Dr. Paksi Satyagraha, MKes.

, SpU(K)
InaGURS (Indonesian Genitourinary Reconstructive Society).
1Urology Department, Faculty of Medicine-University of Brawijaya, Saiful Anwar

General Hospital, Malang, East Java, Indonesia

Bandung, February 23rd, 2018

paksisatyagraha@gmail.com
uropas.fk@ub.ac.id @paksi_PAS
http://www.wowshack.com/25-interesting-facts-
about-indonesia-you-might-not-know/
Urologist Vs Population Growth

Year Urologist Total Year Population Ratio

1971 - 1975 3 3 1971 119,208,229 39,736,076

1976 - 1980 3 6 1980 147,490,298 24,581,716

1981 - 1985 11 17

1986 - 1990 14 31 1990 179,378,946 5,786,417

1991 - 1995 15 46 1995 194,754,808 4,233,800

1996 - 2000 31 77 2000 206,264,595 2,678,761

2001 - 2005 59 136

2006 - 2010 93 229 2010 237,641,326 1,037,735

2011 - 2015 116 345 2015 255,461,700 740,469

July 2017 56 401 2017 270.000.000 673,317

Java Island Population : 160.293.748 (62,7%)

117 289/401 (72%)

21
30
41 64
16
No urologist :
North Kalimantan
West Sulawesi
Mollucas
North Mollucas
West Papua

289/401 (72%)
Problem

Area : 1.904.569 km2

High density population
High working load for urologist
Strictures : PFUIs, infection, instrumentation
Congenital : Hypospadias
Pediatric urologist only available in Peyronie’s
some center Disease

Penile sclerofibromatosis
No prostethic, less peyronie, slings
No mentor
1st MULTICENTER
REPORT

The first
Indonesian
multicentre
report for
the
definitive
treatment
of urethral
stricture

Lukman Hakim, SIU 2012 Fukuoka

 Urethral Stricture In Indonesia ?

1. What kind of urethral stricture??

2. Do we have the same pattern compare to other
country ??
3. What kind of treatment options do we have??
4. Do we treat our fellow, Indonesian people with.......
THE RIGHT and THE BEST TREATMENT OPTION????
Two Centers Experience
How did we start?
 Bandung  Malang
 Urology referral and training
center since 2007 (10 urologist)
 Multiple operators
 High failure rate in early period
 Training :
 Workshops and symposium
 Sub-speciality training
 Cases :
 Mostly strictures
 Hypospadias by pediatric
urologist
 Urology referral and training
center since 2013 (5 Urologist)
 Less urethroplasty prior 2012
 Single operator
 Less failure (less case)
 Training :
 Sub-speciality training
 Cases :
 Strictures
 Hypospadias
 Female
 Single operator PCNLs

Multi Center Data

Bandung Experience
 Results
Group I Group II Group III
(2009-2010) (2011-2012) (2013-2014)

DVIU 93/129 (72.1%) 68/146 (46.6%) 40/156 (25.5%)

Open 36/129 (27.9%) 78/146 (53.4%) 116/156 (77.5%)

Reconstructive

EPA 24/36 (66.7%) 41/78 (52.5%) 71/116 (61.2%)

Success Rate- 11/24 (45.8%) 20/41(48.8%) 62/71(87%)

RA
 Changing Pattern Bandung
70

65

60

53
50 50 51

43 43
40

30

25 25

20 20 20 20

16

10

0
2009 2010 2011 2012 2013 2014
DVIU Open Reconstructive Surgery
Saiful Anwar General Hospital
• Malang, second city in East
Java Province
• 900,000 population
• Government Teaching Hospital
• 900 beds
• One of urology referral center
in East Indonesia
• Conducted national and
international meeting and
workshop in GU reconstruction
 Satygagraha
Palminteri et al Fenton et al.
Stein et al(n=2.589) et al.
(n=1.439) (n=175)
(n = 247)

Characteristic
Italy (2000- US –Italy (2000- India (2000- Texas, US Malang
2010) 2011) 2011) (1997-2002) (2012-2016)

Common site Bulbar Bulbar Bulbar Bulbar Bulbar

Etiology
Idiopatic 35,8 41,3 23,6 31,9 14,2

Trauma 10,8 15,8 36,1 9,6 20,4

Iatrogenic 38,6 35,0 16,6 31,9 22,1

LS 13,5 6,9 21,5 26,6 11,7
Infection - 0,8 1,8 13 28,8
 7 CENTRES
Jakarta, Surabaya, Bandung, Malang, Bali, Makasar

Etiology RSDS RSHS RSCM RSSA RSS RSUH RSZA Total

(2009- (2007- (2013- (2012- (2013- (2013- (2012-
2013) 2015) 2015) 2016) 2015) 2015) 2016)
Surabaya Bandung Jakarta* Malang* Bali* Makasar Aceh*
* *
TRAUMA 46 345 51 49 31 26 76 624

