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ABSTRAK
Tujuan: Penelitian ini bertujuan untuk menganalisis variabel yang berhubungan dengan kondisi intra-operatif dan pasca-operasi selama proses pembelajaran dan melakukan evaluasi hasil dari metode berbasis mentor-initiated pada LDN di Rumah Sakit Cipto Mangunkusumo (RSCM), Jakarta, Indonesia. Material dan Metode: Penelitian retrospektif ini menggambarkan pengalaman pada 140 prosedur LDN yang dilakukan di RSCM sejak November 2011 sampai Agustus 2014. Sebanyak 66 kasus LDN pertama, dilakukan oleh seorang ahli bedah laparoskopi sebagai operator utama (mentor) dan secara bersamaan, membimbing operator kedua (trainee). Setelah itu, operasi dilakukan secara bergantian oleh kedua ahli bedah. Dilakukan analisis pada variabel yang berhubungan dengan kondisi intra-operatif dan pasca operasi pada 66 kasus LDN pertama, serta analisa perbandingan antara prosedur operasi yang dikerjakan oleh masing-masing ahli bedah. Hasil: Rerata usia pendonor adalah 32.97 tahun dengan rasio jenis kelamin 6:4 (laki-laki:perempuan). Sebanyak 64% pendonor tidak memiliki hubungan keluarga dengan resipien. Donor ginjal kiri dilakukan pada 82.1% (n=112) prosedur, dan kanan sebanyak 17.9% (n=28). Tidak ada perbedaan signifikan pada waktu operasi (p=0.36), Warm Ischemia Time (WIT) 1 (p=0.66), jumlah perdarahan intra-operatif (p=0.46) antara kedua operator. Hanya satu variable (time to clip) yang ditemukan secara statistik bermakna, p = 0.024. Perbandingan antara grup pertama (1-50 LDN) dan grup terakhir (100-140 LDN) hanya variable WIT 1 dan time to clip; p = 0.029, p = 0.029 yang ditemukan signifikan secara statistik. Kesimpulan: LDN merupakan suatu prosedur yang cukup menjanjikan dan aman untuk meningkatkan jumlah pendonor ginjal. Kesulitan untuk mencapai suatu learning curve menjadi permasalahan utama yang harus dihadapi oleh setiap ahli bedah laparoskopik, terutama karena dampak yang potensial terhadap keberhasilan suatu transplantasi ginjal. Pengalaman yang cukup pada operasi laparoskopi saluran kemih bagian atas sangat diperlukan sebelum melakukan LDN. Pendekatan berbasis mentor-initiated akan membantu peserta latihan untuk mengenali dan melakukan keseluruhan operasi dengan baik tanpa membahayakan patient safety.

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ABSTRACT
Objective: variables related to both surgical and postoperative outcome during the learning curve and evaluate the result of mentor-initiated approach of laparoscopic donor nephrectomies at Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Materials and Methods: This retrospective study describes our experiences on 140 laparoscopic nephrectomies in living donors performed in Cipto Mangunkusumo Hospital from November 2011 to August 2014. First sixty-six LDN was performed by one experienced laparoscopic surgeon as the main operator while mentoring the second operator. Afterward the surgery was performed alternately between the two surgeons. Variables related to both the surgical and postoperative outcome during the initial phase and comparisons of the procedures performed by each surgeon were analyzed. Results: Donors’ average age was 32.97 years with male female ratio 6 : 4. About 64% patients were not family related. The left kidney procedures was performed 112 times (82.1%), whereas the right kidney 28 procedures (17.9%). No significant difference in operating time done by both operators (p= 0.36), WIT 1 (p=0.66), and intraoperative blood loss (p=0.46) with only time to clip as single statistically significant variable with p=0.024. Comparison between 1-50 LDN group and the 100-140 LDN group on WIT 1 and time to clip were found statistically significant with p = 0.029, p = 0.029. Conclusion: Laparoscopic donor nephrectomy (LDN) is a fairly safe and a promising procedure to increase the kidney donation pool. A steep learning curve is still the main problem that every surgeon had to deal with, mainly due to the concern of its potential impact on graft survival. Experience in laparoscopic upper urinary tract surgery is recommended to start with LDN. A mentor-initiated approach allows the introduction of this procedure to trainees with good results on the overall surgery without compromising patient safety.

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ABSTRAK
Adrenalektomi per laparoskopi telah diterima secara umum sebagai prosedur bedah standar untuk sebagian besar tumor adrenal dalam dua dekade terakhir. Adrenalektomi per laparoskopi telah menunjukkan beberapa keuntungan dibandingkan dengan operasi terbuka dalam hal mengurangi rasa nyeri pasca operasi, waktu rawatan di rumah sakit lebih cepat, lebih cepat kembali dalam aktivitas sebelum operasi, dan meningkatkan kosmesis. Penelitian ini bertujuan untuk menggambarkan karakteristik pasien dan evaluasi dari kurva pembelajaran dalam prosedur adrenalektomi per laparoskopi di Rumah Sakit Cipto Mangunkusumo, Jakarta, Indonesia. Studi ini meninjau karakteristik tumor, status intraoperatif, dan variabel pasca operasi dari semua pasien yang menjalani adrenalektomi per laparoskopi mulai dari 2007 hingga 2014. Penelitian ini melaporkan 14 pasien yang menjalani adrenalektomi per laparoskopi dengan usia rata-rata 41.3 ± 10.1 tahun and BMI rata-rata 23.6 ± 2.5. Lokasi tumor 50% berada di sisi kanan dan 50% di sisi kiri. Ukuran rata-rata tumor 4.4 ± 2.6, 71.4% pada kelompok ≤ 6 cm dan 28.6% dalam kelompok ≥ 6 cm. Sebagian besar pasien (42.9%) secara klinis didiagnosis dengan Conn syndrome, dengan hasil histopatologis sebagian besar menunjukkan adenoma kortikal adrenal (78,6%). Tidak ada perbedaan rata-rata signifikan dalam perdarahan intraoperatif pada sisi dan ukuran tumor yang berbeda, dan tidak ada perbedaan waktu operasi pada sisi tumor yang berbeda. Terdapat perbedaan dalam waktu operasi dimana waktu operasi pada kelompok tumor < 6 cm lebih cepat (172 ± 45.1 minutes) dibandingkan kelompok tumor ≥ 6 cm (222.5 ± 23.9 minutes) dengan p < 0.05. Laparoskopi adrenalektomi adalah teknik minimal invasif yang dapat dilakukan dengan aman dan efisien dengan keunggulan yang signifikan dibandingkan dengan operasi terbuka.

