Poster Abstracts

P01

Antioxidative mechanism of estrogen valerat as inhibitor carbonyl and advanced glycation endproducts (AGEs) from glycation hypothesis

Adenan¹, E. Suhartono², B. Setiawan²

¹Department of Public Health, Lambung Mangkurat University School of Medicine, Banjarbaru; ²Department of Medical Chemistry, Centre for Free Radical and Natural Product Studies, Lambung Mangkurat University School of Medicine, Banjarbaru, Indonesia

Background: Non-enzymatic glycation and oxidation of proteins by aldose sugars produces advanced glycation end products (AGEs). AGE accumulation is prominent in patients with diabetes mellitus, arteriosclerosis, and uraemia. Recently, AGEs have been shown to accumulate in both aged and Alzheimer's disease (AD) brains, and have been suggested to play a role in the aging process as well as in the pathogenesis of AD.

Aim: To measure the antioxidative mechanism from estrogen as inhibitor of glycation reaction.

Methods: This study was an in vitro assay to measure antioxidative mechanism from estrogen valerat. Antioxidative mechanisms consisted of H₂O₂ scavenging, •OH scavenging, metal chelating. Its antioxidative mechanisms applied to inhibit glycation reaction which was marked by decreasing of advanced oxidation protein product (AOPP), carbonyl level, and advanced glycation end products (AGEs). All measurement was done by spectrophotometer. Anti-aging was carried out in four groups (n = 6), i.e P0 control (3 ml of serum), P1 (3 ml of serum + glucose 500 mM), P2 (3 ml of serum + glucose 500 mM + estrogen valerat 0.15 g/100 mL).

Result: Average activity of H₂O₂ scavenging, •OH scavenging, metal chelating from estrogen valerat are 27.042 ± 10.303%; 105.778 ± 5.389%; and 5.128 ± 8.882% respectively. For AOPP inhibition, P0 vs. P1were different significantly (p < 0.05); P3 is higher than P0 and P1 significantly (p < 0.05). Its mean, etsrogen valerat induces AOPP formation in glycation reaction. For carbonyl level inhibition, P0 vs. P1; P1 vs. P2; was different significantly (p < 0.05), P0 vs. P2 was not different significantly (p > 0.05). For AGEs inhibition, P0 vs. P1; P1 vs. P2 was different significantly (p < 0.05), P0 vs. P2 was not different significantly (p > 0.05).

Conclusion: Estrogen valerat antioxidative mechanism is able to inhibit carbonyl level and AGEs from glycation reaction.

P02

Percutaneous nephrolithotripsy complication in the elderly

Akbari, N. Rasyid

Division of Urology, Dept of Surgery, Faculty of Medicine, University of Indonesia, CiptoMangunkusumo Hospital, Indonesia

Introduction: To know the complication rate and type of complication of percutaneous nephrolithotripsy for kidney stone in elderly.

Methods: A retrospective review of PCNL performed on 55 patients ≥ 60 years old was compared with 212 patients <60 years old. The data were collected from the Urology Department medical records, Cipto Mangunkusumo Hospital from January 1999 to December 2006 (8 years), the data of both groups were evaluated with Chi-square test and Student t-test.

Results: In the group aged <60 years, there were 22 patients (10.4%) with complications and 190 patients (89.6%) without complications, whereas in the group aged ≥60 years, there were 6 patients (10.9%) with complications and 49 patients (89.1%) without. There were no significant differences in complication between age group <60 years old and ≥60 years old. In the group <60 years the type of complication were: prolonged extravasation 4 patients (1.9%), fistula 1 patient (0.5%), infection with prolonged extravasation 1 patient (0,5%), bleeding from nephrostomy 1 patient (0.5%), bowel perforation 2 patients (0.9%), bleeding intra-operatively 13 patients (6.1%), no complications 190 patients (89.6%). In the group ≥60 years: prolonged extravasation 1 patient (1.8%), bowel perforation 0 (0%), bleeding intra-operatively 4 patients (7.3%), no complications 240 patients (89.9%). Treatment for the complications in the group <60 years: Dj stent insertion 4 (18.2%), ice compression 1 (4.5%), laparotomy and Dj stent insertion 2 (9.1%), conservative 2 (9,1%), insert 20 Fr drain retroperitoneally 1 (4.5%), transfusion 12 (54.5%), whereas in the group ≥60 years; Dj stent insertion 1(20%), transfusion 4 (80%). Length of stay in age group <60 years 5.45 ± 3.96 days and age group ≥60 years 5.33 ± 5.25 days. There was no significant difference in the length of stay between the 2 groups (p = 0.851).

Conclusion: The result revealed that performing PCNL in elderly patients (≥60 years) had the lowest complication and no significant difference in complications rate with age group <60 years.

P03

Aging male and lipid profile

Akbari, D. Rahardjo, A. Taher

Division of Urology, Dept of Surgery, Faculty of Medicine, University of Indonesia, CiptoMangunkusumo Hospital, Indonesia

Introduction: The goal of this research was to evaluate correlation among aging male symptom (AMS) score, testosterone, and lipid profile consisting of total cholesterol, LDL, HDL and triglyceride.

Method: We evaluated 344 men aged above 50 years old that lived in urban and rural areas. Data that have been collect are: age, AMS score, testosterone, lipid profile consisting of total cholesterol, LDL, HDL, triglyseride. We could evaluate only 210 men for lipid profile and testosterone.

Results: There is significant difference between urban and rural areas for BMI, total AMS, total cholesterol, LDL, and testosterone. The urban area had higher BMI (p = 0.000), total cholesterol (p = 0.000), LDL (p = 0.000) than the rural area. The rural area had higher testosterone (p = 0.000) and total AMS (p = 0.000). There is negative correlation among testosterone level with total cholesterol and triglyceride. There is positive correlation between testosterone with HDL. There is negative correlation among total AMS score with total cholesterol and LDL.

Conclusion: In the urban area, there was an increase in lipid profile and decrease in testosterone in older males.

P04

Giant kidney worm (Dioctophyma renale)

A.S. Bintoro¹, B. Soebhali¹, B. Daryanto², B.B. Purnomo²

¹Department of Urology, Airlangga University, Soetomo Hospital, Surabaya; ²Department of Urology, Brawijaya University, Saiful Anwar Hospital, Malang, Indonesia

Dioctophyma renalis is a very rare worm disease in the kidney. A 67-year-old male came to our hospital with the chief complaint of worm expulsion from the urethral meatus since 1 week before. He also complained of left abdominal discomfort since 2 months before. In physical examination we revealed anaemic condition and knock pain in the left flank. Laboratory findings showed haemoglobin of 9.1 g/dL, leukocyte 52,100, urine sediment showed full of erythrocyte. Pseudomonas aeroginosa was found in the urine culture. Urine cytology revealed atypical cells. We also performed IVU and found the left kidney was not visualised. We confirmed the IVU results with USG examination, and found the left kidney was enlarged, lobulated with solid mass appearance in it. MRI revealed worm in the left kidney, also in the bladder.

As a diagnostic tool we performed cystoscopy, and 65 g of worms were evacuated (diameter of 23 mm and 30–40 cm). Bladder mucosa was hyperemic and we also noticed worm in the left ureteral orifice. Left retrograde pyelography showed filling defect and irregularity in the lower pole.

One week later a left nephrectomy was done, and the histopathology report was squamous cell carcinoma.

P05

The pattern of urological malignancy in three major hospitals in Indonesia

A. Teguh, S. Sugandi

Division of Urology, Department of Surgery, Faculty of Medicine, University of Padjadjaran, Hasan Sadikin Hospital, Bandung, Indonesia

Introduction and objective: The importance of epidemiological information about cancer is well known but information is lacking from many developing countries. At the moment there is still no population based cancer registry in Indonesia. The only available data is hospital based. The objective of this study is to compare the pattern of urological malignancy in three major hospitals namely in Jakarta, Bandung and Surabaya.

Methods: The data of urological malignancy in a 5 year period (2001–2005) obtained from Cipto Mangunkusumo Hospital, Jakarta, Hasan Sadikin Hospital, Bandung, Soetomo Hospital, Surabaya.

Result: In the period of 2001–2005 there were 1331 cases of urological malignancy, bladder cancer 625 cases (46.9%), prostate cancer 360 (27%), renal cancer 154 (11.5%), testicular cancer 119 (8.9%) and penile cancer 119 (8.9%). While the percentage of those malignancies in Bandung were bladder cancer 48.6%, prostate cancer 21.7%, testicular cancer 14.47%, renal cancer 13.8%; in Jakarta bladder cancer 35.6%, prostate cancer 34.7%, renal cancer 10.6%, testicular cancer 8.84%, penile cancer 4.8%; in Surabaya bladder cancer 60.8%, prostate cancer 20.1%, renal cancer 10.8%, testicular cancer 5.5%, penile cancer 1.9%.

