UNDESCENDED TESTIS (UDT)

<div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg38jhrZqadYBGFfiwV6iyS-3v5007TXFZpMZtvHOH3H0aiuQMDREurR9HIlCVhnoiMneEpRlXzzBfNDyo5QXsTY9MCfrBwZ4BC6zgIu4oMeKaLyMr6pBJ9BAprOdD-pDdmIzmcQBaAq0o/s1600/Screen+Shot+2019-08-21+at+5.27.00+AM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="695" data-original-width="1338" height="166" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg38jhrZqadYBGFfiwV6iyS-3v5007TXFZpMZtvHOH3H0aiuQMDREurR9HIlCVhnoiMneEpRlXzzBfNDyo5QXsTY9MCfrBwZ4BC6zgIu4oMeKaLyMr6pBJ9BAprOdD-pDdmIzmcQBaAq0o/s320/Screen+Shot+2019-08-21+at+5.27.00+AM.png" width="320" /></a></div> <div> <br /></div> <div> <div style="text-align: center;"> <a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/Khqorgimfkj6Ql%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/undescended-testis-udt" title="Undescended Testis (UDT)" target="_blank">Undescended Testis (UDT)</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><iframe allowfullscreen="" frameborder="0" height="485" marginheight="0" marginwidth="0" scrolling="no" src="//www.slideshare.net/slideshow/embed_code/key/Khqorgimfkj6Ql" style="border-width: 1px; border: 1px solid #CCC; margin-bottom: 5px; max-width: 100%;" width="595"> </iframe> </a></div> <div style="margin-bottom: 5px;"> <a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/Khqorgimfkj6Ql%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/undescended-testis-udt" title="Undescended Testis (UDT)" target="_blank">Undescended Testis (UDT)</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><strong> </strong></a><strong><a href="https://www.slideshare.net/Ekoindra4/undescended-testis-udt" target="_blank" title="Undescended Testis (UDT)">Undescended Testis (UDT)</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div> </div> Undescended testis or cryptorchidism is the absence of one or both testes<br /> <div> in normal scrotal position and during initial clinical evaluation may refer </div> <div> to palpable or nonpalpable testes, which are either cryptorchid or absent.</div> <div> <br /></div>

UNDESCENDED TESTIS (UDT)

Undescended Testis (UDT) from Eko indra Undescended testis or cryptorchidism is the absence of one or both testes in norma...

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ERECTILE DYSFUNCTION

<br /> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCzYYr7iPMOOFGyXZwKNyDcH9Z2wyd3scN6iPvyxiFHKWsx_xo5FDg32RnBoCh6tyXvCXKdL2bIl6OomWM3Jf8_UQHA1AU-SysMi5gdK39qu4-kkgRukIlsGhITbPgJPPkdeuJOWMynDY/s1600/Screen+Shot+2019-08-01+at+11.51.59+AM.png" imageanchor="1"><img border="0" height="215" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCzYYr7iPMOOFGyXZwKNyDcH9Z2wyd3scN6iPvyxiFHKWsx_xo5FDg32RnBoCh6tyXvCXKdL2bIl6OomWM3Jf8_UQHA1AU-SysMi5gdK39qu4-kkgRukIlsGhITbPgJPPkdeuJOWMynDY/s400/Screen+Shot+2019-08-01+at+11.51.59+AM.png" width="400" /></a><br /> <br /> <br /> <a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/o7PRHHElBp516U%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/erectile-dysfunction-159634738" title="Erectile Dysfunction" target="_blank">Erectile Dysfunction</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><iframe allowfullscreen="" frameborder="0" height="485" marginheight="0" marginwidth="0" scrolling="no" src="//www.slideshare.net/slideshow/embed_code/key/o7PRHHElBp516U" style="border-width: 1px; border: 1px solid #CCC; margin-bottom: 5px; max-width: 100%;" width="595"> </iframe> </a><br /> <div style="margin-bottom: 5px;"> <a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/o7PRHHElBp516U%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/erectile-dysfunction-159634738" title="Erectile Dysfunction" target="_blank">Erectile Dysfunction</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><strong> </strong></a><strong><a href="https://www.slideshare.net/Ekoindra4/erectile-dysfunction-159634738" target="_blank" title="Erectile Dysfunction">Erectile Dysfunction</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div> <br /> <br /> The inability to attain and/or maintain an erection sufficient for satisfactory sexual performance and persistent in 3 months.<br /> <div> (National Institute of Health. JAMA. 1993)<br /> <br /> Massachusetts Male Aging Study (MMAS) reported an overall prevalence of 52% ED in non institutionalized men aged 40-70 years in the Boston area; specific prevalence for minimal, moderate, and complete ED was 17.2%, 25.2%, and 9.6%, respectively.</div>

ERECTILE DYSFUNCTION

Erectile Dysfunction from Eko indra The inability to attain and/or maintain an erection sufficient for satisfactory sexual pe...

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PREMATURE EJACULATION

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PREMATURE EJACULATION

Premature Ejaculation from Eko indra Premature ejaculation is male sexual dysfunction characterized by : • perceived inabilit...

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HYPOGONADOTROPIC HYPOGONADISM

<div> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgdTfPvJ29KJBKqlMV4NQ1rZ8KMQfw4ncbMkhcfHUhfTjOkiR-SFPI_LzlSKo89jPyqHxjh_YFVSZUxGIVOmCr-BvqEthX2u_0NTYKkuJRAdMLU_KNwuL0TQ7RVWTGA3_Fxt8fMGaXff4/s1600/Screen+Shot+2019-08-01+at+11.31.49+AM.png" imageanchor="1"><img border="0" height="163" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgdTfPvJ29KJBKqlMV4NQ1rZ8KMQfw4ncbMkhcfHUhfTjOkiR-SFPI_LzlSKo89jPyqHxjh_YFVSZUxGIVOmCr-BvqEthX2u_0NTYKkuJRAdMLU_KNwuL0TQ7RVWTGA3_Fxt8fMGaXff4/s320/Screen+Shot+2019-08-01+at+11.31.49+AM.png" width="320"></a></div> <div> <br></div> <div> <br></div> <div> <a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/2FmHzcDLcufEs9%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/hypogonadotropic-hypogonadism" title="Hypogonadotropic Hypogonadism" target="_blank">Hypogonadotropic Hypogonadism</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><iframe allowfullscreen="" frameborder="0" height="485" marginheight="0" marginwidth="0" scrolling="no" src="//www.slideshare.net/slideshow/embed_code/key/2FmHzcDLcufEs9" style="border-width: 1px; border: 1px solid #CCC; margin-bottom: 5px; max-width: 100%;" width="595"> </iframe> </a><br> <div style="margin-bottom: 5px;"> <a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/2FmHzcDLcufEs9%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/hypogonadotropic-hypogonadism" title="Hypogonadotropic Hypogonadism" target="_blank">Hypogonadotropic Hypogonadism</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><strong> </strong></a><strong><a href="https://www.slideshare.net/Ekoindra4/hypogonadotropic-hypogonadism" target="_blank" title="Hypogonadotropic Hypogonadism">Hypogonadotropic Hypogonadism</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div> </div> <div> <br></div> <div> <br></div> <div> Hypogonadism is characterised by impaired testicular function, which may affect spermatogenesis and/or testosterone synthesis<br> The symptoms of hypogonadism depend on the degree of androgen deficiency<br> <br> The aetiological and pathogenetic mechanisms of male hypogonadism can be divided into 3 main categories :<br> </div>

HYPOGONADOTROPIC HYPOGONADISM

Hypogonadotropic Hypogonadism from Eko indra Hypogonadism is characterised by impaired testicular function, which may ...

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MALE INFERTILITY

<span style="font-family: "century gothic";"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTWsD67WkzePSk2ETmhTRFGR-8oy4VXKX1FEp-lvHrDMj-cUIhU3kHkK4J0XJLciEFyoTisfgMOEcOP_QI6UWyHQtvs9GVqT3szcIXmadNAo_hRzgU1JXnSbIEbeFDpHcbzMkQw7Odix0/s1600/Screen+Shot+2019-08-01+at+11.20.15+AM.png" imageanchor="1"><img border="0" height="160" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTWsD67WkzePSk2ETmhTRFGR-8oy4VXKX1FEp-lvHrDMj-cUIhU3kHkK4J0XJLciEFyoTisfgMOEcOP_QI6UWyHQtvs9GVqT3szcIXmadNAo_hRzgU1JXnSbIEbeFDpHcbzMkQw7Odix0/s320/Screen+Shot+2019-08-01+at+11.20.15+AM.png" width="320" /></a></span><br /> <span style="font-family: "century gothic";"><br /></span> <span style="font-family: "century gothic";"><a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/cYXblrLdu9rJpz%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/male-infertility-159629747" title="Male Infertility" target="_blank">Male Infertility</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><iframe allowfullscreen="" frameborder="0" height="485" marginheight="0" marginwidth="0" scrolling="no" src="//www.slideshare.net/slideshow/embed_code/key/cYXblrLdu9rJpz" style="border-width: 1px; border: 1px solid #CCC; margin-bottom: 5px; max-width: 100%;" width="595"> </iframe> </a></span><br /> <div style="margin-bottom: 5px;"> <span style="font-family: "century gothic";"><a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/cYXblrLdu9rJpz%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/male-infertility-159629747" title="Male Infertility" target="_blank">Male Infertility</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><strong> </strong></a><strong><a href="https://www.slideshare.net/Ekoindra4/male-infertility-159629747" target="_blank" title="Male Infertility">Male Infertility</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </span></div> <span style="font-family: "century gothic";"> </span> <br /> <br /> <span style="font-family: "century gothic";">“Infertility is the inability of a sexually active, non-contracepting couple to achieve spontaneous pregnancy in one year” – WHO</span><br /> <span style="font-family: "century gothic";"><br /></span> Male fertility can be impaired as a result of:<br /> <span style="font-family: "arial";">•</span><span style="font-family: "century gothic";">Congenital or acquired urogenital abnormalities</span><br /> <span style="font-family: "arial";">•</span><span style="font-family: "century gothic";">Malignancies</span><br /> <span style="font-family: "arial";">•</span><span style="font-family: "century gothic";">Urogenital tract infections</span><br /> <!--StartFragment--> <!--EndFragment-->

MALE INFERTILITY

Male Infertility from Eko indra “Infertility is the inability of a sexually active, non-contracepting couple to achieve spont...

