Study Guide The Urinary and Male Genetalia System and Disorders

STUDY GUIDE
THE URINARY AND MALE GENETALIA SYSTEM AND DISORDERS
MEDICAL FACULTY OF UDAYANA UNIVERSITY
2023
Study Guide Urinary and Male Genetalia system and Disorders
STUDY GUIDE THE URINARY AND MALE GENITAL SYSTEM AND DISORDERS
Planners
G. Wirya K Duarsa
Dewa Ayu Agus Sri Laksemi
I Wayan Yudiana
Kadek Budi Santosa
Pande Made Wisnu Tirtayasa
Ida Bagus Putra Pramana
I Wayan Sumardika
I Gusti Ayu Harry Sundariyati
IGA Sri Darmayani
Contributors
G. Wirya K Duarsa
Dewa Ayu Agus Sri Laksemi I Wayan Yudiana
I Nyoman Gde Wardana Kadek Budi Santosa
I N. Mangku Karmaya A A Wiradewi Lestari
Ketut Tirtayasa Putu Utami Dewi
G A P Nilawati I Ketut Agus Indra Adiputra
Wayan Winarti Pande Made Wisnu Tirtayasa
Nyoman Paramita Ayu Ida Bagus Putra Pramana
I A Ika Wahyuniari Gde Wira Mahadita
I Gusti Ayu Artini IGN Tresna Erawan
Yenny Kandarini Bagus Ngurah Mahakrisna
Editors
I Wayan Sumardika
I Gusti Ayu Sri Darmayani
Layout
Rizky Darmawan
April 2023
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system,
or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or
otherwise without prior written permission of the publisher. Published by the Department of
Medical Education Medicine Programme, Faculty of Medicine, Universitas Udayana.
Department of Medical Education - Faculty of Medicine - Universitas Udayana, 2023