P06

Comparison of body mass index, aging male symptom score between urban and rural Indonesian males

M.A. Palinrungi, D. Rahardjo, A. Taher

Division of Urology, Department of Surgery, Faculty of Medicine, University of Indonesia, CiptoMangunkusumo Hospital, Indonesia

Introduction: The purpose of this research is to evaluate and compare body mass index (BMI), and aging male symptom (AMS) score in urban and rural Indonesian males.

Method: We had evaluated 344 males aged above 50 years old that lived in urban and rural areas. Data that have been collected: age, height, weight, BMI, and AMS score.

Results: There are 344 males, 76 in rural and 268 in urban. Mean age in rural 61.79 ± 10.71, and in urban 58.59 ± 7.89. Rural BMI 19.28 ± 2.11, in urban BMI 24.65 ± 4.09 (p = 0.000). Total AMS score in rural 33.84 ± 7.12, in urban 28.91 ± 8.30 (p = 0.000). AMS psychology subscale in rural 7.47 ± 2.54 and in urban 7.06 ± 2.72 (p = 0.236), AMS somatovegetative subscale in rural 15.26 ± 3.83 and in urban 12.22 ± 3.79 (p = 0.000), AMS sexual sub scale in rural 11.11 ± 2.96 and in urban 9.62 ± 3.59 (p = 0.001).

Urban BMI is higher than rural. Whereas total AMS score, AMS sexual subscore, AMS somatovegetative subscores are higher in rural than in urban area.

Conclusion: There are significant differences among BMI, total AMS score, AMS sexual subscore, and AMS somatovegetative subscores in urban and rural area.

P07

Predictive factors for bladder stone in benign prostate hyperplasia (BPH) patients

A. Amir, R. Umbas, C.A. Mochtar

Division of Urology, Department of Surgery, Faculty of Medicine, University of Indonesia, CiptoMangunkusumo Hospital, Indonesia

Objective: To find predictive factors for bladder stone in benign prostatic hyperplasia (BPH) patient.

Method: Data have been collected from BPH status Urology Department, Cipto Mangunkusumo Hospital since 1 January 1995 until 31 December 2005. Data have been processed using SPSS 13.0 and analysed with logistic regression test with p < 0.05.

Results: There are 240 BPH patients with bladder stones, compared to 1002 BPH patients without bladder stones as control. In 19 BPH patients with bladder stones (7.9%) the stone was found during operation. In BPH patients with bladder stone the mean age was 65.89 ± 7.27 years old, length of LUTS time was 10.49 ± 12.12 months, retention found in 97 patients (40.4%), irritative symptoms score 4.73 ± 1.86, gross haematuria found in 89 patients (37.1%), microscopic haematuria was 47.37 ± 44.11 erythrocyte sediment/hpf, leucocyturia was 35.25 ± 41.55 leucocyte sediment/hpf, mean prostate volume was 43.12 ± 13.47 cc and urinary tract infection (UTI) was found in 78 patients (32.5%). By logistic regression test the significant predictive factors for bladder stone in BPH patient were irritative symptoms score > 4, retention, gross haematuria, microscopic haematuria and leucocyturia.

Conclusion: Predictive factors for bladder stones on BPH patients are irritative symptoms score >4, retention, gross haematuria, microscopic haematuria and leucocyturia.

P08

Intravesical prostatic protrusion as a predictor of bladder outlet obstruction in BPH patients at Cipto Mangunkusumo Hospital

H.M. Bimanggono, D. Rahardjo

Division of Urology, Department of Surgery, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Indonesia

Introduction: Benign prostate hyperplasia (BPH) is the second most common disease after urinary tract stones, affecting 70% of men above 60 years old in urologic practice in Indonesia. The gold standard to determine bladder outlet obstruction is pressure flow study. The aim of this study is to find correlation between IPSS (International Prostatic Symptom Score), QoL (quality of life), VP (volume of the prostate), IPP (intravesical prostatic protrusion), PVR (post voiding residue) with BOO (bladder outlet obstruction) and differentiate between obstructive/non obstructive cases and also to determine a clinical parameter to predict an obstruction.

Method: This is a prospective study including men 50 years old or more with LUTS (lower urinary tract symptoms) without retention in the Urology Department RSCM from 1 December 2005 until 31 August 2006.

Statistical analysis was done using SPSS 13.0 with Pearson and Spearman correlation test and Logistic regression test.

Results: There were 89 patients included in this study, with mean age 65.73 yr (50–87 yr), mean VP 42.31 cc (13.24–99.47 cc), mean IPP 11.96 mm (0–31 mm) and mean BOO index 56 (2.3–142.4).

There was no significant correlation between BOO and age (p = 0.77). There was significant correlation between BOO and IPSS (p = 0.01 r = 0.28), QoL (p = 0.01 r = 0.30), VP (p = 0.00 r = 0.61), IPP (p = 0.00 r = 0.72) and PVR (p = 0.00 r = 0.31).

There was significant correlation between BOO group and IPSS (p = 0.01 r = 0.26), QoL (p = 0.00 r = 0.30), VP (p = 0.00 r = 0.61), IPP (p = 0.00 r = 0.72) and PVR (p = 0.00 r = 0.31) to determine an obstruction.

Age, IPSS, QoL and PVR cannot be used as a predictor of an obstruction (p > 0.05). IPP (p = 0.00) was the strongest predictor an obstruction beside VP (p = 0.02) with R2 = 53.4% and equation was −9.75 + (0.38 IPP + 0.08 VP).

Conclusion: IPP can be used as a predictor to determine and obstruction together with VP.

P09

Prevalence of nocturia in the outpatient of the Surgery Department, Dr Sardjito Hospital

D.D. Kadar¹, B. Syamsul², T. Utama², P. Singodimedjo²

¹Division of Urology, Department of Surgery, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; ²Division of Urology, Department of Surgery, Faculty of Medicine, University of Gadjah Mada, Yogyakarta, Indonesia

Introduction and objective: The functions of the bladder are collecting and emptying urine. Nocturia is one of the symptoms in urine collecting function. It can be defined as urinating more than twice at night. Several authors mentioned that nocturia has a lot of influence in quality of life. The objective of this research is to estimate the prevalence of nocturia in patients' relatives with age group more than 40 years old visiting the Outpatients of the Surgery Department, Dr Sardjito Hospital.

Methods: A cross-sectional study has been done on 724 respondents (response 96%) among a population of patients' relatives at Outpatients of the Surgery Department Dr Sardjito Hospital from April until May 2003.The respondents have been divided into five groups as the following: 40–49, 50–59, 60–69, 70–79 and ≥80 years old, respectively. Each of respondents has answered a question and answer sheet form of the survey.

The data were analysed by statistic t-test.

Result: The prevalence of nocturia for patients' relatives more than 40 years old was 25% (180/724). The prevalence shown in men was 27% (104/377) whereas in females was 21% (76/347). The correlation between bad nutrition, sleep disturbance, occupation, health, and medication with nocturia showed significant effect (p < 0.05).

Conclusion: The prevalence of nocturia in males was more frequent than females. Nocturia is a condition that requires attention because its prevalence increases according to age, and influence in quality of life.

P10

EDAP LT.02 year 2000–2004 at Cipto Mangunkusumo Hospital, Jakarta

E.U. Harahap, R. Soemardi

Division of Urology, Department of Surgery, Faculty of Medicine, University of Indonesia, CiptoMangunkusumo Hospital, Indonesia

Introduction and objectives: This research is a descriptive study to give information about kidney stone treatment using (Extracorporeal Shockwave Lithotripsy) ESWL at Cipto Mangunkusumo Hospital. And from this research, hopefully more research about other aspects of ESWL can be developed.

Method: Data was collected retrospectively from special status of ESWL Urology Department Cipto Mangunkusumo Hospital, sub division Urologic Surgery since January 2000 until December 2004.

Results: From January 2000 until 31 December 2004, there were 2047 patient with kidney stone that had been treated using EDAP LT-02. Patient population consisted of 1377 male and 670 female. Kidney function during therapy; 87.34% good, 3.17% decreased, 0.68% non-functioning, 50.5% had obstruction. Stone location: 26.8% in renal pelvis, 5.8% in superior calyx, 7.48% in medial calyx, 31.5% in inferior calyx. Incidence for new stones is 89.8%, single stone 66.48%, and most of them radioopaque 91.8%.