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LASER TECHNIQUE IN URINARY STONE

<div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg47pJLfI7L2WBVOR8p8vhx4qoJzqGhHL_ZS65FiJEF3MIp0Jwft68cTyneiTr8LCx2nUtVjTKNGoqMVcfCR8P7BTvkI5PWYqX11Wlm5th46p3bPgCBEE9kOIsrgVPsLW8Vnucn93F37cQ/s1600/Lumenis-640x400.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="400" data-original-width="640" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg47pJLfI7L2WBVOR8p8vhx4qoJzqGhHL_ZS65FiJEF3MIp0Jwft68cTyneiTr8LCx2nUtVjTKNGoqMVcfCR8P7BTvkI5PWYqX11Wlm5th46p3bPgCBEE9kOIsrgVPsLW8Vnucn93F37cQ/s320/Lumenis-640x400.jpg" width="320" /></a></div> <div class="separator" style="clear: both; text-align: center;"> <br /></div> <div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgiVUS1JHTIfr_y5tNCSio1UUxRnQ6NGYAo6HcvWoNP6A6xJIWHnv98-nP6j3fFM2apEFatb5QmNqCqt-6zVmSmqwFH8HAaThjZvLfBmWw1kZuyvBKW6ts2V53vYUKpVTZvDMVH_8Rhbbc/s1600/Screen+Shot+2019-08-20+at+10.16.38+PM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="751" data-original-width="1363" height="176" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgiVUS1JHTIfr_y5tNCSio1UUxRnQ6NGYAo6HcvWoNP6A6xJIWHnv98-nP6j3fFM2apEFatb5QmNqCqt-6zVmSmqwFH8HAaThjZvLfBmWw1kZuyvBKW6ts2V53vYUKpVTZvDMVH_8Rhbbc/s320/Screen+Shot+2019-08-20+at+10.16.38+PM.png" width="320" /></a></div> <div class="separator" style="clear: both; text-align: center;"> <br /></div> <br /><a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/9UmwmwJV6uYqJ8%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/laser-techniques-for-urinary-stones" title="Laser Techniques for Urinary stones" target="_blank">Laser Techniques for Urinary stones</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><iframe allowfullscreen="" frameborder="0" height="485" marginheight="0" marginwidth="0" scrolling="no" src="//www.slideshare.net/slideshow/embed_code/key/9UmwmwJV6uYqJ8" style="border-width: 1px; border: 1px solid #CCC; margin-bottom: 5px; max-width: 100%;" width="595"> </iframe> <div style="margin-bottom: 5px;"> <strong> <a href="https://www.slideshare.net/Ekoindra4/laser-techniques-for-urinary-stones" target="_blank" title="Laser Techniques for Urinary stones">Laser Techniques for Urinary stones</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div> </a><br /><br /> <br /><br />The holmium:yttriumaluminum- garnet (Ho:YAG) laser is the most widely used laser for URS, with modern systems providing users with a range of settings and parameters that have numerous effects on stone fragmentation

LASER TECHNIQUE IN URINARY STONE

Laser Techniques for Urinary stones from Eko indra The holmium:yttriumaluminum- garnet (Ho:YAG) laser is the most widely u...

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TURP TECHNIQUE

<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7FKdJqn7mLx5rRUXmAdhI2_hmcu2mOqhn33z4B8HtTjzn17BqNCMTotxhxtiHXqSYOGeu36YYz-IueJ5sSlSg9ESeFxsCjrk9rqPuVzNWO3otIkitbKNVONxpEhkPhWV5_tpjh-tfOyc/s1600/Screen+Shot+2019-05-24+at+10.40.05+PM.png" imageanchor="1"><img border="0" height="265" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7FKdJqn7mLx5rRUXmAdhI2_hmcu2mOqhn33z4B8HtTjzn17BqNCMTotxhxtiHXqSYOGeu36YYz-IueJ5sSlSg9ESeFxsCjrk9rqPuVzNWO3otIkitbKNVONxpEhkPhWV5_tpjh-tfOyc/s400/Screen+Shot+2019-05-24+at+10.40.05+PM.png" width="400" /></a><br /> <br /> <span style="color: #2f2b20; font-family: "calibri";"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrSAnUl712QJ884BftZMTWs-xSIO3q6AYujNaen3H-HSAwI1mpVTkkdl7oOLLOQeCl-zSSNeTIB4esZCGEwN255GUGyO_sBsk8PICC1dE0s8bsongLuXcwxIuE10vp1BQqlHlOdPXt5qE/s1600/Screen+Shot+2019-05-24+at+10.48.39+PM.png" imageanchor="1"><img border="0" height="221" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrSAnUl712QJ884BftZMTWs-xSIO3q6AYujNaen3H-HSAwI1mpVTkkdl7oOLLOQeCl-zSSNeTIB4esZCGEwN255GUGyO_sBsk8PICC1dE0s8bsongLuXcwxIuE10vp1BQqlHlOdPXt5qE/s400/Screen+Shot+2019-05-24+at+10.48.39+PM.png" width="400" /></a></span><br /> <span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="color: #2f2b20; font-family: "calibri";"><br /></span> </span><br /> Transurethral resection of the prostate (TURP) is a commonly performed surgical treatment for benign prostatic hyperplasia. This procedure surgically treat moderate- to-severe LUTS in men with prostate size of 30-80 mL. Strong Indications for Surgery are recurrent urinary retention, acute urinary retention, recurrent haematuria refractory to medical treatment with 5-alpha reductase inhibitors, bladder stones, and renal insufficiency.<br /> <br /> Read below slide :<br /> <br /> <a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/41h2MYfd1EhaRv%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/turp-technique" title="TURP TECHNIQUE" target="_blank">TURP TECHNIQUE</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><iframe allowfullscreen="" frameborder="0" height="485" marginheight="0" marginwidth="0" scrolling="no" src="//www.slideshare.net/slideshow/embed_code/key/41h2MYfd1EhaRv" style="border-width: 1px; border: 1px solid #CCC; margin-bottom: 5px; max-width: 100%;" width="595"> </iframe> </a><br /> <div style="margin-bottom: 5px;"> <a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/41h2MYfd1EhaRv%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/turp-technique" title="TURP TECHNIQUE" target="_blank">TURP TECHNIQUE</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><strong> </strong></a><strong><a href="https://www.slideshare.net/Ekoindra4/turp-technique" target="_blank" title="TURP TECHNIQUE">TURP TECHNIQUE</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>

TURP TECHNIQUE

Transurethral resection of the prostate (TURP) is a commonly performed surgical treatment for benign prostatic hyperplasia. This proced...

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Endoscopic Combined Intrarenal Surgery versus Percutaneous Nephrolithotomy for Renal Stones Management: A Meta-analysis

<div style="direction: ltr; line-height: 28.8pt; margin-bottom: 0pt; margin-left: 0.25in; margin-top: 0pt; text-align: justify; text-indent: -0.25in; unicode-bidi: embed; word-break: normal;"> <div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEil8kmZ-Yg3fX90_nV200dKcalhl2SW3NbdLT1_g39l_M81WzjvYe8cawkm4DaV5RwRc7UBu6xf8grIhPykrLgqpO-T3XAoECFW3kghGo0l0oFpErWANU5LnA0es_gdLRtr0xAp_Fu3X5A/s1600/Screen+Shot+2019-04-17+at+9.41.02+AM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="766" data-original-width="1363" height="356" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEil8kmZ-Yg3fX90_nV200dKcalhl2SW3NbdLT1_g39l_M81WzjvYe8cawkm4DaV5RwRc7UBu6xf8grIhPykrLgqpO-T3XAoECFW3kghGo0l0oFpErWANU5LnA0es_gdLRtr0xAp_Fu3X5A/s640/Screen+Shot+2019-04-17+at+9.41.02+AM.png" width="640" /></a></div> <span style="font-family: "calibri"; text-indent: -0.25in;">   </span><br /> <div style="text-align: left;"> <span style="font-family: "times new roman"; font-size: 12pt; text-indent: -0.25in;">      Endoscopic combined intrarenal surgery (ECIRS) is a novel way to approach renal cavities antero-retrogradely to remove renal stones since it combines flexible ureterorenoscopy (fURS) and percutaneous nephrolithotomy (PCNL). ECIRS is considered useful in managing patients with large stones, special cases regardless of age and body habitus, and is proven to provide benefits including minimizing radiation exposure and risk of hemorrhage.</span><br /> <span style="font-family: "times new roman"; font-size: 12pt; text-indent: -0.25in;"><br /></span> <span style="font-family: "times new roman"; font-size: 12pt; text-indent: -0.25in;">    <b> Read More in Below Slide...</b></span></div> </div> <div style="direction: ltr; line-height: 28.8pt; margin-bottom: 0pt; margin-left: .25in; margin-top: 0pt; mso-line-break-override: none; mso-line-height-rule: exactly; punctuation-wrap: hanging; text-align: left; text-indent: -.25in; unicode-bidi: embed; word-break: normal;"> <div style="text-align: center;"> <span style="font-family: "calibri"; text-indent: -0.25in;"><a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/wymUhgpjuBDWQq%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/erirs-vs-pcnl-uro-fair2019-eko-indra" title="Erirs vs pcnl uro fair2019 eko indra" target="_blank">Erirs vs pcnl uro fair2019 eko indra</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><iframe allowfullscreen="" frameborder="0" height="485" marginheight="0" marginwidth="0" scrolling="no" src="//www.slideshare.net/slideshow/embed_code/key/wymUhgpjuBDWQq" style="border-width: 1px; border: 1px solid #CCC; margin-bottom: 5px; max-width: 100%;" width="595"> </iframe> </a></span></div> <div style="margin-bottom: 5px;"> <span style="font-family: "calibri"; text-indent: -0.25in;"><a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/wymUhgpjuBDWQq%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/erirs-vs-pcnl-uro-fair2019-eko-indra" title="Erirs vs pcnl uro fair2019 eko indra" target="_blank">Erirs vs pcnl uro fair2019 eko indra</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><strong> </strong></a><strong><a href="https://www.slideshare.net/Ekoindra4/erirs-vs-pcnl-uro-fair2019-eko-indra" target="_blank" title="Erirs vs pcnl uro fair2019 eko indra">Erirs vs pcnl uro fair2019 eko indra</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </span></div> <span style="font-family: "calibri"; text-indent: -0.25in;"> </span></div> <div class="separator" style="clear: both; text-align: center;"> <br /></div> <br /> <div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivDFfX31yrpUADAKHF_hNG1ssBBWK8oaGTy-w1Mt0NXTONTY5Kexqw33RxYnzAGeRkiAe3bqRG90bnHPHMtJ7E6aW2Rvp85Oy8eb21bVFFywAEDRBp_CXQ7so8ouhqiBTPcdMe-XnXCqQ/s1600/WhatsApp+Image+2019-04-17+at+09.34.45.jpeg" imageanchor="1" style="margin-left: 1em; 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Endoscopic Combined Intrarenal Surgery versus Percutaneous Nephrolithotomy for Renal Stones Management: A Meta-analysis

          Endoscopic combined intrarenal surgery (ECIRS) is a novel way to approach renal cavities antero-retrogradely to remove renal ...