2
Visi Misi Program Studi Sarjana Kedokteran Fakultas Kedokteran
Universitas Udayana
Visi, misi, tujuan pendidikan yang tercantum dalam Rencana Strategis Program Studi Sarjana
Kedokteran dan Profesi Dokter Fakultas Kedokteran Universitas Udayana (Restra PS SKPD FK
UNUD) merupakan dasar utama penyusunan kurikulum program studi tahun 2021.
1. Visi program studi
“Menjadikan Program Studi Sarjana Kedokteran dan Profesi Dokter Fakultas
Kedokteran Universitas Udayana sebagai Lembaga Pendidikan yang Unggul,Mandiri,
Berbudaya dan Beretika, serta Mempunyai Daya Saing di Tingkat Nasional dan
Internasional pada Tahun 2025.”Berdasarkan visi di atas, yang dimaksud dengan
unggul, mandiri, berbudaya dan beretika adalah sebagai berikut:
1. Unggul. Sumber daya manusia yang memiliki kompetensi tinggi, daya saing, dan
bijaksana dalam mengembangkan ilmu pengetahuan yang dimilikinya untuk
meningkatkan martabat bangsa, negara, serta kemanusiaan pada umumnya
(cakra widya prawartana).
2. Mandiri. Sumber daya manusia yang memiliki kepribadian yang tangguh dan
kemampuan berinteraksi dengan lingkungan yang berkembang secara dinamis.
3. Berbudaya. Sumber daya manusia yang memiliki kepekaan dan ketajaman nurani
serta mampu memanfaatkan nilai-nilai luhur budaya lokal yang bersifat universal
untuk berinteraksi di tengah masyarakat.
4. Beretika. Sumber daya manusia yang memiliki perilaku yang sesuai dengannilai-
nilai dan norma yang dapat menentukan tingkah lakunya dalam bertindak dan
berbuat di kehidupan bermasyarakat.
2. Misi program studi
Untuk mewujudkan visi di atas, PS SKPD FK UNUD memiliki misi untuk
memberdayakan Program Studi Pendidikan Dokter Fakultas Kedokteran Universitas
Udayana sebagai program studi yang melaksanakan Tri Dharma Perguruan Tinggi
berlandaskan pengembangan ilmu pengetahuan dan teknologi di bidang kesehatan,
nilai budaya, serta etika.
3. Tujuan program studi
Program Studi Sarjana Kedokteran dan Profesi Dokter Fakultas Kedokteran
Universitas Udayana memiliki tujuan, antara lain:
Study Guide Urinary and Male Gentalia System and Disorders
1. Menghasilkan lulusan dokter yang unggul, mandiri, berbudaya, dan beretika yang
memiliki integritas ilmiah di bidang ilmu kedokteran sesuai dengan kompetensi dan
perkembangan ilmu pengetahuan dan teknologi.
2. Meningkatkan akses pelayanan pendidikan kepada peserta didik.
3. Mengembangkan tata kelola organisasi dan meningkatkan tertib administrasi
pengelolaan program studi.
4. Menjalin kerjasama di berbagai bidang dan dengan berbagai pihak dalam
mendukung pelaksanaan Tri Dharma Perguruan Tinggi.
5. Menghasilkan penelitian bermutu bertaraf nasional dan internasional
berlandaskan pengembangan ilmu pengetahuan dan teknologi serta
meningkatkan paten dan publikasi hasil penelitian pada publikasi ilmiah nasional
dan internasional.
6. Melaksanakanpengabdiankepadamasyarakatbaikregionalmaupunnasional dengan
mengaplikasikan ilmu pengatahuan yang dimiliki untuk kepentingan masyarakat.
4. Profil Lulusan
Sebagai lembaga pendidikan yang menghasilkan dokter, Program Studi Sarjana
Kedokteran dan Profesi Dokter Fakultas Kedokteran Universitas Udayana (PS SKPD
FK UNUD) membentuk lulusan dokter dengan profil lulusan sebagai berikut:
1. Dokter yang profesional memberikan layanan pada pusat pelayanan kesehatan
primer.
2. Dokter yang unggul di bidang kedokteran pariwisata/ travel medicine.
3. Dokter peneliti di bidang kesehatan.
4. Dokter pengelola program kesehatan
Study Guide Urinary System and Disorders
PREFACE
The medical curriculum has become increasingly vertically integrated, with stronger basic
concept and support by clinical examples and cases to help in the understanding of the relevance
of the underlying basic science. Basic science concepts may help in the understanding of the
pathophysiology and treatment of diseases. Urinary system and disorders block has been written
to take account of this trend, and to integrate core aspects of basic science, pathophysiology and
treatment into a single, easy to use revision aid.
The Urinary block will focus on anatomy, histology and physiology of Urinary system,
pharmacology of different classes of Renal and Urinary tract drugs, symptom and signs of Renal
and Urinary tract disease and its pathophysiology and basic principle concept to education,
prevention, treatment and rehabilitation in Renal and Urinary tract system disorder in patient, family
and community. This study guide is developed by the academic staffs from various departments:
Anatomy, Physiology, Histology, Pharmacology, Anatomy and Clinical Pathology, Pathology
Anatomy, Microbiology, Urology, Pediatric Urology, Radiology.
The learning process will be carried out for 3 weeks (12 working days) starts from April 14th,
2023 as shown in the time table. The final examination will be conducted on May 10th, 2023 in the
form of MCQ. The learning situation include lecture, individual learning, small group discussion,
plenary session, practice, and clinical skills.
Most of the learning material should be learned independently and discuss in SGD by the
students with the help of facilitator. Lecture is given to emphasize the most important thing of the
material. In small group discussion, the students gave learning task to lead their discussion.
This simple study guide need more revision in the future, so that the planners kindly invite
readers to give any comments and critics for its completion. Thank you.
Planners
5
CONTENTS
COVER 1
PLANNER, CONTRIBUTOR, EDITOR 2
VISI MISI PROGRAM STUDI 3
PREFACE 5
TABLE OF CONTENT 6
MAPPING BLOK 8
GENERAL CURRICULUM OF URINARY SYSTEM AND DISORDERS 9
LECTURERS 11
SKDI 2012 12
RPS, CPL, CPMK 14
FACILITATOR 45
LEARNING ACTIVITY 47
IMPORTANT INFORMATIONS 47
STUDENT PROJECT 50
ASSESSMENT METHOD 53
TIMETABLE OF CLASSES 54
LECTURE 1& 2 63
LECTURE 3 65
LECTURE 4 67
LECTURE 5 69
LECTURE 6 71
LECTURE 7 73
LECTURE 8 75
LECTURE 9 77
LECTURE 10 79
LECTURE 11 81
LECTURE 12 84
LECTURE 13 86
LECTURE 14 102
6
LECTURE 15 105
LECTURE 16 110
LECTURE 17 112
LECTURE 18 115
LECTURE 19 118
LECTURE 20 122
LECTURE 21 124
LECTURE 22 127
LECTURE 23 131
LECTURE 24 134
LECTURE 25 136
LECTURE 26 137
LECTURE 27 139
LECTURE 28 142
LECTURE 29 144
LECTURE 30 147
EVALUATION FORM OF THE URINARY SYSTEM AND DISORDERS 150
BLUEPRINT ASSESSMENT 155
REFERENCES 157

