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"ABSTRAK Pendahuluan : Pemasangan double-J stent DJ stent sering dilakukan sebagai pertimbangan pertama untuk dekompresi obsruksi ureter akibat kanker serviks. Namun pemasangan DJ stent pada pasien ini tidak selalu berhasil. Penelitian ini bertujuan untuk mengetahui faktor pra operasi pada pasien kanker serviks yang dapat memengaruhi kegagalan pemasangan DJ stent.Metode : Penelitian ini merupakan studi analitik prospektif terhadap pasien kanker serviks yang direncanakan pemasangan DJ stent ureter di RSUP H. Adam Malik Medan sejak tanggal 1 Januari 2015 hingga 31 Juli 2016. Usia,derajat hidronefrosis, stadium tumor, riwayat radioterapi, fungsi ginjal preoperasi merupakan variabel yang dinilai sebagai faktor prediksi. Faktor-faktor tersebut akan dianalisis secara bivariat untuk kemudian diikutkan dalam regresi logistik sebagai analisis multivariat.Hasil : Studi ini melibatkan 40 pasien kanker serviks dengan rata-rata usia 48,5 tahun dan 72,5 pasien merupakan stadium IIIB. Pemasangan DJ stent tidak berhasil dilakukan pada 31 orang 77.5 dengan muara ureter yang tidak terlihat sebagai penyebab terbanyak kegagalan pemasangan DJ stent 54.9 . Pada analisis bivariat, ditemukan bahwa stadium kanker serviks, sisi hidronefrosis, serta kadar ureum dan kreatinin serum berpengaruh terhadap kebehasilan pemasangan DJ stent p

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ABSTRACT Introduction Insertion of double J stent DJ stent has often used as first choice of method in decompressing obstructed ureters in cervical cancer patients, but it was not always successful. This study was conducted to analyze preoperative factors affecting failures in insertion of DJ Stent.Methods This is an analytical study with prospective design. All cervical cancer patients that was planned on insertion of DJ stent in RSUP H. Adam Malik Medan from January 1st 2015 until July 31st 2016 were included. Age, hydronephrosis degree, tumor staging, history of radiotherapy, and renal function status were included in bivariate analysis. Those with significant results were then included in multivariate analysis of logistic regression.Results Samples were 40 cervical cancer patients with mean age of 48.5 years old which were 72.5 in stage IIIB. Insertion of DJ stent was failed in 31 patients 77.5 with unidentified ureteral openings as the main cause of failure. From bivariate analysis, stage, hydronephrosis side, and renal function test ureum and creatinine were statistically significant factors. Those were then included in multivariate analysis and serum creatinine was the only significant factor. It was then included in ROC analysis and a cut off point of 3.38 mg dL was retracted as the most sensitive and specific 84 and 88 respectively in predicting insertion of DJ stent failure.Conclusions Serum creatinine was the only predictive factor of DJ stent insersion failure. This result can be used as clinical consideration in planning an insertion of DJ stent in cervical cancer patients. "

"ABSTRAKKomposisi batu saluran kemih dapat mempengaruhi pilihan dalam perawatan pasien. Nilai Hounsfield Unit (HU) dapat memprediksi komposisi batu, begitu juga dengan pH urin. Kami mengevaluasi kombinasi nilai HU dan pH urin dalam prediksi komposisi batu saluran kemih. Studi potong lintang terhadap 35 pasien urolitiasis dilakukan dari Januari hingga Desember 2018 di Rumah Sakit Haji Adam Malik, Medan. Data nilai HU, pH urin, dan hasil analisis batu dikumpulkan. Hasil analisis batu dikategorikan menjadi batu dengan komposisi utama asam urat dan kalsium. Analisis HU dan pH antara kedua kelompok tersebut menggunakan uji-t tidak berpasangan. Receiver Operating Characteristic (ROC) digunakan untuk menganalisis hubungan antara HU dan pH dengan komposisi batu. Dari 35 pasien, 14 memiliki batu dengan komposisi utama asam urat dan 21 batu dengan komposisi utama kalsium. Rata-rata HU dari batu dengan komposisi utama asam urat dan kalsium adalah masing-masing 445 (± 155,3) dan 943 (± 284,0), sedangkan pH rata-ratanya masing-masing adalah 5,3 (± 0,46) dan 6,5 (± 0,64). Ada perbedaan signifikan antara nilai HU dan pH dari kedua kelompok (p <0,0001 dan p <0,0001). Hasil penelitian ini menunjukkan bahwa nilai HU dan pH urin dapat digunakan sebagai prediktor pembeda batu asam urat dari batu kalsium pada analisis batu.

