Varicocele repair in improving spermatozoa, follicle-stimulating hormone, and luteinizing hormone parameters in infertile males with azoospermia: a systematic review and meta-analysis.

ABSTRACT: Patients with azoospermia show a prevalence of varicocele of 10.9% and a 14.8% contribution to male infertility. Patients with azoospermia are thought to produce high-quality semen following varicocele treatment. Advising varicocelectomy prior to sperm retrieval in a reproductive program is still debated. This study reviewed the impact of varicocele repair on male infertility using several factors. A literature search was conducted using Scopus, PubMed, Embase, the Wiley Online Library, and Cochrane databases. Sperm concentration, sperm progression, overall sperm motility, sperm morphology, and follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels were also compared. Outcomes were compared between those who received treatment for varicocele and those who did not. The data from the pooled analysis were presented as standardized mean difference (SMD) along with a 95% confidence interval (CI). Heterogeneity was evaluated using I2. Additionally, we conducted analyses for publication bias, sensitivity, and subgroup analysis as appropriate. Nine studies were included after screening relevant literature. Statistical analysis revealed a significant improvement in sperm concentration (SMD: 1.81, 95% CI: 0.84-2.77, P < 0.001), progressive sperm motility (SMD: 4.28, 95% CI: 2.34-6.22, P < 0.001), and sperm morphology (SMD: 3.59, 95% CI: 2.27-4.92, P < 0.001). Total sperm motility showed no significant difference following varicocele repair (SMD: 0.81, 95% CI: -0.61-2.22, P = 0.26). No significant differences were seen in serum FSH (SMD: 0.01, 95% CI: -0.16-0.19, P = 0.87) and LH (SMD: 0.19, 95% CI: -0.01-0.40, P = 0.07) levels as well. This study supports varicocele repair in infertile men with clinical varicocele, as reflected by the improvement in sperm parameters after varicocelectomy compared with no treatment. There were no significant improvements in serum FSH and LH levels.

A comparison between the efficacy and complication of laparoscopic and microsurgical varicocelectomy: Systematic review and meta-analysis.

Varicocele is the dilatation of the scrotal veins and may affect sperm count and infertility. It is caused by congenital vein insufficiency or absence of venous valve. The main treatment is by surgery, and currently, there are two minimally invasive choices: laparoscopic and microsurgical varicocelectomy. This systematic review aimed to record randomized clinical trials from various sources using all qualified studies up to June 2022. The assessed outcomes were operation time, hydrocele, hospital stay, change in semen parameter, recurrence rate, and pregnancy rate. The essential data extracted were Jadad score, publication year, age, and sample size. This systematic review consisted of 509 and 512 patients in the laparoscopic and microsurgery group, respectively, taken from 12 out of 281 studies. The result of this systematic review was significant difference in operation time between patients from two groups (weighted mean difference [WMD] -21.40, 95% confidence interval [CI]: -28.90--13.89); length of hospitalization (WMD: 0.38, 95% CI: 0.02-0.74); laparoscopic could significantly increase the risk of hydrocele by 3.30-fold (risk ratio [RR]: 3.30, 95% CI: 1.07-10.12); laparoscopic could significantly increase the recurrence rate by 6.98-fold (RR: 6.98, 95% CI: 3.46-14.08); no significant difference in spontaneous pregnancy between patients in both groups (RR: 0.81, 95% CI: 0.57-1.16); and laparoscopic surgery decreased the occurrence of sperm parameter changes by 40% (RR = 0.40, 95% CI: 0.25-0.62).

Role of ureteral stent material and coating to prevent ureteral stent related issue: A systematic review and meta analysis.