7
MAPPING BLOK

8
GENERAL CURRICULUM OF URINARY AND MALE GENITAL SYSTEM AND

DISORDERS
Aims:
• Comprehend the biologic function of urogenital system to pathological process of urinary system
disorders.
• Apply and interpret special studies in diagnosis urogenital system disorders, including laboratory
and imaging examination.
• Diagnose and manage patient with common urogenital system disorders.
• Diagnose and refer special patient with urogenital system disorders.
• Plan patient, family, and community education about urogenital system disorders.
Learning outcomes:
• Describe the functional structure of urogenital system and its general clinical implications.
• Comprehend the pathological basis underlying the symptoms and signs of urogenital system
disorders.
• Recognize the potential uses of common diagnostic and therapeutic procedure in urogenital
system disorders.
• Manage urogenital system disorders:
• Diagnose and manage independently uncomplicated urinary tract infection, phymosis and
paraphymosis.
• Diagnose and manage independently phymosis and paraphymosis.
• Diagnose, give initial treatment, and refer some urogenital systemdisorders such as
glomerulonephritis, renal colic, acute kidney injury including acute tubular necrosis, chronic
kidney disease, prostatitis, priapismus and, torsio testis.
• Diagnose and refer some urogenital system disorders such as, horse shoe kidney, kidney tumor,
nephrotic syndrome, symptomatic polycystic kidney, epydidimitis, urothelial carcinoma, benign
prostate hyperplasia, and prostate cancer, common penile tumor, hipospadia, epispadia,
varicocele, hydrocele, retractile testis, cryptorchidism, spermatocele, epydidimitis, and common
testicular tumor (seminoma and teratoma).
• Manage secondary hypertension. Diagnose and refer secondary hypertension, focus on renal
hypertension.
• Implement patient education in the prevention and early detection of common urinary system
disorders.
Curriculum contents:
• Functional structure of urogenital system.
• Pathological basis of urogenital system disorders.
• Symptom and sign of urogenital system disorders.
• Physical examination, laboratory investigation and imaging studies in urogenital
system disorders.
• Interpret and utilize results of Physical examination, laboratory investigation and
imaging studies.
• Rational drug use in urogenital system disorders.
• Management of urogenital system disorders.
• Clinical procedure in urogenital system disorders.
• Communicate and apply basic principle in the prevention, and rehabilitation of
urogenital system disorders.
Curriculum structure:
Structure of curriculum mainly is derive from general competences of Indonesian general
practioner. Those competences in diagnosing diseases and doing clinical skills should be
mastered by all the general practioners here. Local values of our institutions are also
considered as added values in this curriculum.
PLANNERS AND LECTURERS
NO NAME DEPARTMENT PHONE