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SIRS, SEPSIS, AND MODS

<div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1w-YoyFnnjTMKnr5KyKopfF4A1TzOSJ1F-Fu2gFlHGDByA4IrIOxAP6I97gUS_1_kWoODPwg09nxXtEOBmbGc2JKJWUs4cIpYZyTcPfP5AbtPR1-qJt3m_Dy_qkgRC4RTiAxw0aK3zoI/s1600/Screen+Shot+2019-04-17+at+8.42.14+AM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="727" data-original-width="1010" height="230" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1w-YoyFnnjTMKnr5KyKopfF4A1TzOSJ1F-Fu2gFlHGDByA4IrIOxAP6I97gUS_1_kWoODPwg09nxXtEOBmbGc2JKJWUs4cIpYZyTcPfP5AbtPR1-qJt3m_Dy_qkgRC4RTiAxw0aK3zoI/s320/Screen+Shot+2019-04-17+at+8.42.14+AM.png" width="320" /></a></div> <div style="direction: ltr; margin-bottom: 6.0pt; margin-left: 0in; margin-top: 5.28pt; mso-line-break-override: none; punctuation-wrap: hanging; text-align: left; text-indent: 0in; unicode-bidi: embed; word-break: normal;"> <span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></div> <div style="direction: ltr; margin-bottom: 6.0pt; margin-left: 0in; margin-top: 5.28pt; mso-line-break-override: none; punctuation-wrap: hanging; text-align: left; text-indent: 0in; unicode-bidi: embed; word-break: normal;"> <span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></div> <div style="direction: ltr; margin-bottom: 6.0pt; margin-left: 0in; margin-top: 5.28pt; mso-line-break-override: none; punctuation-wrap: hanging; text-align: left; text-indent: 0in; unicode-bidi: embed; word-break: normal;"> <span style="font-family: "arial" , "helvetica" , sans-serif;">SIRS is characterized (1992) by two or more of the following : </span></div> <div style="direction: ltr; margin-bottom: 6.0pt; margin-left: 0in; margin-top: 5.28pt; mso-line-break-override: none; punctuation-wrap: hanging; text-align: left; text-indent: 0in; unicode-bidi: embed; word-break: normal;"> <span style="font-family: "arial" , "helvetica" , sans-serif;">1. Temperature > 38 C or < 36 C.</span></div> <div style="direction: ltr; margin-bottom: 6pt; margin-left: 0in; margin-top: 5.28pt; text-indent: 0in; unicode-bidi: embed; word-break: normal;"> <span style="font-family: "arial" , "helvetica" , sans-serif;">2. Heart rate > 90/minute.</span></div> <div style="direction: ltr; margin-bottom: 6pt; margin-left: 0in; margin-top: 5.28pt; text-indent: 0in; unicode-bidi: embed; word-break: normal;"> <span style="font-family: "arial" , "helvetica" , sans-serif;">3. Respiratory rate > 30/minute, or PaCo2 < 32 mmHg.</span></div> <div style="direction: ltr; margin-bottom: 6.0pt; margin-left: 0in; margin-top: 5.28pt; mso-line-break-override: none; punctuation-wrap: hanging; text-align: left; text-indent: 0in; unicode-bidi: embed; word-break: normal;"> <span style="font-family: "arial" , "helvetica" , sans-serif;">4. WBC count > 12000/mm3, < 4000/mm3, or > 10% band forms</span><br /> <span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">Please read more in below slide...</span></div> <div style="direction: ltr; margin-bottom: 6.0pt; margin-left: 0in; margin-top: 5.28pt; mso-line-break-override: none; punctuation-wrap: hanging; text-align: left; text-indent: 0in; unicode-bidi: embed; word-break: normal;"> <br /></div> <div style="direction: ltr; margin-bottom: 6.0pt; margin-left: 0in; margin-top: 5.28pt; mso-line-break-override: none; punctuation-wrap: hanging; text-align: left; text-indent: 0in; unicode-bidi: embed; word-break: normal;"> <a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/dabzDFMCssaswz%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/sepsis-sirs-mof-and-ards" title="SEPSIS, SIRS, MOF, AND ARDS" target="_blank">SEPSIS, SIRS, MOF, AND ARDS</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><iframe allowfullscreen="" frameborder="0" height="485" marginheight="0" marginwidth="0" scrolling="no" src="//www.slideshare.net/slideshow/embed_code/key/dabzDFMCssaswz" style="border-width: 1px; border: 1px solid #CCC; margin-bottom: 5px; max-width: 100%;" width="595"> </iframe> </a><br /> <div style="margin-bottom: 5px;"> <a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/dabzDFMCssaswz%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/sepsis-sirs-mof-and-ards" title="SEPSIS, SIRS, MOF, AND ARDS" target="_blank">SEPSIS, SIRS, MOF, AND ARDS</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><strong> </strong></a><strong><a href="https://www.slideshare.net/Ekoindra4/sepsis-sirs-mof-and-ards" target="_blank" title="SEPSIS, SIRS, MOF, AND ARDS">SEPSIS, SIRS, MOF, AND ARDS</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> <br /> <br /> <br /> <br /> <br /> <br /></div> </div>

SIRS, SEPSIS, AND MODS

SIRS is characterized (1992) by two or more of the following : 1. Temperature > 38 C or < 36 C. 2. Heart rate > 90/minut...

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ANDROGEN DEPRIVATION THERAPY (ADT)

<div class="separator" style="clear: both; text-align: center;"> </div> <div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxw-FlGWNzMc-5_kjJ9YsoFrIsxEuUVAleRKU4dA0cwNOrdBUVTiaZ3seZq5e_eY_ttOPG85y8DdHxrgpYmkpZ8vkSv1T1_DLUwmm-FpToZ_X4gA_Y8DbHXjfxk38lJkcQ-akjs9ZKCus/s1600/WhatsApp+Image+2019-01-06+at+16.26.42.PNG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="742" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxw-FlGWNzMc-5_kjJ9YsoFrIsxEuUVAleRKU4dA0cwNOrdBUVTiaZ3seZq5e_eY_ttOPG85y8DdHxrgpYmkpZ8vkSv1T1_DLUwmm-FpToZ_X4gA_Y8DbHXjfxk38lJkcQ-akjs9ZKCus/s320/WhatsApp+Image+2019-01-06+at+16.26.42.PNG" width="231" /></a></div> <div class="separator" style="clear: both; text-align: center;"> <br /></div> <div class="separator" style="clear: both; text-align: center;"> <br /></div> <div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXcBZKovMMvYJ180TfkdTH_OHcr0WJIAOfZXS4ie8yG081hBujZaWoy3QJIVeBLzZXlbHjmvtTySy3Iin1HYHwiVo_-G1FfniHHOJLbUnEplFlMZAw-RZ_j6oJ1TOSm-zmTeaZ4pjOeJM/s1600/Screen+Shot+2019-01-06+at+4.26.10+PM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1273" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXcBZKovMMvYJ180TfkdTH_OHcr0WJIAOfZXS4ie8yG081hBujZaWoy3QJIVeBLzZXlbHjmvtTySy3Iin1HYHwiVo_-G1FfniHHOJLbUnEplFlMZAw-RZ_j6oJ1TOSm-zmTeaZ4pjOeJM/s320/Screen+Shot+2019-01-06+at+4.26.10+PM.png" width="320" /></a></div> <br /> <div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwGFtHJZK7GhqV0llFZHM9nAt3t5EYza1rmWl7pPbjzkeCc-4kRgvmLpmQsa-WBnTNHumtnZyqKOjwuZTiQSnlh1Ecbya2YZAp2RxGKE0h1FVyXVvlq9aH9Xg4CYP3XJ5fO4OQT6h41Ik/s1600/WhatsApp+Image+2019-01-06+at+16.26.42.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="color: black;"></span></a></div> <div class="separator" style="clear: both; text-align: center;"> <br /></div> <div class="separator" style="clear: both; text-align: center;"> <!--StartFragment--> <!--EndFragment--></div> <span style="font-family: "georgia" , "times new roman" , serif;">Androgen deprivation therapy (ADT), also called androgen suppression therapy, is an antihormone therapy whose main use in treating prostate cancer...</span><br /> <div class="separator" style="clear: both; text-align: center;"> <br /></div> <a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/x9evI2NP34VLwR%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/androgen-deprivation-theraphy-on-prastate-ca" title="ANDROGEN DEPRIVATION THERAPHY ON PRASTATE CA" target="_blank">ANDROGEN DEPRIVATION THERAPHY ON PRASTATE CA</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><span style="color: black;"><iframe allowfullscreen="" frameborder="0" height="485" marginheight="0" marginwidth="0" scrolling="no" src="//www.slideshare.net/slideshow/embed_code/key/x9evI2NP34VLwR" style="border-width: 1px; border: 1px solid #CCC; margin-bottom: 5px; max-width: 100%;" width="595"> </iframe> </span></a><br /> <div style="margin-bottom: 5px;"> <a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/x9evI2NP34VLwR%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/androgen-deprivation-theraphy-on-prastate-ca" title="ANDROGEN DEPRIVATION THERAPHY ON PRASTATE CA" target="_blank">ANDROGEN DEPRIVATION THERAPHY ON PRASTATE CA</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><span style="color: black;"><strong> </strong></span></a><span style="color: black;"><strong><a href="https://www.slideshare.net/Ekoindra4/androgen-deprivation-theraphy-on-prastate-ca" target="_blank" title="ANDROGEN DEPRIVATION THERAPHY ON PRASTATE CA">ANDROGEN DEPRIVATION THERAPHY ON PRASTATE CA</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </span></div> <span style="color: black;"> </span>

ANDROGEN DEPRIVATION THERAPY (ADT)

Androgen deprivation therapy (ADT), also called androgen suppression therapy, is an antihormone therapy whose main use ...

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ANAK SERING ISK? HATI-HATI!!!