Conclusion: Kidney stones in men are 3 times more common than in females, with peak incidence between 41–50 years old. Most have good kidney function. Half of them are obstructed. Inferior calyx stone is the most common. Most of them are single stones and radioopact.

P11

Stone-free rate and efficacy quotient ESWL machine EDAP LT-02 on kidney stone patient at Cipto Mangunkusumo Hospital in 2000–2004

E.U. Harahap, R. Soemardi

Division of Urology, Department of Surgery, Faculty of Medicine, University of Indonesia, CiptoMangunkusumo Hospital, Indonesia

Introduction and objectives: To know stone-free rate and efficacy quotient on kidney stone patient that had done ESWL machine EDAP LT-02 and correlation among stone-free rate with stone opacity, kidney function, stone location, number of stone and stone burden.

Method: Data have been collected retrospectively from special status of ESWL Urology Department, Cipto Mangunkusumo Hospital, sub division Urologic Surgery since January 2000 until December 2004.

Results: Stone-free rate all kidney stone is 40% with EQ 2.6. Whereas stone-free rate for pyelum stone, superior calyx stone, medial calyx stone and inferior calyx stone are 84.1%, 75%, 70%, and 50% for stone less than 10 mm and 50.87%, 28,5%, 23% and 44.1% for stone size 11–20 mm. And EQ or pyelum stone, superior calyx stone, medial calyx stone, inferior calyx are; 0.427–0.375–0.322–0.300. Significant correlations with stone-free rate are stone position, obstruction, number of stone and stone burden. Whereas those that do not have correlation are stone opacity and kidney function.

Conclusion: ESWL machine EDAP LT-02 at Cipto Mangunkusumo Hospital have the same stone-free rate compared to same type of machine and have effectiveness quotient not that different compared to ESWL using electromagnetic and electrohydraulic as power source. Factors that affect stone-free rate are: stone position, obstruction, number of stones and stone burden.

P12

The association between body mass index and testosterone level in aging men

E.E. Manuputty, D. Rahardjo, A. Taher

Division of Urology, Department of Surgery, University of Indonesia, Faculty of Medicine, Jakarta, Indonesia

Introduction: Obesity is becoming a major health problem worldwide, its prevalence having increased over the last 20 years. Interestingly obesity is frequently associated with low testosterone levels in men. After 40 years of age, men experience a fall in serum total testosterone (TT) levels and obese men have their TT levels up to 25% lower than their non-obese peers. The aim of this study is to determine the association between body mass indexes (BMI) to the decline of TT levels in aging men.

Methods: A hospital and community based cross-sectional study of men age 50 years and above was performed. According to their BMI, men were grouped as obese (BMI ≥23 kg/m²) and non-obese (BMI <23 kg/m²). All of them had their TT levels measured. TT levels of those groups were compared and the correlation between BMI and TT levels were calculated.

Results: There were 210 men aged 50 to 100 years (mean 57.27 ± 8.85 years) included in this study. Their mean BMI and TT levels were 18.52 ± 4.08 kg/m² (range 15.15–33.67 kg/m²) and 543.70 ± 189.85 ng/dL (range 136.50–1,209.00 ng/dL). Respectively 96 men were grouped as obese (mean BMI 26.61 ± 2.39 kg/m²) and 114 others as non-obese (mean BMI 19.58 ± 1.81 kg/m²). The mean TT levels in the obese group were 27% lower than in the non-obese group (450.89 ± 54.99 ng/dL vs. 621.85 ± 181.64 ng/dL; p < 0.001). BMI had significant inverse correlation with TT levels (Spearman's rho −0.440; p < 0.001).

Conclusion: Obesity may predict a greater rate of decline in TT levels and moderately inverse correlated with TT levels in aging men.

P13

Development of direct measures of non-SHBG-bound (bio-available) testosterone using LC-MS/MS

E. Koh, M. Takashima, Y. Kobori, Y. Maeda, M. Namiki

Department of Urology, School of Medicine, Kanazawa University, Kanazawa, Japan

Introduction and objective: Circulating testosterone (T) is comprised of several different forms. The free testosterone could be active form in the target tissues and the protein-bound testosterone complex was thought to be inactive. It has now been demonstrated that the albumin bound fraction of testosterone readily dissociates and is absorbed by the tissues along with the free fraction. Together, these two fractions are referred to as the bio-available testosterone fraction. The purpose of the study was to develop the direct measurement of bio-available testosterone that contained albumin bound fraction and free testosterone.

Methods: Bio-available T is determined by separation of the SHBG bound T from albumin bound T and free T fractions. Serum was pre-treated Con A Sepharose and extracted with ether. T derivates were formed using 2% 2-Fluoro-1-Methylpridinum p-Toluenesulphonate and 10% triethyl-amin-dicloromethane. These non-SHBG-bound T were refined using solid-phase cartridge column and measured by means of LC-MS/MS (liquid chromatography mass spectrometry) directly. We compared conventional measures of the level of bio-available T such as RIA assay and calculated method. The relationship between conventional measurements was evaluated by linear regression analysis.

Results: Correlations of the RIA assay and calculated method were significant. The correlation equations between direct and RIA measurement were found as y = 0.8382X + 97.111. The correlation equations between direct and calculated measurement were found as y = 1.8145X + 750.63.

Conclusion: The assays by LC-MS/MS were performed in fraction removing SHBG-bound T, these assays could measure bio-available T directly.

P14

Cardiovascular disease, diabetes mellitus, hypertension, liver disease, kidney disease, stroke, and BPH

G. Sutanto, D. Rahardjo, A. Taher

Division of Urology, Departmentt of Surgery, Faculty of Medicine, University of Indonesia, CiptoMangunkusumo Hospital, Indonesia

Introduction and objectives: This research aims to find existence of a relation between hypertension, diabetes mellitus, heart disease, liver disorder, kidney disorder and BPH with the AMS score.

Method: We evaluated 347 men above 50 years old living in town or rural. Collected data concerning disease suffered by subjects in the form of hypertension, diabetes mellitus, heart disease, liver disease and kidney disease and also BPH with AMS score.

Results: Respondents with kidney disorder were 6.6% (23 respondents). Respondents with kidney disorder had higher AMS score (p = 0.003) compared to non-kidney disorder. There was increasing mean of AMS score from 29.54 for kidney disorder respondents, becoming 37.13for non-kidney disorder respondents.

Conclusion: There are significant increasing AMS score respondents with kidney disorder, chronic kidney disease with complicated pathophysiology causing hypogonadism.

P15

Comparison of a semi-quantitative two site immunoassay device with 3^rd generation prostate specific antigen (PSA) machine for determining the PSA level

H.B. Zialcita, G.D. Yusi

National Kidney and Transplant Institute, East Avenue, Quezon City, Philippines

Obectives: To compare the agreement of values of PSA level using a semi-quantitative immunoassay tool (Cancheck Device) with the results from a 3^rd generation PSA machine, the Immulite 1000, and to compare the two tests in terms of total cost and time spent for consultations.

Methods: A cross-sectional study involving 100 volunteer patients who underwent PSA determination through the 3^rd generation PSA machine and Cancheck Device.

Results: Cohen's kappa coefficient was used to test the reliability or agreement of values between the PSA results from the Cancheck Device and the 3^rd generation PSA machine. A high 91.53% agreement was the result which is more than satisfactory. The total cost and total number of consultations by the patients were less with the Cancheck Device as compared with the 3^rd generation PSA machine.

Conclusion: The semi-quantitative Cancheck Device has the same reliability as that of the 3^rd generation PSA machine and it shows to be a fast and less costly alternative tool in PSA determination.

P16

Percutaneous nephrolithotripsy (PcNL) in elderly patients

H. Herman, N. Rasyid

Department of Urology, University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia

Introduction: Percutaneous nephrolithotripsy (PcNL) is a safe procedure in urology with minimal post-operative morbidity compared to open surgery. In several studies it has been proven that the PcNL is more superior than open surgery. In this study we try to evaluate the success rate, morbidity and other variable of PcNL that is performed in patients aged equal or above 60 years old (older group) compare to those aged below 60 years old (younger group).

Aims: To find out the safety of PcNL in the elderly, is it safe, effective and less morbid?

Methods: A retrospective review of PcNL performed on 55 patients of the older group compared to 212 patients of the younger group. The data were collected from the Urology Department medical records, Cipto Mangunkusumo Hospital from January 1999 to December 2006 (8 years), the data of both groups were evaluated with Chi-square test and Student t-test.