1 Dr.dr. Dewa Ayu Agus Sri Laksemi, M.Sc ( Secretary) Parasitology 085157303722
2 Dr. dr. G. Wirya K Duarsa, MARS, M.Kes, Sp.U (K), Urology 08155753377
dr. I Nyoman Gde Wardana, S.Ked, M.Biomed
3 Anatomy 087860405625
Prof. Dr. dr. I N. Mangku Karmaya, M.Repro
4 Anatomy 0811387105
Prof. dr. K. Tirtayasa, MS, AIF
5 Physiology 08123623422
6 dr. G A P Nilawati, Sp.A (K), MARS Pediatric 08123616497
Dr.dr Wayan Winarti, Sp.PA ( K)
7 Pathology Anatomy 087860990701
dr. Nyoman Paramita Ayu, Sp.PD-KGH, FINASIM
8 Internal Medicine 087754434970
Dr. dr. I A Ika Wahyuniari, M.Kes
9 Histology 08113891418
Dr.dr. I Gusti Ayu Artini, S.Ked, M.Sc
10 Pharmacology 082236356644
Dr. dr. Yenny Kandarini, Sp.PD-KGH, FINASIM
dr. I Wayan Yudiana, Sp.U ( K)
12 Urology 081338708195
Dr. dr. Kadek Budi Santosa, Sp.U (K)
13 Urology 081339977799
Prof.Dr. dr. A A Wiradewi Lestari, Sp.PK ( K)
14 Clinical Pathology 08155237937
15 dr. Putu Utami Dewi, Sp Rad Radiology 08971115428
dr. I Ketut Agus Indra Adiputra, Sp.MK
16 Microbiology 081916166043
dr. Pande Made Wisnu Tirtayasa, Sp.U(K),Ph.D
17 Urology 082111133211
dr. Ida Bagus Putra Pramana, Sp.U
18 Urology 081246606768
dr. Gde Wira Mahadita, Sp.PD -KGH, FINASIM
dr. IGN Tresna Erawan, M.Biomed., Sp.PD-KGH,
20 FINASIM Internal Medicine 081236743773
21 dr. Bagus Ngurah Mahakrisna, M.Biomed, Sp A Pediatric 082144630623

NO DAFTAR PENYAKIT SESUAI SKDI 2012 TINGKAT KEMAMPUAN
GANGGUAN DAN KELAINAN PADA GINJAL

1 Infeksi saluran kemih 4A
2 Glomerulonefritis akut 3A
3 Glomerulonefritis kronik 3A
4 Gonore 4A
5 Karsinoma sel renal 2
6 Tumor Wilms 2
7 Acute kidney injury 2
8 Penyakit ginjal kronik 2
9 Sindrom nefrotik 2
10 Kolik renal 3A
11 Batu saluran kemih (vesika urinaria, ureter, uretra ) tanpa kolik 3A
12 Ginjal polikistik simtomatik 2
13 Ginjal tapal kuda 1
14 Pielonefritis tanpa komplikasi 4A
15 Nekrosis Tubular Akut 2
ALAT KELAMIN PRIA
16 Hipospadia 2
17 Epispadia 2
18 Testis tidak turun/ kriptorkidismus 2
19 Rectratile testis 2
20 Varikokel 2
21 Hidrokel 2
22 Fimosis 4A
23 Parafimosis 4A
24 Spermatokel 2
25 Epididimitis 2
26 Prostatitis 3A
27 Torsio testis 3B
28 Ruptur uretra 3B
1
29 Ruptur kandung kencing 3B
30 Ruptur ginjal 3B
31 Karsinoma uroterial 2
32 Seminoma testis 1
33 Teratoma testis 1
34 Hiperplasia prostat jinak 2
35 Karsinoma prostat 2
36 Striktura uretra 2
37 Priapismus 3B
38 Chancroid 3A
2
RENCANA PEMBELAJARAN BLOCK/SEMESTER
Block Urinary and Male Genital System and Disorders
Program Studi Sarjana Kedokteran dan Profesi Dokter
Fakultas Kedokteran
Universitas Udayana
Nama Kode Durasi/Bobot Semester Block Syarat

