Cytoplasmic Androgen Receptor, CD24 Expression and Smoking Intensity to Urothelial Carcinoma of the Bladder Invasiveness: A Cross-Sectional Study.

Purpose: To the best of our knowledge, Androgen receptor (AR) and cluster of differentiation 24 (CD24) expression in bladder urothelial carcinoma (UC) has not yet been reported in our population. The aim of this study was to evaluate the expression of both markers in UCB using immunohistochemistry. Materials and Methods: Data from 60 patients with UCB were obtained between 2009 and 2018. The samples were divided into four groups based on their smoking history. Group 1 included non-smokers, group 2 smoked <20 cigarettes/day for 30 years, group 3 smoked for 31-40 years, and group 4 smoked for > 40 years. Each group then divided into Non muscle invasive bladder cancer (NMIBC) and muscle invasive bladder cancer (MIBC) subgroups. The smear was stained with hematoxylin and eosin (HE) - immunohistochemistry of CD24 and RA, followed by histoscore assessment. Results: The male to female smoking rates was 1.8. Based on gender, in the NMIBC group there were 85.7% men and 14.3% were women while in MIBC 74.4% men and 25.6% women. The mean age of the NMIBC and MIBC groups was 56.3 years and 54.5 years, respectively. There was no significant relationship between smoking status in group 2 (OR 0.31, CI 95% CI, p=0,39), group 3 (OR 013, CI 95% CI, p=0,05), and group 4 (OR 0.23, CI 95% CI, p=0215) to the UCB invasiveness. A significant relationship was observed between cytoplasmic AR expression and UCB invasiveness (OR 0.14[0,04; 0.47], CI 95%, p=0.001). There was no significant relationship between RA in the nucleus and UCB invasion (OR 1.09[0,18; 6.48] CI 95%, p=1000). No significant relationship was observed between CD24 expression and UCB invasiveness (OR 0.81[0,27-2,45] CI 95%, p=0712). Conclusion: Cytoplasmic AR expression is associated with UCB invasiveness. Smoking history and CD24 expression were not associated with UCB invasion.

Wunderlich syndrome in a COVID-19 patient with poor outcome.

A 42-years-old female presented with loss of consciousness and gross hematuria. Physical and laboratory examination indicated hemorrhagic shock. CT-Scan showed massive retroperitoneal hemorrhage on left kidney. The patient needed selective arterial embolization, but the facility was not available for COVID-19 patients who require a negative-pressure room. The patient underwent renal exploratory laparotomy and right nephrectomy, but did not survive due to multiple organ dysfunction syndromes. Wunderlich syndrome is a severe hemorrhagic complication in COVID-19. The three symptoms are known as Lenk's triad which includes hypovolemic shock, acute flank pain, and flank mass.

Single dose Tadalafil 5 mg in Muscle Invasive Bladder Cancer (MIBC) patient induce priapism: A case report and literature review.

There are several etiology related to priapism with incidence is less than 0.01%. A 47-year-old man was referred to our Emergency Room with a chief complaint of persistent and painful erection for 3 days. Previously, the patient took Tadalafil 5 mg to overcome the complaints of erectile dysfunction that he felt after undergoing (TURBT) and external radiation treatment. The patient treated with epinephrine injection and distal shunting surgical procedure Minimal and single dose of tadalafil can cause priapism as in this case. Time interval between onset and therapy affect patient outcome.

Spontaneous intraperitoneal bladder rupture managed conservatively.

Spontaneous intraperitoneal bladder rupture is a rare urological case. Repair usually done by operation and conservative management was unusual. We present a case of a 43-year-old man who presented to ED with lower abdominal pain and distension. He underwent a cystoscopy, several rupture and thin bladder wall was found. We decided to managed the patient conservatively with urinary catheter for 1 month. Upon follow up, the patient was in good condition. Conservative treatment with urinary catheter for 1 month may be considered in patients who are in good condition, do not have signs of peritonitis and sepsis.

Case of metachronous clear cell bladder metastasis on low risk localized renal cell carcinoma patient.

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.

Comparison of TransPerineal Prostate Biopsy Using Novel Affordable VY Probe (TPPB-VY) and TransRectal Prostate Biopsy (TRPB) in Detection of Prostate Cancer on Hypoechoic Lesions.