<div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhqDlCepROQfypn-f45YGMpADdcyjLF6EdrY8C-ivYT6ipobaSClk36vB8hNuFcTtK9wIeTYeVjzuL9C8iPoPQGHXMqdE7_wDAD5fIhP-YrGZNLs53xvd62GyxSUScocTamCGr_TyaVs8Q/s1600/INFEKSI+SALURAN+KENCING++PADA+ANAK.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="342" data-original-width="557" height="196" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhqDlCepROQfypn-f45YGMpADdcyjLF6EdrY8C-ivYT6ipobaSClk36vB8hNuFcTtK9wIeTYeVjzuL9C8iPoPQGHXMqdE7_wDAD5fIhP-YrGZNLs53xvd62GyxSUScocTamCGr_TyaVs8Q/s320/INFEKSI+SALURAN+KENCING++PADA+ANAK.jpg" width="320" /></a></div> <div> <br /></div> <div> <br /></div> Dalam pendekatan klinis terhadap penyakit infeksi saluran kemih (ISK) pada anak, ada kalanya kita melakukan underdiagnosis. Tidak jarang pasien anak berulang-ulang bahkan Saya beberapa kali menemukan hingga bertahun-tahun, didiagnosis ISK kronis dan tidak mendapatkan pendekatan yang betul-betul terapeutik, hanya simptomatik. Dokter yang merawat hanya memberikan antibiotik dana analgenik untuk penanganan penyakit ini.<br /> <div> Tidak sepenuhnya keliru memang, namun pendekatan ideal dan sistematik sebaiknya menjadi perhatian kita bersama untuk penanganan ISK pada anak. Kenapa?</div> <div> <br /></div> <div> Ada salah satu etiologi/penyebab pasien anak menderita ISK kronis, yang jika tidak tertangani dengan baik, akan menyebabkan komplikasi yang demikian serius. Ciyus? Hahaha... Berikut penjelasannya :</div> <div> <br /></div> <div> <br /></div> <div> <b>DEFINISI</b></div> <div> <b>VUR</b> adalah aliran balik abnormal urine yang berasal dari vesica urinaria (buli/kandung kencing) menuju saluran kemih bagian atas (ureter dan ginjal) yang disebabkan oleh abnormalitas dari ureterovesical junction. Insidensinya 0.4-1.8 % pada anak yang mengalami ISK. Biasa terjadi lebih banyak pada anak laki-laki dibandingkan dengan perempuan pada anak usia kurang dari satu tahun.</div> <div> <br /></div> <div> <b>PATOFISIOLOGI</b></div> <div> Ada dua tipe dari VUR, primer dan sekunder. <b>VUR tipe primer</b> disebabkan karena adanya kelainan anatomi pada vesicoureteric juntion (UVJ), yaitu area yang menghubungkan vesica urinaria dan ureter, dimana terjadi perubahan rasio antara panjang dari ureter intramural dan diameternya, normalnya 4-5:1. Ini terjadi saat perkembangan embrional pada minggu ke-6 kehamilan. Walaupun demikian resolusi spontan masih mungkin terjadi hingga 30%.</div> <div> Nah, untuk<b> reflux tipe sekunder</b> disebabkan karena adanya kelainan anatomi atau ketidakseimbangan tekanan dari vesioureteric junction (UVJ) seperti yang terjadi pada disfungsi berkemih (voiding disfuction), posterior urethral valves, divertikel ureter, dan neurogenik bladder.</div> <div> <br /></div> <div> <b>DIAGNOSIS</b></div> <div> Pendekatan diagnosis diawali  melalui anamnesis berupa gejala klinis ISK, seperti nyeri atau menangis saat berkemih, sering berkemih (frekuensi), urgensi, BAK berdarah (hematuria), dan sebagainya. pemeriksaan berikutnya adalah ultrasonografi (USG), <i>voiding cystourethrography (VCUG), dan renal scintigraphy.</i> Dari 3 pemeriksaan ini, yang bisa dilakukan pertama kali tentu adalah USG, sejawat dapat melakukannya sendiri jika terdapat fasilitas ditempat kerja, atau merujuk ke sejawat radiologi. Tentu hal ini dilakukan jika pasien datang dengan ISK berulang, jangan pernah melakukan ketika pasien pertama kali datang. Nanti BPJS marah... hehehe...</div> <div> <br /></div> <div> Jika menemukan hidronefrosis, dan kita sudah bisa singkirkan penyebab lain hidronefrosis, seperti batu saluran kemih, massa atau tumor, maka perlu kita curigai adanya VUR. Sejawat dapat merujuk pasien ke dokter Urologi untuk dilakukan  VCUG. VCUG merupakan pemeriksaan minimal invasif yang menggunakan teknologi <i>x-ray </i>yang disebut fluoroskopi untuk memvisualisasikan saluran kemih dan vesica urinaria. European Association of urology (EAU) sepakat jika pemeriksaan ini dilakukan jika pada pemeriksaan USG ditemukan adanya kelainan korteks ginjal (lapisan terluar ginjal tipis), hidronefrosis bilateral (bengkak kedua ginjal) dengan grade tinggi, ureterocele, dilatasi ureter, atau abnormalitas vesicaurinaria.</div> <div> Gambaran pemeriksaan ini dapat dilihat <a href="http://senseheal.blogspot.com/2018/06/voiding-cystourethrography-vcug.html" target="_blank">disini</a>.</div> <div> <br /></div> <div> Sementara ini, pemeriksaan <i>renal scintigraphy </i>jarang dilakukan di negeri tercinta untuk penegakkan diagnosis ini, cukup sampai VCUG saja. Tanya kenapa? Invasif karena pake nuklir dan mahal! hehe...</div> <div> <br /></div> <div> <br /></div> <div style="text-align: center;"> GRADING VUR</div> <div> <br /></div> <div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVwl5XGUvkAlN_lo2vI8ZBB39MQKFNAGOUIGsXJvUlw3y3VJZlLVwtBg9hKtbYW4uQ28EDQTTB5coj2AJzrYUytrTRdnjai6KjJaKCscdwPH4Rf8gLW7iz0KEdrbIRpX89HF9KzfJB7_Q/s1600/vur.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="280" data-original-width="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVwl5XGUvkAlN_lo2vI8ZBB39MQKFNAGOUIGsXJvUlw3y3VJZlLVwtBg9hKtbYW4uQ28EDQTTB5coj2AJzrYUytrTRdnjai6KjJaKCscdwPH4Rf8gLW7iz0KEdrbIRpX89HF9KzfJB7_Q/s1600/vur.jpg" /></a></div> <div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgg6McO83qPd7gfhy0_NZQQ1z5to1lO77fVpIfvKx0TN583KbBjdgPN4qFX804AyXpaEnpqcpoyweeH-F2oOqylEehJ_OVonW1UxF3HdgcgHa68sorvuc_RBoAZSKSQD-sJWdq6ghA-A1w/s1600/IMG_7706+%25282%2529.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="201" data-original-width="1242" height="100" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgg6McO83qPd7gfhy0_NZQQ1z5to1lO77fVpIfvKx0TN583KbBjdgPN4qFX804AyXpaEnpqcpoyweeH-F2oOqylEehJ_OVonW1UxF3HdgcgHa68sorvuc_RBoAZSKSQD-sJWdq6ghA-A1w/s640/IMG_7706+%25282%2529.jpg" width="640" /></a></div> <div> <br /></div> <div> <br /></div> <div> <b>TREATMENT</b></div> <div> Tujuan penanganan kasus ini adalah untuk preservasi fungsi ginjal dan mencegah pyelonefritis dan minimalisir morbiditas. Pendekatan primer untuk penyakit ini adalah konservatif (nonsurgical), endoskopi, dan pembedahan konvensional.</div> <div> <br /></div> <div> <b>Konservatif</b></div> <div> Pendekatan konservatif tetap menjadi pilihan karena teori yang mengatakatan bahwa VUR dapat sembuh spontan, termasuk dengan pendekatan observasional, pemberian antibiotik profilaksis intermiten (intermitten antibiotic prophylaxis) atau continuous antibiotik prophylaxis (CAP), rehabilitas vesicaurinaria dan bowel management pada pasien dengan <i>bladder dan bowel dysfuction.</i></div> <div> <i><br /></i></div> <div> <i>Tingkat resolusi VUR : </i></div> <div> Grade I-II    : 80% </div> <div> Grade III-V : 30-50% </div> <div> <b><br /></b></div> <div> Nah, ada yang menarik bicara tentang penyakit ini, banyak penulis yang menghubungkan tingkat kejadian ISK dan VUR dengan sirkumsisi/khitan. Sirkumsisi dianggap sebagai salah satu pendekatan konservatif, karena sirkumsisi dapat menurunkan resiko infeksi saluran kemih. Sirkumsisi terbukti menurukan kolonisasi dari flora bakteri patogen disekitar uretra. American urological Assosiation  (AUA) dan EAU merekomendasikan serkumsisi pada anak untuk pencagahan infeksi. </div> <div> <br /></div> <div> Pendekatan terapi konservatif ini direkomendasikan untuk anak usia kurang dari 12 bulan, dann pendekatan pembedahan konvensional sebaiknya dihindari untuk anak usia kurang dari 12 bulan.</div> <div> <br /></div> <div> <b>Endoskopi</b></div> <div> pertama kali diperkenal oleh O'Donnel and Puri tahun 1984. Awalnya dilakukan dengan menginjeksikan Teflon secara subureter. Berkembang lebih lanjut, ada beberapa <i>agent </i>yang dapat digunakan sebagai bulking agent termasuk BOTOX, namun pendekatan ini jarang dilakukan di Indonesia, karena terbatasnya bulking agent yang tersedia. Seringnya digunakan untuk kasus dengan komponen neurogenik (kelainan saraf).</div> <div> <br /></div> <div> Bulking Agent yang dapat digunakan dalam pendekatan endoskopi  :</div> <div> <div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_bMXRCc5EiUQ3svdOibHdWZTrzdZpginR0gGeiAjI6KlFkhxwveJhoj2QJzdROtglRMmOQ2_AuE_7NFdTnsCL-jZtYCDYgmdDu2t1duPjkmujhWvqYJivTKs7tgeQmm1rPvPx8B0D4oo/s1600/IMG_7707.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="753" data-original-width="1169" height="206" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_bMXRCc5EiUQ3svdOibHdWZTrzdZpginR0gGeiAjI6KlFkhxwveJhoj2QJzdROtglRMmOQ2_AuE_7NFdTnsCL-jZtYCDYgmdDu2t1duPjkmujhWvqYJivTKs7tgeQmm1rPvPx8B0D4oo/s320/IMG_7707.jpg" width="320" /></a></div> </div> <div> <br /></div> <div> <br /></div> <div> <br /></div> <div> <br /></div> <div> <br /></div> <div> <br /></div> <div> <br /></div> <div> <br /></div> <div> <br /></div> <div> <br /></div> <div> <br /></div> <div> <br /></div> <div> <b><br /></b></div> <div> <b>Pembedahan</b></div> <div> Ketika teknik endoskopi gagal untuk menjadi solusi maka pembedahan adalah pilihan terapi terakhir dengan angka keberhasilan 95-98%. </div> <div> Prinsipnya adalah memperpanjang bagian ureter intramural dengan mengimplantasi submukosa dari ureter untuk mencapai rasio panjang 4-5:1 antara panjang tunnel submukosa dan diameter ureter. Ada dua teknik operasi yang dikenal pada VUR, yaitu <b>intravesical Cohen cross-trigonal reimplantation dan etravesical Lich-Gregoir procedure</b>.</div> <div> Pembedahan dapat dilakukan baik secara operasi terbuka, laparoskopi, maupun laparoskopi. Operasi jenis ini,bukanlah sesuatu yang mudah, bahkan tidak semua dokter spesialis urologi melakukannya. ada sub bagian khusus pediatri urologi yang sangat menguasai teknik operasi ini. </div> <div> pesannya, sekali lagi jangan anggap remeh jika anak anda berulang-ulang mengalami penyakit infeksi saluran kemih, komunikasikan dengan dokter anak anda untuk konsultasi dengan dokter spesialis urologi.</div> <div> <br /></div> <div> <br /></div> <div> <span style="font-size: x-small;">Referensi  :</span></div> <div> <ol> <li><span style="font-size: x-small;">Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA. Campbell-Walsh urology: expert consult premium edition: enhanced online features and print, 4-volume set. Elsevier Health Sciences; 2011 Aug 25.</span></li> <li><span style="font-size: x-small;">Lopez PJ, Celis S, Reed F, Zubieta R. Vesicoureteral reflux: current management in children. Current urology reports. 2014 Oct 1;15(10):447.</span></li> </ol> </div> <div> <span style="font-size: x-small;">Image  :</span></div> <div> <span style="font-size: x-small;">https://www.rumahmedis.com/2018/02/infeksi-saluran-kencing-isk-pada-anak.html</span></div> <div> <span style="font-size: x-small;"><br /></span></div> <div> <br /></div> <div> <br /></div> <div> <div> Demikian, semoga bermanfaat, terutama buat yang penasaran... ;) </div> <div> Medan, Sebelum bisa libur lebaran 2018</div> </div> <div> <br /></div> <div> <br /></div> <div> <br /></div> <div> <br /></div> <div> <br /></div> <div> <br /></div> <div> <br /></div> <div> <br /></div> <div> <br /></div> <div> <br /> <div> <br /></div> </div>

ANAK SERING ISK? HATI-HATI!!!