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ABSTRACT
Laparoscopic adrenalectomy has become generally accepted as the standard surgical procedure for the vast majority of adrenal tumors over the past two decades. Laparoscopic adrenalectomy has shown several advantages compared to the open approach in terms of reduced postoperative pain, shorter hospital stay, faster return to preoperative activity level, and improved cosmesis. This study was aimed to describe patients characteristics and evaluate our learning curve of laparoscopic adrenalectomy at Cipto Mangunkusumo Hospital, Jakarta, Indonesia. This study reviewed tumor characteristics, intraoperative status, and postoperative variables of all patients who underwent laparoscopic adrenalectomy starting from 2007 until 2014. This study reported 14 patients who had underwent laparoscopic adrenalectomy with mean of age was 41.3 ± 10.1 years and mean BMI was 23.6 ± 2.5. The tumor were 50% on the right side and 50% on the left side. The mean size of the tumor was 4.4 ± 2.6, 71.4% in ≤ 6 cm group and 28.6% in ≥ 6 cm group. Most of the patients (42.9%) were clinically diagnosed with Conn syndrome, with histopathological result mostly showing adrenal cortical adenoma (78.6%). There were no significant mean differences of intraoperative bleeding on different sides and sizes of tumor, and no differences in operation time on different sides of tumor. There were lower operating time in tumor size <6 cm group (172 ± 45.1 minutes) compared to size ≥ 6 cm group (222.5 ± 23.9 minutes) with p < 0.05. Laparoscopic adrenalectomy is a minimally invasive technique that can be performed safely and efficiently with significant advantages compare to open approach.

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Pendahuluan dan tujuan: Renal cell carcinoma (RCC) adalah tumor paling umum kedua pada sistem urologi. Sampai saat ini, satu-satunya pendekatan kuratif bagi mereka yang memiliki RCC lokal adalah operasi radikal; namun, kejadian rekurensi setelah nefrektomi memadai telah dilaporkan terjadi sebanyak 20 hingga 40% dari pasien dengan RCC lokal. Penelitian ini bertujuan untuk menyelidiki karakteristik dan kesintasan hidup pasien dengan RCC yang menjalani nefrektomi. Metode: Kami menggunakan desain studi retrospektif dengan mengevaluasi rekam medis pasien yang didiagnosis dengan RCC yang menjalani tindakan bedah di Rumah Sakit Cipto Mangunkusumo, Rumah Sakit Kanker Dharmais, Rumah Sakit Medistra, dan Rumah Sakit Metropolitan Medical Centre, Jakarta, Indonesia selama periode Januari 1994 hingga Desember 2016. Hasil: Usia rata-rata pasien saat operasi dilakukan adalah 52,92 ± 14,85, dan 114 (71,7%) subyeknya adalah laki-laki. Lima puluh dua (32,7%) subyek dengan pT2 RCC, dan tiga puluh lima (22%) subyek dengan patologis stadium 2. Seratus empat puluh tujuh (92,4%) subyek memiliki clear cell RCC. Kesintasan hidup rata-rata adalah 8,37 (0,1-143) bulan. Kesimpulan: Angka median kesintasan pasien karsinoma sel ginjal (RRC) yang menjalani nefrektomi adalah 8,37 bulan, yang menunjukkan bahwa perawatan lebih lanjut diperlukan untuk meningkatkan tingkat kelangsungan hidup populasi ini. Namun, penelitian ini dibatasi oleh sifat studi retrospektif dan jumlah subjek yang terbatas. Studi acak, terkontrol, multicenter, yang lebih besar diperlukan untuk mengevaluasi angka kesintasan pasien RCC. ......Introduction and objectives: Renal cell carcinoma (RCC) is the second most common urologic tumour. To this date, the only curative approach for those with localised RCC is radical surgery; yet, the development of disease recurrence after adequately performed nephrectomy has been reported in 20 to 40% of those with localised RCC. The present study aims to investigate the characteristics and survival of those with RCC undergoing nephrectomy. Methods: We used retrospective study design by evaluating the medical records of patients diagnosed with RCC who were treated surgically at Cipto Mangunkusumo Hospital, Dharmais Cancer Hospital, Medistra Hospital, and Metropolitan Medical Centre Hospitals, Jakarta, Indonesia during the period from January 1994 to December 2016. Results: The mean age at surgery of the subjects was 52.92 ± 14.85, and 114 (71.7%) subjects were male. Fifty-two (32.7%) subjects had pT2 RCC, and thirty-five (22%) of the subjects had pathologic stage of 2. One hundred and forty-seven (92.4%) subjects had clear cell RCC. The median survival was 8.37 (0.1-143) months. Conclusion: The median survival of those with renal cell carcinomas (RCCs) who underwent nephrectomy was 8.37 months, which demonstrate that further treatment is required to increase the survival rate of these population. However, this study was limited by its retrospective nature and limited subjects. Larger multicenter controlled randomised studies are required to evaluate the survival of those with RCC.