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ABSTRACTUrinary stone composition may affect the treatment of choice for patients. Hounsfield Unit (HU) and urinary pH may help predict the composition of urinary stones. We evaluated HU and urinary pH combination in the prediction of urinary stone composition. A cross-sectional study on 35 urolithiasis patients were performed from January to December 2018 in Haji Adam Malik Hospital, Medan. Data on HU, urinary pH, and stone analysis results were collected. Stone analysis results were categorized into predominantly uric acid and calcium. We analyzed HU and pH between the two groups using independent T-test. Receiver operating characteristic (ROC) were used to analyze the relationship between HU and pH and the stone composition. Among 35 patients, 14 stones were predominantly uric acid and 21 stones were predominantly calcium. The mean HU of the predominantly uric acid and calcium were 445 (±155.3) and 943 (±284.0) respectively, while the mean pH was 5.3 (± 0.46) and 6.5 (± 0.64). There is a statisticallysignificant difference of HU and pH between the two groups (p<0.0001 and p<0.0001). Our study results showed that HU and urinary pH can be used as predictors to differentiate uric acid stones from calcium stones in stone analysis."

"ABSTRAKPenelitian prospektif ini bertujuan untuk membandingkan keluaran PCNL dengan posisi prone dibandingkan dengan posisi supine. Sebanyak 57 pasien yang menjalani PCNL dari 1 Januari 2017 hingga 31 Desember 2017 diikutkan dalam penelitian. Kriteria inklusi meliputi pasien dengan batu ginjal > 20 mm dari foto KUB (Kidney-Ureter-Bladder) atau abdominal NCCT (Non Contrast Computed Tomography) yang bersedia operasi PCNL. Kriteria ekslusi berupa pasien berusia < 17 tahun, pasien menolak operasi, pasien sudah pernah menjalani PCNL pada sisi yang sama, pasien dengan gangguan pembekuan darah, kehamilan, dan pasien batu ginjal dengan kelainan ginjal kongenital. Dilakukan randomisasi pasien untuk menjalani PCNL dengan posisi prone atau supine. Sebanyak 29 pasien menjalani PCNL posisi prone dan 28 pasien menjalani PCNL posisi supine. Data karakteristik pasien, lokasi pungsi, jumlah pungsi, penggunaan nefrostomi paska PCNL, lama operasi, ada atau tidaknya batu sisa berukuran ≥ 5 mm, komplikasi total, demam paska operasi, terjadinya sepsis, perdarahan yang memerlukan tranfusi, hematom retroperitoneal, efusi pleura, cidera usus, dan selisih hemoglobin sebelum dan setelah operasi dibandingkan antara kedua kelompok. Tidak didapatkan perbedaan yang bermakna pada jumlah, jenis kelamin, usia, BMI, ukuran batu, hidronefrosis, komorbid pasien pada kedua kelompok. PCNL dengan posisi prone memiliki angka bebas batu 82.8% sedangkan pada posisi supine 92.9%. Perbandingan yang bermakna didapatkan pada perbedaan rerata lama operasi dimana lama operasi PCNL dengan posisi prone 150 menit sedangkan untuk posisi supine 130 menit (p=0.003). Tidak didapatkan perbedaan yang signifikan antara keberhasilan pungsi, komplikasi total, demam paska operasi, sepsis, dan perdarahan yang membutuhkan transfusi. Tidak didapatkan pasien yang mengalami efusi pleura, cidera usus, atau kematian dalam penelitian ini. PCNL posisi supine memiliki efektifitas dan keamanan yang sama dengan PCNL dengan posisi prone. Angka bebas batu PCNL posisi supine lebih tinggi dibandingkan PCNL posisi prone. Lama operasi PCNL posisi supine secara signifikan lebih singkat dibandingkan PCNL posisi prone.

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ABSTRACTThis prospective study aimed to compare the outcomes of PCNL between prone and supine position. A total of 57 patients treated with PCNL in the time period of January 1st, 2017 until December 31st, 2017 were included in the study. Inclusion criteria includes patients with kidney stones greater than 20 mm in size measured with KUB, imaging (Kidney-Ureter-Bladder) or abdominal NCCT (Non Contrast Computed Tomography), who were willing to be treated with PCNL. The exclusion criteria were patients younger than 17 years old, patients who refused surgerical procedure, patients with history of PCNL on the same side, patients with bleeding disorders, pregnancy, and kidney stone in patients with congenital kidney disorders. Patients were randomized for prone or supine group of PCNL, in number of 29 and 28 patients respectively. Data on patient characteristics, puncture location, number of puncture, nephrostomy after PCNL, duration of surgery, presence or absence of residual stones measuring ≥ 5 mm in size, total complications, postoperative fever, sepsis, bleeding requiring transfusion, retroperitoneal hematoma, pleural effusion, intestinal injury, and the difference between hemoglobin count before and after surgery were compared between two groups. There were no significant differences observed in terms of number, sex, age, BMI, stone size, hydronephrosis, and comorbidities in patients of both groups. Stone free rate in PCNL with prone position and supine position were 82.8% and 92.9% respectively. Significant differences were observed in mean duration of surgery, with prone position duration time of 150 minutes and supine position duration time of 130 minutes (p = 0.003). There were no significant differences between successful puncture, total complications, postoperative fever, sepsis, and bleeding requiring transfusion. No patients with pleural effusion and intestinal injury were reported, and no death was reported in this study. PCNL with supine position showed similar effectivity and safety with PCNL prone position. Stone free rate was higher in PCNL with supine position and the duration was also significantly shorter in PCNL with supine position than prone position."