Results: The average stone size in the older group versus the younger group was slightly bigger in the older group (33.20 ± 13.23 mm vs. 31.65 ± 14.72 mm, p = 0.45), success rate in the older group was higher than the younger group (83.6% vs. 75.5%, p = 0.199). Residual stones were lower (24.5% vs. 16.4%, p = 0.199) in the older group, but there was no statistical difference. The delta haemoglobin of both groups (Hb before and after operation; 1.09 ± 1.28 vs. 1.02 ± 1.47, p = 0.75) were slightly higher in the older group but there was no significance. After treatment, length of stay was less (5.33 ± 5.25 days vs. 5.45 ± 3.96 days, p = 0.87), length of nephrostomy were also less (2.61 ± 1.99 vs. 2.80 ± 2.02, p = 0.56) and blood transfusion was higher (7.3% vs. 7.1%, p = 0.960) in the older group, but there was no statistical difference.

Conclusions: PcNL is a safe, effective and less morbid procedure for stone removal in the elderly, and equally in younger patients.

P17

Comparison of efficacy between morphine sulphate oral and diclofenac suppository for analgesia during transrectal ultrasound-guided prostate biopsy

H. Haswir, R. Umbas

Division of Urology, Dept of Surgery, Faculty of Medicine, University of Indonesia, CiptoMangunkusumo Hospital, Indonesia

Introduction and objectives: To prospectively evaluate the degree of pain during transrectal ultrasound-guided prostate biopsy after received oral analgesia morphine sulphate compared to suppository analgesia sodium diclofenac.

Method: The study group comprised 60 consecutive men (median age 67.8 years) undergoing transrectal prostate biopsy. They were randomised into two groups; men in group 1 received oral analgesia morphine sulphate 10 mg and group 2 received suppository analgesia sodium diclofenac 100 mg 1 hour before biopsy. Biopsy was taken using a gun biopsy 18 G needle with total biopsy 10 (5 at each lobe). Immediately after the procedure patients were asked to indicate the degree of pain based on visual analogue scale (VAS) from 0 (no pain) to 10 (unbearable pain) scale.

Results: The mean VAS score was 3.83 in the morphine sulphate group and 4.10 in the sodium diclofenac group. According to subdividing of VAS score, low degree of pain was found in 17 patients (56.7%) of the morphine sulphate group and in 14 patients (46.7%) of the sodium diclofenac group. There was no statistically significant difference in pain between the two groups (P > 0.05).

Conclusion: Oral analgesia morphine sulphate 10 mg had the same efficacy with sodium diclofenac suppository 100 mg to decrease the pain during transrectal prostate biopsy.

P17

Diagnosing bladder outlet obstruction in men with benign prostatic hyperplasia: A systematic review

I.N. Setyaningsih, C.A. Mochtar

Division of Urology, Dept of Surgery, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Indonesia

Background: Currently, pressure flow studies (PFS) have been accepted as the standard method of establishing bladder outlet obstruction (BOO). However, due to its invasiveness, cost and morbidities, many other methods have been proposed to replace PFS. This review was aimed to compare the diagnostic ability of these other methods in detecting BOO due to benign prostatic hyperplasia (BPH).

Method: A simple MEDLINE search was performed between January 1995 and August 2006 for published literature describing a diagnostic method of BOO in men with BPH. Articles were included if the methods were tested against PFS as the standard method. Comparisons were made using sensitivity, specificity, positive predictive value and likelihood ratio (LR).

Results: Various methods have been developed to diagnose BOO which include non-invasive, non-urodynamic and non-invasive, urodynamic methods. The non-invasive, non-urodynamic methods consisted of a symptom scoring system, post-void residual urine, serum prostatic-specific antigen level, bladder wall thickness (BWT), bladder weight, and intravesical protrusion of the prostate measurements. Non-invasive, urodynamic methods consisted of uroflowmetry, condom-catheter method, and Doppler ultrasonography. The highest diagnostic accuracy (LR > 10) was achieved by BWT measurement and urinary flow velocity by Doppler ultrasonography.

Conclusion: Several non-invasive diagnostic techniques have been proposed to diagnose BOO. Among them, only BWT measurement and urinary flow velocity could potentially replace PFS. More studies and training are needed before applying these methods in routine clinical practice. Combinations of two or more methods might increase diagnostic accuracy, but studies designed specifically for this purpose are limited and need to be further explored.

P18

Evaluation of a herbal formula with horny goat weed and ginseng complex (Nhance-X) in the maintenance of general well being in men

M.I.M. Tambi

Damai Service Hospital, Jalan Ipoh, Kuala Lumpur, Malaysia

Nhance-X is a herbal formula containing Epimedium or horny goat weed extract, ginseng complex, Ginkgo Biloba, Tribulus terrestris, Muira puama,Whitania somnifera and Damiana. These herbal extracts are associated with improved blood circulation, alleviating stress, enhancing libido and vitality and improving sense of well-being. It has been available in the Western market as a potent adaptogen and has been found to provide relief for stress and to improve physical strength, endurance and overall wellness for men and women and this relates to improvement in libido and sexual health. No study has been done locally to evaluate its efficacy since its availability in the local pharmacy. In the present evaluation, new users, namely the men, were monitored on their wellness using the following Quality of Life Questionnaires: Aging Male Symptoms (AMS) for men, Sexual Health Inventory for Men (SHIM), Grade of Erection score (GE). The study was an open labelled evaluation. Fifty sexually active males of all lifestyles of ages above 20 with problems of wellness, based on their complaints, participated in the evaluation. They were counselled on the voluntary nature of the evaluation and the need to come for regular follow-ups to assess the various QoL questionnaires and feedbacks from time to time as scheduled. Clients who were known to be diabetic or hypertensive and on treatment and whose medical condition was stable were included. Clients were registered into the study once their general health screenings were normal. They filled out the series of QoL questionnaires before the herbal products were given. The dose regime was two tablets twice daily. The study was scheduled for 6 weeks and the follow-ups week 1, week 3 and week 6. Fifty clients were recruited and all completed the study. The ages of the men ranged between 28 to 57 years. Twenty-six men were above the age of 40 and the remaining between 25–40 years. All men whose age was above 40 showed a high AMS score, indicating some aging symptoms. These symptoms reduced from the first week of taking the herbal preparation. These symptoms became progressively lower on the second follow-ups onwards. All men above the age of 40 had reduced SHIM score indicating some problem with getting quality erections. Thirty-four men had SHIM scores below 21 indicating some degree of ED (erectile dysfunction). Those men on the herbs showed improvements in the score, including the nine clients with diabetes on treatment and eight clients with hypertension on treatment that were able to get partial to complete firmness of the penis for penetrative sex. The quality of their erection improved from first week follow-up and improves further on second and third follow-up. All men above 40 have a lower grade of erection. Men on the herb showed improvement with the grade of erection, the majority with grade 3 became grade 4, and the majority with grade 4 became grade 5 on the second and third follow-up. The range of detoxification effects of the herb include headache (2/50), back ache (1/50), leg cramps (1/50), flushes (4/50), lethargy (2/50), increased urination (2/50), constipation (1/50) and itchiness of the flexures of forearm (1/50). These detoxification symptoms appear as early as within the same day of taking the herb and lasted up to 2–4 days. Only one client experienced constipation throughout the study. The intensity reduces from the second day onwards. The study showed that men on NhanceX benefited in their quality of life as their symptoms of tiredness and poor wellbeing identified through the SHIM score improved over time of taking the herb. The symptoms of detoxification of the herb that ranged from headache and backache were minimal and the rest of the detoxification effects were negligible. Men with problems of erection found relief with the herbs. The quality of their erections improved. Those who were able to perform penetrative sex found that they could have firmer erections. NhanceX herbal formula that contains seven herbal extracts known to have adaptogenic effects was found to benefit men in the maintenance of their wellbeing and sexual health. The herbal formula improves the symptoms usually experienced by aging persons as well as improves the quality of libido and sexual health in younger and older men as seen in the improvement in the SHIM scores of men with low SHIM score and improves quality of erection. It has erectogenic features and is useful in men with partial ED as it improves their SHIM score from less than 21 to above 21 and improves the grade of erection. Its detoxification effect when compared to other herbal supplement of similar class is less disturbing. NhanceX is recommended as a health herbal supplement specifically for vitality and maintenance of well being in men young and old.

