Sungsang Rochadi
Division of Urology/Department of Surgery, Faculty of Medicine/Gajah Mada University, Sardjito General Hospital, Yogyakarta.

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EFFECTIVITY OF PCNL WITH COMBINED ULTRASOUND AND FLUOROSCOPY Herwandar, Rajasa; Rochadi, Sungsang
Indonesian Journal of Urology Vol 21, No 2 (2014)
Publisher : Indonesian Urological Association

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Objective: To assess the effectiveness of Percutaneous Nephrolithotomy (PCNL) at age > 65 years and its complication. Material & method: Fifty-four patients with renal and proximal ureteral stones who underwent PCNL with ultrasound techniques combined with X-Ray at Sardjito and Pantirapih hospital, during 2007 to 2012. Laboratory data is in the form of hemoglobin, leukocyte count, trombocyte, haematocrit, natrium, potassium, chloride, BUN, creatinine both pre-operative and post-operative. The samples were divided according to age < 65 years old and above. In analyzing categorical data, we used chi-square test, whereas the numeric data analysis is using independent t-test with p < 0.05. Results: We found no significant differences between the age groups < 65 years and age > 65 years in stone location, presence of hydronephrosis, its grade and location. There also no difference based on operative time, intra-operative procedure, its complication and the day of DJ stents removal and nephrostomy. Both group showed similar result on laboratory findings. However, we found that the older age group have 2 days longer in the length of hospitalization than the younger age groups (p = 0.05) and history of diabetes mellitus and hypertension with p < 0.05. Conclusion: PCNL is a safe and effective procedure with minimal complications for the treatment of kidney and proximal ureteral stone, even for patients with co-morbidity. PCNL technique with guidance of ultrasound for early access would help tomake the operating time shorter and less exposure to ionizing radiation.Keywords: Percutaneous nephrolithotomy, age > 65 years old, effectiveness, safety.
CORRELATION OF PSA, PV, AND IPP IN DETECTING BOO CAUSED BY PROSTATE ENLARGEMENT Kurnia, Indra Cahya; Ghinorawa, Tanaya; Rochadi, Sungsang
Indonesian Journal of Urology Vol 21, No 2 (2014)
Publisher : Indonesian Urological Association

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Objective: To define the relationship between intravesical prostatic protrusion (IPP), prostate specific antigen (PSA), and prostate volume (PV), and to determine which one is the best predictor of bladder outlet obstruction (BOO) due to benign prostatic enlargement. Material & method: 95 male patients > 40 years old presenting with LUTS and BPH, between January until July 2012. They were evaluated with digital rectal examination (DRE), International Prostate Symptoms Score (IPSS), total PSA serum, uroflowmetry, post-void residual urine measurement, IPP and PV using transabdominal ultrasound. Statistical analysis included Chi-square and Spearman’s Rank correlation test.Receiver Operator Characteristic (ROC) curves were used to evaluate the correlation of PSA, PV, and IPP with BOO. Results: Mean PSA was significantly higher in obstructed patients (8.6 ng/mL; 0.76-130) compared to non-obstructed patients (6.44 ng/mL; 1.0-40.6). Mean PV was significantly larger in obstructed patients (50.33 mL ± 24.34) compared to non-obstructed patients (45.39 mL ± 23.43). Mean IPP was significantly greater in obstructed patients (7.29 ± 2.78) compared to non-obstructed patients (6.59 ± 2.93). The Spearman rho correlation coefficients were 0.617, 0.721, and 0.797, for PSA, PV, and IPP, respectively. Using ROC curves, the areas under the curve for PSA, PV, and IPP were 0.509, 0.562 and 0.602, respectively. The positive predictive values of PV, PSA, and IPP were 59.7%, 55.6% and 60.2% respectively. Conclusion: PSA, PV, and IPP measured through transabdominal ultrasonography are noninvasive and accessible method that significantly correlates with BOO in BPH patients. IPP is a better predictor for BOO than PSA or PV.Keywords: Bladder outlet obstruction, intravesical prostatic protrusion, prostate specific antigen, prostate volume, transabdominal ultrasound, benign prostate hyperplasia.
CONTINUOUS AMBULATORY PERITONEAL DIALYSIS USING STRAIGHT TYPE VS COILED TYPE TENCKHOFF CATHETER IN END-STAGE RENAL DISEASE PATIENTS AT SARDJITO HOSPITAL Rahman, Eka Yudha; Rochadi, Sungsang; Utomo, Trisula
Indonesian Journal of Urology Vol 18, No 1 (2011)
Publisher : Indonesian Urological Association

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Objective: The purpose of this study was to compare straight type versus coiled type Tenckhoff catheter for continuous ambulatory peritoneal dialysis (CAPD) in end stage renal disease. Material & method: A prospective cohort study enrolled end-stage renal disease patients undergoing CAPD for renal replacement therapy in Urology and Nephrology Department, Sardjito Hospital from January to December 2007. Identity and type of Tenckhoff catheter were recorded. Patients were grouped into two groups who used straight type catheter and coiled type catheter for CAPD, then observed for post-operative complication. Statistical analysis was done using SPSS 14.0 with chi-square test. Results: There were 27 patients included in this study. The cause of end-stage renal disease was mostly DM and hypertension. The most common complication after  operation  was catheter  obstruction  (9 patients). Another complication was intraabdominal bleeding (1 patient), and catheter migration (1 patient). In patients with straight catheter (20 patients), there were 8 patients (40%) with complication. In patients with coiled catheter (7 patients), there were 3 patients (42%) with complication. There was no significant difference in complications between straight and coiled catheter groups (p = 0,895). Conclusion: The result of this study revealed that no significant difference in complication between straight and coiled catheter for CAPD in end-stage renal disease patients
Early detection of Prostate Cancer with Prostate Specific Antigen > 4 ng/ml : A Multivariate Logistic Regression Yuri, Prahara; Rochadi, Sungsang
Indonesian Journal of Urology Vol 22, No 1 (2015)
Publisher : Indonesian Urological Association