"Kanker prostat merupakan kanker yang terdiagnosis kedua terbanyak dan mendudukiperingkat keenam dari penyebab kematian pada pria di seluruh dunia. Diperkirakan914.000 kasus ditemukan dan berperan dalam 6% (258.400) dari total angka kematiandi tahun 2008. Telah diciptakan Indonesian Prostate Cancer Risk Calculator (IPCRC)yang diperoleh dari penelitian multisenter sebelumnya, namun masih perlu dilakukanvalidasi eksternal untuk menguji validitas dari kalkulator tersebut. Kami inklusikanseluruh pasien pembesaran prostat jinak (BPH) dan kanker prostat (PCa) yangmenjalani biopsi prostat ataupun prostatektomi di RS Adam Malik Medan pada periode11 Agustus sampai 31 Desember 2014. Dilakukan analisis untuk membandingkanvariabel-variabel yang terkait resiko kanker prostat, termasuk: usia, kadar PSA, volumprostat, dan temuan pemeriksaan colok dubur (DRE). Kemudian resiko kanker prostatpada masing-masing pasien dihitung menggunakan IPCRC dan dianalisis hasilnyamenggunakan kurva receiver operating characteristic (ROC). Kami jugamembandingkan hasilnya dengan luas area di bawah kurva (AUC) untuk PSA. Padastudi ini dijumpai 21 pasien PCa dan 24 pasien BPH. Rata-rata umur, PSA, dan volumprostat secara berturut-turut adalah 66.8±7.3 tahun, 27.3±32.2 ng/ml, dan 64.9±38.1 ml.Temuan DRE abnormal dijumpai pada 6 pasien PCa dan 1 pasien BPH. Seluruhvariabel antara PCa dan BPH tidak berbeda signifikan (p>0.05). AUC dari IPCRCadalah 79.8% (95% IK= 66.2%-93.3%; p=0.001) dalam memprediksi kanker prostat.Analisis ROC IPCRC memiliki sensitivitas 85.7% dan spesifisitas 70.8%. AUC IPCRCini lebih tinggi daripada AUC PSA dengan selisih sebesar 11.4%. Indonesian ProstateCancer Risk Calculator (IPCRC) lebih baik daripada PSA tunggal dalam memprediksikejadian kanker prostat. Validasi dan studi prospective lebih lanjut dengan sampel yanglebih besar perlu dilakukan.

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Prostate cancer is the second most frequently diagnosed cancer and the sixth leadingcause of cancer death in men worldwide. It was estimated 914.000 new cases werefound and responsible for 6% (258.400) of total cancer deaths in men in 2008.Indonesian Prostate Cancer Risk Calculator (IPCRC) was developed from a multicentricstudy to predict the risk of prostate cancer in suspected patient. An externalvalidation is needed to c onfirm the validity of the calculator. We included all benignprostatic hyperplasia (BPH) and prostate cancer (PCa) patients who underwent prostatebiopsy and prostatectomy in Adam Malik Hospital between August 11th and December31st 2014. The relationship between variables affecting the percentage of prostatecancer risk were evaluated, including: age, PSA level, prostate volume, and digitalrectal examination (DRE) findings. We calculated the risk of prostate cancer for eachpatient using IPCRC and analyse the results using the receiver operating characteristic(ROC) curve. We also compared them with the area under curve (AUC) of PSA results.There were 21 PCa and 24 BPH patients in our study. The mean ages, PSA, and prostatevolume were 66.8±7.3 years old; 27.3±32.2 ng/ml and 64.9±38.1 ml, repectively.Abnormal DRE was found in 6 PCa and 1 BPH. Each variable didnt show significantdifference between PCa and BPH groups (p > 0.05). The AUC of IPCRC was 79.8%(CI 95%: 66.2%-93.3%; p=0.001) in predicting prostate cancer. The ROC analysis ofIPCRC had sensitivity of 85.7% and specificity of 70.8%. This AUC of IPCRC washigher than of PSA, with 11.4% difference. The Indonesian Prostate Cancer RiskCaluclator is better than PSA alone in predicting prostate cancer in this population.Further validation and future prospective study in larger population is needed."