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Tujuan: Melaporkan pengalaman TUR-P menggunakan NaCl 0,9% sebagai irigasi (sistem bipolar) dan efeknya terhadap kadar hemoglobin, hematokrit dan natrium. Bahan dan Cara: Studi ini adalah studi prospektif non randomisasi. Enam puluh pasien PPJ memenuhi kriteria penelitian (30 sistem bipolar, 30 sistem monopolar), dinilai lama operasi, jumlah cairan irigasi, berat chip prostat, penurunan kadar hemoglobin, hematokrit, natrium dan ada tidaknya TUR sindrom. Hasil : Terdapat perbedaan yang bermakna antara volume prostat pada kedua grup. Pada sistem bipolar rerata lama operasi adalah 39,66+12,02 menit dan 54,33+19,01 menit pada sistem monopolar, rerata berat chip yang direseksi 14,09+11,25 gram pada sistem bipolar dan 24,26+18,15 gram pada sistem monopolar. Rerata penurunan hemoglobin 0,7601 pada sistem bipolar dan 1,09g/dl pada sistem monopolar, rerata penurunan natrium 2,3mEg11 pada sistem bipolar dan 1,7meg11 pada sistem ronopolar. Tidak terdapat korelasi yang bermakna antara lama operasi dengan penurunan hemoglobin dan natrium pada kelompok sistem bipolar sedangkan pada sistem monopolar terdapat korelasi yang bermakna antara lama operasi dengan penurunan hemoglobin(p:0,04), dan penurunan natrium(p:0,008). Tidak dijumpai adanya TUR sindrom pada kedua kelompok. Simpulan: Dari pengalaman awal ini, disimpulkan bahwa TUR-P dengan sistem bipolar merupakan prosedur yang aman dan tidak memerlukan keahiian tambahan. Penelitian lanjutan dengan studi prospektif randomisasi untuk membandingkan sistem ini dengan sistem monopolar sangat dianjurkan.

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Objectives: To report our experience in TUR-P using normal saline as irrigation (bipolar system) and its effect towards patient's hemoglobin, hematocryte and sodium content. Materials and methods: This study was performed in a prospective non-randomized fashion. Sixty BPH patients were included (30 patients were done with bipolar system, 30 patients with monopolar system). The parameters recorded were operation time, amount of irrigation, resected tissue weight, hemoglobin, hematocryte and sodium decline and presence of TUR syndrome. Results : There was a significant difference in prostate volume between the two groups. Mean operation time was 39,66+12,02 mnt in the bipolar group and 54,33+19,01 mnt in the monopolar group, resected tissue weight was 14,09+11,25 grams in the bipolar group and 24,26+18,15 grams in the monopolar group. Hemoglobin decline was 0,7601 in the bipolar group and 1,09 in the monopolar group, sodium decline was 2,3mEg11 in the bipolar group and 1,7meg11 in the monopolar group. There was no significant correlation between operation time with hemoglobin and sodium decline in the bipolar group whilst in the monopolar group there was significant correlation between operation time with hemoglobin decline (p:0,04), and sodium decline (p:0,008). There was no TUR syndrome seen in either groups. Conclusions: TUR-P with bipolar system is a new technology which is safe and requires no additional skills. Further investigation using randomized controlled trial to compare this technology with monopolar system is recommended.

Abstrak :
Tujuan: Untuk mengetahui bagaimana upaya diagnosis kanker prostat yang dilakukan oleh spesialis urologidi Indonesia. Metode: Dilakukan pembagian kuesioner yang dirancang sendiri kepada Spesialis Urologi di Indonesia. Kuesioner berisi 11 pertanyaan tentang jenis dan indikasi pemeriksaan yang dilakukan, serta fasilitas yang tersedia di tempat responden dalam penegakan diagnosis kanker prostat. Hasil: Sebanyak 65 (36%) dari 182 (saat penelitian ini dilakukan) spesialis urologi di Indonesia mengembalikan formulir kuesioner. Dari jenis RS primer tempat bekerja terbanyak berasal dari RS swasta (35%), disusul RS pendidikan utama Fakultas Kedokteran (32%). Seluruh responden menjadikan lower urinary tract symptoms (LUTS) sebagai indikasi untuk melakukan pemeriksaan colok dubur. Selain itu 83% responden juga menjawab, peningkatan PSA sebagai salah satu indikasi pemeriksaan colok dubur. Pemeriksaan PSA dilakukan oleh 72% responden pada penderita dengan kecurigaan kanker prostat tanpa melihat usia. Sebanyak 66% responden mengerjakan sendiri pemeriksaan transrectal ultrasonografi (TRUS) dan biopsi, 18% merujuk pada sejawat lain di propinsi yang sama dan 15% tidak memiliki fasilitas TRUS dan biopsi di propinsi tempat bekerja. Sebanyak 75% responden memiliki fasilitas bone scan di Rumah Sakit primer, atau tersedia di RS pada propinsi yang sama. Indikasi tersering melakukan biopsi prostat adalah pada PSA lebih dari 10 ng/ml tanpa melihat usia. Sebanyak 86% responden melakukan biopsi pada kecurigaan kanker prostat melalui colok dubur tanpa melihat usia. Sembilan puluh persen responden menggunakan antibiotik profilaksis golongan Kuinolon untuk biopsi prostat. Sebanyak 46% menggunakan analgesia oral atau suppositoria atau kombinasi keduanya sebagai analgesia dalam biopsi prostat. Kesimpulan: Dalam mendiagnosis kanker prostat, spesialis urologi di Indonesia melakukan pemeriksaan colok dubur, PSA dan TRUS biopsi prostat, namun masih terdapat perbedaan pendapat tentang indikasi dan waktu dilakukannya masing-masing pemeriksaan. Ketersediaan fasilitas diagnostik juga berpengaruh dalam diagnostik kanker prostat di Indonesia. Belum tersedianya guideline Nasional pada saat penelitian ini dilakukandiduga menyebabkan perbedaan pendapat tersebut. ......Purpose: To get information on diagnosis of prostate cancer conducted by urologist in Indonesia. Method: A self-constructed questionnare of 11 questions about the type and indication of the tests, as well as the available facilities at the place of the respondents to diagnose prostate cancer distributed to Indonesian Urologist. Result: As much as 65 (36%) from 182 (when the survey was conducted) Indonesian Urologist returned the questionnare. Most of them worked in Private Hospital (35%), followed by Medical School Hospital (32%). All respondents performed DRE in patients with Lower Urinary Tract Symptoms (LUTS). Elevated PSA was also indication for conducting DRE in 83% respondents. PSA level was tested by 72% respondents in patients with suspicion of prostate cancer regardless of age. As much as 66% respondents did Trans Rectal Ultrasound (TRUS) and prostate biopsy by themselves, 18% referred to other urologists in the same province and 15% didn?t have TRUS and prostate biopsy facilities in their province. Bone scan was available in the Primary Hospital or another hospital in the province of 75% respondents. Main indication to perform prostate biopsy was elevated PSA level above 10ng/ml regardless of the age. Meanwhile, 86% respondents did prostate biopsy in suspiciousness of prostate cancer by DRE regardless of age. Most respondents (90%) chose Quinolon as prophylaxis antibiotic in prostate biopsy and 46% respondents used oral analgesia or suppository or both in prostate biopsy. Conclusions: In diagnosing prostate cancer, Indonesian Urologists performed DRE, PSA serum analysis and TRUS biopsy of the prostate. But the Indonesian Urologists still had different opinions about the indications and timing of the procedure. The availability of diagnostic equipment and unavailability of National Guideline of Prostate Cancer when this study was conducted played a role of how the prostate cancer diagnosed in Indonesia.

