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GROUND GROUND
Urology Department
DM Angel
DM Bilton
Consultant :
dr. Made Tambunan Sp.U
dr. Richman Patandung Sp.U

TOTAL PATIENTS OF dr. Made, SpU : 5
? Kelimutu : 2
? Asoka : 1
? Anggrek : 1
? Bougenvill : 1

PATIENT IDENTITY
? Name : Mr. Soleman Boimau
? Sex : Man
? Age : 66 years
? Medical records : 587188
? Date of Admission : 08/06/2024
? Insurance : BPJS
Kelimutu

ANAMNESIS
S : Pain when urinating
The patient was referred to urology with complaints of pain when
urinating. The patient complained of pain since approximately 1 month
ago. Patients also complain of not being able to hold urine, urinating
continuously. The patient also complained that when urinating he had
to strain and after urinating he felt that there was still urine remaining.
The patient also complained of frequent urination >5 times at night.

Past medical history : Appendicitis (+)
Family history of illness : -
Medication history : -
Operation history : Appendectomy (Mei 2024) in Atambua
Allergic history : -
ANAMNESIS

PHYSICAL EXAMINATION (17/06/2024)
General Condition : GCS 15
Vital Signs
? BP : 120/60 mmHg
? HR : 92x/mins
? RR : 20x/mins
? Temperature : 36 oC
? SpO2 : 99% (room air)

Secondary Survey
? Head : Normocephalic
? Eyes : anemic conjunctive (-/-), icteric sclera (-/-)
? Skin : pale (-), icteric (-)
? Neck : within normal limit
? Thorax : Symmetrical chest wall expansion, retraction (-)
? Pulmo : Vesicular (+/+), rhonchi (-), wheezing (-/-)
? Cor : S1S2, single, regular, murmur (-), gallop (-)
? Abdomen : supel, normal bowel sounds (+), no mass palpable, tenderness (+)
in the left lumbar, left iliac, right lumbar, and right iliac and hypogastric
regions
? Extremity : warm acral, CRT < 2”, edema lower extremities (-/-)

Urology statue :
? Flank : Bulging (-/-), mass (-/-), hematoma (-/-), scar (-/-), tenderness (-/-), CVA
(+/+)
? Suprasimphysis : bulging (-), distension (-), mass (-), hematoma (-), scar (-),
tenderness (+/+)
? Eksternal genitalia : bulging (-), mass (-), hematoma (-), scar (-), ulcus (-)

Laboratory Examination at RSUD Prof. Dr. W. Z. Johannes 11/06/2024
Labs Result Reference value
HB 12.7 g/dL 13.0 - 18.0
HCT 37.6 % 42.0 – 62.0
RBC 4.92 x 106uL 3.70 - 6.10
WBC 10.40 x 103uL 5.00 - 20.00
PLT 237.80 x 103uL 150.00 - 400.00
Cr 1.97 mg/dL 0.00 - 1.40
Ur 15.20 mg/dL 6.00 - 20.00
Na 138 mmol/L 132 - 147
K 2.99 mmol/L 3.50 - 4.50
Cl 103 mmol/L 96 - 111
Ca 1.23 mmol/L 1.12 - 1.32
Tot Ca 2.63 mmol/L 2.20 - 2.55

BON/KUB/BOF 12/06/2024
Clinical : abdominal pain BPH
? There is no visible abdominal distension, the preperitoneal fat
line is firm
? ntestinal gas distribution was normal
? The liver and spleen shadows do not appear enlarged
? The contour of the right and left kidneys appears normal
? No radioopaque stones were seen in the urinary tract
? Psoas line right and left is normal
? The bones appear osteophyte on the lumbar CV
Impression:
? No radiopaque stones were seen in the urinary tract
? Illeus doesn't appear
? Lumbar spondylitis

ASSESMENT
LUTS ec susp BPH
PLANNING
? Recommendation of urological ultrasound and
repeat PVR for a second opinion
? Urief 2x4 mg (1-0-1)
? Avodart 1x0.5 mg (1-0-0)

PATIENT IDENTITY
Kelimutu
? Name : Mr. Matheos Yunus
? Sex : Man
? Age : 68 years old
? Insurance : BPJS

ANAMNESIS
S/ : Pain in left hip
The patient was consulted to urology with complaints of left lower back pain
since 3 weeks before entering the hospital. Complaints of pain like being
stabbed with 2-3 vases. Patients complain that the pain worsens when holding
in urination, and the complaint does not improve with taking medication.
Painless urination, cloudy urination (-), bloody urination (-), lower abdominal
pain (-), LUTS (-).