Dalam pendekatan klinis terhadap penyakit infeksi saluran kemih (ISK) pada anak, ada kalanya kita melakukan underdiagnosis. Tidak jara...

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VOIDING CYSTOURETHROGRAPHY (VCUG)

<br /> <div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiy4IKH6-ZVRbKxLRA_89XOhGi_8upnojXfP8SZUhgSiePAwuiNO6hKWatF1qzU2ceByB2LkAJcsMpeROd-EbenpjCGu0goiF7daibag-FDhJpOqfF2g3KNmkfJA9CQZJcWp6zebq_sJLA/s1600/IMG_7705.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiy4IKH6-ZVRbKxLRA_89XOhGi_8upnojXfP8SZUhgSiePAwuiNO6hKWatF1qzU2ceByB2LkAJcsMpeROd-EbenpjCGu0goiF7daibag-FDhJpOqfF2g3KNmkfJA9CQZJcWp6zebq_sJLA/s320/IMG_7705.JPG" width="320" /></a></div> <br /> <br /> VCUG merupakan pemeriksaan minimal invasif yang menggunakan teknologi <i>x-ray </i>yang disebut fluoroskopi untuk memvisualisasikan saluran kemih dan vesica urinaria. European Association of urology (EAU) sepakat jika pemeriksaan ini dilakukan jika pada pemeriksaan USG ditemukan adanya kelainan korteks ginjal (lapisan terluar ginjal tipis), hidronefrosis bilateral (bengkak kedua ginjal) dengan grade tinggi, ureterocele, dilatasi ureter, atau abnormalitas vesicaurinaria.<br /> Pada pemeriksaan ini, pasien tidak dibius karena kita akan menilai fungsi dari saluran kemih. Orang tua dapat diikutsertakan dalam pemeriksaan ini.<br /> <br /> Teknik pemeriksaan  :<br /> - Pasien posisi terlentang (supine)<br /> - Kosongkan kandung kemih dengan kateter sesuai ukuran uretra anak<br /> - Insersi feeding tube (NGT) no. 5 hubungkan dengan drip kontras (Nacl : Iopamiro 1:1) dengan tetesan secepatnya<br /> - Masukkan kontras dengan maksimal pengisian sesuai dengan kapasitas buli (Umur+2)x30 ml. Pengukuran kapasitas Buli dapat dilihat di <a href="http://senseheal.blogspot.com/2018/05/bladder-capacity.html" target="_blank">sini</a>.<br /> - Perhatikan monitor fluoroscopy/C-arm, apakah terdapat reflux contras (aliran kontras menuju ureter dan ginjal)? pada pengisian berapa ml hal tersebut terjadi? Grading Hidronefrosis?<br /> - Buat tabel pemeriksaan untuk mendokumentasikan pemeriksaan ini.<br /> - Kosongkan kandung kemih, tindakan selesai<br /> <br /> <div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhepq4XVnChhFC7g8JCjkh3PHfJf_DJnZbrMSNZ7s7hkHNn_qUoHfaCuodor8OYEJZ902f9RdXpZyjlA8fJuaSNt1NSkWkDAws_wNqluFvbZiTzYedoQhuM1Xj1WNYgc3FbknCRVgW0rkI/s1600/IMG_7701.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhepq4XVnChhFC7g8JCjkh3PHfJf_DJnZbrMSNZ7s7hkHNn_qUoHfaCuodor8OYEJZ902f9RdXpZyjlA8fJuaSNt1NSkWkDAws_wNqluFvbZiTzYedoQhuM1Xj1WNYgc3FbknCRVgW0rkI/s320/IMG_7701.JPG" width="320" /></a></div> <br /> <div class="separator" style="clear: both; text-align: center;"> <br /></div> <br /> <div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgnyKMRzBa7CzB4K06lm_-Cdp0Y9NyDn0mZFBJde4NeyorCcA-K9lwnznHKeJBkFdX-T0vTc3xf9YBmkW3stiRz8DOfKQGyu-0FYXETK_DqFGgyt-vMkO_3MIiVUn-UJeueK4atNQYDB0Y/s1600/IMG_7703.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgnyKMRzBa7CzB4K06lm_-Cdp0Y9NyDn0mZFBJde4NeyorCcA-K9lwnznHKeJBkFdX-T0vTc3xf9YBmkW3stiRz8DOfKQGyu-0FYXETK_DqFGgyt-vMkO_3MIiVUn-UJeueK4atNQYDB0Y/s320/IMG_7703.JPG" width="320" /></a></div> <div class="separator" style="clear: both; text-align: center;"> <br /></div> <div class="separator" style="clear: both; text-align: center;"> <br /></div> <div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJ_XD3R32XswtE6DSq06ApFp6tlgFxOgot9fyobxybmJOxT_KZoJR2lCnWXLs_ri1lkuKOUr7F4UfIuIB7PjHp6sRvkMVyBuXjRuG0hyJtmKxb_GMpKcCvYFIBKU7v_HDKhDFZk2P8gHs/s1600/IMG_7702.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJ_XD3R32XswtE6DSq06ApFp6tlgFxOgot9fyobxybmJOxT_KZoJR2lCnWXLs_ri1lkuKOUr7F4UfIuIB7PjHp6sRvkMVyBuXjRuG0hyJtmKxb_GMpKcCvYFIBKU7v_HDKhDFZk2P8gHs/s320/IMG_7702.JPG" width="320" /></a></div> <div class="separator" style="clear: both; text-align: center;"> <br /></div> <br /> <div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh8PoNzRA8HGL60jrAOwqmbJLYQTP5okwmcQhXDJkgQbe7tCbHpoXDzU88zIERbiGBelA_Anp9FsABZ7DMIPOkHyHzZyhVMhMO40U4OV8Kx9HKg7KLlCL2lvhdPj9STI2oUmfAd03KkJ_M/s1600/IMG_7704.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh8PoNzRA8HGL60jrAOwqmbJLYQTP5okwmcQhXDJkgQbe7tCbHpoXDzU88zIERbiGBelA_Anp9FsABZ7DMIPOkHyHzZyhVMhMO40U4OV8Kx9HKg7KLlCL2lvhdPj9STI2oUmfAd03KkJ_M/s320/IMG_7704.JPG" width="320" /></a></div> <br /> <div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiy4IKH6-ZVRbKxLRA_89XOhGi_8upnojXfP8SZUhgSiePAwuiNO6hKWatF1qzU2ceByB2LkAJcsMpeROd-EbenpjCGu0goiF7daibag-FDhJpOqfF2g3KNmkfJA9CQZJcWp6zebq_sJLA/s1600/IMG_7705.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiy4IKH6-ZVRbKxLRA_89XOhGi_8upnojXfP8SZUhgSiePAwuiNO6hKWatF1qzU2ceByB2LkAJcsMpeROd-EbenpjCGu0goiF7daibag-FDhJpOqfF2g3KNmkfJA9CQZJcWp6zebq_sJLA/s320/IMG_7705.JPG" width="320" /></a></div> <div class="separator" style="clear: both; text-align: center;"> <br /></div> <br /> <br /> <br /> Semoga Bermanfaat,<br /> Medan, Juni 2018<br /> <br /> <div class="separator" style="clear: both; text-align: center;"> <br /></div>

VOIDING CYSTOURETHROGRAPHY (VCUG)

VCUG merupakan pemeriksaan minimal invasif yang menggunakan teknologi  x-ray  yang disebut fluoroskopi untuk memvisualisasikan saluran ...

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SUBCAPSULAR NEPHRECTOMY TIPS