INTRODUCTION: Ureteral stents require materials that balance bulk and surface properties. Achieving both can be challenging, as ideal bulk properties may not align with optimal surface properties. Thus, researching coatings and biomanufacturing methods for ideal materials is essential. METHODS: A systematic review and meta-analysis, following PRISMA Guidelines, involved literature searches across five databases: PubMed, Scopus, Embase, ClinicalKey, and Cochrane. From 417 screened articles, eight studies were deemed eligible for qualitative and quantitative analysis. The selected articles underwent bias assessment using ROB Tools 2. RESULTS: The systematic review analyzed 1.356 participants. Findings revealed that firm ureteral stents significantly increased risk of infection, hematuria, and lower body pain. On the contrary, soft stents reduced infection (OR: 0.62; p=0.004), hematuria (OR: 0.60; p<0.001), and lower body pain (OR: 0.63; p=0.0002). However, infection reduction effect was uncertain due to heterogeneity. Coated vs non-coated material analysis found no difference in encrustation (OR: 1.26; p=0.52) or infection (OR: 1.67; p=0.99). Stent firmness did not affect encrustation on double J stent (OR: 0.97; p=0.17). CONCLUSIONS: Softer materials like silicone are preferred for ureteral stents to reduce symptoms like hematuria and lower body pain. Coatings like silver nanoparticles and triclosan, while enhancing antimicrobial properties, did not effectively lower infection risk.

Comparison of Early Inguinal Lymph Node Dissection and Neoadjuvant Chemotherapy in Penile Cancer Patient with Bulky Nodal Metastasis: A Cohort Study.

PURPOSE: Penile cancer is a rare malignancy, where extranodal extension in inguinal or pelvic lymph nodes is associated with decreased 5-year cancer-survival rate in this study, we try to assess survival and quality of life in a penile cancer patient with bulky lymph node. METHODS: We retrospectively reviewed data from penile cancer patients with bulky lymph nodes who underwent treatment between July 2016 and July 2021 at tertiary referral hospital care. The inclusion criteria (age >18 yr, histologically proven penile cancer, and completion of last treatment 6 months prior to this study) yielded a cohort of 20 eligible penile cancer patients with bulky lymph nodes (> 4 cm/bilateral mobile/unilateral fixed). Only patients who had completed therapy at least 6 months prior to the study were included. After obtaining consent, they were asked to complete the EORTC QLQ-C30 questionnaire to evaluate the patient's quality of life. RESULTS: Out of 20 patients, 5 patients underwent direct ILND and 15 patients underwent chemotherapy. Median follow-up after primary diagnosis was 114+32 months in patients with early ILND and 52+11 months in patients who underwent delayed lymph node dissection. Out of 5 patients who underwent early ILND, all of them survived during follow-up, and achieved cancer-free status without residual tumor and with excellent functional outcomes (Karnofsky 90). There was no significant difference in social function (p-value = 0.551), physical function (p-value = 0.272), role function (p-value = 0.546), emotional function (p-value = 0.551), cognitive function (p-value = 0.453), and global health status (p-value = 0.893) between patient which treated with early ILND and Neoadjuvant Chemotherapy. However, patients who underwent early ILND showed a relatively better clinical outcome. CONCLUSION: Early ILND followed by adjuvant chemotherapy for penile cancer with palpable lymph nodes is more favourable than neoadjuvant TIP chemotherapy.

Prediction of locally advanced bladder tumor using preoperative clinical parameters.