P20

The effect of life style (exercise and alcohol consumption) on AMS score and testosterone level

L. Wirawan, D. Rahardjo, A. Taher

Division of Urology, Department of Surgery, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Indonesia

Introduction and objectives: Many studies have addressed aging male problems, the common scoring system in use is the Aging Male Score (AMS). Many factors, for example life style, affect aging problems. In this study we tried to find the correlation between an exercise and alcohol group and non-alcohol consumption to AMS score and testosterone level.

Method: We evaluated 344 men aged above 50 years old that lived in urban and rural area. Data that have been collected are: history of exercise, alcohol consumption, AMS score and testosterone level. Only 65 men could be evaluated for testosterone value in the exercise group and 145 men in the non-exercise group (N = 210), for the alcohol and non-alcohol groups the samples that could be evaluated subsequently were 17 patients and 193 patients (N = 210). The data were evaluated with Pearson Chi-square and Spearman correlation.

Results: Proportion of normal AMS score was higher in the exercise group (56.7%) than the non-exercise group (65.7%) (p = 0.064), and higher in the non-alcohol group (62.0%) than the alcohol group (60.7%) (p = 0.891). The proportion of lower testosterone level was higher in the exercise group (23.1%) than non-exercise group (18.6%) (p = 0.455), and also higher in the alcohol group (52.9%) than the non-alcohol group (17.1%) (p = 0.000).

Conclusion: There was a lower proportion in abnormal AMS score in the exercise group and higher proportion in low testosterone level in the alcohol group.

P21

Antioxidative mechanism from soya bean juice with ethynil estradiol as anti-aging caused by glycosylation hypothesis

M. Syachrumsyach¹, E. Suhartono², B. Setiawan²

¹Department of Obstetric Gynecology, Ratu Zalecha Hospital, Lambung Mangkurat University School of Medicine, Martapura; ²Department of Medical Chemistry, Centre for Free Radical and Natural Product Studies, Lambung Mangkurat University School of Medicine, Banjarbaru, Indonesia

Background: Aging can be defined as a progressive accumulation of changes with time which are responsible for damage to essential macromolecules and may be responsible for the high susceptibility to age-related diseases. The term glycation (non-enzymatic glycosylation) is employed to refer to the reaction of reducing sugars with side-chain amino groups in proteins, giving rise to intermediate compounds which further undergo intramolecular rearrangements to ultimately procure the stable so-called advanced glycation end-products (AGEs). The process is now considered to be implicated in aging.

Aim: To compare of antioxidant mechanism from soya bean juice (SB) with ethinyl estradiol (EE) and its potency to inhibit glycosylation reaction.

Methods: This study was an in vitro assay. Antioxidative mechanisms consisted of H₂O₂ scavenging, •OH scavenging, metal chelating. Its antioxidative mechanisms applied to inhibit glycosylation reaction which was marked by decreasing of advanced oxidation protein product (AOPP), carbonyl level, and advanced glycation end-products (AGEs). All measurement was done by spectrophotometer. Anti-aging was carried out in four groups (n = 6), i.e P0 control (3 ml of serum), P1 (3 ml of serum + glucose 500 mM), P2 (3 ml of serum + glucose 500 mM + ethinyl estradiol 0.15 g/100 mL) and P3 (3 ml of serum + glucose 500 mM + soya bean juice 1%) were used in this study.

Result: H₂O₂ scavenging, •OH scavenging, metal chelating from SB and EE are 284.750% vs. 48.889%; 2.437% vs. 15.139%; and 72.650% vs. 11.538% respectively. AOPP inhibition, P0 vs. P1; P0 vs. P3; P1 vs. P2; P1 vs. P3; and P2 vs. P3 were different significantly (p < 0.05); P0 and P2 were not different significantly (p > 0.05). For carbonyl level inhibition, P0 vs. P1; P0 vs. P2; P1 vs. P2; P1 vs. P3; P2 vs. P3 were different significantly (p < 0.05), P0 vs. P3 was not different significantly (p > 0.05). For AGEs inhibition, P0 vs. P1; P0 vs. P3; P1 vs. P2; P1 vs. P3; P2 vs. P3 were different significantly (p < 0.05), P0 vs. P2 was not different significantly (p > 0.05).

Conclusion: Antioxidative mechanism from soya bean juice is better to inhibit carbonyl level. Ethynil estradiol is better than soya bean juice to inhibit AOPP and AGEs.

P23

Androgen replacement therapy for micropenis caused by Kallmann's syndrome

M. Hendry, D.M. Soebadi

Department of Urology, Soetomo Hospital, School of Medicine, Airlangga University, Surabaya, Indonesia

Purpose: Kallmann's syndrome refers to the association of congenital hypogonadotropic hypogonadism with anosmia or hyposmia. Patients with Kallmann's syndrome usually come to medical attention because of delayed puberty or incomplete sexual development. Prepubertal testes, micropenis and cryptorquidism are usually seen and this also can lead to infertility. The proper diagnosis can manage the patient to be a real man and a father, since androgen replacement is the only therapy and has been proved to have a good result.

Material and methods: We reported a male who was diagnosed as having micropenis caused by the Kallmann's syndrome. The clinical signs and symptoms, laboratory findings, karyotype, ultrasound and magnetic resonance imaging were the modalities for diagnosis. Androgen replacement therapy with Sustanon^R (is a blend of four testosterone components : propionate, phenyl propionate, isocaproate and decanoate). Starting with a dose of 75 mg every 3 or 4 weeks for 3 months and afterwards the dose was increased to 150 mg intramuscular, and this is a lifelong therapy.

Results: Induction and maintenance of secondary sexual characteristics are quite successful for this patient. Virilisation was achieved about 3–4 months after the first injection, as well as the size of the penis becoming bigger and longer. The patient was satisfied with these dramatic physical and psychological changes.

Conclusion: It has been reported one male patient that came to medical attention because of micropenis and delayed puberty caused by Kallmann's syndrome. The clinical signs and symptoms, laboratory, ultrasonographic and MRI were the modalities for diagnosis. Androgen replacement therapy inducted and maintained the secondary sexual characteristics successfully.

P24

Effect of exercise on dynamic balance and quality of life in elderly males

N.H. Taufik¹, R.D.H. Soebadi², B. Santoso²

¹Dept of Physical Medicine and Rehabilitation, Syah Kuala University School of Medicine, Zainul Abidin Hospital Banda Aceh; ²Department of Physical Medicine and Rehabilitation, Airlangga University School of Medicine, Dr Soetomo Hospital, Surabaya, Indonesia

Purpose: The purpose of this research is to evaluate the effectiveness of exercise ‘SO-IRM RS Dr Soetomo’ version in improving dynamic balance, fall-risk reduction, and improving quality of life.

Subjects: Forty-two adults between the ages of 62 and 79 years.

Method: Randomised controlled experimental study was conducted among 42 community-dwelling elderly persons. The Timed Get Up and Go test (TUG) was used to assess fall risk, and Short Form 36 to measure quality of life. Measurement was done before and after 8 weeks of intervention. Subjects were randomly assigned in two groups; the first group of subjects exercised ‘SO-IRM RS Dr Soetomo’ version three times a week and the second group of subjects served as control.

Results: The first group showed a significant improvement of dynamic balance (p = 0.000) and quality of life. The second group did not show improvement of dynamic balance nor quality of life.

Conclusion: This study demonstrates the effectiveness of exercise ‘SO-IRM RS Dr Soetomo’ version in improving dynamic balance and quality of life. No significant correlation between dynamic balance and quality of life was demonstrated.

P25

Prevalence of lower urinary tract symptoms and associated factors in the aging male

S.F. Tong¹, W.Y. Low², E.M. Khoo³, C.J. Ng³, P.K. Yap⁴, H.M. Tan⁴

¹Department of Family Medicine, Faculty of Medicine, National University of Malaysia, Malaysia; ²Health Research Development Unit; ³Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Malaysia; ⁴Subang Jaya Medical Centre, Malaysia

Introduction: Presence of lower urinary tract symptoms (LUTS) is a crucial risk factor for sexual dysfunction which is associated strongly with many cardiovascular diseases. We aimed to examine the prevalence of LUTS in aging men and its associated factors.

Methods: This was a community-based cross-sectional study among randomly selected urban men aged ≥40 years old. Trained doctors assessed participants using structured questionnaires that included demographic data, medical history, IPSS and IIEF-5, clinical examination (blood pressure, weight, height and waist circumference) and laboratory investigations (fasting blood sugar, serum fasting cholesterol profile, PSA and testosterone levels). Erectile dysfunction (ED) is defined as IIEF-5 < 17.