INTRODUCTION: Prostate cancer is one of the most commonly encountered urologic malignancy. Biopsy samples may be attained using TPPB-VY or TRPB; both of the approaches are relatively comparable in terms of accuracy. Transperineal Access System revolutionizes the methodology for obtaining prostate biopsies. But in Indonesia this device is not available and expensive, we developed VY probe mounted needle guide device. The study was aimed to compare cancer detection rate and rates of cancer detection in Grade Groups (GG) between these two approaches, particularly in prostate cancer patients. METHODS: A cross-sectional study with retrospective data from patients diagnosed with prostate cancer in Hasan Sadikin General Hospital in 2019 - 2020 was performed. Ethical approval of this study was sought from the hospital authorities (IRB number: LB.02.01/X.6.5/ 55/2020). The patient was included to the study if PSA ≥ 4 ng/ml, DRE results suggestive of prostate cancer. The diagnostic accuracy of both approaches was compared using histopathological analysis. RESULTS: There were 44 patients included in the study; 22 patients had received TRPB and 22 patients had TPPB-VY. Higher degree of cancer detection rates was found in patients receiving TPPB-VY. Patient with Prostatic adenocarcinoma were all found having hypoechoic lesion in TPPB-VY. On the other hand, half of the patient with Prostatic adenocarcinoma shown having no lesion in TRPB. Prostate cancer with hypoechoic lesion can be detected better by TPPB-VY than TRPB. Cancer detection rates on TPPB-VY were significantly higher than on TRPB for each grade group. CONCLUSION: Among patient with hypoechoic lesions, TPPB-VY led to more detectionof prostate cancer, it provides detection of all grade groups and high-grade prostate cancer, this showed a non-inferior TPPB-VY compared to TRPB. TPPB-VY should be considered as an option for all men in whom a prostate biopsy is indicated.

Type II Hem-o-lok clip migration and stone formation in robot assisted laparoscopic prostatectomy patient: A case report and serial cases review.

Hem-o-lok clips (HOLC) migration after laparoscopic surgery may cause delayed postoperative issues. We present a delayed lower urinary tract symptoms (LUTS) and urinary stones due to HOLC migration from previous radical prostatectomy approximately 10 years ago. A 88-year-old man presenting clinic with LUTS; previously received robotic-assisted laparoscopic radical prostatectomy (RALP) 10 years ago. HOLC and stones from the bladder were extracted with cystoscopy lithotripsy. Latest follow-up noted complete resolution of symptoms. RALP may cause HOLC migration with variable duration of LUTS symptoms occurring, reaching up to 10 years.

Atypical presentation of recurrent female urethral diverticulum: A case report.

INTRODUCTION AND IMPORTANCE: The atypical urethral mucosal outpouching into adjacent tissue is termed urethral diverticulum (UD). Most patients present with a post-void dribble, dyspareunia, and dysuria. CASE PRESENTATION: We reported a 60 years old woman who presented with recurrent urethral discharge, and a palpable lump in the vagina. Cystoscopy showed the location of the diverticular ostium. CLINICAL DISCUSSION: Urethral diverticulum (UD) is uncommon and requires a relatively high level of suspicion, particularly in women with symptoms of atypical voiding. The widely-known classic symptoms involve the 'three Ds': post-void dribbling, dyspareunia, and dysuria. For radiological modalities, the transvaginal and transperineal ultrasound (US), Voiding cystourethrogram (VCUG), and cystoscopic examinations should be conducted to establish the diagnosis. CONCLUSION: Urethral Diverticulum (UD) should always be considered in cases of urethral discharge and intravaginal mass. A complete history, complete clinical, VCUG, and cystoscopic examinations should be conducted to establish the diagnosis. The technique of three-layer vaginal flap is related to a very good success rate without major complications.

Testicular ischemia in patient with acute epididymitis: A rare case.

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.

Penile epidermal inclusion cyst mimicking ectopic testis mass: A case report.

Epidermal inclusion cyst is a benign lesion that can originate in all parts of the human body. However, the penile location is quite rare. We reported a 24-years old man with a painless, soft, progressive-growing mass at the distal part of the penis with a history of ectopic undescended testis. Complete resection was performed, and further histopathologic study revealed an epidermal inclusion cyst of the penis. This report would like to present a rare case of a penile epidermal inclusion cyst mimicking an ectopic testis mass at our institution.

Inferior vena cava thrombus shrinkage in patient with adult Wilms' tumor: A Case report.