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Pendahuluan: Saat ini belum ada publikasi tentang hasil radioterapi eksterna (RT) pada kanker prostat lokal atau lokal-lanjut di Indonesia. Metode: Studi retrospektif ini meneliti 96 pasien dengan kanker prostat lokal atau lokal-lanjut yang mendapat terapi radiasi dari tahun 1995-2009, di Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo dan Rumah Sakit Kanker Dharmais, Indonesia. Jenis / dosis kumulatif radiasi prostat dan pelvis pada 84,4% pasien sebesar <70Gy dengan RT konvensional, dan pada 15,6% pasien diberikan dosis ≥70Gy dengan three dimensional-conformal RT atau intensity modulated RT. Sintasan Overall survival (OS) dan biochemical progression-free survival (BFS) diestimasi dengan Kaplan-Meier. Faktor-faktor prediksi dari OS dan biochemical recurrence dianalisis dengan Multivariate Cox regressions. Hasil: Median durasi follow-up adalah 61 bulan (rentang, 24-169 bulan). Diantara seluruh kasus kanker prostat, terdapat 3,1% risiko rendah, 26% risiko sedang, dan 70,8% risiko tinggi. Lebih dari separuh pasien (52,1%) memiliki nilai Prostatespecific antigen (PSA) sebelum terapi >20 ng/ml. Angka sintasan 5 tahun pada pasien-pasien dengan risiko rendah, sedang, dan tinggi, secara berurutan adalah: OS, 100%, 94,7%, 67,9% (P=0,297); dan BFS, 100%, 94,1%, 57,1% (P=0,016). Pada kelompok risiko tinggi, didapatkan OS 5 tahun 88,3% pada pasien yang mendapatkan terapi adjuvan hormonal androgen deprivation therapy (HT), dibandingkan dengan 53% pada pasien yang mendapat terapi radiasi saja, P =0,08. Faktor prediksi yang signifikan pada OS meliputi kelompok risiko tinggi (hazard ratio [HR], 9,35; confidence interval [CI] 95%, 1,52-57,6; P=0,016), terapi adjuvan (HR, 0,175; 95% CI, 0,05-0,58; P=0,005), deteksi dengan transurethral resection of the prostate (TUR-P) (HR, 6,81; 95% CI, 2,28-20,33; P=0,001), dan nilai PSA sebelum terapi (HR, 1,003; 95% CI, 1,00-1,005; P=0,039). Satu-satunya faktor prediksi biochemical failure adalah PSA sebelum terapi (P=0,04), dengan odds ratio 4,52 (95% CI, 1,61-12,65) untuk PSA > 20 ng/ml. Kesimpulan: RT merupakan modalitas yang efektif untuk terapi kanker prostat lokal atau lokal-lanjut di Indonesia, dengan hasil dan faktor prediksi yang konsisten dengan publikasi di tempat lain. Faktor prediksi dari hasil yang lebih buruk meliputi kelompok risiko tinggi, PSA sebelum terapi yang lebih tinggi, temuan insidental pada TUR-P, dan tidak diberikannya terapi adjuvan HT. Terapi adjuvan hormonal secara signifikan meningkatkan sintasan pada pasien dengan risiko tingggi. ......Introduction: Presently there is no published data on the outcomes of localized or locally-advanced prostate cancer (PCa) treated by external-beam radiotherapy (RT) in Indonesia. Methods: This study retrospectively analyzed 96 patients with localized or locally-advanced PCa treated by RT from year 1995 to 2009, at the national referral hospital and the national cancer hospital of Indonesia. Cumulative prostate and pelvic radiation dose/ type was <70 Gy conventional RT in 84.4% patients, and ≥70 Gy Three dimensional-conformal or intensity modulated RT in 15.6% patients. Overall survival (OS) and biochemical progression-free survival (BFS) were estimated by Kaplan-Meier. Predictors of OS and biochemical recurrence were analyzed by multivariate Cox regressions. Results: The median follow-up was 61 months (range, 24 to 169 months). There were 3.1% low-risk, 26% intermediate-risk, and 70.8% high-risk cases. More than half of the patients (52.1%) had pretreatment prostate specific antigen (PSA) >20 ng/mL. The 5-year survival outcome of low-risk, intermediate-risk, and high-risk patients were: OS, 100%, 94.7%, and 67.9% (P=0.297); and BFS, 100%, 94.1%, and 57.1% (P=0.016), respectively. In the high-risk group, the 5-year OS was 88.3% in patients who received adjuvant hormonal androgen deprivation therapy (HT), compared to 53% in RT only, P=0.08. Significant predictors of OS include high-risk group (hazard Ratio [HR], 9.35; 95% confidence interval [CI], 1.52 to 57.6; P=0.016), adjuvant therapy (HR, 0.175; 95% CI, 0.05 to 0.58; P=0.005), detection by transurethral resection of the prostate (TUR-P) (HR, 6.81; 95% CI, 2.28 to 20.33; P=0.001), and pretreatment PSA (HR, 1.003; 95% CI, 1.00 to 1.005; P=0.039). The sole predictor of biochemical failure was pretreatment PSA (P=0.04), with odds ratio of 4.52 (95% CI, 1.61 to 12.65) for PSA >20 ng/mL. Conclusions: RT is an effective treatment modality for localized or locally advanced PCa in Indonesian patients, with outcomes and predictors consistent to that reported elsewhere. Predictors of poorer outcomes include high-risk group, higher pretreatment PSA, incidental detection by TUR-P, and lack of adjuvant HT. Adjuvant hormonal therapy significantly improve the survival of high risk patients.

