Surgeon's point of view in vesico-vaginal fistula management.

OBJECTIVES: Vesicovaginal fistulas (VVF) are the most commonly acquired fistulas of the urinary tract. The management of VVF is mainly based on expert opinion and surgeon experience. This study aims to provide the practice patterns and outcomes of vesicovaginal fistula (VVF) management in Indonesia. METHODS: This study utilizes the results of a survey among the surgeons who performs VVF repair in referral hospitals throughout Indonesia between June and July of 2021. Data analysis was carried out with SPSS descriptively by displaying the relative frequency of the answers to each question of the questionnaire form. RESULTS: We collected responses from 93 respondents consisting of 68 urologists and 25 gynecologists. The most commonly reported cause of VVF was obstetric (50.5%). Most respondents confirmed the diagnosis of VVF by cystoscopy (81.7%). Waiting time to repair VVF was generally 12 weeks (79.6%), while the transvaginal approach repair was more often performed (77.4%). An additional procedure, such as tissue interposition was performed in 50.5% of cases. Tissue interposition was mostly indicated in recurrent VVF (81%), with omentum being the most selected tissue interposition (71%). When indicated, the most selected method of transabdominal approach was open transvesical (54,84%). A laparoscopic approach was performed only in 7.5% of cases. Overall, the success rate for VVF repair in Indonesia was 70-100% at first attempt. CONCLUSIONS: The transvaginal approach is preferred, either with or without an interposition tissue flap. The success rate at the first attempt is satisfactory.

Vaginal calculus in adult woman: A case report.

Vaginal calculus in adult woman is an extremely rare condition. The diagnosis and management can be challenging due to rare cases. We present a case of vaginal calculus in adult woman secondary to urethrovaginal fistula due to previous pelvic trauma. The patient barely has no complaint until one day she is experiencing infertility. Stone extraction, vaginoplasty and urethroplasty with Martius flap were performed with satisfactory results.

Serum testosterone and prostate-specific antigen levels are major risk factors for prostatic volume increase among benign prostatic hyperplasia patients.

OBJECTIVE: Benign prostatic hyperplasia (BPH) is one of the most common diseases found among elderly men. Even though multiple risk factors of BPH have been identified in the past, the risk factors which have a direct impact on prostate volume have not been identified. In this study, we aim to determine the most significant contributing risk factors to prostate volume enlargement by analyzing possible associated risk factors previously studied. METHODS: This is a quantitative study with an analytical observational design, performed using a retrospective cohort approach. Total sampling was performed on 83 patients who underwent transurethral resection of the prostate (TURP) in Sanglah General Hospital from January to February 2019. Bivariate analysis is performed to examine each variable's association with prostate volume followed by a multivariate analysis. All variables were reassessed with path analysis to measure the direct effects, indirect effects, and total effects on prostate volume. RESULTS: Bivariate analysis shows that serum testosterone (R=0.208; p=0.059) and prostate-specific antigen (PSA) level (R=0.626; p=0.001) have a significant association with prostate volume. Multivariate analysis shows that serum PSA (B=1.4; p=0.001; 95% confidence interval [95% CI]=1.039-1.770) and testosterone (B=0.024; p=0.005; 95% CI=0.008-0.041) levels are significant among all the analyzed risk factors. There is a significant and strong effect of PSA to prostate volume (c=0.636; p=0.001) whereas testosterone has a significant albeit weak effect to prostate volume (c=0.246; p=0.009) based on the total effect of the path analysis. CONCLUSION: Serum testosterone and PSA levels are significantly associated with prostatic volume increase among BPH patients.

A Comparison of Erectile Dysfunction Improvement Between Patients With Regular Hemodialysis and Patients With Continuous Ambulatory Peritoneal Dialysis.