Background: Staging of bladder cancer (BC) still remains a challenge. In conjunction with imaging, there is a critical need for accessible and cost-effective predictors to evaluate the existence of locally advanced disease. Objective: Our aim was to determine the role of preoperative clinical parameters in predicting locally advanced cT3/4 and/or cN+ in BC. Materials and Methods: Single-center data consisting of 32 patients were collected prospectively and eligible for the final analysis. The demographics data, presence of hydronephrosis, and results of renal function test (blood urea nitrogen [BUN] and serum creatinine [SCr]) were analyzed between the groups. Analysis of the receiver-operating characteristics curve was performed to determine the optimal cutoff value, sensitivity, and specificity of the preoperative clinical parameters, whereas multivariate logistic regression was used to assess the predictive analysis. Results: According to preoperative computed tomography imaging, 17 (53.1%) out of 32 patients with BC had locally advanced disease. Preoperative hydronephrosis and renal insufficiency as indicated by BUN and SCr levels were independently associated with the presence of locally advanced disease (P < 0.05). Multivariate analysis confirmed that the presence of preoperative hydronephrosis and higher level of BUN and SCr were the independent predictors of locally advanced BC (Odds ratio [OR] =6.6; 95% confidence interval [CI]: 1.40-31.05; P = 0.017; OR = 6.6; 95% CI: 1.40-31.05; P = 0.017; OR = 18.67; 95% CI: 3.16-110.29; P = 0.001, respectively). No further variables were statistically significant. Conclusion: Preoperative assessment of hydronephrosis and renal insufficiency was able to predict locally advanced stage risk of BC cT3/4 and/or cN+; thus, preoperative staging might be improved. However, further studies are required to corroborate these findings.

Tumor Markers as Predictors of Acute Kidney Injury Incidence and Staging of the Muscle-Invasive Bladder Cancer Receiving Chemoradiation Therapy.

Background: Bladder cancer, as one of types of cancers within the urinary tract, is associated with a greater risk of acute kidney injury (AKI), resulting in a poorer prognosis, discontinuation of effective oncological treatments, longer hospitalization, and higher expenses. There is no discussion yet on tumor markers in bladder cancer. With the revolutionary advances in bladder cancer molecular subtyping over the past decade, the presence of tumor markers to assess the staging of bladder cancer has yet to be discussed. In this study, we intended to assess the relationship between tumor markers and incidence of AKI, also between tumor markers and the cancer staging. Methods: This retrospective cross-sectional study utilized secondary data from 26 medical records of patients diagnosed with bladder cancer at the Adam Malik and Universitas Sumatera Utara Hospital between 2021and 2022. This study included all patients with bladder cancer who met the inclusion criteria. Continuous variables were reported as mean (standard deviation (SD)) and examined using an independent t-test. Categorical variables were reported as proportions, examined using Chi-square or Fisher's exact test. Pre- and post-tumor marker data were evaluated with dependent sample t-test for normal variance data, and Wilcoxon test for data with atypical distribution. P values were set at 0.05. Results: CD44 (P = 0.003) and programmed cell death 1 (PD-1) (P = 0.030) were the only significant markers in their pre- and post-chemoradiation states among the four investigated tumor markers in this study. Meanwhile, PD-1 tumor marker levels were only found to be significant between AKI and pre-chemoradiation (P = 0.011). Even though the multivariate study of tumor staging did not show any statistical significance, both tumor markers CD44 and PD-1 showed a significant effect on the incidence of acute renal damage (P = 0.034). Conclusions: Pre-chemoradiation PD-1 tumor markers showed promise as good predictive indicators for staging and AKI incidence in muscle-invasive bladder cancer patients undergoing chemoradiation therapy.

The Efficacy and Safety of Avanafil During a Treatment of Male Erectile Dysfunction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Purpose: Erectile dysfunction (ED) contributes to a large burden and impairs the quality of life among males. Avanafil appears to be a promising treatment for ED; however, its efficacy and safety profile remain unclear. This study aimed to evaluate the efficacy and safety of avanafil for the treatment of ED. Patients and Methods: An extensive search of PubMed, ScienceDirect, Web of Science, and Embase databases with 11 publications was performed, with outcomes evaluated are International Index of Erectile Function - Erectile Function (IIEF-EF), Sexual Encounter Profile (SEP), and Treatment-Emergent Adverse Events (TEAE). Statistical parameter Mean Difference (MD) and Risk Ratio (RR) with 95% Confidence Interval (CI) were used to measure effect size. Results: The pooled estimates demonstrated that changes in IIEF-EF function (MD=4.39, 95% CI [3.41, 5.37], p<0.001), SEP-2 (RR=3.43, 95% CI [2.79, 4.22], p<0.001), SEP-3 (RR=2.30, 95% CI [2.01, 2.62], p<0.001), and TEAE (RR=1.49, 95% CI [1.12, 1.96], p=0.005) were significantly higher in the avanafil group than in the placebo group. Moreover, 200 mg avanafil was superior to that mg 100 mg-avanafil, indicated by the IIEF-EF score (MD=-1.15, 95% CI [-1.40, -0.89], p<0.001). In contrary, there were no significant differences in SEP-2 (RR=0.90, 95% CI [0.75, 1.08], p=0.26), SEP-3 (RR=0.92, 95% CI [0.81, 1.05], p=0.21) and TEAE (RR=1.00, 95% CI [0.87, 1.15], p=0.99) for both 100 mg and 200 mg doses. Conclusion: This review highlights the potential use of this drug in ED treatment. Further large-scale Randomized Controlled Trials investigations involving various racial groups are required to confirm these findings.