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[ABSTRAK
Tujuan: Insiden kanker prostat secara global terus meningkat. Meskipun dapat dilakukan deteksi dini kanker prostat, perlu dipahami bahwa progresivitas penyakit ? menjadi metastasis ? berbeda untuk setiap pasien. Penelitian ini bertujuan untuk mengamati aspek-aspek yang mungkin berperan sebagai faktor prediktif metastasis pada kanker prostat tidak terpalpasi. Material dan Metode: Data dikumpulkan dari Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo dan Rumah Sakit Pusat Kanker Nasional Dharmais sejak tahun 1995-2013. Pasien dengan kanker prostat tidak terpalpasi kemudian dibagi menjadi dua kelompok: dengan metastasis dan tanpa metastasis. Usia, volume prostat, nilai prostate-spesific antigen (PSA), Gleason score sum group, stadium tumor, Karnofsky performance score (KPS), kadar hemoglobin, dan kadar kreatinin serum merupakan faktor yang dianalisis dalam penelitian ini. Data dianalisis menggunakan analisis bivariat dan uji regresi logistik. Hanya pasien dengan data lengkap yang dimasukkan dalam penelitian ini. Hasil: Didapatkan 91 pasien dengan data lengkap, 59 pasien (64,83%) tanpa metastasis dan 32 pasien (35,16%) dengan metastasis. Terdapat perbedaan statistik yang signifikan antara kelompok tanpa metastasis dan kelompok dengan metastasis, yakni untuk PSA (13.7ng / mL vs 71.5ng / mL; p = 0,001), kadar hemoglobin (13,60 g / dL vs 12,25 g / dL; p = 0,002), dan KPS (90 vs 90 ; p = 0,004). Perbedaan yang signifikan secara statistik juga didapatkan pada kelompok GSS (35 dan 24 pada kelompok tanpa metastasis vs 12 dan 20 pada kelompok dengan metastasis; p = 0,047). Usia, volume prostat, stadium tumor, dan kadar kreatinin antara kedua kelompok tidak memiliki perbedaan signifikan secara statistik (p> 0,05). Nilai pretreatment PSA adalah satu-satunya faktor prediktif untuk metastasis dengan odds ratio 1.014 (95% CI, 1,005-1,022; p = 0,002). Kesimpulan: Sebagian besar pasien kanker prostat tidak terpalpasi terdeteksi pertama kali tanpa metastasis. Nilai pretreatment PSA yang diperoleh pada kunjungan awal pasien dapat digunakan sebagai faktor prediktif metastasis di masa depan.

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ABSTRACT
Objective: Prostate cancer incident is globally increasing. Despite early detection of prostate cancer, the progressivity of the disease itself toward metastatic disease remains different for each patient. The purpose of this study is to observe aspects that may have roles as predictive factors for metastasis in nonpalpable prostate cancer. Materials and Methods: Data was collected from National Hospital Cipto Mangunkusumo and Dharmais National Cancer Center Hospital from 1995-2013. Patients with nonpalpable prostate cancer then divided into two groups: metastasis-free group and metastasis group. Age, prostate volume, pretreatment Prostate-specific antigen (PSA) value, Gleason score sum group, tumor stadium, Karnofsky performance score (KPS), hemoglobin level, and serum creatinine level were factors that were analyzed in the study. The data was analyzed using bivariate analysis and logistic regression test. Only patients with complete data are included in the study. Results: There are 91 patients with complete data, 59 patients (64.83%) were patients without metastasis and 32 patients (35.16%) were with metastasis. There was significant statistical difference between no metastasis group with metastasis group for PSA (13.7ng/mL vs71.5ng/mL; p = 0.001), hemoglobin level (13.60 g/dL vs 12.25 g/dL; p = 0.002), and KPS (90vs90; p = 0.004). There was also significant statistical difference in GSS groups (35 and 24 in metastasis-free group vs 12 and 20 in metastasis group; p = 0.047). Age, prostate volume, tumor stadium, and creatinine level had no statistical difference between the two groups (p > 0.05). Pretreatment PSA value was the only predictive factor for metastasis with odds ratio 1.014 (95% CI, 1.005 to 1.022; p = 0.002). Conclusion: Most nonpalpable prostate cancer patients are first detected without metastasis. Pretreatment PSA value that was obtained at their initial visit might be used as predictive factor for metastasis for them in the future.;Objective: Prostate cancer incident is globally increasing. Despite early detection of prostate cancer, the progressivity of the disease itself toward metastatic disease remains different for each patient. The purpose of this study is to observe aspects that may have roles as predictive factors for metastasis in nonpalpable prostate cancer. Materials and Methods: Data was collected from National Hospital Cipto Mangunkusumo and Dharmais National Cancer Center Hospital from 1995-2013. Patients with nonpalpable prostate cancer then divided into two groups: metastasis-free group and metastasis group. Age, prostate volume, pretreatment Prostate-specific antigen (PSA) value, Gleason score sum group, tumor stadium, Karnofsky performance score (KPS), hemoglobin level, and serum creatinine level were factors that were analyzed in the study. The data was analyzed using bivariate analysis and logistic regression test. Only patients with complete data are included in the study. Results: There are 91 patients with complete data, 59 patients (64.83%) were patients without metastasis and 32 patients (35.16%) were with metastasis. There was significant statistical difference between no metastasis group with metastasis group for PSA (13.7ng/mL vs71.5ng/mL; p = 0.001), hemoglobin level (13.60 g/dL vs 12.25 g/dL; p = 0.002), and KPS (90vs90; p = 0.004). There was also significant statistical difference in GSS groups (35 and 24 in metastasis-free group vs 12 and 20 in