Infection 95 121 10 98 25 11 34 394

Iatrogenic 29 191 36 55 17 16 70 414

Idiopathic/ 0 27 3 45 0 0 2 77
Congenital

Total 170 684 100 247 73 53 182 1509

*Johan, Kuncoro, Gampo, Paksi, GWK, Askar, Jufriady

Trauma : PFUI (Pelvic Fracture Urethral Injury) – Straddle Injury

Infection : LS/BXO, NG
Iatrogenic : Catheter, Instrumentation, TURP, Failed Hypospadias repair, Radiotherapy Radical Prostatectomy
Traumatic ??
Malang Experience
 Changing Pattern Malang
The Change of Urethral Stricture Management Saiful Anwar
General Hospital 2012-2016

37

33

2016, 30
2014, 29

2015, 23
19

16
2013, 17

5
2012, 4 4 4

1 1

2012 2013 2014 2015 2016

DVIU Urethral Dilatation Augmented/EPA/Staged urethroplasty, perineoustomy, meatoplasty
 Location 2017
Meatal 7
Naviculare 2
Penile 11 Procedure
Bulbar 52 DVIU 5
32
Panurethral 13 Urethral Dilatation 27
Membranous 16 Staged Urethroplasty 3
Total 101 EPA Urethroplasty 21
Augmented 44
19
Urethroplasty
Perineostomy 1
Etiology Cystostomy 25 25
Trauma 29 Others 6 6
Instrumentation 27 Total 107 107
Lichen Sclerosus 13
Infection 8
Idiopathic 24
Hypospadia related 7
TOTAL 101
Anastomotic Urethroplasty 2012 – 2016 (n=62)

ETIOLOGY
STRADDLE INJURY 14 (22,6%) AGE
0-15 3 (4,9%)
PFUI 45 (72,6%) 16-30 20 (32,2%)
31-50 25 (40,3%)
INSTRUMENTATION 2 (3,2%) >50 14 (22.6%)
INFECTION 1 (1,6%)

Surgery No of Pts Success Rate

EPA URETHROPLASTY 31 50% 27 87.10%
EPA + CRURA SEPARATION 2 3.20% 2 100%

EPA + INFERIOR PUBECTOMY 21 34.00% 19 90,5%

EPA + TANSPUBECTOMY +
2 3.20% 1 50%
OMENTAL WRAP
NON TRANSECTING 3 4.80% 3 100%

AUGMENTED ANASTOMOSIS 3 4.80% 3 100%

TOTAL 62 100% 55 88.7%

Oral Mucosal Graft Urethroplasty 2012 – 2016
n=41

Etiology
Iatrogenic 2 4.80%
Infection 20 48.9%
Idiopathic 5 12.2%
LS 12 29.30%
Hypospadias related 2 4.8%
Location
Pendular 3 7.30%
Bulbar 16 39.00%
Panurethral 22 53.70%
 Type Of surgery
Dorsal Inlay 1 2.40%
One Side Dissection
33 80.6%
Dorsal Onlay
Ventral Onlay 2 4.80%
Double Face 3 7.30%
Staged Urethroplasty 2 4.8%
Type of Graft
Lingual 1 2.40%
Buccal 40 97.60%
Success rate
Success 33 80.50%
Failes 8 19.50%
Hypospadias (2012-2015)
n=36
2017

Hypospadias Type
Proximal 9
Distal 13
Total 22
Procedure
Staged Urethroplasty 9
TIP Urethroplasty 12
Onlay Island Flap 1
 2012 Is a New Start

Guido Barbagli and Sanjay Kulkarni, Faculty in ASMIUA

Jakarta, 2012
So, Where Are We Now?
 We are new emerging force in
the world
 Building ‘Recon Team’ local and
national
 Start collecting data
 Papers
 Organization
 Workshops and Roadshows
Building Local and National Team
 Organization

Declaration : Surabaya, Des 3rd 2015

Poster and Papers

 JUA Kanazawa, 2015

 SIU Melbourne 2015
 Best poster by Dr. Boyke Soebhali
 Invited speaker in IUA-SIU session
 GURS Masterclass, London 2015
 Malaysian Urological Conference 2015, 2016
 ASMIUA 2014, 2015
 IMORU, Hamburg, 2016
 SIU 2015, 2016
 EAU, 2016
 UAA 2017
 Pre Congress Workshop SIU 2017
Cipto Mangunkusumo
Hospital Jakarta
Acta Med
Indones.
2016
Apr;48(2):9
9-105.

Acta Med
Indones.
2016
Jan;48(1):1
7-27.
Roadshows
`

Malang Samarinda Medan

Bandung Balikpapan Jakarta
Surabaya Denpasar Makassar
Surakarta Pakanbaru Yogyakarta
Semarang Banda Aceh
Banjarmasin Cirebon
Workshops and Meeting
Conclusion and Plan
Indonesian Urologist are the ‘New Kids on The Block’ for
genito urinary reconstruction surgery
High number of cases
Sub-speciality training is important to improve the success
rate in urethral reconstructive surgery
Urethroplasty is starting to become more common choice
for urethral stricture disease management
Setting up a refferal and training center
Multi data center collection
More papers and publication
 In InaGURS We’re Band of Brothers
If You Want To Go Fast, Go Alone.
If You Want To Go Far, Go Together

Thanks to :
Malang
Urology Family
RAN, RID, UDI, RIN, GUD