Past medical history : Tumor paru sinistra
Operation history : -
ANAMNESIS

General Condition : E4M6V5
Vital Signs
? BP : 120/60 mmHg
? HR : 89x/mins
? RR : 22x/mins
? Temperature : 36.2 oC
? SpO2 : 99% on NK 7 lpm

Secondary Survey
? Head : Normocephal
? Pulmo : Vesiculer (+/decreased), rhonci (-/-), wheezing (-/-)
? Abdomen : Distension, decreased bowel sound (+), no palpable mass,
tenderness (+) in suprapubic region, left flank
? Extremity : warm acral, CRT < 2”, edema (+/+)

Urology statue :
? Flank : bulging (-/-), mass (-/-), hematoma (-/-), scar (-/-), tenderness (-/-),
CVA (-/+)
tenderness (-)
? Eksternal genitalia : bulging (-), mass (-), hematoma (-), scar (-)

HB 10 g/dL 13.0 - 18.0
HCT 30 % 42.0 – 62.0
RBC 3.71 x 106uL 3.70 - 6.10
WBC 23.55 x 103uL 5.00 - 20.00
PLT 198.00 x 103uL 150.00 - 400.00
Albumin 2.70 g/dL 3.40 – 5.20
Ur 7.00 mg/dL 6.00 - 20.00
Na 133 mmol/L 132 - 147
K 4.19 mmol/L 3.50 - 4.50

Urinalysis examination 12/06/2024
Crystal negative
Urobilinogen negative
Macroscopic
Yellow color
Clarity : clear
Specific gravity : 1.020
pH : 6.0
Leukocyte esterase : negative
Nitrite (-), protein (+2), glucose (-), Ketone (-), bilirubin (-), blood (+2)
Sediment
Erythrocytes 8-10/lpb
Leukocytes negative/lpb
Cylinders negative/lpb
Epithelial cells 5-7/lpk
Bacteria negative/lpk

ASSESMENT
Bilateral hydronephrosis ec susp bilateral ureteral stones dd/bilateral ureteral
stenosis
Right kidney stone
PLANNING
Recommendation for non-contrast CT urography to evaluate the lower
abdomen (lower urinary tract)
Surgery after the results of non-contrast CT urography

PATIENT IDENTITY
? Name : Mr. Hasan Bai Atawani
? Sex : Male
? Age : 72 Years Old
? Date of Admission : 16/06/2024
? Insurance : BPJS
Asoka

ANAMNESIS (17/06/2024)
S/ : Bloody bowels
The patient came with complaints of bloody urination since 2 days at SMRS. Since June
14 2024, patients have come to the ER at Ende Regional Hospital with complaints of
not being able to urinate. The patient is then placed with a catheter. During
monitoring, the patient's BAK was mixed with blood, making the urine color clear light
yellow mixed with blood. Other complaints such as lower abdominal pain come and go
(worse when the patient is going to urinate), pain in the genitals comes and goes
(when going to urinate), urinating a little and feels incomplete. Fever (-), nausea (-),
vomiting (-), weakness (-), eating and drinking normally. Normal bowel movements.
BAK through the catheter, the amount of urine is 250 cc, dark red blood color.

Past medical history : Ca bulli
Medication history : Amlodipine 1x10 mg, gliquidone 1x30 mg, cefixime
2x10 mg, paracetamol 3x500 mg, valisanbe 1x1 tablet, tranexamic acid 3x500 mg
Operation history : Laser (2018)
Allergic history : Vitamin k

General Condition : E4V5M6
Vital Signs
? BP : 100/80 mmHg
? HR : 85x/mins
? RR : 19x/mins
? Temperature : 36.4 oC
? SpO2 : 97% RA

Secondary Survey
? Eyes : anemic conjunctive (+/+), icteric sclera (-/-)
? Skin : petechie in both lower limbs (+)
? Pulmo : Vesiculer (+/+), rhonci (-), wheezing (-/-)
? Abdomen : supel, distension (-), bowel sound (+), tenderness (-)
? Extremity : warm acral, CRT < 2”, edema (-/-)