Results: 1046 men participated (response rate 62%). Mean age was 55.8 years old (SD = 8.4). Chinese formed the major group (48.9%) followed by Malays (34.6%) and Indians (14.8%). Prevalence of LUTS (IPSS score of ≥8) was 27.1%. Presence of LUTS was significantly associated with age (p < 0.001). LUTS was significantly associated with self-reported hypertension (p < 0.001), diabetes (p = 0.025), coronary heart disease (p < 0.001), ED (p < 0.001) and metabolic syndrome (Asian criteria) (p = 0.008). LUTS has a significant negative correlation with IIEF-5 scores (r = −0.204, p < 0.001) and LDL-cholesterol (r = −0.119, p < 0.001). Stepwise logistic regression analysis showed age, coronary heart disease, BPH and ED were predictors of LUTS. The logistic regression model explained about 15% of the variance.

Conclusions: LUTS is common in aging men. It was significantly associated with cardiovascular risk factors and ED. Age, CHD, ED were significant predictors of LUTS.

P26

Erectile dysfunction in BPH patients treated by Holmium laser enucleation compared to treated by transurethral resection

R. Anggraeni, F. Safriadi, S. Sugandi, Z. Haroen, B.S. Noegroho, Tjahjodjati, S. Siregar

Urology Division, Department of Surgery, Hasan Sadikin Hospital, Medical School, Padjadjaran University, Bandung, Indonesia

Objective: To evaluate the incidence of erectile dysfunction (ED) in BPH patients treated by Holmium laser enucleation of the prostate (HoLEP) and treated by transurethral resection of the Prostate (TUR-P).

Methods: Forty patients were noted in this study, 20 patients underwent HoLEP (group I), 20 patients underwent TURP (group II). ED was assessed using the International Index of Erectile Function-5 (IIEF-5) questionnaire prior to and 2 months after the treatment. Volume of the prostate was also noted and other risk factors for ED were excluded. Student t-test and ANOVA were used as the statistical analysis.

Results: Mean age in group I was 63 (54–68) and group II: 69 (55–77). IIEF-5 score group I was 23.45 (pre-operative) and 22.7 (post-operative), group II: 23.50 (pre-operative) and 22.90 (post-operative). Mean prostate volume was 64.95 in group I and 42.76 in group II. ED was obtained in 3 patients in both groups (≈15%). There was no significant difference in relative risk of ED between the two groups. Statistical analysis using t-test revealed no significant correlation in prostate volume and ED as well as in both methods, post-operatively (p > 0.05).

Conclusion: Although there was an obvious risk of ED in both operative methods, there was no difference in the incidence of ED in post-operative of both methods. Based on those findings, HoLEP can be recommended as an alternative to TUR in large prostate.

P28

The impact of radio frequency electromagnetic radiation (RFEMR) of mobile phones on spermatozoa and serum testosterone level of rabbit

R. Adriansjah¹, G. Richata¹, R. Anggraeni¹, A.H. Rizky¹, A.T. Sihombing¹, T. Yunono¹, S. Sugandi¹, Z. Haroen¹, B.S. Noegroho¹, Tjahjodhati¹, F. Safriadi¹, S. Siregar¹, B.S. Hermono², A. Tanggo³

¹Urology Division, Department of Surgery; ²Pathology of Anatomy Department; ³Pathology of Clinic Department, Hasan Sadikin Hospital, Medical School of Padjadjaran University, Bandung, Indonesia

Background: There is a growing interest in the potential biological effects of electromagnetic fields (EMFs) on human. The mobile phone is currently known as one of the most worldwide used tool which emits, up to certain extent, EMFs. We try to explore the possible adverse effects of mobile phones on the function of the reproductive system, particularly focused on serum testosterone level, as one of the most important parameters of reproductive function.

Objective: To evaluate the biological effect of RFEMR of mobile phones on spermatozoa and serum testosterone level.

Method: As a model, we exposed 36 New Zealand rabbits to RFEMR of mobile phone, Nokia 8110, 900 MHz and 1800 MHz, built in antenna, with specific absorption rate (SAR) of 0.6 mW/cm². The rabbits were divided into two groups. Group 1 was conducted for spermatozoa analysis and group 2 for testosterone level. Each group was divided into two subgroups (900 MHz and 1800 MHz) and were divided again into three other subgroups. Groups 1 and 2 were exposed in the same manner. The first subgroups were exposed to 10 calls per day, the second subgroups were exposed to 20 calls, while the third groups were exposed to 30 calls; duration of exposure was 120 seconds, within 7 consecutive days. In group 1, left orchidectomy was conducted prior to exposure. After the exposure, right orchidectomy was conducted. All the testes were labelled and kept in different pots with formaldehyde 10% solution. The quantity and quality of spermatozoa were evaluated from 3 different areas of each slide. Total serum testosterone level in group 2 was evaluated from 2 ml of rabbit blood collected prior and after the exposure.

Result and conclusion: Significant correlation was found between mobile phone RFEMR and quality of spermatozoa (p = 0.14; p < 0.15 in 900 MHz; p = 0.137; p < 0.15 in 1800 MHz) and between intensity of radiation and spermatozoa quality (p = 0.05; p < 0.15 in 900 MHz; p = 0.07; p < 0.15 in 1800 MHz).

A significant correlation was shown between RFEMR of mobile phone and serum total testosterone level (p = 0.0208; p < 0.1, in 900 MHz) and (p = 0,00769; p < 0.1, in 1800 MHz) as well as between intensity of radiation and serum total testosterone level (p = 0.0753; p < 0.1, in 900 MHz) and (p = 0.770; p < 0.1, in 1800 MHZ).

P29

The effect of smoking on aging male symptoms (AMS) score and testosterone level

R. Hamid, D. Rahardjo, A. Taher

Division of Urology, Dept of Surgery Faculty of Medicine University of Indonesia, CiptoMangunkusumo Hospital, Indonesia

Introduction: To evaluate the effect of smoking on aging male symptoms (AMS) score and testosterone level.

Method: We evaluated 347 males over 50 years old classified into urban and rural areas. Age, smoking history, length of smoking, and amount of cigarette, body mass index (BMI), AMS score and testosterone level were collected. Only in 210 male was testosterone level evaluated.

Results: Smokers were found in 45.2% respondent's and the proportion was higher in the rural area (p < 0.000). Smokers had higher AMS score (p = 0.028) and testosterone level (p = 0.001) than ex-smokers or non-smokers. There was a positive correlation between length of smoking and total amount of cigarettes to AMS score and testosterone level.

Conclusion: Smoking increased AMS score and testosterone level. The increasing of AMS score in smokers was probably caused by adverse effects of smoking.

P30

Sexual dysfunction in type 2 diabetes mellitus patients

R. Putranto¹, P. Soewondo², E. Mudjaddid¹

¹Division of Psychosomatic Medicine; ²Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia

Introduction: Diabetes is known to cause multiple medical, psychological, and sexual dysfunctions. Sexual dysfunction (SD) refers to the persistent impairment of the normal patterns of sexual interest or response. The objectives of this study are to 1) study the prevalence of sexual dysfunction in men and women with type 2 diabetes; and 2) describe how descriptive variables, psychological variables, diabetic complications, glucose control and sexual dysfunction relate in patients with type 2 diabetes.

Methods: This was a cross-sectional study. Patients have sexual dysfunction if they answer yes for the question on number 21 of the Beck Depression Inventory (1. I am less interested in sex that I used to be, or 2. I am much less interested in sex now, or 3. I have lost interest in sex completely). We examined of glucose control using HbA1c.

Results: During the course of study, which was done between January and April 2004, we consecutively studied 80 patients. The subjects of this study consisted of 32 (40%) males, 48 (60%) females. Number and proportion of sexual dysfunction was 33 (41.3%). Prevalence of sexual dysfunction was a total of 60.6% of women and 39.4% of men with type 2 diabetes who reported sexual dysfunction (p = 0.926). There was association between depression and sexual dysfunction (p = 0.018). There was no difference in sexual dysfunction in patients with complications of diabetes compared to those without complications (p = 0.698). We did not find any difference in glucose control (HbA1c) between patients with sexual dysfunction compared to those without sexual dysfunction (8.21 ± 2.14 and 8.43 ± 2.49) (p = 0.295).

Conclusions: The proportion of sexual dysfunction in patients with type 2 diabetes was 41.3%. Both women and men with diabetes are at increased risk for sexual dysfunction. This study suggests that for patients with type 2 diabetes, sexual dysfunction is related to somatic and psychological factors, whereas psychological factors (depression) are more predominant.