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Background:Early detection of prostate cancer is a possible means of decreasing the mortality and increasing the quality of life. Objective :To determine whether the prostate specific antigen (PSA), abnormal DRE, family history, age, and prostate volume could increase the specificity and sensitivity of screening for prostate cancer. Methods :We included 92 patients with PSA > 4 ng/ml between January and December 2011 in Sardjito Hospital. Patients received prostate biopsy due to having abnormal serum prostate specific antigen (PSA) level. The relationship between the possibility of prostate cancer and the following variables were evaluated including: age; PSA level, prostate volume, DRE finding and family history. By using chi-square analysis, multiple logistic regression and receiver operating characteristic (ROC) curve were drawn based on the predictive scoring equation to predict the possibility of prostate cancer. All analyses were performed with SPSS, version 18.0. Results:We analyzed 92 patients with PSA > 4 ng/ml. It showed the relationship between the possibility of prostate cancer and the following variables, including : age (p < 0.001), PSA level (p < 0,001), DRE finding (p < 0.001) family history (p < 0,001) except prostate volume (p = 0.398). Using a predictive equation, P = 1/(1-e-X), where X= -3,821 +1.846 (if DRE positive) + 2,488 ( if family history positive ) + 1.718 ( when PSA > 10 ) + 1.414 ( when age > 68), followed by receiver-operating characteristic curve analysis, it showed the sensitivity 90,4% and specificity 85 % in predicting the possibility of prostate cancer. Conclusion:  Age,  DRE  finding,  PSA  and  family  history  are  factors  associated prostate cancer. They can be used as independent predictor to predict prostate cancer. Key words: Logistic regression, early detection,prostate cancer
AGE, TOTAL PSA, PSA DENSITY AND GLEASON SCORE, TAUS AS PREDICTIVE FACTORS IN PATIENTS WITH PROSTATE CANCER Albar, Daruqutni; Rochadi, Sungsang
Indonesian Journal of Urology Vol 23, No 1 (2016)
Publisher : Indonesian Urological Association

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Objective: To find the factors related as predictive factors for Gleason score in prostate cancer patients. Material & methods: This study obtained a total sample of 144 patients with prostate cancer in Sardjito General Hospital Yogyakarta in 2009-2013. Of the total 144 patients, only 64 patients had complete medical records. All patient samples were patients who had biopsy of the prostate. This study is a retrospective case-control study to predict the Gleason Score in patients with prostate cancer in terms of age, total prostate specific antigen (PSA), PSA density and TAUS. Normality test assessed the distribution of the data. Pearson test assessed normal distribution and Spearman test for normal distribution. All data were analyzed using SPSS version 18. Results: Analysis of data from 64 patients with prostate cancer with a normal distribution of the variables obtained on age and TAUS with p > 0.05 whereas abnormal distribution obtained on total PSA, PSA density with p < 0.05. Of the data on the data with a normal distribution, age and TAUS with values obtained p 0.039 and p 0.738. From these data it can be said there is a relationship between age and Gleason score where the higher the age the higher the Gleason score. TAUS of the data can be said there is no relationship between TAUS and Gleason score. Then the abnormal distribution of the data obtained with a total PSA p < 0.001 and PSA density p < 0.001. The data is obtained from the relationship between total PSA and PSA density with Gleason score. Conclusion: It was found that age, total PSA, PSA density affect the increase in Gleason score where the higher the age, total PSA and PSA density the higher the Gleason score in patients.
PERCUTANEUS NEPHROSTOMY IN PATIENTS WITH OBSTRUCTIVE UROPATHY DUE TO MALIGNANCY: A SURVIVAL ANALYSIS Yuri, Prahara; Rochadi, Sungsang
Indonesian Journal of Urology Vol 23, No 2 (2016)
Publisher : Indonesian Urological Association

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Objective:To find out effectiveness of percutaneous nephrostomy (PCN) and patient survival rate as palliative decompression of the obstructed urinary system due to malignancy (urogenital neoplasias). Materials &amp; Methods: A cohort retrospective study was performed with 76 patients (58 female and 18 male) with malignancy process who were undergoing percutaneous nephrostomy during January 2009 – December 2012, in Sardjito General Hospital Yogyakarta. Survival analysis was done by Kaplan-Meier method and differences were assessed using the log-rank test. Results:There was no procedure-related mortality. The mean of age was 49.14 years. The primary tumoral site was the uterine cervix in 56.6 %, the bladder in 17.1 %, the prostate in 2.6% and other sites (intestinal, ovarium and other malignancies caused obstructive uropathy) in 23.7%. The patients died during the hospitalization period due to advanced neoplasia are 17.1%. The mortality rate was higher in patients with interval between diagnose of obstructive uropathy and nephrostomy &gt; 7 days (HR=5.7; 95%CI 4.5-6.9; p = 0.001) and in those who required hemodialysis before the procedure (HR=6.1; 95%CI 4.7-7.4; p = 0.001). The survival rate was 55.2% (42/76) at 6 months and 32.9% (25/76) at 12 months. The percentage of the lifetime spent in hospitalization was 17.1% (13/76). There are no differences on survival rate in that patients based on neoplasias type and age.Conclusion: The urinary obstruction must be immediately relieved. The percutaneous nephrostomy is a safe and effective method for relief the obstruction. Patient with hemodialysis before the procedure had a poor prognosis.