The effect of standing and sitting voiding position on uroflowmetric findings and postvoiding residual volume in men with Benign Prostatic Hyperplasia (BPH)

Background: Some studies proposed that different voiding position can affect voiding quality in men with benign prostatic hyperplasia (BPH). It is said that a particular voiding position can provide better uroflowmetric findings and less post-void residual volume (PVR) in men with BPH. This study aimed to analyze the effect of the two most common voiding positions (standing and sitting) on uroflowmetric findings and PVR in men with BPH to make a recommended voiding position for men with BPH.

Methods: In this cross-sectional study, 36 men with symptomatic BPH were enrolled. The uroflowmetric study was done for each subject in 2 positions: standing and sitting. The following uroflowmetric parameters were studied: maximum flow rate (Qmax), time to maximum flow, average flow rate (Qave), and voiding time. PVR was assessed after each test. Data were analyzed by SPSS version 23 for Windows.

Results: The mean Qmax was significantly better in sitting than a standing position (11.106±4.7801 mL/s vs. 9.536±5.3374 mL/s; p=0.018); the mean Qave, time to maximum flow, and PVR were not different between 2 positions. The mean for Qave for standing and sitting positions were 5.014±2.9888 mL/s and 5.508±2.4437 mL/s in, (p=0.058), the mean voiding time were 43.08±7.980 seconds and 40.22±9.897 seconds, respectively (p= 0.31), and the meantime to maximum flow was 12.39±7.454 seconds and 10.06±4.610 seconds, respectively (p=0.192). In contrast, mean PVR was 87.28±44.810 mL and 72.53±42.779 mL, respectively (p=0.091).

Conclusion: The result of this study showed that sitting position had better Qmax than standing position. Incorporating a sitting position with other BPH management might give a synergistic effect that improves urinary flow in men with BPH.

Evaluation cut-off point of Prostate-Specific Antigen (PSA) and Prostate-Specific Antigen (PSA)-density in prostate cancer suspected patients at Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia

Background: PSA is a test performed to detect prostate cancer. There is currently no rational standard for its cut-off point, resulting in the increasing number of patients with prostate biopsy complications. This study aims to determine the estimated cut-off point of PSA and PSAD among patients with suspected prostate cancer (PCa) in Makassar.

Methods: A single-center retrospective analysis using a cross-sectional design was applied in this research. The sample was obtained through medical record data from benign prostate enlargement (BPE) and PCa patients in three affiliate hospitals from January 2014 to December 2019. Mann-Whitney U, Chi-Square, Fisher's Exact, and ROC tests were performed in the statistical analysis (considered significant if p <0.05). Data were analyzed using SPSS version 22 for Windows.

Results: Among 470 subjects, 88.3% were BPE patients, and 11.7% were PCa. Lower urinary tract symptoms (LUTS) were found in 70.6% of patients, and those with hematuria remained at 10.6%. The average prostate volume was 53.8±25.72 ml. The prostate consistency examination with the digital rectal examination (DRE) made up 84.3% Solid Chewy in the BPE sample and 96.4% hard solid in the PCa sample. The average PSA value in BPE was 14.82±20.1 ng/ml, and the PCa was 48.10±42.58 ng/ml, while the average PSAd BPE value was 0.287±0.40 ng/ml, and PCa was 1.19±1.32 ng/ml. PSA cut-off point was 18.62 ng/ml. PSAD cut-off point was 0.533.

Conclusion: PSA and PSAD cut-off points in this study 18.62 ng/ml and 0.533. The cut-off point obtained is far higher than the value agreed upon in advance.

Insulin resistance is associated with severe coronary artery stenosis in non-diabetic chronic coronary syndrome at Sanglah General Hospital, Bali

Background: The prevalence of insulin resistance (IR) increases worldwide due to the increasing number of the elderly population, obesity, and physical inactivity. IR modifies insulin’s effect on blood vessel walls, with anti-atherogenic effects on insulin-sensitive and pro-atherogenic effects on IR conditions. However, the relationship between IR and the degree of atherosclerosis is still not conclusive. This study will examine the relationship between insulin resistance marker HOMA-IR and the degree of coronary artery stenosis using SYNTAX score measurements in non-diabetic subjects with the chronic coronary syndrome.

Methods: The study was conducted on 68 subjects with non-diabetic chronic coronary syndrome taken by consecutive sampling. The diagnosis of the chronic coronary syndrome (CCS) is defined as subjects with significant ≥50% stenosis findings on coronary angiography. The degree of insulin resistance was measured using HOMA-IR and subjects were divided according to the HOMA-IR quartile. Data were analyzed in bivariate and multivariable modeling by SPSS version 25 for Windows.