P31

Clinical features of community acquired pneumonia in old age patients and its relations with mortality in Cipto Mangunkusumo Hospital in 2001

S. Ridho¹, S. Setiati², A. Bahar³, H.M.S. Markum⁴

¹Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia; ²Division of Geriatry, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia; ³Division of Pulmonology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia; ⁴Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia

Introduction and objective: It is known that clinical features of pneumonia in old age patients differ from those in younger patients, and varies. This study examined the morbidity rate, clinical features, mortality rate and determined the association between clinical features and mortality of old age patients with community acquired pneumonia treated in Cipto Mangunkusumo Hospital in the year 2001.

Subjects and methods: a cross-sectional retrospective study has been conducted on 342 subjects from medical records. We registered the data in datasheets containing demographic and clinical features, co-morbid illnesses and laboratory data. Finally, we determined the association between those variables and the mortality of the patients.

Results: The morbidity rate was 12.5%. The respiratory signs and symptoms that were prominent were dyspnoea, cough and rales. The non-respiratory signs and symptoms that were prominent were apyrexia, immobilisation, and altered mental state. The co-morbid illnesses were malnutrition, hypertension, diabetes mellitus, cerebrovascular disease, congestive heart failure and renal disease. The mortality rate was 37.7% (21.1% was pneumonia related). Variables related to mortality were male gender (p = 0.000), immobilisation (p = 0.000), unconsciousness (p = 0.010), respiratory rate > 30 x/minute (p = 0.001), pulse rate > 125 x/minute (p = 0.044), and haematocrit < 30% (p = 0.009).

Conclusions: The morbidity rate was 12.5%. The clinical features of old age patients with community acquired pneumonia varies, because signs and symptoms not related to respiratory tract can dominate, aside from the usual respiratory signs and symptoms. Often these patients also had co-morbid illnesses. The mortality rates were 37.7% (21.1% was pneumonia related). There were associations between mortality and the male gender, immobilisation, unconsiousness, respiratory rate > 30 x/minute, pulse rate > 125 x/minute, and haematocrit < 30% in the old age patients treated in Cipto Mangunkusumo Hospital in the year 2001.

P32

How useful is the St Louis ADAM questionnaire as a screen for testosterone deficiency in a private primary care men's health practice?

S.H. Teoh, T.K. Gan, C.S.K. Yeo

Singapore Men's Health Clinic, Singapore

Introduction and objectives: It is said that the ADAM questionnaire can be a reasonable screening questionnaire to detect androgen deficiency in males over 40 years of age. The objective of this study is to evaluate the association between serum total testosterone (TT) levels and positive score on the ADAM questionnaire among patients in a private primary men's health practice.

Method: This is a retrospective study of TT assessed in 46 men 40 years old and above who had a positive score in the ADAM questionnaire. The case records of 107 consecutive new patients seen from 17 November 2003 through to 16 July 2004, who had TT and the ADAM questionnaire assessed, were reviewed.

Results: Of 107 men, 85 were 40 years old and above. Of these 85, 46 men had a positive ADAM questionnaire score. Of these 46, only 7 men (15.2%) had TT less than 350 ng/dl which is the commonly taken level below which men are considered hypogonadal. There was also no correlation between age and TT among these 46 men (R² = 0.001).

Conclusions: A low proportion of our patients 40 years old and above had low TT and positive ADAM score. There are issues with the use of screening instruments in different cultures. The correlation of type of testosterone assay with symptoms is another problem. Bio-available testosterone assays may identify more men who are hypogonadal and be appropriate to use with the ADAM questionnaire. A valid and reproducible index that reflects the health status of androgen-deficient men will help physicians better understand and manage them.

P33

Correlation of aging male symptom score (AMS score) with age in men

T. Ghinorawa, D. Rahardjo, A. Taher

Division of Urology, Department of Surgery, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Indonesia

Introduction and objectives: To examine the relationship of the Aging Male Symptom score (AMS score) with age group in men, and to define the age of men that AMS score begins to increase.

Method: In all, 347 patients beginning at 50 years old, underwent interview with AMS score questionnaire.

Results: In 344 patients there were 26 patients at age 50 years old, with abnormal psychological AMS score there were 18 patients, with abnormal somatic AMS score there were 20 patients, abnormal sexual AMS score there were 20 patients, and abnormal total AMS score there were 14 patients. At age range 51 to 55 years old there were 146 patients, with abnormal psychological AMS score there were 75 patients, abnormal somatic AMS score there were 114 patients, abnormal sexual AMS score there were 123 patients, and abnormal total AMS score there were 71 patients. At age range 56 to 60 years old there were 48 patients, with abnormal psychological AMS score there were 35 patients, abnormal somatic AMS score there were 44 patients, abnormal sexual AMS score there were 45 patients, and abnormal total AMS score there were 35 patients. At age range more than 60 years old there were 124 patients, with abnormal psychological AMS Score was there were 85 patients, abnormal somatic AMS score there were 109 patients, abnormal sexual AMS score there were 119 patients, and abnormal total AMS score there were 93 patients. AMS score increased significantly in all age groups, except psychological AMS score in 60 years old.

Conclusion: In this study, AMS score begins to significantly increase at age 55 years old, and AMS score increase was begun in men's estimates at age less than 50 years old.

P34

Uroflowmetry pattern in male adolescents

T. Yuwono, S. Sugandi, Z. Haroen, B.S. Noegroho, Tjahjodjati, F. Safriadi, S. Siregar

Department of Urology, Hasan Sadikin Hospital, Bandung, Indonesia

Background and objectives: Uroflowmetric parameters of urination may be influenced by many factors including age, sex, voiding position, technique used and also anatomical and physiological variations. A cross-sectional study was carried out to evaluate the uroflowmetric parameters in normal adolescent males as well as its variations in different ages and to compare these parameters among different ages.

Method: One hundred and fifty healthy males were studied. They were classified into two groups. Group I comprised of 77 male young adults aged 18–40 years. Group II comprised of 73 male pre-elderly aged 41–60 years. A UDS-64-IIs uroflowmeter from Laborie Medical Technologies was used. The residual urine was measured sonographically.

Result: In group I, the mean peak flow rate was 29.974 (±1.4069) ml/sec, mean flow rate 26.423 (±1.5756) ml/sec, voiding time 26.90 (±1.03543) sec and voided volume 365.931 (±18.1506) ml. In group II the peak flow rate was 23.048 (±1.19) ml/sec, mean flow rate 19.22 (±0.693) ml/sec, voiding time 22.72 (±1.678) sec and voided volume 299.51 (±14.466) ml. The peak flow and mean flow rates were significantly higher in group I. The voided volume in group I was higher with similar voiding time. Residual urine was less than 50 ml in all subjects indicating that these subjects could void completely well. This study yielded normal uroflowmetric parameters in young adult and pre-elderly subjects without urological symptoms. These parameters vary with age and are useful for the investigations of bladder function in urological clinic.

P35

Intrascrotal extratesticular schwannoma

T. Budiyanto, D.M. Soebadi

Department of Urology, Soetomo Hospital, School of Medicine, Airlangga University, Surabaya, Indonesia

Introduction: Schwannoma is a benign tumour of the peripheral nerves. It is very rarely found in the scrotum.

Case report: We report a 46-year-old male who complained of right intrascrotal mass. The solid mass was palpable in the right intrascrotal extratesticular space. Ultrasonography and CT scan showed a solid tumour in the right testes. The preoperative diagnosis was right testes tumour. We performed right orchiectomy, and histopathology report revealed schwannoma.

Conclusion: Schwannoma is difficult to diagnose. Radiology findings are often non-specific. The only gold standard diagnostic investigation is histology of either biopsy or excised specimen. The exact incidence of schwannoma is unknown but intrascrotal extratesticular schwannoma is very rare.

P36

Sperm survival test on an infertile patient with varicocele undergoing IVF

W. Sani, S. Rochadi

Division of Urology, Department of Surgery, Faculty of Medicine, Gajah Mada University, Sardjito Hospital, Yogyakarta, Indonesia

Introduction: To evaluate the result of sperm survival test among infertile patients with varicocele undergoing IVF at Sardjito Hospital, Yogyakarta.

Methods: Based on sperm analysis and the presence of varicocele, 67 patients were categorised into 3 different groups. First, a group of 22 normozoospermic men. Second, a group of 13 infertile men with varicocele. Third, a group of 32 infertile men without varicocele. The sperm survival tests were assessed at 24 and 48 hours.