metastasis group; p = 0.047). Age, prostate volume, tumor stadium, and creatinine level had no statistical difference between the two groups (p > 0.05). Pretreatment PSA value was the only predictive factor for metastasis with odds ratio 1.014 (95% CI, 1.005 to 1.022; p = 0.002). Conclusion: Most nonpalpable prostate cancer patients are first detected without metastasis. Pretreatment PSA value that was obtained at their initial visit might be used as predictive factor for metastasis for them in the future.;Objective: Prostate cancer incident is globally increasing. Despite early detection of prostate cancer, the progressivity of the disease itself toward metastatic disease remains different for each patient. The purpose of this study is to observe aspects that may have roles as predictive factors for metastasis in nonpalpable prostate cancer. Materials and Methods: Data was collected from National Hospital Cipto Mangunkusumo and Dharmais National Cancer Center Hospital from 1995-2013. Patients with nonpalpable prostate cancer then divided into two groups: metastasis-free group and metastasis group. Age, prostate volume, pretreatment Prostate-specific antigen (PSA) value, Gleason score sum group, tumor stadium, Karnofsky performance score (KPS), hemoglobin level, and serum creatinine level were factors that were analyzed in the study. The data was analyzed using bivariate analysis and logistic regression test. Only patients with complete data are included in the study. Results: There are 91 patients with complete data, 59 patients (64.83%) were patients without metastasis and 32 patients (35.16%) were with metastasis. There was significant statistical difference between no metastasis group with metastasis group for PSA (13.7ng/mL vs71.5ng/mL; p = 0.001), hemoglobin level (13.60 g/dL vs 12.25 g/dL; p = 0.002), and KPS (90vs90; p = 0.004). There was also significant statistical difference in GSS groups (35 and 24 in metastasis-free group vs 12 and 20 in metastasis group; p = 0.047). Age, prostate volume, tumor stadium, and creatinine level had no statistical difference between the two groups (p > 0.05). Pretreatment PSA value was the only predictive factor for metastasis with odds ratio 1.014 (95% CI, 1.005 to 1.022; p = 0.002). Conclusion: Most nonpalpable prostate cancer patients are first detected without metastasis. Pretreatment PSA value that was obtained at their initial visit might be used as predictive factor for metastasis for them in the future.;Objective: Prostate cancer incident is globally increasing. Despite early detection of prostate cancer, the progressivity of the disease itself toward metastatic disease remains different for each patient. The purpose of this study is to observe aspects that may have roles as predictive factors for metastasis in nonpalpable prostate cancer. Materials and Methods: Data was collected from National Hospital Cipto Mangunkusumo and Dharmais National Cancer Center Hospital from 1995-2013. Patients with nonpalpable prostate cancer then divided into two groups: metastasis-free group and metastasis group. Age, prostate volume, pretreatment Prostate-specific antigen (PSA) value, Gleason score sum group, tumor stadium, Karnofsky performance score (KPS), hemoglobin level, and serum creatinine level were factors that were analyzed in the study. The data was analyzed using bivariate analysis and logistic regression test. Only patients with complete data are included in the study. Results: There are 91 patients with complete data, 59 patients (64.83%) were patients without metastasis and 32 patients (35.16%) were with metastasis. There was significant statistical difference between no metastasis group with metastasis group for PSA (13.7ng/mL vs71.5ng/mL; p = 0.001), hemoglobin level (13.60 g/dL vs 12.25 g/dL; p = 0.002), and KPS (90vs90; p = 0.004). There was also significant statistical difference in GSS groups (35 and 24 in metastasis-free group vs 12 and 20 in metastasis group; p = 0.047). Age, prostate volume, tumor stadium, and creatinine level had no statistical difference between the two groups (p > 0.05). Pretreatment PSA value was the only predictive factor for metastasis with odds ratio 1.014 (95% CI, 1.005 to 1.022; p = 0.002). Conclusion: Most nonpalpable prostate cancer patients are first detected without metastasis. Pretreatment PSA value that was obtained at their initial visit might be used as predictive factor for metastasis for them in the future.;Objective: Prostate cancer incident is globally increasing. Despite early detection of prostate cancer, the progressivity of the disease itself toward metastatic disease remains different for each patient. The purpose of this study is to observe aspects that may have roles as predictive factors for metastasis in nonpalpable prostate cancer. Materials and Methods: Data was collected from National Hospital Cipto Mangunkusumo and Dharmais National Cancer Center Hospital from 1995-2013. Patients with nonpalpable prostate cancer then divided into two groups: metastasis-free group and metastasis group. Age, prostate volume, pretreatment Prostate-specific antigen (PSA) value, Gleason score sum group, tumor stadium, Karnofsky performance score (KPS), hemoglobin level, and serum creatinine level were factors that were analyzed in the study. The data was analyzed using bivariate analysis and logistic regression test. Only patients with complete data are included in the study. Results: There are 91 patients with complete data, 59 patients (64.83%) were patients without metastasis and 32 patients (35.16%) were with metastasis. There was significant statistical difference between no metastasis group with metastasis