Brawijaya Journal of Urology

Physical Activity on Erectile Dysfunction: Screening and Counseling in Kendalkerep Community Health Center Area

Yhusi Karina Riskawati — 2026-07-01

Introduction. Erectile dysfunction negatively impacts self-esteem, quality of life, and interpersonal relationships. Studies have shown significant improvements in sexual function in men and women who undergo regular moderate-intensity physical exercise interventions. However, public awareness of the importance of physical activity in sexual health remains low. This study aims to evaluate the relationship between physical activity level and erectile function among community members in the Kendalkerep Primary Health Care area.

Methods. This is an observational analytic study with a cross-sectional design involving 50 adult men who participated in screening and educational activities, selected using incidental sampling. Physical activity levels were categorized as low, moderate, and high, while erectile function was assessed using the International Index of Erectile Function-5 (IIEF-5). Descriptive and bivariate analyses were performed using Spearman correlation tests.

Result. The results demonstrated a strong positive correlation between physical activity level and IIEF-5 score (ρ = 0.702; p < 0.001), as well as a significant negative correlation between physical activity level and erectile dysfunction severity (ρ = −0.643; p < 0.001). Body mass index and blood pressure were also significantly associated with erectile function, whereas age showed no significant correlation.

Conclusion. Higher levels of physical activity are associated with better erectile function. Physical activity may serve as an effective non-pharmacological strategy for the prevention of erectile dysfunction at the community level.

Comparison of Bacteriuria, Hematuria, and Pain Complications after Transrectal and Transperineal Prostate Biopsy in Patients with Suspected Prostate Cancer

Kurnia Penta Seputra — 2026-07-01

Introduction. Prostate cancer is the most common cancer in men with the second-highest mortality rate in the United States. In Indonesia, 1,102 patients with an average age of 67.18 years have been diagnosed with prostate cancer in the last 8 years. The primary diagnostic approach for prostate cancer involves two biopsy methods: transrectal prostate biopsy (TRPB) and transperineal prostate biopsy (TPPB). This study aims to evaluate the complications of bacteriuria, hematuria, and pain levels after the procedures between TRPB and TPPB.

Methods. This study is an analytical observational study with a cohort design. The sample consists of 34 patients suspected of prostate cancer, undergoing prostate biopsy with a 1:1 technique comparison between TPPB (17) and TRPB (17). Data were analyzed using SPSS software version 28.

Result. The Friedman test and paired T-test results show a significant difference in urine culture and urinalysis before and after transrectal biopsy, but no significant difference in pain assessment. For transperineal biopsy, a significant difference was only found in pain assessment before and after the biopsy. The Mann-Whitney test results show a significant difference in the incidence of bacteriuria and hematuria, with TPPB showing lower rates and higher VAS in the TPPB group.

Conclusion. TPPB tends to be better at avoiding the risk of bleeding and infection complications, while TRPB is better at avoiding pain. Therefore, TPPB is more beneficial for patients.

Nephrocolic Fistula in a Compromised Urinary Tract : A Case Identified via Radioisotope Mercaotiacetyltriglycine (MAG3) Diuretic Renography

Hsin Yen Tan — 2026-07-01

Introduction. Nephrocolic fistula is an abnormal communication between the kidney and colon. It is rare and the presentation may be atypical. Diagnosis is usually made using retrograde pyelograde, CT scan or barium enema.

Case. We present the case of a nephrocolic fistula detected on a radioisotope renography (MAG3) scan in a 74-year-old woman, who has a poorly controlled diabetes mellitus with a dysfunctional urinary tract due to recurrent emphysematous pyelonephritis (EPN) of the left kidney, complicated by a left ureteric stricture, pyonephrosis and neurogenic bladder secondary to diabetic cystopathy. She underwent multiple ureteric stentings, drainage procedures, and prolonged antimicrobial treatments for multidrug-resistant and fungal urosepsis. A renal MAG3 scan later revealed abnormal tracer accumulation in the descending colon, suggestive of a nephrocolic fistula. This case underscores the diagnostic challenges of nephrocolic fistula in individuals with a compromised urinary tract.

Conclusion. Urologists should maintain a high index of suspicion for nephrocolic fistula particularly in individuals with a compromised urinary tract. Alternative diagnostic imaging may be utilized to establish the diagnosis.

Multifocal HPV-Associated Anogenital Lesion: Histopathology in the Diagnosis of Penile Intraepithelial Neoplasia

Lita Setyowatie — 2026-07-01

Introduction. Human papillomavirus (HPV) is a common sexually transmitted infection that can manifest as lesions ranging from benign conditions to premalignant disease.