<div style="text-align: center;"> </div> <div style="text-align: justify;"> <div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0bs7spKjvhwmlrB6Xf4f-tUoLCcIxA84fkNjV7Ku7v7jD9UgxjspTi9mlo59iyIDoio6C7H4rN-GMzKoOswrYkKzR-X6495ekVGE5tKaoEiJ9YgZHUSgJHy1AnATa6RMOxZjk-htts-0/s1600/WhatsApp+Image+2019-01-06+at+07.01.45%25281%2529.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="580" data-original-width="609" height="304" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0bs7spKjvhwmlrB6Xf4f-tUoLCcIxA84fkNjV7Ku7v7jD9UgxjspTi9mlo59iyIDoio6C7H4rN-GMzKoOswrYkKzR-X6495ekVGE5tKaoEiJ9YgZHUSgJHy1AnATa6RMOxZjk-htts-0/s320/WhatsApp+Image+2019-01-06+at+07.01.45%25281%2529.png" width="320" /></a></div> <div class="separator" style="clear: both; text-align: center;"> <br /></div> <div class="separator" style="clear: both; text-align: center;"> </div> <div class="separator" style="clear: both; text-align: center;"> </div> <div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiaZQE6G9TtKMmSLdWRW0y0qul2_bq7C4qsOJ80ZRYHAO2MKCYjVQQkKO6NBohkVv5ZKIhWCZhTnMMs_T623XBuKA0oEa_mZvYEObpapRovLfjOUjne5gMd-DlYaEDTzeij-Gipthc1jAQ/s1600/WhatsApp+Image+2019-01-06+at+07.01.45.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="649" data-original-width="591" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiaZQE6G9TtKMmSLdWRW0y0qul2_bq7C4qsOJ80ZRYHAO2MKCYjVQQkKO6NBohkVv5ZKIhWCZhTnMMs_T623XBuKA0oEa_mZvYEObpapRovLfjOUjne5gMd-DlYaEDTzeij-Gipthc1jAQ/s320/WhatsApp+Image+2019-01-06+at+07.01.45.jpeg" width="291" /></a></div> <span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></div> <div style="text-align: justify;"> <div class="separator" style="clear: both; text-align: center;"> </div> <span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></div> <div style="text-align: justify;"> <span style="font-family: "trebuchet ms" , sans-serif;">Teknik nefrektomi ini dikerjakan apabila konvensional nefrektomi tidak dapat dikerjakan, semisal durante operasi kita menghadapi perlengketan ginjal dengan jaringan sekitar seperti lemak pararenal, intestine, liver, dll.</span></div> <div style="text-align: justify;"> <span style="font-family: "trebuchet ms" , sans-serif;">Tips Teknik Operasi  :</span></div> <div style="text-align: justify;"> <span style="font-family: "trebuchet ms" , sans-serif;">- Berdoa kepada Allah SWT dengan memohon pertolongan dan kemudahan  </span></div> <div style="text-align: justify;"> <span style="font-family: "trebuchet ms" , sans-serif;">- Jika kita menghadapi perlengketan yang demikian menghambat untuk membebaskan ginjal, buka kapsul ginjal di daerah termudah dan teraman diantara perlengketan yg ada</span></div> <div style="text-align: justify;"> <span style="font-family: "trebuchet ms" , sans-serif;">- Telusuri kapsul dengan membebaskan ginjal yang ada dengan klem 90 (<i>right angle clamp</i>), ambil bagian dalam parenkim ginjal dibagian dlm kapsul dan potong/bakar menggunakan kauter. </span></div> <div style="text-align: justify;"> <span style="font-family: "trebuchet ms" , sans-serif;">- Perluas pembebasan parenkim dengan cara yang sama hingga mencapai pedikel. </span></div> <div style="text-align: justify;"> <span style="font-family: "trebuchet ms" , sans-serif;">- Gunakan teknik dua klem dan potong seperti approach pada nefrektomi tumor ginjal, hingga mencapai pedikel</span></div> <div style="text-align: justify;"> <span style="font-family: "trebuchet ms" , sans-serif;">- Jika mencurigai menemukan pembuluh darah besar, dapat dilakukan pengikatan dan pemotongan</span></div> <div style="text-align: justify;"> <span style="font-family: "trebuchet ms" , sans-serif;">- setelah mencapai pedikel, atau kira-kira semua parenkim dpt diklem, gunakan teknik surginal knot, potong</span></div> <div style="text-align: justify;"> <span style="font-family: "trebuchet ms" , sans-serif;">- jika mengalami kesulitan dalam mencapai pedikel, gunakan teknik jahit parenkim dengan teknik jelujur, kemudian angkat atau tarik ke distal, klem kembali dibagian proksimal dst hingga dpt mencapai pedikel, baru kemudian dilakukan klem pedikel dan CUT!</span></div> <div style="text-align: justify;"> <span style="font-family: "trebuchet ms" , sans-serif;">- Tempelkan surgisoft atau sejenisnya untuk membantu hemostasis, cukup ditempelkan atau jahit pada daerah yang aman.</span></div> <div style="text-align: justify;"> <span style="font-family: "trebuchet ms" , sans-serif;">- Peritoneum yang terbuka setelah kita masukkan air cucian maka tidak perlu dilakukan penutupan.</span></div> <div style="text-align: justify;"> <span style="font-family: "trebuchet ms" , sans-serif;">- Operasi selesai, semoga bermanfaat.</span></div> <div style="text-align: justify;"> <span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></div> <div style="text-align: justify;"> <span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></div> <div style="text-align: justify;"> <span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></div> <div style="text-align: right;"> <span style="font-family: "trebuchet ms" , sans-serif;">Eko Indra, </span></div> <div style="text-align: right;"> <span style="font-family: "trebuchet ms" , sans-serif;">Medan, 6 Januari 2019</span></div> <br /> <br />

SUBCAPSULAR NEPHRECTOMY TIPS

Teknik nefrektomi ini dikerjakan apabila konvensional nefrektomi tidak dapat dikerjakan, semisal durante operasi kita men...

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Principles of Endourology

<div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiEvXcumIINyybnAhmvWWpZv-QvXRnl4HfIuKDxDR7aKEmVW_DIsvgZRKfuYi5JPCu79Rq3_o-alfiEWynFrwLVNiAwN-UGqb55uLWeec4LQTkMDWWVJgp39KDjejqMT7c-3zWOMjPPjV8/s1600/Screen+Shot+2018-05-29+at+5.25.08+PM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="205" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiEvXcumIINyybnAhmvWWpZv-QvXRnl4HfIuKDxDR7aKEmVW_DIsvgZRKfuYi5JPCu79Rq3_o-alfiEWynFrwLVNiAwN-UGqb55uLWeec4LQTkMDWWVJgp39KDjejqMT7c-3zWOMjPPjV8/s400/Screen+Shot+2018-05-29+at+5.25.08+PM.png" width="400" /></a></div> <span style="font-family: "calibri light"; font-weight: bold;"></span><span style="font-family: "calibri light"; font-weight: bold;"><br /></span> <span style="font-family: "calibri light"; font-size: large; font-weight: bold;">CYSTOURETHROSCOPY</span><!--EndFragment-->  <br /> <div style="direction: ltr; line-height: 90%; margin-bottom: 0pt; margin-left: .25in; margin-top: 10.0pt; mso-line-break-override: none; punctuation-wrap: hanging; text-align: left; text-indent: -.25in; unicode-bidi: embed; word-break: normal;"> <span style="font-family: "arial"; mso-special-format: bullet;">•<span style="font-size: large;"> </span></span><span style="font-size: large;"><span style="color: black; font-family: "calibri";">Provides direct visualization of the </span><span style="color: black; font-family: "calibri";">anterior </span><span style="color: black; font-family: "mangal";">–</span><span style="color: black; font-family: "calibri";"> posterior urethra </span><span style="color: black; font-family: "calibri";">and bladder</span></span></div> <div style="direction: ltr; line-height: 90%; margin-bottom: 0pt; margin-left: .25in; margin-top: 10.0pt; mso-line-break-override: none; punctuation-wrap: hanging; text-align: left; text-indent: -.25in; unicode-bidi: embed; word-break: normal;"> <span style="font-size: large;"><span style="font-family: "arial"; mso-special-format: bullet;">• </span><span style="color: black; font-family: "calibri";">Rigid or flexible</span></span></div> <div style="direction: ltr; line-height: 90%; margin-bottom: 0pt; margin-left: .25in; margin-top: 10.0pt; mso-line-break-override: none; punctuation-wrap: hanging; text-align: left; text-indent: -.25in; unicode-bidi: embed; word-break: normal;"> <span style="font-size: large;"><span style="font-family: "arial"; mso-special-format: bullet;">• </span><span style="color: black; font-family: "calibri";">Rigid provides larger </span><span style="color: black; font-family: "calibri";">workshing</span><span style="color: black; font-family: "calibri";"> channels, easier to control, and better visualization...</span></span><br /> <span style="color: black; font-family: "calibri";"><br /></span> <span style="color: black; font-family: "calibri";"><br /></span> <span style="color: black; font-family: "calibri";"><a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/1F0miL8dIpG3Sw%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/principles-of-endourology" title="Principles of Endourology" target="_blank">Principles of Endourology</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><iframe allowfullscreen="" frameborder="0" height="485" marginheight="0" marginwidth="0" scrolling="no" src="//www.slideshare.net/slideshow/embed_code/key/1F0miL8dIpG3Sw" style="border-width: 1px; border: 1px solid #CCC; margin-bottom: 5px; max-width: 100%;" width="595"> </iframe> </a></span><br /> <div style="margin-bottom: 5px;"> <span style="color: black; font-family: "calibri";"><a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/1F0miL8dIpG3Sw%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/principles-of-endourology" title="Principles of Endourology" target="_blank">Principles of Endourology</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><strong> </strong></a><strong><a href="https://www.slideshare.net/Ekoindra4/principles-of-endourology" target="_blank" title="Principles of Endourology">Principles of Endourology</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </span></div> <span style="color: black; font-family: "calibri";"> </span> <br /> <br /> <br /> <br /> <br /> <br /> <br /></div>

Principles of Endourology

CYSTOURETHROSCOPY   •   Provides direct visualization of the anterior – posterior urethra and bladder •  Rigid or flexible • Rigid...

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BLADDER CAPACITY

<span style="color: black;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWzuG-qEV2GRa1eg8FmAFEot3jzUySBFWyQC08vPUFzcY2qFk590vY57OlUReasP4vqCtNtQjxmb0d7Iuq4ZRHVOqeYCMhVVaKj2oUFF7v1kgcuCELQJ09DfcUhu85dy2YoItR8AxrtX4/s1600/Screen+Shot+2018-05-29+at+5.50.42+PM.png" imageanchor="1"><img border="0" height="443" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWzuG-qEV2GRa1eg8FmAFEot3jzUySBFWyQC08vPUFzcY2qFk590vY57OlUReasP4vqCtNtQjxmb0d7Iuq4ZRHVOqeYCMhVVaKj2oUFF7v1kgcuCELQJ09DfcUhu85dy2YoItR8AxrtX4/s640/Screen+Shot+2018-05-29+at+5.50.42+PM.png" width="640" /></a></span><br /> <div class="O0" style="direction: ltr; margin-bottom: 0pt; margin-left: .3in; margin-top: 0pt; mso-line-break-override: none; punctuation-wrap: hanging; text-align: left; text-indent: -.3in; unicode-bidi: embed; word-break: normal;"> <span style="font-family: "arial rounded mt bold";"><br /></span></div> <div style="direction: ltr; margin-bottom: 0pt; margin-left: 0in; margin-top: 5.2pt; mso-line-break-override: none; punctuation-wrap: hanging; text-align: left; text-indent: 0in; unicode-bidi: embed; word-break: normal;"> </div> <br /> <ul> <li><span style="font-family: "arial rounded mt bold"; text-indent: -0.3in;">Koff</span><span style="font-family: "arial rounded mt bold"; text-indent: -0.3in;"> formula (bladder capacity [in ounces]: </span><span style="font-family: "arial rounded mt bold"; text-indent: 0in;">(Age </span><span style="font-family: "arial rounded mt bold"; text-indent: 0in;">(in years) + 2) × 30</span></li> <li><span style="font-family: "arial rounded mt bold";">The ABC formula  : </span><span style="font-family: "arial rounded mt bold";">(Age (A) x 30) / 2</span></li> <li><span style="font-family: "arial rounded mt bold"; text-indent: -0.38in;">Daniel Costa et al : </span><span style="font-family: "arial rounded mt bold"; text-indent: 0in;"> </span><span style="font-family: "arial rounded mt bold"; text-indent: 0in;">[1.6 × age (months) + 45]</span></li> <li><span style="font-family: "arial rounded mt bold"; text-indent: -0.38in;">Fairhurst</span><span style="font-family: "arial rounded mt bold"; text-indent: -0.38in;"> formula  : </span><span style="font-family: "arial rounded mt bold"; text-indent: 0in;">[7 × weight (kg)] </span><span style="font-family: "arial rounded mt bold"; text-indent: 0in;">which gives a bladder capacity estimate in </span><span style="font-family: "arial rounded mt bold"; text-indent: 0in;">millilitres</span></li> </ul> <div> <span style="font-family: "arial rounded mt bold";"><br /></span></div> <div> <span style="font-family: "arial rounded mt bold";"><a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/9h7VLvc3VYC9N6%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/bladder-capacity" title="Bladder Capacity " target="_blank">Bladder Capacity </a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><iframe allowfullscreen="" frameborder="0" height="485" marginheight="0" marginwidth="0" scrolling="no" src="//www.slideshare.net/slideshow/embed_code/key/9h7VLvc3VYC9N6" style="border-width: 1px; border: 1px solid #CCC; margin-bottom: 5px; max-width: 100%;" width="595"> </iframe> </a></span><br /> <div style="margin-bottom: 5px;"> <span style="font-family: "arial rounded mt bold";"><a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/9h7VLvc3VYC9N6%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/bladder-capacity" title="Bladder Capacity " target="_blank">Bladder Capacity </a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><strong> </strong></a><strong><a href="https://www.slideshare.net/Ekoindra4/bladder-capacity" target="_blank" title="Bladder Capacity ">Bladder Capacity </a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </span></div> <span style="font-family: "arial rounded mt bold";"> </span></div>

BLADDER CAPACITY

Koff formula (bladder capacity [in ounces]:  (Age (in years) + 2) × 30 The ABC formula  :  (Age (A) x 30) / 2 Daniel Costa et al :...