INTRODUCTION AND IMPORTANCE: Adult Wilms' tumor is infrequent in adults and usually has poor prognosis. We report a case of inferior vena cava thrombus shrinkage in patient with adult Wilms' tumor. CASE PRESENTATION: A 27-year-old male came to hospital due to pain in his left flank and repeated hematuria since one year ago. An inhomogeneous mass and thrombus in IVC and abdominal aorta near renal artery were found from his abdominal CT scan with contrast, so cytoreductive nephrectomy was performed. However, the patient was unstable during operation so the thrombus couldn't be operated. Post-op immuno-histo-chemistry evaluation conethicfirmed the diagnosis of adult Wilms Tumor. A follow-up CT scan with contrast showed shrinkage of thrombus size with no sign of peripheral congestion. This phenomenon was rare in adult Wilms tumors, especially when the patient didn't undergo thrombus removal or adjuvant chemotherapy. CLINICAL DISCUSSION: Adult Wilms' tumor tends to invade blood vessels in the form of thrombus, as shown in this case. Up to 4% of patients with thrombus had it around vena cava [3,4]. The recommended treatment is open surgery. Patients with chronic thrombus obstruction might have several venous collateral pathways to maintain blood flow to the right atrium. Generally, there are three major alternative pathways found in such complications. CONCLUSION: This study presented a patient with adult Wilms' tumor that experienced post-operative thrombus shrinkage without doing adjuvant chemotherapy or thrombus removal during surgery.

Ketoconazole for the Treatment of Docetaxel-Naïve Metastatic Castration-Resistant Prostate Cancer (mCRPC): A Systematic Review.

OBJECTIVE: This systematic review aimed to determine the efficacy of ketoconazole in the treatment of metastatic castration-resistant prostate cancer (mCRPC). MATERIALS AND METHODS: A literature search was performed on four databases of PubMed, Google Scholar, Cochrane Database of Systematic Reviews, and Directory of Open Access Journals (DOAJ). The initial search resulted in 602 articles, which were progressively eliminated based on duplication, irrelevancy, and unsuitable methodology. A total of seventeen articles were included in the final analysis, including four randomized controlled trials, nine retrospective cohorts, and four prospective cohorts, with a total population of 1,095 patients. A 200-400 mg, tid dose of ketoconazole was used in these studies along with corticoid replacement therapy with hydrocortisone, 20-30 mg in the morning and 10-20 mg in the evening, or prednisone, 5 mg, bid. RESULTS: Based on our findings, 8 out of 17 studies reported PSA decrease of >50% in approximately half of the population, with a more significant PSA response at 400 mg ketoconazole dosage, and the average progression-free survival (PFS) of 2.6-14.5 months, or time to progression of 3.2-6.7 months. CONCLUSION: Ketoconazole with corticosteroid could be an effective alternative for the treatment of mCRPC with a satisfactory PSA response and disease progression.

Polyorchidism and testicular malignancy, what can we learn: A case report.

INTRODUCTION: Polyorchidism is a rare condition with a total number of approximately 190 cases. Malignancy was found in 6,4% of cases. CASE PRESENTATION: A 57 years old man came with a sudden and persistent painful mass in right inguinal region. The patient decided to undergo surgery with diagnosis of incarserated lateral hernia inguinal and obtained a testicular-like lump in the right inguinal canal, then the patient underwent orchiectomy. Histopathological examination revealed a soft tissue tumor with microscopic characteristic of seminoma. CT-Scan revealed metastasis to lung and liver. CONCLUSION: Attention must be given to detect malignancy in polyorchidism.

Uterus as one of the ectopic ureter openings: Case report.

Ectopic ureter is defined as any ureter, single or duplex, that does not open in the trigonal region of the bladder. A 19-years-old girl was presented with urinary incontinence. Physical examination revealed a normal urethral meatus with pooling of urine at the introitus. A Kidney-Ureter-Bladder ultrasound revealed a duplex-system suspicion on the right side. The patient was managed by laparoscopic heminephrectomy of right ureter. The uterus gains its normal shape and sized without any fluid filling after the operative being completed. In conclusion, a complete diagnostic work up is important to achieve better prognosis and early treatment.

Affordable novel device (VY) for transperineal prostate biopsy: A trial on prostate mannequin.

