacement therapy.

Background: Coronavirus disease 2019 (COVID-19) pandemic has rapidly spread worldwide and affected the healthcare system, including the deferral of surgical practice. There are various reactions regarding delayed surgeries, but parental viewpoints towards circumcision remain scarce. In light of the pandemic, this study aimed to evaluate how parents feel about circumcision and the probable determining variables. Materials and Methods: This study is a cross-sectional study based on an online questionnaire available from March to April 2022. The factors affecting the decision were analysed using logistic regression. Results: Of 1,218 (26.28%) parents who completed the survey, 879 (18.96%) met the inclusion criteria and were included in this study. Among them, 615 (70.00%) parents agreed to delay circumcision during the COVID-19 pandemic. These respondents were more likely to be non-Muslim (P = 0.01), have no relatives whose work is related to medicine or paramedicine (P = 0.02) and have monthly income equal to or below the regional minimum wage (P = 0.03). After adjusting the potential confounder, non-Muslim religion (odds ratios, 2.87; 95% confidence interval, 1.27–6.49; P = 0.012) was found to be the only independent predictor for agreeing to the deferral of circumcision amid the pandemic. Conclusion: Most parents agreed to postpone circumcision due to the fear of COVID-19 exposure. In order to help them feel less apprehensive about this matter, it is important to educate them about the medical benefits of circumcision and the safety of this procedure.

Objective: Reporting a rare case and provide a view of bladder extrophy management. Case(s) Presentation: A 12-year-old female complained of an open abdominal wall below the umbilicus accompanied by continuous incontinence of urine since birth. The MRI showed diastasis symphisis 5.1 cm and a soft tissue defect in the suprapubic region, suspicious of bladder exstrophy. Bladder mucose biopsy showed squamous metaplasia. The patient underwent pelvic osteotomy, bladder wall closure, bladder neck reconstruction, abdominal closure with double keystone flap with proceed mesh, and external fixation. A cystostomy catheter was placed until one week after surgery, and the patient was able to hold the urge to urinate and started to move around while sitting. Two months after the reconstruction, the primary closure and keystone removal on skin defect were carried. The patient was already able to walk and continence the urine. Discussion: Bladder extrophy is a rare condition. Currently delayed reconstruction on bladder growth is the subject of debate and speculation. The patient’s condition in this presented case improved, this is in accordance with the literature that states that delayed reconstruction can still be considered in special conditions that do not allow early reconstruction. Conclusion: Delayed bladder reconstruction and bladder neck reconstruction can improve the anatomy of the bladder and quality of life on certain cases. Keywords: Bladder exstrophy, bladder reconstruction, female bladder exstrophy.

Objective: Prostate cancer is the second most common cancer in men and the fifth leading cause of death worldwide. 10-20% of cases can progress to a more aggressive stage called castration-resistant prostate cancer (CRPC) with a higher death rate. Clinical guidelines recommend docetaxel as first-line chemotherapy and evaluated using the PSA test. This study aims to investigate the effect of docetaxel chemotherapy on PSA levels in CRPC. Material & Methods: A retrospective study was conducted from January 2016 until August 2022 according to the medical records database Saiful Anwar Hospital. There were 16 patients who met the inclusion criteria, including male patients with a diagnosis of CRPC who received castration therapy and found an increase in PSA 3 times of nadir or found 2 or more bone metastatic lesions or soft tissue lesions > 2 cm, received 6 series of docetaxel chemotherapy, and have a PSA data was performed before and after chemotherapy. Statistical analysis was performed using a differential T-test. Results: The results, obtained were significantly different (p

Objective: This case report will present transurethral resection of double anterior urethral valves in tertiary hospital. Case(s) Presentation: A three-year-old boy who complained of a poor stream of urine and discomfort during micturition. From the radiological examination, the main finding was found on ultrasound (USG), with thickening of the bladder wall without upper tract abnormality. On panendoscopy, we found double anterior urethral valves at bulbar part and trabeculation in bladder. Discussion: The resection of the valves was performed and achieved an excellent result included normal stream of urine and there was no discomfort during micturition. Conclusion: Anterior Urethral Valve is a rare case that can be caused a lower urinary tract obstruction. A good understanding of AUV’s radiological and endoscopic anatomy is required to differentiate it from other diseases, essential to prevent further injury, and also to decide for appropriate management. Keywords: Anterior Urethral Valve, Congenital Anomaly, Urinary Obstruction