BACKGROUND: Erectile dysfunction (ED) is one of the sexual dysfunctions that are often encountered as a complication of male patients with stage 5 chronic kidney disease (stage 5 CKD). ED can be caused by psychological factors in patients with regular dialysis therapy. Currently, Hemodialysis (HD) therapy is the first choice in dialysis therapy and only 2% of stage 5 CKD patients are using Continuous Ambulatory Peritoneal Dialysis (CAPD) as a dialysis therapy. ED in stage 5 CKD patients should become a part of the treatment of patients with dialysis, which hopefully will improve the quality of life of patients. This study aims to compare the improvement in ED degree in patients with HD and CAPD. METHOD: This study is an observational analytic comparative study involving 44 male patients with stage 5 CKD; 22 of whom underwent HD and the remaining 22 patients underwent CAPD. The differences evaluated were changes in the ED degree before and after dialysis, which were assessed using the International Index of Erectile Function-5 (IIEF-5). RESULT: There were significant differences in the improvement in ED degree and IIEF-5 scores in CAPD group. In the HD group, no significant difference was obtained in the improvement in ED degree and IIEF-5 score. A significant difference was obtained in the improvement in ED degree between the HD and CAPD groups by comparing the improvement in IIEF-5 score. CONCLUSION: Patients with CAPD have a better improvement in ED degree than patients with HD. Duarsa GWK, Kandarini Y, Winarta GK, et al. A Comparison of Erectile Dysfunction Improvement Between Patients With Regular Hemodialysis and Patients With Continuous Ambulatory Peritoneal Dialysis. J Sex Med Rev 2021;18:920-925.

Sexual Dysfunction Reduction in Female Patients with Chronic Kidney Disease Undergoing Continuous Ambulatory Peritoneal Dialysis.

BACKGROUND: chronic kidney disease (CKD) is a major worldwide health problem. One key treatment for end-stage CKD patients is dialysis therapy such as Continuous Ambulatory Peritoneal Dialysis (CAPD). This study aimed to find out the differences in the incidence of sexual dysfunction in women with CKD by CAPD. METHODS: this study was a multicenter observational analytic study design in female samples before CAPD and after CAPD. It was conducted between November 2018 - January 2019 with 26 female respondents. They were assessed using the Female Sexual Function Index (FSFI) questionnaire at pre-CAPD and post-CAPD. RESULTS: the results of the FSFI score before CAPD were 32.77 (SD 19.72) and after CAPD was 48.88 (SD 20.29). Analysis of differences in FSFI scores before and after CAPD demonstrates that there was a significant difference (p = 0.003). CONCLUSION: women with CKD who underwent CAPD, had an increase in FSFI scores compared to before CAPD. Thus, the use of CAPD can be seen to reduce sexual dysfunction and therefore improve the quality of life of women with CKD.

Risk Factors for Prostate Volume Progression After Prostate-Transurethral Resection.

BACKGROUND: Many factors could contribute to the cases of residual benign prostate hypertrophy (BPH) volume after transurethral resection of the prostate (TURP), such as age, obesity, testosterone level, and inflammation. The goal of this study was to determine the risk of tumor necrosis factor-α (TNF-α), transforming growth factor-ß (TGF-ß) in prostate tissue, serum prostate-specific antigen (PSA), serum testosterone, and age in promoting prostate volume progression after TURP. PATIENTS AND METHODS: This was a prospective cohort study on 83 BPH patients who underwent TURP at five hospitals in Bali, Indonesia. Trans-rectal ultrasonography (TRUS) was carried out to examine the prostate's size. Three years after, we redo the TRUS examination to collect the data of the latest prostate size. TNF-α, TGF-ß, serum PSA, testosterone, and age were registered for analysis. We used Pearson's and Spearman's correlation tests and multivariate analytic linear regression test (coefficient ß) by SPSS 13.0 software. RESULTS: Age, testosterone, PSA, TNF-α, TGF-ß were positively correlated to prostate's volume progression. The prostate volume was strongly correlated with age (r= 0.749, p <0.001), PSA level (r=0.896, p <0.001), testosterone level (r=0.818, p <0.001), and TGF-ß (r=0.609, p <0.001). The TNF-α level has a weak correlation to prostate's volume progression (r=0.392, p <0.001). CONCLUSION: TNF-α, TGF-ß, PSA, testosterone, and age were significant as the risk factors in promoting the prostate volume progression after TURP.

Functional and Cosmetic Urethroplasty Outcome, Emotional Stress after Genital Examination, Post Traumatic Stress Disorder, and Ages at the Time of Urethroplasty as Potential Risk Factor Causing Psychosocial Disorder of Hypospadia Children.