The Assessment of Male Erectile Dysfunction Characteristics in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis and Hemodialysis Using the International Index of Erectile Function (IIEF-5) Combined with Hospital Anxiety and Depression Scales.

Purpose: To determine the differences in mean scores of erectile dysfunctions (EDs) assessed by the International Index of Erectile Function (IIEF-5) questionnaire between patients with chronic kidney disease (CKD) undergoing hemodialysis and patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Patients and Methods: This is an analytic observational study with a cross-sectional design that was conducted from June to December 2022 at the Urology Center of Haji Adam Malik General Hospital and Rasyida Kidney Specialized Hospital. The sample of this study were male CKD-patients who underwent regular hemodialysis (HD) and who underwent CAPD, and met the inclusion and exclusion criteria. Psychological disorders experienced during therapy session are considered as risk factors and assessed via the Hospital Anxiety and Depression Scale (HADS). These disorders assessment was used to evaluate the severity of the patients' anxiety and depressive symptoms. Statistical data analysis was carried out. Results: Both groups had HADS-A and HADS-D scores with an average <7, classified as normal anxiety and depression. Most of the patients in the HD group had mild-to-moderate ED (28.6%), while in the CAPD group had mild severity of ED (38.1%). There were no significant differences in severity of ED between patients undergoing HD and CAPD (p > 0.05). However, there was a significant difference in ED scores (IIEF-5) between patients undergoing HD and those with CAPD (p < 0.05), in which patients in the CAPD group had a higher IIEF-5 score. In addition, there was a significant positive correlation with moderate strength (p<0.001; r=0.494) between anxiety disorders and ED disorders in patients undergoing HD and CAPD, whereas there is no significant correlation between depressive disorders and ED conditions (p > 0.05). Conclusion: There was a significant difference in IIEF-5 scores between patients undergoing HD and CAPD.

PCA3 and TMPRSS2: ERG Urine Level as Diagnostic Biomarker of Prostate Cancer.

Background: Prostate cancer is a highly prevalent urological carcinoma with an increasing incidence in Indonesia and all around the world. Early diagnosis can greatly affect treatment outcomes and increase life expectancy. Several biomarkers for detecting prostate cancer have been studied and showed great promise. Purpose: This study aims to analyze prostate cancer antigen 3 (PCA3) as well as transmembrane serine protease 2:ERG (TMPRSS2:ERG) for diagnosing and serving as urine biomarkers in predicting prostate cancer incidences. Methods: We conducted an analytical study to assess the utility of PCA3 and TMPRSS2:ERG for detecting prostate cancer. Thirty samples were included in this study to see the utilization of PCA3 and TMPRSS2:ERG as diagnostic biomarkers of prostate cancer. A urine sample was taken and the PCA3 test was performed using the PCA3 PROGENSA test, while the TMPRSS2:ERG was performed using the chemiluminescent DNA probe method with a hybridization protection test. Results: The average age of the subject was 61.07±8.3 years. Based on calculations using the Mann-Whitney test, there was a significant relationship between prostate-Specific Antigen (PSA) overexpression (p<0.001), TMPRSS2:ERG (p=0.001), and PCA3 (p=0.003) with prostate cancer incidence. The sensitivity of PCA3 and TMPRSS2:ERG in detecting prostate cancer was 76.9% and 92.3%, respectively. Hence, TMPRSS2:ERG and PCA3 can be used as biomarkers for the occurrence of prostate cancer. We also performed a Kruskal-Wallis test; however, there was no significant relationship between PSA (p=0.236), TMPRSS2:ERG (p=0.801), and PCA3 (p=0.091) with the Gleason score. Conclusion: There is a significant correlation between overexpression of PSA, TMPRSS2:ERG and PCA3 with the incidence of prostate cancer, and TMPRSS2:ERG and PCA3 can be used as biomarkers of prostate cancer.