The Urinary and Male Genital KSN3231B 4 minggu (SKS) 6 Studium Generale
Block/Mata
1 System and Disorder Biomedik II
Kuliah
Medical Communication
Medical Professionalism
1. Gde Wirya K Duarsa
2. Dewa Ayu Agus Sri Laksemi
3. Nyoman Gde Wardana
Dosen 4. I N. Mangku Karmaya
2 5. Tirtayasa
Pengampu
6. G A P Nilawati
7. Wayan Winarti
8. Nyoman Paramita Ayu
9. I A Ika Wahyuniari
10. I Gusti Ayu Artini
11. Yenny Kandarini
12. I Wayan Yudiana
13. Kadek Budi Santosa
3
14. A A Wiradewi Lestari
15. Putu Utami Dewi
16. I Ketut Agus Indra Adiputra
17. Pande Made Wisnu Tirtayasa
18. Ida Bagus Putra Pramana
Kantor : Departemen Urologi FK UNUD/ RS Sanglah Ruang Kuliah 3.01 dan 3.02 Fakultas Kedokteran Universitas Udayana
Kontak Telp : 0361 222510 Ruang Small Group Discussion (SGD) Fakultas Kedokteran Universitas
Udayana
Blok ini fokus pada anatomi, histologi dan fisiologi sistem kemih dan alat genital pria, farmakologi berbagai kelas obat ginjal dan
saluran kemih, gejala dan tanda penyakit ginjal dan saluran kemih serta patofisiologi dan konsep prinsip dasar pendidikan,
Deskripsi pencegahan, pengobatan dan rehabilitasi di Gangguan Sistem Ginjal, Saluran Kemih dan alat genital pria pada pasien, keluarga dan
3 Block/Mata komunitas.
Kuliah Di akhir Blok mahasiswa diharapkan mampu memahami fungsi biologis sistem urogenital terhadap proses patologis gangguan
sistem kemih dan alat genital pria, mampu mendiagnosis gangguan sistem urogenital, termasuk pemeriksaan laboratorium dan
pencitraan untuk kemudian menangani pasien atau merujuk ke pelayanan yang lebih tinggi tingkatannya, serta mampu
merencanakan pendidikan pasien, keluarga, dan komunitas tentang gangguan sistem urogenital.
4
CPL-S1 bertaqwa kepada Tuhan Yang Maha Esa dan mampu Indikator: Mahasiswa dalam pembelajaran selalu
menunjukkan sikap religius; (S1) menjunjung tinggi nilai, norma, dan etik akademik,
menghindari plagiarism dalam pembuatan semua
tugas-tugas dalam pembelajaran
CPL-S5 menghargai keanekaragaman budaya, pandangan, Indikator: Ketepatan identifikasi, analisis,
agama, dan kepercayaan, serta pendapat atau temuan menunjukkan kepedulian, toleransi,
orisinal orang lain; (S5) ketepatan solusi.
CPL-PU1 Mampu menerapkan Ilmu Biomedik, Ilmu Indikator: Ketepatan identifikasi, analisis,
CPL yang Humaniora, Ilmu Kedokteran Klinik dan Ilmu merumuskan dan penyelesaian masalah
Dibebankan Kesehatan Masyarakat/Kedokteran
4 pada Pencegahan/Kedokteran Komunitas yang terkini
Block/Mata untuk mengelola masalah kesehatan secara
Kuliah holistik dan komprehensif (PU 1)
CPL-KU11 Kemampuan menggali, menerima dan bertukar Indikator: Ketepatan/kejelasan menyampaikan,
informasi secara verbal dan nonverbal dan mempresentasikan, menjawab, mendiskusikan, dan
menunjukkan empati dengan pasien semua usia, menyimpulkan
anggota keluarga, masyarakat dan kolega, dalam
tatanan keragaman budaya lokal, regional dan
global
CPL-KU14 Mampu meningkatkan kapasitas diri melalui mawas Indikator: Mahasiswa mampu menerapkan
diri dan pembelajaran secara mandiri (KU 14) pembelajaran mandiri dalam pembelajaran yang
berpusat pada mahasiswa (student center learning)
CPL-KU17 Mampu memanfaatkan keterampilan pengelolaan Indikator: Ketepatan identifikasi, analisis,

informasi kesehatan untuk dapat belajar sepanjang merumuskan dan penyelesaian masalah
hayat (KU 17)
CPL CPL- CPL- CPL-