Result: Among 67 patients, 67.2% had abnormality on sperm analysis from which 28.9% had varicocele. There was significant difference in sperm survival test at 24 h after incubation. Infertile patients with varicocele was 42.69% (SD ± 26.97), infertile men without varicocele 60.94% (SD ± 14.62) and normozoospermic patients 63.86% (SD ± 17.11). After 48 h, there was no significant difference, but infertile men with varicocele still had the lowest result, 11.23% ± 13.09 compared with the first group (17.95%) and third group (15.47%).

Conclusion: Male factor in the infertility problem is still high and varicocele is commonly found. Infertile men with varicocele have the lowest sperm survival for fertilising potential in IVF. There is strong correlation between the sperm survival test with sperm motility.

Further investigation to assess the success rate on pregnancy among this group after IVF and whether surgical treatment of varicocele can improve this, is needed.

P37

Hypogonadal men and their quality of life

W.Y. Low¹, E.M. Khoo², H.M. Tan³

¹Health Research Development Unit; ²Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur; ³Subang Jaya Medical Centre, Selangor, Malaysia

Objective: This paper assessed prevalence of hypogonadism in men, their quality of life and its predictors.

Materials and methods: A population-based study where 351 men, aged 50 years and above, were randomly selected and interviewed face to face in the Klang Valley, Malaysia. The International Index for Erectile Function (IIEF-15) was used to assess erectile function. Quality of life and depression was measured using the SF-12 and the Geriatric Depression Scale (GDS-15) respectively.

Results: Mean age of the men surveyed was 58 ± 7 years old. There were 18.2% (64) men with hypogonadism (testosterone < 11 nmol/l). No significant difference was noted in their age between hypogonadal men (mean 57.23 years) and those without (mean 58.17 years). Among hypogonadal men, 29.68% (19) had moderate/severe depression and 43.74% (28) had moderate/severe erectile dysfunction (ED). Significant association was found between hypogonadism and ethnicity (p < 0.05), but not with age group, occupational status and educational levels. Based on SF-12, the mean physical component score (PCS) and the mental component score (MCS) of this population were 34.04 and 35.18 respectively. These were lower than the average norm of 50 and suggested a poorer quality of life. When comparing the PCS and MCS scores between men with and without hypogonadism, there was no significant difference. However, for the various domains in SF-12, significant differences were found between these 2 groups: general health (p < 0.01), emotional role functioning (p < 0.05), and bodily pain (p < 0.05). Based on multiple regression, IIEF and GDS significantly predict PCS and MCS respectively.

Conclusion: Hypogonadism affects certain aspects of men's quality of life.

P38

The effect of bladder volume on the length of prostatic protrusion on transabdominal ultrasonography

Z. Ali, C.A. Mochtar

Division of Urology, Department of Surgery, Faculty of Medicine, University of Indonesia, CiptoMangunkusumo Hospital, Indonesia

Objective: To know the effect of differences in bladder volume on the length of prostatic protrusion on transabdominal ultrasonography.

Method: This is an observational study on 48 BPH retention patients in the urology outpatient clinic at Cipto Mangunkusomo Hospital, Jakarta, from 1 March 2006 to 28 February 2007. The bladder of each patient was filled by normal saline in stepwise manner from 50 ml and then an additional 50 ml until the need to void or 500 ml. Measurement of the length of prostatic protrusion by transabdominal ultrasonography was performed on each volume of the bladder in every patient.

Results: The average length of prostatic protrusion on 50 ml, 100 ml, 150 ml and 200 ml are 11.14 mm, 11.42 mm, 11.88 mm, 10.20 mm respectively. There is no statistically significant difference in the length of prostatic protrusion on transabdominal ultrasonography on each bladder volume.

Conclusion: Measurement of the length prostatic protrusion on transabdominal ultrasonography could be done on 50 ml to 200 ml bladder volume without statistically significant difference.

P39

Correlation between age and testosterone level in rural and urban area

F.D. Rahardjo, A. Taher

Urology Department, Cipto Mangunkusumo Hospital, Indonesia

Introduction: To evaluate correlation between age and testosterone level in a rural and urban area.

Method: We evaluated 210 men aged above 50 years that lived in urban (Jakarta) and rural (Jasinga, West Java) areas. Age and total testosterone level were collected. Data was analysed by t-test and Spearman correlation test.

Result: Mean age respondents in the rural area (61.8 ± 10.7 years old) was higher than in the urban area (58.7 ± 7.9 years old) with p = 0.006. Testosterone levels in the rural area (593.9 ± 165.9 ng/dl) were higher than in the urban area (515.2 ± 197.1 ng/dl) with p = 0.004. In the rural area, the proportion of low testosterone in the 50–59 age group was 18.8%, in the 60–69 age group was 4.2%, and in the older than 70 age group was 5%. Meanwhile in the urban area, the proportion of low testosterone in 50–59 age group was 26.1%, in the 60–69 age group was 33.3%, and in the older than 70 age group was 30%. Age has positive correlation with testosterone level (r = 0.164).

Conclusion: Testosterone level was higher in the rural area. There was a positive correlation between age and testosterone level.

P40

PSA density as indication for prostate biopsy in men with intermediate PSA values

M. Fitrah, C.A. Mochtar

Urology Division Department of Surgery, School of Medicine University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia

Introduction: Since the beginning of the TRUS (transrectal ultrasound)-guided prostate biopsy programme in our clinic in 1994, PSA density is still used as a guide to do prostate biopsy in intermediate PSA values (4.01–10 ng/ml). The aim of this study is to evaluate the efficacy of PSAD ≥ 0.15 as an indication for biopsy in our patients with intermediate serum PSA values, with normal DRE and ultrasoundfinding.

Materials and methods: This study was performed in a retrospective manner. We collected data from 1994 patients who had prostate biopsy in our clinic between 1994–2006 (13 years).

Results: This group comprised 392 PCa and 995 non-PCa patients. There were 409 patients with intermediate PSA values (156 BPH, 18 BPH + prostatitis, 6 BPH + PIN, 31 PCa). In these groups, BPH, BPH with prostatitis, BPH with PIN, and PCa mean PSADs were 0.23 ± 0.075; 0.23 ± 0.05; 0.22 ± 0.05 and 0.25 ± 0.057, and for BPH, BPH with prostatitis, BPH with PIN and PCa range PSADs were 0.1501–0.5350; 0.165–0.3595; 0.15–0.32; and 0.1621–0.3983. The detection of prostate cancer in the intermediate PSA values (with PSAD ≥ 0.15), was 7.57%.

Conclusions: PSAD ≥ 0.15 may detect PCa in a small number of men with intermediate PSA values. To determine the actual value of PSA density measurement, a randomised controlled trial is warranted.

P41

Correlation of prostate dimensions from transrectal ultrasound with prostate volume in determining the shape of the prostate

Sufriadi, C.A. Mochtar

Urology Department, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia

Introduction: It has been widely accepted that the prostate is a cone-shaped organ. In everyday practice ultrasonographic findings frequently revealed that the length of the prostate was smaller than its width. The aim of the study is to evaluate the dimensions of the prostate measured by transrectal ultrasonography and its correlation with prostate volume in determining the shape of the prostate.

Methods: A retrospective study was done on the patients who were given TRUS-guided prostate biopsy in our clinic between 1999 and 2006. Length, width and volume of the prostate was recorded. Correlation of length and width with prostate volume was calculated using Spearman's correlation test. Patients were classified according to the proportion of length against width into two groups, cone-shaped groups if the length was bigger than width and ellipsoid-shaped groups if the length was smaller than width. Correlation between the shape with the prostate volume was analysed using Mann-Whitney test and Chi-square test.

Results: From 1548 patients that had transrectal biopsy of the prostate in that period, 218 patient was excluded due to incomplete data. There was strong correlation between length and width with prostate volume (p < 0.01; r = 0.79 and p < 0.01; r = 0.75). Cone- shaped prostates were found in 633 patients (52.18%) and 637 patients had ellipsoid-shaped (47.82%). Mean prostate volume in the cone-shaped prostate group was bigger than the ellipsoid-shaped group (53.32 cc ± 28.09 cc versus 49.08 ± 26.81 cc). Statistically there was significant difference of prostate volume between the cone-shaped group and ellipsoid group (p < 0.01). Using Chi-square test, a larger prostate had more chance of having a cone-shape than a smaller prostate (OR 1.5; p < 0.01).

Conclusion: In our study, prostate shape correlated with prostate volume. A larger prostate volume tended to have cone-shaped form.