Urology statue :
CVA (-/-)
tenderness (+)
? Eksternal genitalia : bulging (-), mass (-), hematoma (-), scar (-), catheter
inserted

HB 12.8 g/dL 13.0 - 18.0
HCT 47.1% 42.0 – 62.0
RBC 4.35 x 106uL 3.70 - 6.10
WBC 8.44 x 103uL 5.00 - 20.00
PLT 197.80 x 103uL 150.00-400.00
Cr 1.70 mg/dL 0.00-1.40
Ur 13.0 mg/dL 6.00-20.00
Na 140 mmol/L 132-147
K 3.46 mmol/L
3.50-4.50
Cl 101 mmol/L 96-111
Ca 1.21 mmol/L 1.12-1.32
Tot Ca 2.56 mmol/L 2.20-2.55

ASSESMENT
Working Diagnosis
Infiltrasi urothelial carcinoma buli (ca bulli)
PLANNING
IVFD nacl 0.9% 500 ml : futrolit 500 ml/24 hours
Skin test for vitamin K, if there are no signs of allergy then add vitamin K
3X1 mg
Ranitidine 2x50 mg IV
Ketolorac 3x30 mg IV
Contrast CT whole abdomen
AP thorax photo/Lat view
Recheck creatinine and urea

PATIENT IDENTITY
? Name : Mr. Markus Mita
? Sex : Male
? Insurance : BPJS
Cempaka

S/Intermittent urination
The patient was referred to urological surgery with a diagnosis of BPH
and nephrolithiasis. Patients complain of intermittent urination and
frequent urination. In a day the patient can urinate >10 times and claims
to have no pain when urinating. The patient also said that when
urinating, the stream was weak but there was no straining. Last night, the
patient woke up to urinate 5 times. bloody urine (-), fever (-)

Past medical history : TBC (+) completed treatment, Mass in the left
stomach since 5 years ago

Vital Signs
? BP : 110/60 mmHg
? HR : 93x/mins
? RR : 20x/mins
? Temperature : 36oC
? SpO2 : 96%

Secondary Survey
? Abdomen : Distension, bowel sound (+) normal, mass in the left abdomen,
tenderness (+) in the left region

Urology statue :
? Flank : bulging (-/-), mass (-/-), hematoma (-/-), scar (-/-), tenderness (+/+)
tenderness (-/+)

Laboratory Examination at RSUD Prof. Dr. W. Z. Johannes
HB 10.6 g/dL 13.0 - 18.0
HCT 41.0 % 42.0 – 62.0
RBC 3.56 x 106uL 3.70 - 6.10
WBC 11.39 x 103uL 5.00 - 20.00
PLT 287.10 x 103uL 150.00-400.00
Cr 9.16 mg/dL 0.00-1.40
Ur 109 mg/dL 6.00-20.00

Urinalysis examination 15/06/2024
Crystal negative
Urobilinogen negative
Macroscopic
Yellow color
Clarity : clear
Specific gravity : 1.010
pH : 6.0
Leukocyte esterase : negative
Nitrite (-), protein (-), glucose (-), Ketone (-), bilirubin (-), blood (+2)
Sediment
Erythrocytes negative/lpb
Leukocytes negative/lpb
Cylinders negative/lpb
Epithelial cells 10-20/lpk
Bacteria negative/lpk

CT SCAN ABDOMEN 14/06/2024
? Heterogeneous multilobulated solid mass with suspicion of central necrosis in
the peritoneal cavity where the boundary with the intestinal system and aorta
does not appear clearly, dd/:
1. Lymphoma
2. Extralumen mass (GIST)
? Illeus does not appear
? Bilateral severe hydronephrosis accompanied by bilateral proximal ureteral
dilatation, ec susp of mass filtration into the ureter Right nephrolithiasis
? Prostate hypertrophy
? Ascites
? Obsv single right lung nodule scanned, suspected pulmonary metastases
? Bilateral pleural effusion