CPL-S1 S5 CPL-PU1 KU11 KU14 CPL-KU17
Kontribusi
thdp CPL (sks)
0,1 0,5 0,5 0,4 0,2 0,3
5
Capaian kontribusi
5 thdp CPL (%)
0,06 0,3 0,3 0,24 0.12 0,18
Pembelajaran
Block/Mata
Kuliah CPB/MK
(CPB/MK) dan Mampu menjelaskan Menjelaskan konsep secara CPB/MK-1
Kontribusinya komprehensif dan sistematis yang berkaitan ✔
terhadap CPL dengan system urinary. ✔
6
Mampu menjelaskan konsep dasar, bentuk, CPB/MK-2
struktur, letak, dan fungsi sistem urinary
✔
manusia dalam mempertahankan homeostasis
Mampu menjelaskan dasar-dasar abnormalitas CPB/MK-3

sistem urinary manusia mulai dari sel, jaringan,
✔ ✔ ✔
organ, sampai sistem organ.
Mampu menjelaskan konsep dasar CPB/MK-4

komunikasi interseluler yang mencakup ✔
sistem urinary dalam mempertahankan ✔
homeostasis
Mampu menjelaskan konsep dasar farmakologis CPB/MK-5
obat-obat yang sering digunakan pada kasus yang ✔ ✔ ✔
melibatkan sistem urinary
Mampu menjelaskan implikasi klinik struktur- CPB/MK-6

struktur penting pada sistem urinary
1. Struktur fungsional sistem urogenital.

2. Dasar patologis gangguan sistem urogenital.
3. Gejala dan tanda gangguan sistem urogenital.
4. Pemeriksaan fisik, pemeriksaan laboratorium dan studi pencitraan pada gangguan sistem urogenital.
6 Bahan Kajian 5. Menafsirkan dan memanfaatkan hasil pemeriksaan fisik, pemeriksaan laboratorium dan studi pencitraan.
6. Penggunaan obat rasional pada gangguan sistem urogenital.
7. Penatalaksanaan gangguan sistem urogenital.
8. Prosedur klinis pada gangguan sistem urogenital.
9. KIE dan prinsip dasar dalam pencegahan, dan rehabilitasi gangguan sistem urogenital.
7 Rencana Pembelajaran
Hari I: Pendahuluan dan Dasar Biomedis Ginjal, sistem saluran Kemih dan Alat genital Pria
Kemampuan Akhir • Memahami fungsi biologis sistem urogenital terhadap proses patologi gangguan sistem saluran kemih
Mahasiswa • Mendeskripsikan anatomi umum dan topografi serta permukaan sistem Urinary dan Genital Pria.
•
•
7
•
• Mahasiswa mampu menjelaskan CP Lulusan dan Block/mata kuliah, dan cara pencapaiannya selama 3 minggu
• Mampu menjelaskan Menjelaskan konsep secara komprehensif dan sistematis yang berkaitan dengan system urinary.
• Mampu menjelaskan konsep dasar, bentuk, struktur, letak, dan fungsi sistem urinary manusia dalam mempertahankan
homeostasis.
• Mampu menjelaskan dasar-dasar abnormalitas sistem urinary manusia mulai dari sel, jaringan, organ, sampai sistem organ.
• Mampu menjelaskan konsep dasar komunikasi interseluler yang mencakup sistem urinary dalam mempertahankan
homeostasis
• Mampu menjelaskan implikasi klinik struktur-struktur penting pada sistem urinary
Kriteria /Indikator • Kedalaman pemahaman/ketepatan penjelasan
Capaian • Kemampuan mengkritisi/ketepatan membedakan, membandingkan, dan pendapat
Materi
Pembelajaran Teks Slide (ppt) Audio Video URL lainnya
8
• Study Guide • Pengenalan Block https://www.youtube.com/watch?v=9nQm
Block • Anatomy Urinary and cRtRIKo#action=share
Male Genital System
• Histology Urinary and https://www.youtube.com/watch?v=ivBCcR
Male Genital System 4jAKA
• Physiology Urinary and
Male Genital System https://www.youtube.com/watch?v=l128t
• Pathology Anatomy W1H5a8
Urinary and Male https://www.youtube.com/watch?v=-
Genital System Of88XpYM3E
Bentuk /Metode On-line F2F