Case. We report the case of a 37-year-old widowed man who presented with multiple nodular lesions on the penis for one year and on the anus for seven months prior to seeking medical care. The patient had a history of Hodgkin lymphoma and had previously undergone chemotherapy. Physical examination of the penile shaft and pubic region revealed multiple erythematous papules with well-defined margins, irregular borders, and variable shapes and sizes. Examination of the anal and perianal regions revealed with similar characteristics. The diagnosis was established based on histopathological evaluation, which demonstrated distinct features at the two lesion sites. Biopsy of the genital lesions revealed findings consistent with Penile Intraepithelial Neoplasia (PeIN), supported by positive p16 immunohistochemical staining and HPV genotyping positive for HPV types 18 and 45, confirming HPV-associated Penile Intraepithelial Neoplasia. In contrast, biopsy of the anal lesions showed histopathological features consistent with condyloma acuminata.

Conclusion. This report highlights the importance of clinical vigilance and the crucial role of histopathological examination in establishing an accurate diagnosis and guiding appropriate management, particularly in patients with risk factors for malignancy and a history of immunocompromised status.

Efficacy and Safety of Ultrasound-Guided versus Fluoroscopy-Guided Percutaneous Nephrolithotomy in Children: A Systematic Review and Meta-Analysis

Muhammad Reza Amara Taqwa — 2026-07-01

Introduction. Ultrasound-guided percutaneous nephrolithotomy (PCNL) is a radiation-sparing alternative to conventional fluoroscopy-guided PCNL in children, yet pediatric evidence remains limited. This systematic review and meta-analysis evaluated the efficacy and safety of both modalities in pediatric patients.

Methods. Following PRISMA 2020 guidelines, PubMed, Embase, and Scopus were searched from inception to March 3, 2026. Comparative studies evaluating ultrasound-guided versus fluoroscopy-guided PCNL in children were included. Three reviewers independently performed study selection, data extraction, and quality assessment. Risk of bias was evaluated using the Cochrane Risk of Bias 2 tool for randomized controlled trials and the Newcastle-Ottawa Scale for non-randomized studies. Meta-analyses were performed in RStudio using a random-effects model with restricted maximum likelihood estimation and Hartung-Knapp-Sidik-Jonkman adjustments.

Result. Five comparative studies involving 300 pediatric patients (136 ultrasound-guided; 164 fluoroscopy-guided) were included. There was no significant difference between groups in stone-free rate (RR 0.99, 95% CI 0.90–1.09; I²=0.0%) or overall complication rate (RR 0.82, 95% CI 0.29–2.28; I²=66.4%). Ultrasound guidance was associated with reduced fluoroscopy screening time (SMD -1.48, 95% CI -2.97 to 0.00; I²=88.8%). No significant differences were observed in operative time, puncture/access time, or radiation dose.

Conclusion. Ultrasound-guided PCNL demonstrates comparable efficacy and safety to fluoroscopy-guided PCNL in children while reducing fluoroscopy exposure. Further prospective multicenter randomized studies are needed to confirm these findings.

Efficacy and Safety of Percutaneous Nephrolithotomy versus Ureteroscopy for Pediatric Kidney Stone Management: A Systematic Review and Meta-Analysis

Gilang Samudero — 2026-07-01

Introduction. Percutaneous Nephrolithotomy (PCNL) and ureteroscopy are surgical options performed in children with kidney and/or ureteral calculi, despite no differences in stone clearance. Percutaneous nephrolithotomy was reported to have a high Stone Free Rate (SFR) for paediatric patients. The use of ureteroscopy in children has increased with high ureteral and kidney Stone-Free Rate (SFR) and low complication rate. The safety of PCNL and ureteroscopy is assessed by the complaints of patients. The study aims to comprehend the efficacy and safety of percutaneous nephrolithotomy and ureteroscopy procedures for paediatric kidney stone management.

Methods. A systematic search was carried out following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Multiple databases, including Medscape, Science Direct, and ProQuest, were systematically searched for relevant articles. Relevant parameters explored using Review Manager V5.4.1.

Results. Three prospective and two retrospective comparative studies involving a total of 1443 renal units, with 209 cases done using PCNL and 1229 cases using ureteroscopy. There was no significant difference in stone-free rate and sepsis between these two groups of patients (OR: 0,89; 95% CI: 0,59-1,35; P=0,58 and OR: 0,34; 95% CI: 0,04-3,13; P=0,97, respectively). The risk of fever and hematuria was significantly lower in patients treated with ureteroscopy compared to PCNL (OR: 2,41; 95% CI: 1,07-5.46; P=0.04 and OR: 17,93; 95% CI: 2,28-140,93; P=0,006, respectively).

Conclusion. The analysis found that PCNL has a similar SFR compared to ureteroscopy. The risk of fever and hematuria was significantly lower in patients treated with ureteroscopy compared to PCNL. Further randomized clinical trials are required to compare the safety and efficacy of PCNL versus ureteroscopy for pediatric kidney stone management.