Evaluation of Health-Related Quality of Life in Patients Receiving Treatment for Penile Cancer: A Single-Center Cross- Sectional Study.

INTRODUCTION: Penile cancer is one of the uncommon types of cancer in men. The treatment could significantly impact a patient's quality of life (QOL), leading to difficulties in fulfilling life functions. METHODS: This descriptive observational study aimed to describe a situation using a cross-sectional design objectively. The population of this study was all patients with a diagnosis of penile cancer who underwent therapy at the Haji Adam Malik Hospital from September 2020 to September 2021. Quality of life was assessed using EORTC QLQ-C30. RESULTS: The respondents' mean age and standard deviation were 54.44 and 8.647 years, respectively. The youngest was 38 years, while the oldest age was 64 years. Most respondents had no history of circumcision (55.6%). All respondents had a poor QOL based on the 28 components in the questionnaire. This study showed that erectile function, changes in sexual function, and overall sexual function were correlated with health-related quality of life (HRQoL) post-treatment. In general, lack of sexual activity is the primary factor responsible for decreasing HRQoL in penile cancer patients. It has been reported that 70% of patients experienced a negative impact on sexuality post-treatment. CONCLUSION: The quality of life in patients receiving treatment for penile cancer at RSUP H. Adam Malik, Medan, was poor. It is associated with a lack of sexual activity.

Nephrolithiasis-Associated Renal Cell Carcinoma in Patients Who Underwent Nephrectomy: A Single-Center Experience.

Background: Kidney stones (nephrolithiasis) affect around 5% of the world's population. Some medical disorders, like obesity or diabetes, have increased the incidence and prevalence of nephrolithiasis. In addition, chronic inflammation and infection are frequently linked to kidney stone formation. Urothelial cell proliferation may change as a result of chronic inflammation, tumors will therefore develop as a result of this. The correlation between nephrolithiasis and renal cell cancer can also be explained by shared risk factors. At Adam Malik General Hospital, we strive to identify the risk factor for stone-induced renal cell cancer. Methods: This study was carried out at Adam Malik General Hospital by collecting medical record reports from patients who had nephrectomy for nephrolithiasis between July 2014 and August 2020. A variety of information was obtained, including identification, smoking status, body mass index (BMI), hypertension, diabetes mellitus, and nephrolithiasis history. The histopathological examination of cancer patients was used to determine adjusted odds ratios (ORs) both separately and in combination with other variables. Age, smoking status, BMI, hypertension, and diabetes mellitus all influenced the OR. The single variable was examined using Chi-square test, and the multivariate analysis was carried out using linear regression. Results: A total of 84 patients who underwent nephrectomy due to nephrolithiasis were included in the study, with an average age of 48.77 ± 7.23 years old; 48 (60%) of those were aged < 55 years old. In this study, 52 male patients (63.4%) and 16 patients (20%) were found to have renal cell carcinoma. Univariate analysis showed that the OR of patients with familial history of cancer was 4.5 (95% confidence interval (CI) 2.17 - 19.8), and the OR for smokers was 1.54 (95% CI 1.42 - 1.68). Similar results were shown in patients with hypertension and urinary tract infections due to stones. Nephrolithiasis patients with hypertension were 2.56 (95% CI 1.075 - 6.106) times more likely to develop a malignancy, while patients who had an infection due to a urinary tract stone were 2.85 (95% CI 1.37 - 5.92) times more likely to develop renal cell carcinoma compared to its counterpart. Both have a P-value of less than 0.05. Contrarily, alcoholism and frequent nonsteroidal anti-inflammatory drugs (NSAIDs) user results were different. Both have a P-value of 0.264 and 0.07, respectively. Furthermore, diabetes mellitus type 2 and BMI over 25 are not statistically significant, with a P-value of 0.341 and 0.12, respectively. In multivariable-adjusted analyses, participants with a family history of cancer and recurrent urinary tract infection due to urinary tract stones had a statistically significant increase in overall renal cell carcinoma risk (hazard ratio (HR): 1.39, 95% CI 1.05 - 1.84 and HR: 1.12, 95% CI 1.05 - 1.34). Conclusion: Kidney stone and renal cell carcinoma are significantly correlated due to recurrent urinary tract infection and familial history of cancer, which increases renal cell carcinoma risk.