Objective: This case report presented giant hydronephrosis (GH) due to Ureteropelvic Junction Stenosis in pediatrics. Case(s) Presentation: A three-year-old boy was admitted with abdominal distension and pain for the last three month. CT scan without contrast of the abdomen showed a left kidney size of 141x 97x 63.5 mm, massive dilatation of the pelvicalyceal system, thinning cortex in the left kidney, and left ureter measurement of 16 mm in diameter. An urgent percutaneous nephrostomy tube (10Fr) was placed in the left kidney for this patient, followed by a pyeloplasty procedure in the next three weeks. The patient was discharged on day five, and the six-month follow-up results were good. Discussion: Giant Hydronephrosis is a rare entity, with less than 500 global cases reported in the literature. The diagnostic approach to suspected hydronephrosis in pediatrics is sonography and may be followed by CT or MRI. Management of giant hydronephrosis requires two stages procedure with percutaneous nephrostomy followed by pyeloplasty. This two-stage method ensure the renal function is preserved. Conclusion: Ureteropelvic Junction Stenosis is a common cause of giant hydronephrosis in pediatrics. Appropriate physical examination and other diagnostic approaches are needed to diagnose patients with giant hydronephrosis and determine the best management. Keywords: Giant hydronephrosis, ureteropelvic junction stenosis, pyeloplasty.

Objective: This case report presented Penile Torsion in pediatrics. Case(s) Presentation: A two-year-old boy with a chief complaint of rotated penile to the right side since birth. There were 45º in clockwise torsion, slight chordee, and uncircumcised. Patient underwent penile reconstruction surgery, including penile degloving, urethral mobilization, and plication. After seven days follow-up, parents were satisfied with straight penile erection and no torsion at all. After 3 months follow-up, parents reported satisfaction with the surgical outcome such as cosmetic appearance, straight erection, and normal stream urine. Discussion: Surgical techniques ranging from simple penile degloving with foreskin repositioning to more complex surgical procedure involving corporeal tissue. Surgery by using degloving of penile skin and realignment could be suitable for penile torsion 90°, other techniques should be considered such as corporopexy procedure, rotation flap of dorsal dartos, or diagonal suturing of corporeal folds away from and parallel to the neurovascular bundle. Conclusion: Penile reconstruction surgery using penile degloving, urethral mobilization, and plication for penile torsion showed satisfaction result including cosmetic appearance, penile erection, and normal urine flow. Keywords: Chordee, penile reconstruction, penile torsion.

ABSTRACT Objective: This case report aims to describe a different approach of PFUI by conservative management that resulted in good outcome. Case(s) Presentation: A 7-year-old girl patient was brought to the emergency department after falling from public transportation diagnosed with suspicious urethral rupture, perineal rupture grade III, vertical-shear type pelvic-ring injury, laceration wound on the right lower leg, abrasion on the medial side left lower leg and urinary retention. The patient underwent percutaneous cystostomy, pelvic bandage, a perineal debridement and repair, a cystography, percutaneous vesicolithotripsy, cystostomy and synechiae incision. One year after the first admission it was planned for urethroplasty due to completely obliterated from antegrade and retrograde panendoscopy. Discussion: 8 months later urethroplasty was aborted because of an open bladder neck, a fistula at the anterior connected to the distal of the bladder neck with size of 3 mm. The patient was performed a silicon cystostomy catheter insertion for 6 weeks. At the time of evaluation, the fistula was closed, it was proven by Qmax uroflowmetry was 18ml/s with average flow: 9.8 ml/s, voiding volume: 90ml, flow time: 9s, voiding time: 9s, hesistance:1.5, and PVR:5.35 cc. Conclusion: In this case, it showed that conservative management could improve PFUI with satisfactory result, proved by good result of uroflowmetry. However, periodic evaluations must be carried out to follow the progress of the disease and the possibility of future complications including sexual function. Keywords: PFUI, girl, urethral rupture

ABSTRACT Objective: This case report aimed to present our experience of conservative treatments for High Flow Priapism in children. Case(s) Report: A 7 years old boy presented with persistent and painless erections without sexual stimulation for 24 hours, the erection was first noticed when he woke up in the morning after accidentally consuming aphrodisiac chocolate 2 days before admitted to the hospital. There was no previous history of priapism and trauma or other risk factors. Discussion: Laboratory studies were within normal limits. Physical examination revealed a fully erect, nontender penile with rigid corpora cavernosa, soft glans, and erection hardness scale (EHS) 3. A cavernosal blood gas analysis was collected with the following values PH 7.41, pO2 117,7 mmHg, and pCO2 24, 8 mmHg. With diagnosis of High Flow Priapism, he was observed and got conservative treatments; ice and site-specific compression and after that EHS become 1. On follow-up after 2 months reported that patient had normal erections with no further episodes of priapism. Conclusion: High flow priapism in old boy after accidentally consuming aphrodisiac chocolate can managed by conservative therapy with favourable outcome. Keywords: Aphrodisiac chocolate, penile erection, priapism.