Results: The prevalence of severe coronary stenosis was 11.8%, 17.6%, 29.4% and 64.7% in quartiles 1, 2, 3 and 4, respectively. In multivariate analysis, it was found that quartile 4 subjects with cut-off value HOMA-IR ≥12.30 (OR 7.0; 95% CI=1.3-39.0; p=0.025) is an independent predictor of severe coronary stenosis, along with age ≥50 years (OR 13, 8; 95% CI=1.1-174.1; p=0.042), BMI ≥25 kg/m² (OR 15.1; 95% CI=2.4-96.7; p=0.004), smoking (OR 18,0; 95% CI=2.0-160.5; p=0.010)  Also found that statin therapy ≥2 months (OR 0.11; 95% CI 0.02-0.59; p=0.010) is an independent protective factor against severe coronary stenosis in non-diabetic CCS subjects.

Conclusion: This study shows an independent association between IR and severe coronary stenosis in non-diabetic CCS subjects. This finding further strengthens clinical evidence of the direct pro-atherogenic effect of IR regardless of its glucose control effect and other metabolic syndrome components.

Correlation of bacterial index to zinc serum level in multibacillary type leprosy patient

Background: Leprosy Multibacillary type is the leading source of infection because total of bacteria is high. Zinc is an essential trace element of viability of host or pathogen. This research aimed to determine the relationship between bacterial index with zinc serum level in patients with leprosy multibacillary type.

Methods: It was cross-sectional observational analytic research in 31 subjects selected using consecutive sampling and they met inclusion and exclusion criteria conducted in Outpatient Installation at RSUD Dr. Saiful Anwar Malang and RS Kusta Kediri in February to March 2019. Examination of acid-resistant bacteria used Ziehl Neelsen's staining method and measurement based on Ridley and Joplin. Test/examination of zinc serum level was conducted in Prodia Laboratory using Inductively Coupled Plasma-Mass Spectrometer (ICP-MS). data were analyzed statistically using program of Statistical Package for Social Sciences (SPSS) version 24.

Results: From 31 research subjects, it was obtained that the lowest bacteria index of 1+ and the highest bacteria index of 6+ with median value of 3.5±2. the average of zinc serum level was 61.81±13.28 µg/dL with the lowest level of 37.00 µg/dL and the highest of 94.00 µg/dL. Based on Spearman correlation test, it was obtained correlation value of - 0.557 (55.7%) and value p = 0.001.

Conclusion: There is a significant correlation between bacteria index and zinc serum level with strong closeness value. Correlation is negative, the higher bacteria index, the lower zinc serum level.

Correlation between loss of cervical lordosis and the degree of cervical disc herniation

Background: Chronic neck pain is a common health problem and is increasingly relevant in health-related quality of life, not only in industrialized countries. The etiology of neck pain is very complex and may be associated with disc herniation, facet joints, muscles, and ligaments that cervical stability will gradually decrease and can cause damage and lead to loss of cervical lordosis. However, studies rarely report the correlation between cervical lordosis and cervical herniation in patients with neck pain. The purpose of this study was to determine the profile of cervical lordosis curves in patients with chronic neck pain and prove the correlation between the degree of cervical disc herniation with loss of cervical lordosis.

Method: This study was designed as an analytic study with a retrospective cross-sectional approach. Cervical lordosis curves are measured from mid sagittal cervical MRI while the degree of cervical disc herniation is evaluated using a herniation score. The Spearman correlation test and a simple linear regression test were performed to assess the relationship between loss of cervical lordosis and cervical herniation severity. Multivariate analysis was performed to adjust for the effect of confounding variables.

Result: A total of 67 study samples, 64.2% male and 35.8% female, with an average age of 54.7 ± 12.5. Cervical lordosis angle was found not normal (86.6%), most are in the form of hypolordosis (41.8%) and kyphosis (43.3%). The most herniation was in protrusion stage (47.8%). There was a significant correlation between the loss of the cervical lordosis and the degree of disc herniation (r -0.259, and p-value 0.034), each increase of one cervical disc herniation score affects the angle of the lordosis curve by -1.9 degrees, with a coefficient value of B = -1,914 (95% CI, p = 0.026).

Conclusion: there is a significant correlation between loss of cervical lordosis and cervical disc herniation (p <0.05).

Development of ureteroneocystostomy in pediatric population: ten years of experience from Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia

Background: Ureteroneocystostomy is one of the most common surgery in pediatric urology. The procedure can be performed either laparoscopically or in open surgery fashion. Currently, there is limited data available regarding the outcome of pediatric ureteroneocystostomy in Indonesia. The aim of this study is to evaluate the efficacy and safety of pediatric ureteroneocystostomy in both laparoscopic and open surgery techniques in one of the largest referral hospitals in Indonesia.

Methods: This is a retrospective study in which all patients with age of 18 or below underwent ureteroneocystostomy in Cipto Mangunkusumo general hospital was included in ten years period. The outcome analyzed was the patients' demographic profile, procedure duration, blood loss, and length of stay of the patients.