Bilateral synchronous testicular cancer: A case report.

INTRODUCTION AND IMPORTANCE: Testicular cancer is the most common type of malignancy in young adult males, accounting for 1 % of all cancer diagnosis in men and 5 % of all urologic tumors. It is one of the malignancies with the highest cure rate. Bilateral germ cell tumor of the testicles is rare, representing only 1 % of all new cases of testicular cancer, around 30 % of which occur synchronously. Interestingly, there is not yet an occurrence where the bilateral synchronous testicular cancer has different histopathological type. CASE PRESENTATION: In this paper, we performed bilateral radical orchiectomy in different occasion, followed by adjuvant chemotherapy (BEP regiment). CLINICAL DISCUSSION: Since the clinical result is excellent, this finding could be a breakthrough in testicular cancer study. A cellular communication between different cancer cell type through chemokine which could affect response to chemotherapy. CONCLUSION: Treatment with surgery and chemotherapy is well tolerated and received. A further specific clinical study needs to be performed to investigate this finding in the future.

Poor prognosis of urothelial carcinoma in patients presented with persistent paraneoplastic leukocytosis with anemia.

Introduction: Paraneoplastic leukocytosis is a rare manifestation of urological cancer. This condition is well associated with the poor prognosis in other solid tumors. Anemia is the most common hematological manifestation of cancer, affecting 40%-64% of patients with cancer. This condition is also well associated with a poor prognosis. The goal of this research is to determine the clinical presentation and fate of individuals with urothelial carcinoma who have persistent paraneoplastic leukocytosis and anemia. Methods: From January 2014 to December 2020, a retrospective cohort of patients with a histological result of urothelial carcinoma was collected. Data were extracted from a single National Cancer Center Hospital in Indonesia. Persistent leukocytosis is defined as a leukocyte count ≥20,000/mL on at least two occasions with a minimum interval of 30 days. Anemia is defined using the WHO definition of anemia. Urinalysis, chest X-ray, and other blood tests were performed to exclude other probable causes of leukocytosis. Results: Thirteen of 123 patients screened presented with persistent paraneoplastic leukocytosis and anemia. All patients presented with bladder cancer, with two patients (15.4%) presented with a mixed histological urothelial carcinoma. During the trial, all of the patients died, with a median survival of 20 days after the beginning of paraneoplastic leukocytosis with anemia. Conclusions: Persistent paraneoplastic leukocytosis and anemia in a patient with urothelial carcinoma are a rare condition that is associated to a poor prognosis and a lower median overall survival time.

Association Between Interleukin-6 Levels and Lymph Node Metastasis in Bladder Cancer Patients.