BACKGROUND: Children with hypospadias, being born with congenital abnormalities, having repeated genital examination, hospitalization, and undewent genital surgery, experienced psychological stress that may negatively affect their psychosocial life. Choosing the proper time of surgery as recommended is important, since it may have a positive impact on the psychosocial adaptation. AIM: This study aims to find the risk factors causing psychosocial disorders in post-repair surgery on hypospadias children. METHODS: This is a case control study, from 203 hypospadias patients underwent urethroplasty from 2009 to 2018. Subjets were screened for psychosocial disorders by Pediatric Symptoms Questionnaire 17 (PSC-17) questionnaire to find those with psychosocial disorders, score 15 or more (case group) and those without psychosocial disorders (control group), score 0-14. We traced back the data retrospectively from both group (history of utrethrocutaneous fistula and meatal stenosis, age upon urethroplasty) and collecting new ones (cosmetic outcome, emotional stress after genital examination, and the existence of PTSD). Fisher's exact test was performed to see the Odds ratio (OR) for each variable. RESULTS: Some children with hypospadias show impaired on psychocosial. Functional and cosmetic outcome not significantly different as potensial risk factor psychosocial disorders, genital examination doesn't trigger psychological stress and also none children show PTSD symtomp after surgery. Comparison time of age urethroplasty did not differ significantly between two group. CONCLUSIONS: Twenty-nine children post urthroplasty show psychosocial disorders. Functional and cosmetic urethroplasty outcomes, emotional stress after genital examination, post-traumatic stress disorder were not risk factors of pshycosocial disorder of hypospadias patients. Ages at time of surgery did not differ significantly between two group and this is contradict to the previous recommendations.

An unusual case of lymphadenopathy due to Continuous Ambulatory Peritoneal Dialysis becomes a challenge during renal transplantation.

A 31-year-old male was diagnosed with Stage V Chronic Kidney Disease and treated with Continuous Ambulatory Peritoneal Dialysis (CAPD) for five years before agreeing to a renal transplantation. Prior to the procedure he suffered from lymphadenopathy due to peritonitis. This complication became an obstacle as it prevented vascular access to the iliac artery and vein. An extensive lymphadenectomy had to be performed before continuing with the procedure. Nevertheless, the procedure was carried out successfully. Iliac lymphadenopathy as a result of peritonitis due to CAPD could become a challenge during renal transplantation if it hindered vascular access during anastomosis.

Association between Early Resistive Index Measurement and Early Graft Function and Long-Term Graft Survival after Kidney Transplantation: an Evidence-based Clinical Review.

BACKGROUND: resistive index (RI) is highly utilised to assess the graft function using Doppler ultrasonography. The RI has been shown as the best ultrasound parameter to assess kidney allograft dysfunction. Several studies have established the role of the RI as a predictor of transplant failure. However, these studies were using RI measurement in the later stages post transplantation. The present study has conducted to identify the association between early RI measurement and early graft function represented as delayed graft function (DGF) and immediate graft function (IGF), as well as long-term graft survival. METHODS: an evidence-based clinical review of studies published before May 2018 was conducted from Medline, Science Direct, EMBASE and Cochrane databases. Studies on early measurement of RI whereby the primary or secondary goals of the study related to graft function and/or graft survival were included. Studies using late RI measurement and without RI value groups were excluded. The Mantzel-Haenzel method was used to analyse pooled risk ratio and 95% confidence interval, while the heterogeneity of the study was calculated through I2 value. Data analysis was performed using Review Manager 5.3. RESULTS: nine studies with a total of 1802 patients who had undergone a kidney transplant were analysed. DGF was found in 19% (193/1015) of the low RI group and in 42.8% (337/787) of the high RI group (RR 2.04 (95% CI 1.72 - 2.41), p < 0.00001, I2 = 28%). IGF was found in 39.5% (62/157) of the low RI group and in 10.5% (28/268) of the high RI group (RR 0.26 (95% CI 0.17 - 0.40), p < 0.00001, I2 = 0%). Long-term graft survival, with follow up between 60-144 months, was found in 83% (701/845) of the low RI group and in 69.4% (395/569) of the high RI group (RR 0.82 (95% CI 0.72 - 0.93), p = 0.002, I2 = 63%). CONCLUSION: the results of this study emphasise the association between early measurement of RI and early graft function, and long-term graft survival. An elevated RI provides the chance of recognizing the patients with poor long-term prognosis, from the first moment after kidney transplant.

Urethral cavernous hemangioma in female: Surgical resection and reconstruction with ventral vaginal graft urethroplasty.

Urinary hemangiomas are uncommon and can predispose any part of the urinary system. The urethra is infrequently involved and usually affected male urethra. We reported a sixty-three-year-old female patient with intermittent urethral bleeding due to tumor arising at the edge of the urethra. Urethrocystoscopy was done prior to surgical resection and ventral vaginal graft urethroplasty was performed directly afterwards. Histopathological reported a urethral cavernous hemangioma. An individualized approach regarding the most appropriate procedure for a given patient should be recommended.