ASSESMENT
PLANNING
Tumor abdomen
Malnutrisi
AKI dd ACKD
BPH
Hidronefrolitiasis
Kidmin 14 tpm
Furosemide 20-0-0
Pantoprazole 1x40 mg
Metoklopramid 1x40 mg
Asam folat 2x2 tab
Liv b plex 2x1 tab
Lactulosa 2xC1
Vip albumin 3x1 PO
Ketorolac 2x1 k/p
Harnal 0.4 0-0-1 PO

PATIENT IDENTITY
? Name : Mrs. Wattrina Lomi
? Sex : Female
? Insurance : BPJS
IGD

S/Pain when urinating and burning sensation in the stomach
The patient complained of weakness when he finished HD and
the patient experienced a loss of consciousness. Patients also
complain of pain when urinating accompanied by low back pain,
bleeding (-), cloudy urine (-). Complaints are also accompanied
by no chapter since yesterday, the last chapter was mixed with
blood. The patient was taken by the family to the emergency
room with complaints of weakness and was unconscious.

Past medical history : -
Medication history : Left kidney stone laser and DJ stent installation (April
2024), CDL installation (May 2024)

Vital Signs
? BP : 90/60 mmHg
? HR : 69x/mins
? RR : 18x/mins
? Temperature : 35.7oC
? SpO2 : 99% on RA

Secondary Survey
? Abdomen : supel, distension (-), bowel sound (+), tenderness (-)

Urology statue :
? Flank : bulging (-/-), mass (-/-), hematoma (-/-), scar (-/-), tenderness (-/-)
tenderness (-)

HB 9.6 g/dL 13.0 - 18.0
HCT 27.6 % 42.0 – 62.0
RBC 3.58 x 106uL 3.70 - 6.10
WBC 14.44 x 103uL 5.00 - 20.00
GDS 168 mg/dL 70.00-150.00
Cr 0.96 mg/dL 0.00-1.40
Ur 10.30 mg/dL 6.00-20.00
Na 128 mmol/L 132-147
K 5.07 mmol/L
3.50-4.50
Cl 100 mmol/L 96-111
Ca 1.61 mmol/L 1.12-1.32
Tot Ca 3.32 mmol/L 2.20-2.55

ASSESMENT
Grade IV right hydronephrosis ec susp total ureteral
stenosis + DJ left stent in situ + CKD + Genitourinary
TB on OAT
PLANNING
Pro URS + right DJ stent insertion k/p right nephrostomy
Aff left DJ stent k/p replace left DJ Stent

TOTAL PATIENTS OF dr. Richman, SpU : 1
Teratai : 1

PATIENT IDENTITY
? Name : Mr. Petrus Muda
? Sex : Male
? Age : 73 years old
? Date of Admission : June 12, 2024
? Insurance : BPJS

Chief complaint : Difficult to Urinating
The patient came to the Hospital with complaint difficult to urinating and
looks like there is a blood in the urine. The Complaints have appeared
since 3 days before came to the Hospital. At first it felt like urinating was
incomplete so the patient had to urinate several times a day. One day
before came to the hospital the patient’s urinating was dripping. The other
Complaint: Patient said that the color of the Urine looks like Bloody,
Nausea(-),Vomitting(-), Fever(-)

Past medical history : CKD on HD, HT(+)

General Condition : GCS 15
Vital Signs
? BP : 140/70 mmHg
? HR : 67x/mins
? RR : 21x/mins
? Temperature : 36.8oC
? SpO2 : 98% (room air)

Secondary Survey
? Pulmo : Vesiculer (+/+), rhonci (-), wheezing (-)
? Abdomen : supel, distension (-), bowel sound (+), tenderness (-), tympani

Urology statue :
CVA (-/-)
tenderness (-), Pressure Pain(+)

LABORATORIUM CHECK (11/05/2024)
Hb 9,3 g/dL 12 – 16
RBC 3,05 x 10^6/uL 4.20 – 5.40
Hct 25.1 % 37 – 47
WBC 7,55 x 10^3/uL 4 – 10
Plt 127,5 x 10^3/uL 150 – 400
Ur 43,7 6.00-20.00
Cr 8,73 0.00-1.40

ASSESMENT
Working Diagnosis
Hematuria ec Ca Bladder + CKD
PLANNING
Urology
● Planning Transurethral Resection of Bladder Tumor
● X-Ray Thorax
Internist
? Hemodialysis

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