Results: A total of 46 patients underwent ureteroneocystostomy from year 2010 to 2020 with 38 patients underwent open surgery and 8 patients underwent laparoscopic surgery. The median age of the patients was 5 years old, which predominantly female (60.9%). The most common urology condition was vesicoureteral reflux and ectopic ureter at 34.8%. The median procedure duration was significantly shorter in the open surgery than laparoscopic group (180 and 325 minutes, respectively; p=0.002). There was no significant difference in blood loss and length of stay between two groups.

Conclusion: The preferred ureteroneocystostomy technique used was open surgery, with the most common etiology of the patients underwent the procedures were vesicoureteral reflux and ectopic ureter. In addition, the open surgery approach also leads to a shorter procedure duration than laparoscopy.

The voiding pattern of aterm neonates

Introduction: The concept of voiding patterns in neonates had not been completely understood. The voiding pattern in neonates was physiologically different from that in older children. The brain's development affects voiding patterns in frequency, bladder volume, and post-void residual bladder volume, as the child keeps growing. This study aims to understand the physiological neonates' voiding system in Indonesian newborns.

Materials and methods: We evaluate ten normal-born and 12 perinatology-hospitalized aterm neonates without anatomical or physiological urologic abnormalities at RSUP Haji Adam Malik from October to November 2019. We used an observational study, assessing the voiding physiology in newborns, including voiding frequency and urine volume. Infants with a history of urinary tract infection or present bacteriuria confirmed by urine culture were excluded. Voiding volume, frequency, bladder capacity, and residual volume were measured.

Results: We collected a total of 22 patients, with 12 patients were perinatology-hospitalized and ten patients were healthy neonates with ten subjects were male, and 12 subjects were female. There was no correlation between voiding frequency and total voiding volume with perinatology-hospitalized, healthy neonates, and sex. (p>0.05). Independent T-test was performed with a p-value for volume, frequency, bladder capacity, and residual volume of 0.225, 0.112, 0.031, and 0.663. We got a significant difference in bladder capacity between healthy neonates and perinatology-hospitalized. No significant differences were noted in other variables. Pearson correlation analysis was performed to determine the correlation between total voiding volume and age of gestation, body weight, length, head circumference, abdominal circumference, and chest circumference. The correlation coefficients were 0.772, 0.869, 0.623, 0.698, 0.079, 0.523 in order, with significant p-value in the age of gestation, body weight, length, head circumference, and chest circumference. There were correlations between total voiding volume and age of gestation, body weight, length, head circumference, and chest circumference. 

Conclusion: In conclusion, we found there was a significant difference in bladder capacity between healthy neonates and perinatology-hospitalized.

Effect of high-fat high fructose diet and carbon tetrachloride on high sensitivity C reactive protein (hsCRP) levels male Wistar rat

Background: The consumption of a high-fat diet affects fat metabolism in the body, and it gets progressively worse by adding high fructose to the diet. Similarly, the chemical compound carbon tetrachloride (CCl4) can cause toxic effects in multiple organs. High sensitivity C reactive protein (hsCRP) is a micro-inflammatory marker used as a primary preventive tool against several diseases. This study aimed to determine the impact of giving a high-fat, high-fructose diet (HFHFD) and CCl4 on hsCRP levels of Wistar rats.

Methods: An experimental study among 24 male Wistar rats aged 8-12 weeks divided into four groups. Rats were fed an HFHFD and were either administered CCl4 biweekly (0.08 mL/kg, peritoneal) or not. The other two groups were fed with standard chow meal with CCl4 injection, and the un-injected group stands as a control group. All groups were monitored for eight weeks, and serum parameters were examined. Data were analyzed using SPSS version 17 for Windows. P-value <0.05 was significant.

Results: The intake of a high fat and high-fructose diet for eight weeks was proven to have higher levels of hsCRP than those without the diet. Similar to the administration of 0.8 ml/kg peritoneal CCl4 biweekly shown to have higher levels of hsCRP compared to the control group. This study also showed increased body weight except for the group that received a standard meal and CCl4 peritoneal injection.

Conclusion: High-fat high fructose diet and carbon tetrachloride had a significant effect on hsCRP level.

Pure prostatic ductal adenocarcinoma with elevated prostate-specific antigen level: a rare case report and literature review

Introduction: Prostatic ductal adenocarcinoma (PDA) is rare, representing approximately 0.4 to 0.8% of all prostate malignancies. It usually occurs in the prostatic urethra around verumontanum, its prognosis is generally considered to be worse compared to acinar adenocarcinoma.

Case description: We present a 75-year-old male with PDA with an elevated PSA level. PDA histologically characterized by pseudostratified columnar cells. It is associated with aggressive behavior with an overall poor prognosis. Although normal PSA is a common finding in those with PDA, the presence of elevated PSA levels should not be used to exclude the possibility of PDA.

Conclusion: PDA is a rare variant of prostate cancer which is histologically characterized by pseudostratified columnar cells. Although normal PSA is a frequent finding in those with PDA, the presence of elevated PSA should not be used to exclude the possibility of PDA.