Shifting learning process due to COVID-19 has led to increased burnout prevalence among medical students. Thus, this study aimed to assess burnout prevalence and its associated factors among Indonesian medical students during the COVID-19 pandemic. An online cross-sectional study was carried out among medical students in Malang, Indonesia. Burnout was assessed using the Maslach Burnout Inventory-Student Survey tool. Pearson's Chi-square was used to assess significant associations, and binary logistic regression was conducted to evaluate the relationships between the predictor variables and burnout. The difference of each subscale score was evaluated using an independent sample t test. This study analyzed 413 medical students with a mean age of 21.1 ± 1.4 years old. About 29.5% and 32.9% of students reported a high level of emotional exhaustion and depersonalization, respectively, resulting in 17.9% of burnout prevalence. Stage of study was the only sociodemographic factor independently associated with burnout prevalence (odds ratio = 0.180, 95% confidence interval = 0.079-0.410, p-values = 0.000). Preclinical students had significantly higher levels of emotional exhaustion (p-value = 0.004, d = 0.3) and depersonalization (p-value = 0.000, d = 1.1), and lower levels of personal accomplishment (p-value = 0.000, d = -0.5). Around one-sixth of the medical students experienced burnout during the COVID-19 pandemic, with preclinical students being more prone to have burnout. Future study with other adjusted confounding factors is needed to completely understand the issue and obtain immediate interventional strategies to reduce burnout among medical students.

Objective: This study aims to report a case of bladder embryonal rhabdomyosarcoma in an 18-months-old boy. Case(s) Presentation: An 18-months-old boy presented with complaint of difficult urinating since the last 2 months before presentation. It was accompanied with hematuria, blood clot and palpable mass in the lower abdomen. Magnetic resonance imaging (MRI) of lower abdomen showed a solid mass in the inferior bladder wall, involved bilateral ureterovesical junction (UVJ) that caused bilateral severe hydroureteronephrosis, lymphadenopathy, and multiple nodul in both lungs. Cystoscopy was performed and found intrabladder tumor near the bladder neck and trigonum. Then biopsy of the bladder tumor was performed. Pathology result of the specimens showed bladder embryonal rhabdomyosarcoma. Then immunohistochemistry examination was performed with desmin and myogenin antibody to confirm bladder embryonal rhabdomyosarcoma diagnosis. Discussion: Bladder embryonal rhabdomyosarcoma often involves the bladder neck and trigone. In general, clinical symptoms relate to mass and blockage caused by mass. Ultrasound is the first imaging examination performed. Magnetic resonance imaging (MRI) helps depict the mass, usually hyperintense on the T2 image. The immunohistochemical examination is an important examination of skeletal muscle markers. Desmin found in muscle is used to diagnose rhabdomyosarcoma. Conclusion: Bladder embryonal rhabdomyosarcoma is a diagnostic challenge as it is a rare malignant tumor. The clinician needs to be aware of this entity and performed immunohistochemistry as an important examination to accurately diagnose embryonal rhabdomyosarcoma of the bladder. Keywords: Bladder, immunohistochemistry, rhabdomyosarcoma.

Objective: This study was conducted to determine the correlation between Presume Circle Area Ratio (PCAR) and IPSS score, Qmax, and post voiding residual urine (PVR) and to find PCAR cut-off value in determining the presence Bladder Outlet Obstruction (BOO) in Benign prostatic hyperplasia (BPH) Lower Urinary Tract Symptoms (LUTS). Materials & Methods: This study was observational analytic study with 30 BPH LUTS patients as subjects during the period September 2015 to January 2016. The determined variables were PCAR, IPSS score, Qmax, post voiding residual urine (PVR) and analyzed using the SPSS program v21. Results: There were 30 patients who met the inclusion and exclusion criteria with the mean age of 67.47 years. In the correlation test, there was insignificant correlation between PCAR with IPSS (r=0.138, p=0.467), a significant correlation between PCAR with Qmax (r=0.468, p=0.009), PCAR with PVR (r=0.399, p=0.029), PCAR with BOO (r=0.491, p=0.006) PCAR cutoff value is 0.65 with sensitivity of 69% and specificity of 71%. Conclusion: PCAR has a significant correlation with PVR, Qmax and BOO but no significant with IPSS score. PCAR value >0.65 indicating BOO in BPH LUTS. PCAR can be used as an alternative non-invasive examination in determining the existence of BOO.