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Urologic Ultrasonography

<div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_xp6U6jBMqpM5CAuNjCyCHBNBoG92aSZ6DNxZQwVHElN9N-rRveO_fULwdUkViJ0YDFyOJE60gOadAfwd8KFvSmoRSX8-8ZnwIWSfDTTfrjdeooxM6k_iIjMi3PcMtedy1Ubn_FuIGjQ/s1600/Screen+Shot+2018-03-19+at+11.24.47+PM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="color: black;"><img border="0" data-original-height="719" data-original-width="1021" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_xp6U6jBMqpM5CAuNjCyCHBNBoG92aSZ6DNxZQwVHElN9N-rRveO_fULwdUkViJ0YDFyOJE60gOadAfwd8KFvSmoRSX8-8ZnwIWSfDTTfrjdeooxM6k_iIjMi3PcMtedy1Ubn_FuIGjQ/s320/Screen+Shot+2018-03-19+at+11.24.47+PM.png" width="320" /></span></a></div> <br /> <span style="font-family: "calibri"; text-indent: -0.38in;"><br /></span> <br /> <div style="direction: ltr; margin-bottom: 0pt; margin-left: .38in; margin-top: 6.0pt; mso-line-break-override: none; punctuation-wrap: hanging; text-align: left; text-indent: -.38in; unicode-bidi: embed; word-break: normal;"> <ul> <li><span style="font-family: "calibri"; text-indent: -0.38in;">Interaction of soundwaves w/ tissues and structures within the human body </span><span style="font-family: "wingdings"; text-indent: -0.38in;">à</span><span style="font-family: "calibri"; text-indent: -0.38in;"> ultrasound imaging</span></li> <li><span style="font-family: "calibri"; text-align: justify; text-indent: -0.38in;">The soundwaves are longitudinal waves </span><span style="font-family: "wingdings"; text-align: justify; text-indent: -0.38in;">à</span><span style="font-family: "calibri"; text-align: justify; text-indent: -0.38in;"> the particle motion is in the same direction as the propagation of the wave. </span><span style="font-family: "calibri"; text-align: justify; text-indent: -0.38in;">The transducer = a receiver for the returning sound wave reconverting the mechanical wave to </span><span style="font-family: "calibri"; text-align: justify; text-indent: -0.38in;">electrical energy</span></li> </ul> </div> <!--StartFragment--> <!--EndFragment--><br /> <br /> <br /> <a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/FMloJI7n2OZL0U%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/urologic-ultrasonography-91178538" title="Urologic Ultrasonography" target="_blank">Urologic Ultrasonography</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><span style="color: black;"><iframe allowfullscreen="" frameborder="0" height="485" marginheight="0" marginwidth="0" scrolling="no" src="//www.slideshare.net/slideshow/embed_code/key/FMloJI7n2OZL0U" style="border-width: 1px; border: 1px solid #CCC; margin-bottom: 5px; max-width: 100%;" width="595"> </iframe> </span></a><br /> <div style="margin-bottom: 5px;"> <span style="color: black;"><a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/FMloJI7n2OZL0U%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/urologic-ultrasonography-91178538" title="Urologic Ultrasonography" target="_blank">Urologic Ultrasonography</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"> </a><a href="https://www.slideshare.net/Ekoindra4/urologic-ultrasonography-91178538" target="_blank" title="Urologic Ultrasonography">Urologic Ultrasonography</a> from <a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></span> </div>

Urologic Ultrasonography

Interaction of soundwaves w/ tissues and structures within the human body à ultrasound imaging The soundwaves are longitudinal wave...

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OPEN PYELOLITHOTOMY TECHNIQUE

<div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-w9gaaQawAlrQTIO4tLT-TN82l0dMKxVRmQg6peziArK9cAo1budT6UqHfCQmW9bCEnbshE0lXD2fxdKxJoEDHZBsENeQCncezRz4Qm4X7zJBzGcSAurOwXKgfVU9NSuELVrT8ivjpio/s1600/Screen+Shot+2018-06-02+at+6.18.07+AM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-w9gaaQawAlrQTIO4tLT-TN82l0dMKxVRmQg6peziArK9cAo1budT6UqHfCQmW9bCEnbshE0lXD2fxdKxJoEDHZBsENeQCncezRz4Qm4X7zJBzGcSAurOwXKgfVU9NSuELVrT8ivjpio/s320/Screen+Shot+2018-06-02+at+6.18.07+AM.png" width="320" /></a></div> <br /> <br /> <div style="direction: ltr; margin-bottom: 0pt; margin-left: .25in; margin-top: 5.28pt; mso-line-break-override: none; punctuation-wrap: hanging; text-align: left; text-indent: -.25in; unicode-bidi: embed; word-break: normal;"> <h3> <span style="color: #404040; font-family: "cambria"; font-size: medium;">The indications for removing stones surgically</span></h3> <h3> <span style="font-size: medium;"><span style="color: #404040; font-family: "cambria";">(</span><span style="color: #404040; font-family: "cambria";">1) economy and the personal convenience of the patient,</span></span></h3> <h3> <span style="font-size: medium;"><span style="color: #404040; font-family: "cambria";"><span style="color: #404040; font-family: "cambria"; text-indent: -0.25in;">(</span><span style="color: #404040; font-family: "cambria"; text-indent: -0.25in;">2) associated disorders that require open operation,</span></span></span></h3> <h3> <span style="color: #404040; font-family: "cambria"; text-indent: -0.25in;">(</span><span style="color: #404040; font-family: "cambria"; text-indent: -0.25in;">3) infected cases need- </span><span style="color: #404040; font-family: "cambria"; text-indent: -0.25in;">ing</span><span style="color: #404040; font-family: "cambria"; text-indent: -0.25in;"> definitive and expeditious clearance of calculi</span><span style="color: #404040; font-family: cambria; text-indent: -0.25in;">...</span></h3> <h3> <span style="color: #404040; font-family: "cambria"; font-size: medium;"><br /></span></h3> <h3> <span style="color: #404040; font-family: "cambria"; font-size: medium;">Slide down for complete information :</span></h3> </div> <!--StartFragment--> <!--EndFragment--><br /> <div style="direction: ltr; margin-bottom: 0pt; margin-left: .36in; margin-top: 4.8pt; mso-line-break-override: none; punctuation-wrap: hanging; text-align: left; text-indent: 0in; unicode-bidi: embed; word-break: normal;"> <br /> <a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/zWr11jNS2ZEp5s%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/open-pyelolithotomy" title="Open Pyelolithotomy" target="_blank">Open Pyelolithotomy</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><iframe allowfullscreen="" frameborder="0" height="485" marginheight="0" marginwidth="0" scrolling="no" src="//www.slideshare.net/slideshow/embed_code/key/zWr11jNS2ZEp5s" style="border-width: 1px; border: 1px solid #CCC; margin-bottom: 5px; max-width: 100%;" width="595"> </iframe> </a><br /> <div style="margin-bottom: 5px;"> <a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/zWr11jNS2ZEp5s%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/open-pyelolithotomy" title="Open Pyelolithotomy" target="_blank">Open Pyelolithotomy</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><strong> </strong></a><strong><a href="https://www.slideshare.net/Ekoindra4/open-pyelolithotomy" target="_blank" title="Open Pyelolithotomy">Open Pyelolithotomy</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div> </div>

OPEN PYELOLITHOTOMY TECHNIQUE

The indications for removing stones surgically ( 1) economy and the personal convenience of the patient, ( 2) associated disorders...

