Feasibility and safety of transvaginal specimen extraction for laparoscopic living donor nephrectomy: An Indonesian perspective compared with three different approaches.

INTRODUCTION: Laparoscopic live donor nephrectomy (LLDN) continues to expand in minimally invasive surgery; nevertheless, the studies are inadequate to compare standard kidney extraction with TV-NOSE in less-developed countries. This study compared TV-NOSE with conventional kidney specimen extractions. OBJECTIVE: To examine the feasibility of TV-NOSE in live donor nephrectomy. MATERIALS AND METHODS: 53 patients received LDN surgery at our hospital from September 2017 to December 2021. Retrospectively, living donor nephrectomy with TV-NOSE was compared to three different surgical procedures with standard specimen extraction. RESULTS: 53 donor patients were included: 15 open (OLDN), 12 retroperitoneoscopic living donor nephrectomy (RPLDN), 10 transperitoneal living donor nephrectomy (TPLDN), and 16 standard laparoscopic living donor nephrectomy with transvaginal extraction (SLLDN TV-NOSE). SLLDN TVNOSE's longer operating time (p<0.0041) did not affect graft function. SLLDN TV-NOSE and RPLDN had shorter lengths of stay and better VAS trends than open LDN and TPLDN (p<0.05). SLLDN TV-NOSE donors reported acceptable surgical outcomes and unchanged sexual function. All patients had similar discharge creatinine levels, with 1-year transplant survival of 98% and just 1 graft loss in the TPLDN group. CONCLUSION: SLLDN TV-NOSE is equivalent to RPLDN and better than open LDN and TPLDN in terms of duration of stay, VAS score, surgical outcomes, and sexual function. TVNOSE is a safe surgical procedure with an acceptable donor complication. TV-NOSE may be safely conducted in both developed and developing countries with proper patient selection.

Role of somatostatin receptor SSRT5-AS1 in predicting biomarkers of primary androgen deprivation therapy on prostate cancer in Indonesian population.

INTRODUCTION: Androgen deprivation therapy (ADT) has been the pivotal strategy for treating advanced prostate cancers. Despite the high efficacy of ADT in prohibiting tumor growth, >50% cases of prostate cancer will develop into an aggressive variant known as castration resistant prostate cancer (CRPC). This study aimed to evaluate the potential role SSRT5-AS1 expression as a biomarker for response to ADT in prostate cancer. MATERIALS AND METHODS: In total, 36 patients diagnosed with prostate cancer at Dr. Sardjito General Hospital, Yogyakarta, Indonesia were enrolled from 2015 and 2019. The expression of SSRT5-AS1 in primary tumors was quantified using quantitative real-time polymerase chain reaction. RESULTS: The mean age of patients enrolled in this study was 69.07 ± 8.7 years, and the mean of prostate-specific antigen in patients was 141.22 ±112.28 ng/ml. Compared with the median, a higher expression of SSTR5-AS1 had more significant prognostic value than the variable shorter time to CRPC (p= 0.043). CONCLUSION: This study demonstrated that high expression of SSRT5-AS1 is a promising biomarker to predict response to ADT in patients with prostate cancer.

Coping with Coronavirus disease 2019: current state review and SWOT analysis to improve the urological services in Southeast Asia.

INTRODUCTION: We investigated the impact of Coronavirus Disease 2019 (COVID-19) pandemic on urological services by analyzing current attitudes and practices of urologists in the Southeast Asian (SEA) countries and create ways for improvement. MATERIALS AND METHODS: Quantitative data were used as critical indicators of workload of urological services from each country in SEA. Qualitative data analysis was done to describe the current state of attitudes of urologists against COVID-19 in the region. A strengths, weaknesses, opportunities, and threats (SWOT) analysis was performed to formulate strategic action plans. RESULTS: A total of seven urologists from six SEA countries completed the survey. Approximately 21-40% reduction in elective surgeries and outpatient visits, as stated by 42.9% and 57.1% of respondents, respectively was noted. Collectively, most respondents (71.4%) experienced <20% reduction in emergency visits. Various strategies were utilized as reaction to the pandemic. These include utilization of virtual communication platforms, pre-surgical COVID-19 screening, and limited number of accepted outpatient appointments and surgeries. Face to face patient consultations were still considered needed by many urologists although most countries had prohibited direct patient contact. The national response of countries such as Malaysia, Singapore, Thailand, and Vietnam were successful in controlling the pandemic. However, Indonesia and Philippines struggled because of the limited testing and tracing capabilities. Through the SWOT analysis, strategies were identified which can help overcome COVID-19 and any other future pandemics: (1) restarting the urological services in a safe and sustainable manner; (2) optimizing financial and infrastructural capacities; and (3) regional collaboration to strengthen the health systems. CONCLUSION: COVID-19 negatively impacted many health aspects, especially the delivery of urological services in SEA. Therefore, to ensure sustainability of urological services during the pandemic crisis, health care system should focus on safe, resilient, and adaptive approach with regional collaboration.