group for PSA (13.7ng/mL vs71.5ng/mL; p = 0.001), hemoglobin level (13.60 g/dL vs 12.25 g/dL; p = 0.002), and KPS (90vs90; p = 0.004). There was also significant statistical difference in GSS groups (35 and 24 in metastasis-free group vs 12 and 20 in metastasis group; p = 0.047). Age, prostate volume, tumor stadium, and creatinine level had no statistical difference between the two groups (p > 0.05). Pretreatment PSA value was the only predictive factor for metastasis with odds ratio 1.014 (95% CI, 1.005 to 1.022; p = 0.002). Conclusion: Most nonpalpable prostate cancer patients are first detected without metastasis. Pretreatment PSA value that was obtained at their initial visit might be used as predictive factor for metastasis for them in the future., Objective: Prostate cancer incident is globally increasing. Despite early detection of prostate cancer, the progressivity of the disease itself toward metastatic disease remains different for each patient. The purpose of this study is to observe aspects that may have roles as predictive factors for metastasis in nonpalpable prostate cancer. Materials and Methods: Data was collected from National Hospital Cipto Mangunkusumo and Dharmais National Cancer Center Hospital from 1995-2013. Patients with nonpalpable prostate cancer then divided into two groups: metastasis-free group and metastasis group. Age, prostate volume, pretreatment Prostate-specific antigen (PSA) value, Gleason score sum group, tumor stadium, Karnofsky performance score (KPS), hemoglobin level, and serum creatinine level were factors that were analyzed in the study. The data was analyzed using bivariate analysis and logistic regression test. Only patients with complete data are included in the study. Results: There are 91 patients with complete data, 59 patients (64.83%) were patients without metastasis and 32 patients (35.16%) were with metastasis. There was significant statistical difference between no metastasis group with metastasis group for PSA (13.7ng/mL vs71.5ng/mL; p = 0.001), hemoglobin level (13.60 g/dL vs 12.25 g/dL; p = 0.002), and KPS (90vs90; p = 0.004). There was also significant statistical difference in GSS groups (35 and 24 in metastasis-free group vs 12 and 20 in metastasis group; p = 0.047). Age, prostate volume, tumor stadium, and creatinine level had no statistical difference between the two groups (p > 0.05). Pretreatment PSA value was the only predictive factor for metastasis with odds ratio 1.014 (95% CI, 1.005 to 1.022; p = 0.002). Conclusion: Most nonpalpable prostate cancer patients are first detected without metastasis. Pretreatment PSA value that was obtained at their initial visit might be used as predictive factor for metastasis for them in the future.]

Abstrak :
[Tujuan: Mengidentifikasi korelasi dan insiden metastasis tulang pada pasien kanker prostat dengan Gleason Score (GS) dan Prostate Specific Antigen (PSA) yang rendah. Material dan Metode: Studi deskriptif retrospektif pada pasien kanker prostat di Rumah Sakit Cipto Mangunkusumo periode 2006-2011. Ada 478 pasien dengan kanker prostat. Pasien kanker prostat dengan PSA rendah, telah menjalani pemeriksaan histopatologi, dan bone scan diikutsertakan dalam studi, sehingga didapatkan 358 pasien sebagai subjek penelitian. Nilai PSA diukur dengan sandwich electrochemiluminescent immunoassay. Pemeriksaan histopatologi diklasifikasikan menurut sistem grading Gleason dan dibagi menjadi 3 kategori: diferensiasi baik (GS ≤6), diferensiasi sedang (GS 7), dan diferensiasi buruk (GS 8-10). Bone scan dikerjakan dengan dengan agen radiofarmaka (Tc99m methylenendiphosphonate) dan kemudian gambar ditangkap dengan kamera gamma. Hasil: Rerata usia 67.52±7.8 tahun, rerata GS 7.7±1.3, dan median PSA adalah 56.9 (rentang: 0,48-17000 ng/mL). Ada 11 orang pasien (3,0%) dengan bone scan positif dengan PSA <20 ng/mL dan GS<8. Lebih lanjut, ada 2 pasien (0,6%) dengan GS≤6 dan PSA<10 ng/mL memperlihatkan metastasis ke tulang. Kesimpulan: Pada studi ini, ada sebagian kecil pasien mengalami metastasis tulang dengan PSA (PSA<10 mg/mL) dan GS (GS≤6) rendah., Objective This study was aimed to identify correlation and incidence of bone metastases in prostate cancer patient with low Gleason Score GS and Prostate Specific Antigen PSA Materials and Methods A descriptive restrospective study to patients with prostate cancer in Cipto Mangunkusumo Hospital in 2006 2011 There were 478 patient with prostate cancer Patients with prostate cancer who had PSA value histological examination and bone scan were included in the study resulting in 358 eligible patients for the study PSA value was measured using the sandwich electrochemiluminescent immunoassay Histological examination was graded according to Gleason rsquo s grading system and divided into 3 category well differentiated GS le 6 moderately differentiated GS 7 and poorly differentiated GS 8 10 Bone scan was done using radiopharmaceuticals agent Tc 99m methylenen diphosphonate and then the image was captured using gamma camera Results The mean age was 67 52 7 8 mean GS was 7 7 1 3 and median PSA was 56 9 range 0 48 17000 ng mL There were 11 patients 3 0 with positive bone scan with PSA]

Abstrak :