Background: Bladder cancer (BC) is one of the urological cancers with high prevalence, mortality, morbidity, and expenditure rates. Urothelial malignancies account for about 90% cases of BC, with squamous and adenocarcinomas making up the remaining 10%. Lymph node metastasis (LNM), the most common type of BC metastasis, is generally found in the pelvic lymph nodes. LNM significantly affects the chances of survival and prognosis for patients with BC. It is feasible to stratify and assess the malignancy of the tumor and its response to therapies using potential tumor markers. Interleukin-6 (IL-6) has been observed to be a predictor of metastasis in lymph nodes in BC. The aim of this study was to evaluate the relationship between IL-6 levels and lymph node metastases in BC patients. Methods: Thirty-two BC patients between August 2021 and January 2022 were admitted to this study. Data on patient characteristics, clinical data, TNM staging, and IL-6 levels were collected. Univariate analysis was used in the characteristics of the patients. Results: The total subjects were 32 with 15 results in LNM. The difference in IL-6 levels between the LNM (+) group and the LNM (-) was statistically significant by Fisher's exact test (P = 0.041) and Mann-Whitney U tests (P = 0.003). Conclusions: The BC patients who had lymph node metastases also had higher serum levels of IL-6.

Open pyelolithotomy in an ectopic kidney: A case report.

Renal ectopia with stone is a rare case with no specific reported incidence rate. The treatment of kidney stone in ectopic kidneys poses a challenge to urologists. A 48-year-old male presenting with colicky pain on the right flank since one year ago. CT urography revealed an right-crossed renal ectopia and hyperdense lesions (25 × 20 mm and 10 × 10 mm) in the ureteropelvic junction of the right kidney. Under general anesthesia, we performed open pyelolithotomy for the patient and removed two stones completely. Open surgery could be the choice for patients with complex stone burden and associated renal anomalies such as ectopic kidney.

Neo Adjuvant Chemotherapy on Testicular Cancer after Scrotal Exploration: A Case Report.

BACKGROUND: A case of testicular cancer treated with neo adjuvant therapy in a patient in male is rare. When testicular cancer presents, it is usually directly operated due to the size of cancer which presented within the order of operable size. CASE PRESENTATION: Here, we report a rare case of a 5-year-old male patient presented to the emergency room (ER) due to mass on the scrotum without the difficulty of urination. From clinical findings, mass with a size of 15 x 10 cm was found with multiple abscesses on both sides of the scrotum. Pathological Anatomy Examination confirmed yolk sac tumour present within the scrotal mass. Initially, palliative chemotherapy took place to reduce the growth rate of the tumour. However, due to the responsiveness of testicular cancer to chemotherapy drugs, it reduced into operable size testicular cancer. Wide excision and Orchidectomy was then performed, followed by adjuvant chemotherapy. CONCLUSION: This case report showed the possibility of using neo adjuvant chemotherapy as an alternative treatment when inoperable testicular cancer presented in hospital.

Evaluation of Paclitaxel, Ifosfamide, and Cisplatin (TIP) Regimen on Penile Cancer in Adam Malik Medan: A Single Center 2 Years of Experience.