Prostate cancer (PCa) is the most frequent malignancy in men worldwide after lung cancer. The gold standard for diagnosing prostate cancer is prostate biopsy. There are two main approaches for diagnosing PCa: transrectal biopsy and transperineal biopsy. In Indonesia, transperineal approach is rarely done as a part of diagnostic work up. The most known method of transperineal biopsy is the fan technique, which is a difficult technique to perform, particularly when directing the needle to the target accurately. For this reason, we develop an affordable bioplastic VY probe mounted needle guide device ($10) to provide precise needle insertion during the biopsy. In this study, we assessed the objective and subjective factors of the newly developed VY device.•Basic knowledge and operation technique were equalized by holding a prostate biopsy training using fan technique and VY device to 20 first-year Residents•Participants were randomized and devided into two groups to perform fan technique and VY technique based on the training given•Subjective factors (usefulness, the easiness, and preference) and objective factors (duration of puncture to needle visualization on USG, biopsy duration time, and the ability to reach the target tissue) were evaluated.

Pleomorphic retroperitoneal liposarcoma with kidney infiltration mimicking renal trauma.

Pleomorphic retroperitoneal liposarcoma are uncommon malignant tumor which hard to treat condition for its local aggressiveness and clinical specificity. A 84 years-old male patient complained with an abdominal mass and left flank pain without hematuria. The patient also complained of shortness of breath due to left pleural effusion. Contrast CT Scan revealed left renal hematoma with suggestive of renal trauma. Left flank exploration and tumor excision was performed to the patient. Histopathological examination showed pleomorphic retroperitoneal liposarcoma. In seventh day post-operative, the condition was fully recovered. This is an unusual presentation retroperitoneal mass. Pleomorphic retroperitoneal liposarcoma can provide atypical imaging.

A case report of one of the largest (9900 cm3) clear cell renal carcinoma removed in Asia.

INTRODUCTION: Giant renal cell carcinoma (volume more than 1000 cc) is a rare case. Management included surgical resection combined with targeted therapy. CASE PRESENTATION: We reported a case of giant clear cell renal carcinoma with 9.900 cm3 of total volume, that required surgical resection of the tumor. This is the largest giant clear cell RCC reported in Asia. DISCUSSION: Giant renal cell carcinoma management without targeted therapy was not optimal. Multimodal therapy was recommended for better outcome. CONCLUSION: Surgical resection of Giant RCC is challenging, for that reason targeted therapy is recommended to be the alternative regardless the outcome.

A large bladder leiomyoma.

INTRODUCTION: Bladder leiomyoma is a rare, benign tumor of the bladder. We present the first large endovesical leiomyoma case report in Indonesia and the largest bladder leiomyoma without any post-operation symptoms. CASE PRESENTATION: A 42-year-old female came with painless hematuria and irritative symptoms in the past year. Cystoscopy and open excision of the tumor showed well-encapsulated papillary solid mass at trigone (7 x 6.5 × 4 cm with a weight of 800 g). Postoperative histopathology confirmed the diagnosis of endovesical leiomyoma of the urinary bladder. CONCLUSION: Open excision of bladder leiomyoma had good outcomes on large endovesical mass patients.

The largest adrenal leiomyoma: A case report and literature review.

Leiomyoma is a benign tumor of smooth muscle origin. Primary leiomyoma of the adrenal gland is very rare. Adrenal tumors are often diagnosed during the ultrasound or computerized tomography (CT) study as incidentaloma. According to the literature review, up to 2018, the largest size of adrenal leiomyoma which had ever been reported was 12 × 10 × 8 cm in dimension (Maher et al.). Herein, we report the largest adrenal leiomyoma with the tumor mass of 600 g (14,1x11,4x10,1 cm) from a female patient admitted to our hospital.

Intravesical foreign object: A case report of autoerotism.

The lower urinary tract's foreign body is an uncommon condition, with the bladder being the most common site. Most foreign bodies are self-inserted via the urethra due to exotic impulses, psychometric problems, or sexual curiosity. We present a case of a 39 years old male with a lower urinary tract and abdominal pain. An abdominal CT Scan showed a sharp metal in the bladder. The patient underwent a successful extraction of a foreign body with biopsy forceps transurethrally. Foreign bodies in the bladder represent a urological challenge that requires prompt management. Treatment is determined by size, location, and shape. Minimally invasive procedures are recommended to prevent bladder and urethral injuries. However, surgical treatment should be performed if further injuries are expected. The suspected history and presenting symptoms are crucial and could lead to further investigations. Extraction should be carefully performed to minimize bladder and urethral injury. Gentle endoscopic management is the primary treatment with a high success rate. This case report aims to describe a case of the longest 12 cm sharp metal foreign material inserted to the bladder in South East Asia along with the management and subsequent condition to provide a better insight in managing future unusual cases.