[Pendahuluan: Sejak tahun 70-an hingga sekarang, skor Gleason merupakan parameter penting pada penatalaksanaan kanker prostat. Biopsi prostat yang umum dipakai untuk membedakan antara kondisi jinak dan ganas semakin menjadikan skor Gleason berperan penting dalam menentukan tatalaksana selanjutnya. Meskipun demikian, terdapat diskrepansi antara skor Gleason yang diambil secara biopsi dan paskaoperasi. Tujuan: Untuk menentukan perbedaan skor Gleason sebelum dan setelah dilakukan prostatektomi radikal, dan untuk mencari faktor-faktor yang berperan dalam peningkatan skor Gleason. Metode: Dilakukan evaluasi laporan patologi dari spesimen prostat yang didapatkan secara biopsi dan paska prostatektomi radikal antara Januari 2004 sampai Desember 2013. Kriteria eksklusi dari studi ini adalah laporan-laporan yang tidak mencantumkan skor Gleason ataupun diagnosis selain adenokarsinoma prostat. Hasil: Studi ini menginklusikan 36 subjek dengan adenokarsinoma prostat yang telah menjalani prostatektomi radikal. Skor Gleason 6 merupakan skor tersering yang dilaporkan pada biopsi, sedangkan skor Gleason 7 merupakan skor tersering yang dilaporkan pada spesimen prostatektomi radikal. Diantara subjek, 58,3% (n=21) memiliki perbedaan antara skor Gleason biopsi dan prostatektomi radikal; 11,1% (n=4) memiliki penurunan dan 47,2% (n=17) mengalami peningkatan. Dengan menggunakan analisis statistik dijumpai bahwa rendahnya densitas PSA (PSAD) memiliki korelasi dengan likelihood peningkatan (r=0,658, p=0,006). Kesimpulan: Sebagian besar pasien memiliki perbedaan antara skor Gleason hasil biopsi dan paskaoperasi dimana terlihat kecenderungan peningkatan dibandingkan dengan penurunan skor. PSAD merupakan faktor yang berkorelasi dengan peningkatan skor Gleason., Introduction: Since its introduction in mid 70 until now, Gleason Score is an important parameter in the treatment of prostate cancer. The common practice of prostate biopsy to differentiate between malignant and benign condition of the prostate, hence makes Gleason score plays important role in determine the next step of treatment. Still there is a discrepancy between Gleason score taken from biopsy and postoperatively. Aim: To determine the Gleason score difference before and after radical prostatectomy, and to find factors that has a role in the upgrading of Gleason score. Methods: We evaluated pathology reports of prostate specimens obtained from biopsy and after radical prostatectomy between January 2004 until December 2013. Exclusion criteria of this study were reports that failed to mentioned Gleason score or a diagnosis apart from adenocarcinoma of the prostate. Results: This study enrolled 36 subjects with adenocarcinoma of the prostate who underwent radical prostatectomy. Gleason score 6 was the most reported score in initial biopsy while Gleason score 7 was the most reported in radical prostatectomy specimen. Among the subjects 58.3% (n=21) had diferrences of Gleason score between biopsy and radical proistatectomy; 11.1% (n=4) had a downgrading and 47.2% (n=17) had an upgrading. Using statistical analysis we found out that low prostate specific antigen densities (PSAD) had correlation with upgrading likelihood (r 0.658, p = 0.006) Conclusion: More than half of our patient had differences between biopsy Gleason score and postoperative scores with majority showed a likelihood of upgrading rather than downgrading, PSAD was the factors that correlates with upgrading in Gleason score.]

Abstrak :
Angka prevalensi hiperurisemia yang sudah menunjukkan manifestasi sebagai penyakit sendi atau gout tercatat sebesar 1.36%. Kondisi hiperurisemia diketahui merupakan faktor risiko yang berperan dalam penurunan fungsi ginjal dan memiliki hubungan erat dengan batu ginjal. Tujuan: Mengetahui adanya hubungan antara kondisi hiperurisemia pada pasien dengan batu ginjal terhadap fungsi ginjal. Metode: Studi potong lintang dilakukan pada 942 pasien batu ginjal di RSUPN Cipto Mangunkusumo pada tahun 2000-2013. Hasil: Dari 5464 pasien batu di RSUPN Cipto Mangunkusumo sepanjang tahun 2000-2013, didapatkan 942 subjek yang memenuhi kriteria inklusi dan eksklusi yang telah ditetapkan. Hasil analisis menunjukkan hubungan yang bermakna antara hiperurisemia dengan fungsi ginjal pada pasien dengan batu ginjal (p < 0.001). Didapatkan pula bahwa predominansi pasien dengan batu ginjal adalah laki-laki (68.5%), serta rerata usia pasien batu ginjal adalah 47 tahun (SD = 12.4). Subjek dengan hiperurisemia yang mengalami penurunan fungsi ginjal tercatat sebanyak 11.3%. Kesimpulan: Terdapat hubungan yang bermakna antara kondisi hiperurisemia dengan fungsi ginjal pada pasien dengan batu ginjal. Oleh karena itu, pengendalian kadar asam urat dalam darah harus menjadi perhatian khusus untuk menghindari terjadinya perburukan fungsi ginjal.

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The recorded prevalence of hyperuricemia demonstrated as a manifestation of joint disease or gout is 1.36%. Hyperuricemia is known as a risk factor which plays an important role in the declining of renal function and has a close relationship with kidney stones. Aim: To find out the relationship between the hyperuricemia in patients with kidney stones and renal function. Method: A cross-sectional study conducted on 942 kidney stone patients in the Cipto Mangunkusumo Hospital through 2000-2013. Result: Out of 5464 kidney stone patients in Cipto Mangunkusumo Hospital during the years 2000-2013, we obtained 942 subjects who meet the appointed inclusion and exclusion criterias. The analysis revealed a significant association between hyperuricemia and renal function in patients with kidney stones (p <0.001). It was also found that the predominance of patients with kidney stones are men (68.5%), and the mean age of the patients with kidney stones was 47 years (SD = 12.4). Prevalence of hyperuricemic subjects whom renal function declines, is recorded as 11.3%. Conclusion: There is a significant association between hyperuricemia and renal function in patients with kidney stones. Therefore, the control of serum uric acid levels should be a particular concern to avoid the deterioration of renal function.