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URETHRAL INJURY & PER

<div style="direction: ltr; margin-bottom: 0pt; margin-left: .28in; margin-top: 5.76pt; mso-line-break-override: restrictions; punctuation-wrap: simple; text-align: left; text-indent: -.28in; unicode-bidi: embed; vertical-align: baseline;"> <span style="font-family: "arial";"><a href="https://www.blogger.com/"></a><span id="goog_2079978604"></span><span id="goog_2079978605"></span><br /></span></div> <div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGHlTt1M5vkKpGqBdEwVeEVGF4X6qsDEiqog3voJ1YbixZ8LHUrtZaDXa_53-lPBTRCGFPz9B44Ihdzl0uai500DLWuI6ZZa744Bf8haOw_QNmeb0Y02kYqM6c_WRN6oqxJWL67vONaCE/s1600/Screen+Shot+2018-01-14+at+11.23.58+AM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="color: black;"><img border="0" data-original-height="733" data-original-width="1026" height="228" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGHlTt1M5vkKpGqBdEwVeEVGF4X6qsDEiqog3voJ1YbixZ8LHUrtZaDXa_53-lPBTRCGFPz9B44Ihdzl0uai500DLWuI6ZZa744Bf8haOw_QNmeb0Y02kYqM6c_WRN6oqxJWL67vONaCE/s320/Screen+Shot+2018-01-14+at+11.23.58+AM.png" width="320" /></span></a></div> <div style="direction: ltr; margin-bottom: 0pt; margin-left: .28in; margin-top: 5.76pt; mso-line-break-override: restrictions; punctuation-wrap: simple; text-align: left; text-indent: -.28in; unicode-bidi: embed; vertical-align: baseline;"> <span style="font-family: "arial";"><br /></span></div> <div style="direction: ltr; margin-bottom: 0pt; margin-left: .28in; margin-top: 5.76pt; mso-line-break-override: restrictions; punctuation-wrap: simple; text-align: left; text-indent: -.28in; unicode-bidi: embed; vertical-align: baseline;"> <span style="font-family: "arial";">INTRODUCTION  : </span></div> • Ormond and Cothran first described in 1934<br /> • The aim is to correct severe distraction injuries rather than to prevent a stricture<br /> • Traditionally, urethral injury is managed with an initial suprapubic cystostomy and urethral reconstruction 3 – 6 months after.<br /> • Endoscopic re-alignment is the preferred technique.<br /> <div style="direction: ltr; margin-bottom: 0pt; margin-left: .28in; margin-top: 5.76pt; mso-line-break-override: restrictions; punctuation-wrap: simple; text-align: left; text-indent: -.28in; unicode-bidi: embed; vertical-align: baseline;"> <span style="font-family: "calibri";"><br /></span></div> <div style="direction: ltr; margin-bottom: 0pt; margin-left: .28in; margin-top: 5.76pt; mso-line-break-override: restrictions; punctuation-wrap: simple; text-align: left; text-indent: -.28in; unicode-bidi: embed; vertical-align: baseline;"> <span style="font-family: "calibri";"><a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/KrMpvAsHiDwOVN%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/primary-endoscopic-realignment-86122672" title="Primary endoscopic realignment" target="_blank">Primary endoscopic realignment</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><iframe allowfullscreen="" frameborder="0" height="485" marginheight="0" marginwidth="0" scrolling="no" src="//www.slideshare.net/slideshow/embed_code/key/KrMpvAsHiDwOVN" style="border-width: 1px; border: 1px solid #CCC; margin-bottom: 5px; max-width: 100%;" width="595"> </iframe> </a></span><br /> <div style="margin-bottom: 5px;"> <span style="font-family: "calibri";"><a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/KrMpvAsHiDwOVN%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/primary-endoscopic-realignment-86122672" title="Primary endoscopic realignment" target="_blank">Primary endoscopic realignment</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><strong> </strong></a><strong><a href="https://www.slideshare.net/Ekoindra4/primary-endoscopic-realignment-86122672" target="_blank" title="Primary endoscopic realignment">Primary endoscopic realignment</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </span></div> <span style="font-family: "calibri";"> </span></div> <div style="direction: ltr; margin-bottom: 0pt; margin-left: .28in; margin-top: 5.76pt; mso-line-break-override: restrictions; punctuation-wrap: simple; text-align: left; text-indent: -.28in; unicode-bidi: embed; vertical-align: baseline;"> <span style="font-family: "calibri";"><br /></span></div> <div style="direction: ltr; margin-bottom: 0pt; margin-left: .28in; margin-top: 5.76pt; mso-line-break-override: restrictions; punctuation-wrap: simple; text-align: left; text-indent: -.28in; unicode-bidi: embed; vertical-align: baseline;"> <span style="font-family: "calibri";"><br /></span></div> <div style="direction: ltr; margin-bottom: 0pt; margin-left: .28in; margin-top: 5.76pt; mso-line-break-override: restrictions; punctuation-wrap: simple; text-align: left; text-indent: -.28in; unicode-bidi: embed; vertical-align: baseline;"> <span style="font-family: "calibri"; text-indent: -0.28in;"></span><!--EndFragment--></div> <div style="direction: ltr; margin-bottom: 0pt; margin-left: .28in; margin-top: 5.76pt; mso-line-break-override: restrictions; punctuation-wrap: simple; text-align: left; text-indent: -.28in; unicode-bidi: embed; vertical-align: baseline;"> <span style="font-family: "calibri";"><br /></span></div>

URETHRAL INJURY & PER

INTRODUCTION  :  • Ormond and Cothran first described in 1934 • The aim is to correct severe distraction injuries rather than to pr...

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EXTENDED PYELONEPHROLITHOTOMY

<br /> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWZbjvj0TvWSMt9VgYQVG1xgOsU1huR-hRGo0vcI2XTAWkBXlvQPEcCbu6TxpmVMO-fXHmlnXZfE1hRBQVKa9mOjvxpBFnJB5XjK3cE61N3UpJjnKNco8kaTcKgTyYJsZIONBluEbMemM/s1600/Screen+Shot+2018-06-02+at+6.40.21+AM.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="204" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWZbjvj0TvWSMt9VgYQVG1xgOsU1huR-hRGo0vcI2XTAWkBXlvQPEcCbu6TxpmVMO-fXHmlnXZfE1hRBQVKa9mOjvxpBFnJB5XjK3cE61N3UpJjnKNco8kaTcKgTyYJsZIONBluEbMemM/s320/Screen+Shot+2018-06-02+at+6.40.21+AM.png" width="320" /></a><br /> <br /> <br /> <br /> <a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/FhW08GUpzrJsH3%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/extended-pyelonephrolithotomy" title="EXTENDED PYELONEPHROLITHOTOMY" target="_blank">EXTENDED PYELONEPHROLITHOTOMY</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><iframe allowfullscreen="" frameborder="0" height="485" marginheight="0" marginwidth="0" scrolling="no" src="//www.slideshare.net/slideshow/embed_code/key/FhW08GUpzrJsH3" style="border-width: 1px; border: 1px solid #CCC; margin-bottom: 5px; max-width: 100%;" width="595"> </iframe> </a><br /> <div style="margin-bottom: 5px;"> <a href="https://www.blogger.com/%3Ciframe%20src=%22//www.slideshare.net/slideshow/embed_code/key/FhW08GUpzrJsH3%22%20width=%22595%22%20height=%22485%22%20frameborder=%220%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20style=%22border:1px%20solid%20#CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe> <div style="margin-bottom:5px"> <strong> <a href="//www.slideshare.net/Ekoindra4/extended-pyelonephrolithotomy" title="EXTENDED PYELONEPHROLITHOTOMY" target="_blank">EXTENDED PYELONEPHROLITHOTOMY</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>" target="_blank"><strong> </strong></a><strong><a href="https://www.slideshare.net/Ekoindra4/extended-pyelonephrolithotomy" target="_blank" title="EXTENDED PYELONEPHROLITHOTOMY">EXTENDED PYELONEPHROLITHOTOMY</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div> <br /> <br /> <br /> <br />

EXTENDED PYELONEPHROLITHOTOMY

EXTENDED PYELONEPHROLITHOTOMY from Eko indra

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OPEN URETEROLITHOTOMY

<div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdc-Xr43tk9zt6g23XDYJlJQKNRR8nYNqpVBKDAs4m4XZ5k3xSpUUiB5u6nmPqk3I39op1lV5nkla3F9ggsS_kkdTqiocBg0LH1XeTdv0qvTYPZkntUZv6MpOYDjA9DWHzbZMEbog4G8o/s1600/Screen+Shot+2018-01-14+at+9.46.25+AM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="711" data-original-width="1019" height="223" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdc-Xr43tk9zt6g23XDYJlJQKNRR8nYNqpVBKDAs4m4XZ5k3xSpUUiB5u6nmPqk3I39op1lV5nkla3F9ggsS_kkdTqiocBg0LH1XeTdv0qvTYPZkntUZv6MpOYDjA9DWHzbZMEbog4G8o/s320/Screen+Shot+2018-01-14+at+9.46.25+AM.png" width="320" /></a></div> <div style="direction: ltr; line-height: normal; margin-bottom: 0pt; margin-left: .38in; margin-right: 0in; margin-top: 5.0pt; text-align: left; text-indent: -.38in; unicode-bidi: embed; word-break: normal;"> <span style="font-size: 24.0pt;"><span style="font-family: Arial; font-size: 100%; mso-special-format: bullet;"><br /></span></span></div> <div style="direction: ltr; line-height: normal; margin-bottom: 0pt; margin-left: .38in; margin-right: 0in; margin-top: 5.0pt; text-align: left; text-indent: -.38in; unicode-bidi: embed; word-break: normal;"> <!--StartFragment--><span style="color: #2f5897; font-family: 'Palatino Linotype'; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-position: normal; letter-spacing: 0pt; vertical-align: baseline;">Indication :</span><!--EndFragment--></div> <div style="direction: ltr; line-height: normal; margin-bottom: 0pt; margin-left: .38in; margin-right: 0in; margin-top: 5.0pt; text-align: left; text-indent: -.38in; unicode-bidi: embed; word-break: normal;"> <span style="font-family: Arial;">•</span><span style="color: black; font-family: 'Century Gothic'; font-style: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-position: normal; font-weight: normal; letter-spacing: 0pt; text-transform: none; vertical-align: baseline;">Stones with a low likelihood of treatment success using </span><span style="color: black; font-family: 'Century Gothic'; font-style: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-position: normal; font-weight: normal; letter-spacing: 0pt; text-transform: none; vertical-align: baseline;">ESWL</span><span style="color: black; font-family: 'Century Gothic'; font-style: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-position: normal; font-weight: normal; letter-spacing: 0pt; text-transform: none; vertical-align: baseline;"> &</span><span style="color: black; font-family: 'Century Gothic'; font-style: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-position: normal; font-weight: normal; letter-spacing: 0pt; text-transform: none; vertical-align: baseline;"> URS</span></div> <div style="direction: ltr; line-height: normal; margin-bottom: 0pt; margin-left: .38in; margin-right: 0in; margin-top: 5.0pt; text-align: left; text-indent: -.38in; unicode-bidi: embed; word-break: normal;"> <span style="font-family: Arial;">•</span><span style="color: black; font-family: 'Century Gothic'; font-style: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-position: normal; font-weight: normal; letter-spacing: 0pt; text-transform: none; vertical-align: baseline;">Secondary treatment for treatment failure after less invasive </span><span style="color: black; font-family: 'Century Gothic'; font-style: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-position: normal; font-weight: normal; letter-spacing: 0pt; text-transform: none; vertical-align: baseline;">techniques</span></div> <!--StartFragment--> <!--EndFragment--><br /> <div style="direction: ltr; line-height: normal; margin-bottom: 0pt; margin-left: .38in; margin-right: 0in; margin-top: 5.0pt; text-align: left; text-indent: -.38in; unicode-bidi: embed; word-break: normal;"> <span style="font-family: Arial;">•</span><span style="color: black; font-family: 'Century Gothic'; font-style: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-position: normal; font-weight: normal; letter-spacing: 0pt; text-transform: none; vertical-align: baseline;">Developing countries without access to URS or lithotripsy </span><span style="color: black; font-family: 'Century Gothic'; font-style: normal; font-variant-caps: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-position: normal; font-weight: normal; letter-spacing: 0pt; text-transform: none; vertical-align: baseline;">equipment</span></div> <br /> <br /> <br /> <br /> <a href="http://[slideshare%20id%3D83715082%26doc%3Dteknikoperasiopenuretereko-171209110135]/" target="_blank"><iframe allowfullscreen="" frameborder="0" height="485" marginheight="0" marginwidth="0" scrolling="no" src="//www.slideshare.net/slideshow/embed_code/key/AD8GyWEqChlxko" style="border-width: 1px; border: 1px solid #CCC; margin-bottom: 5px; max-width: 100%;" width="595"> </iframe> </a><br /> <div style="margin-bottom: 5px;"> <a href="http://[slideshare%20id%3D83715082%26doc%3Dteknikoperasiopenuretereko-171209110135]/" target="_blank"><strong> </strong></a><strong><a href="https://www.slideshare.net/Ekoindra4/open-ureterolithotomy" target="_blank" title="Open Ureterolithotomy">Open Ureterolithotomy</a> </strong> from <strong><a href="https://www.slideshare.net/Ekoindra4" target="_blank">Eko indra</a></strong> </div>

OPEN URETEROLITHOTOMY

Indication : • Stones with a low likelihood of treatment success using ESWL & URS • Secondary treatment for treatment fa...

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