BACKGROUND: Penile tumour is a rare tumour in the genitourinary system, account for 0.4-0.6%. Although rare, patients are often unaware and come in late stage, so the use of chemotherapy agents is becoming crucial. AIM: This study was conducted to evaluate responses and overall survival rate of Paclitaxel, Ifosfamide, and Cisplatin (TIP) regimen in penile cancer with nodal involvement. METHODS: We included all medical records of penile squamous cell carcinoma patients associated with nodal involvement who acquired TIP regimen in Adam Malik Hospital between 2014 and 2016. We administered 175 mg/m2 of Paclitaxel on day 1, 1200 mg/m2 of Ifosfamide on days 1 to 3, and 25 mg/m2 of Cisplatin on days 1 to 3 as our standard TIP regimen. The regimen was re-administered every 21-28 days. Characteristics of the patient including age, history of circumcision, races, primary lesion of the tumour and TNM staging were noted. Adverse event, clinical responses, and overall survival were assessed and evaluated. RESULTS: We extracted data from 17 patients of penile cancer with nodal involvement who acquired TIP regimen with a mean age of 44.18 ± 11.13 years old from our medical records. Only 10 patients completed the full 4 cycles of the regimen. Four patients died before completion, two patients refused to continue the regimen, and 1 patient is still on the second cycle. Total penectomy was the most frequent procedure had taken, and clinical stage T4 and N3 was the most findings at initial diagnosis. There was no complete response noted. Six patients were noted as partial response, and 1 patient was noted as progressive disease. The Kaplan-Meier curve shows an overall 6 months (95% CI: 4.4-7.6 months) of survival with a median of follow-up time was 7 (1-11) months. In subgroup analysis, we found that the responder group has significantly better overall survival than the non-responder group (log-rank test, p = 0.004). CONCLUSION: Paclitaxel, Ifosfamide, and Cisplatin (TIP) regimen give significant clinical benefit in penile cancer with nodal involvement.

P53 and Survival Rate in Penile Cancer.

BACKGROUND: Penile cancer accounts for 0.4-0.6% of all malignancy in men in Europe and the United States of America. It also accounts for 10% of all malignancy in men in some Asian, South American, and African countries. P53 protein has the function to regulate apoptosis in the cell cycle. Therefore, the presence of p53 in cells may indicate higher proliferative activity of the cells as a feedback mechanism, indicating disease progression. AIM: This study aims to identify the association between p53 expression and survival rate in penile cancer patients. METHODS: This study was a retrospective observational analytic study. This study was conducted in Pathology Anatomy Laboratory Faculty of the Medicine University of Sumatera Utara/Haji Adam Malik Hospital/University of Sumatera Utara Hospital to assess p53 expression. This study was conducted from January 2018 to December 2018. RESULTS: The total subjects in this study were 33 with the mean age of 50.79 ± 10.62. Based on clinical stage, patients in this study are divided into 11 patients (33.3%) in stage T II and 22 patients (66.7%) in stage T III/T IV. P53 expression was positive in 13 patients (35.3%). There were 19 patients (57.6) alive and 14 patients (42.4%) deceased. Statistical analysis using chi-square showed that there was an association between p53 expression and mortality (p = 0.011). In the Kaplan-Meier Curve for 3-year overall survival based on p53 expression, the survival rate in 36 months in the p53 positive group is 18%, while in p53 negative group, the survival rate was 60%. The survival rate based on p53 status was significantly different (p = 0.025). CONCLUSION: There is a significant association between p53 expression and mortality in penile cancer patients. In conclusion, p53 expression in penile cancer cells examined by immunohistochemistry may show prognostic values in the disease progression.

Renal Arteries Embolization in Unresectable Clear Cell Renal Carcinoma: First Time Experience at Haji Adam Malik Hospital.

OBJECTIVE: To report a case of renal arterial embolisation (RAE) in unresectable renal tumour before nephrectomy. CASE REPORT: On presentation, the clinical features of this patient, including medical history, signs and symptoms, imaging examinations were recorded. After diagnosis and initial treatment, the result and histopathological examination were performed and discussed. We performed RAE in the unresectable renal tumour in the 28-year-old male that was complaining a palpable pain right flank mass and intermittent hematuria that had been observed five months earlier. A month after RAE, the tumour shrinks and become resectable. The parameter used was tumour volume, propulsion and component, with subjective value VAS, hematuria symptom and Quality Of Life Score EORTC-QLQ C30. The next step we performed nephrectomy with histopathology results in Clear Cell Renal Carcinoma (CCRC). CONCLUSION: RAE is an effective therapeutic and adjuvant tool because it facilitates the dissection of unresectable large renal tumours and tumours with extensive involvement around the renal hilum; it leading to lower overall morbidity. However, the lack of randomised prospective studies is the primary reason that RAE is not used often before surgery.