Pembelajaran
• Belajar mandiri (membaca sumber • Aktivitas kelas: Pemaparan singkat dan diskusi (kuliah pendahuluan)
pembelajaran dan melakukan penilaian diri)
• Tugas terstruktur (menyusun karya ilmiah
student project secara berkelompok)
On-line F2F (aktivitas kelas)
Beban Waktu
2 x 1 x 60 menit belajar mandiri;
Pembelajaran 2 x 1x 60 menit tugas terstruktur 1 x 4 x 50 menit (Aktivitas Kelas besar/kuliah pendahuluan)
Metode Instrumen
On-line F2F On-line F2F

Penilaian
Laporan SP Observation (Q/A) Rubrik Deskriptif
Pembelajaran
Quiz Presentasi Pilihan ganda dan B/S (Format Rubrik Holistik
Forum Online)
Forum (Format Online)
Pengalaaman
On-line • F2F (aktivitas kelas)
Belajar / Aktivitas • Belajar mandiri Belajar dan berdiskusi dalam kelas besar
Mahasiswa • Menulis paper student project secara
berkelompok
• Mengerjakan Quiz dan Forum
Media
On-line: perangkat computer/gadget dan Pembelajaran di kelas: Komputer, LCD projector
Pembelajaran
akses internet
Aktivitas On-line Aktivitas Kelas/Praktikum
9
Dr. DAA Sri Laksemi, M.Sc Dr. DAA Sri Laksemi, M.Sc
Fasilitator Prof. Dr. dr. Mangku Karmaya Prof. Dr. dr. Mangku Karmaya
Dr.dr. I A Ika Wahyuniari, M.Kes Dr.dr. I A Ika Wahyuniari, M.Kes
Prof. dr. Ketut Tirtayasa, MS, AIF Prof. dr. Ketut Tirtayasa, MS, AIF
Dr. dr. Ni Wayan Winarti, SpPA Dr. dr. Ni Wayan Winarti, SpPA
10
Hari II: Biomedis Ginjal, sistem saluran Kemih dan Alat genital Pria serta Infeksi Saluran Kencing tanpa Komplikasi
Kemampuan Akhir • Mahasiswa mampu menjelaskan CP Lulusan dan Block/mata kuliah, dan cara pencapaiannya selama 3 minggu
Mahasiswa • Mampu menjelaskan Menjelaskan konsep secara komprehensif dan sistematis yang berkaitan dengan system urinary.
• Mampu menjelaskan konsep dasar, bentuk, struktur, letak, dan fungsi sistem urinary manusia dalam mempertahankan
homeostasis.
• Mampu menjelaskan dasar-dasar abnormalitas sistem urinary manusia mulai dari sel, jaringan, organ, sampai sistem
organ.
• Mampu menjelaskan konsep dasar komunikasi interseluler yang mencakup sistem urinary dalam mempertahankan
homeostasis
• Mampu menjelaskan implikasi klinik struktur-struktur penting pada sistem urinary
• Mampu mendiagnosis dan melakukan penatalaksanaan pada pasien ISK, merujuk dan memberikan komunikasi
informasi pencegahan ISK
Capaian • Kemampuan mengkritisi/ketepatan membedakan, membandingkan, dan pendapat
Materi Pmbelajaran Sumber Pembelajaran on-line
Teks Slide (ppt) Audio Video URLlainnya
• Study Guide Block • Uncomplicated UTI https://youtu.be/9JP0utTAg
OI
Bentuk / Metode On-line F2F
Pembelajaran
• Belajar mandiri (membaca sumber • Aktivitas kelas: Pemaparan singkat dan diskusi (kuliah pendahuluan)
pembelajaran dan melakukan penilaian diri) • Aktivitas kelas kecil: Diskusi kelompok kecil didampingi oleh fasilitator
• Tugas terstruktur (menyusun karya ilmiah (Small Group Discussion/SGD)
student project secara berkelompok) • Aktivitas kelas: Diskusi dalam kelas besar (pleno)
Beban Waktu On-line F2F (aktivitas kelas/Praktikum)
Pembelajaran 2 x 1 x 60 menit belajar mandiri; 1x1x50 menit (aktivitas kelas besar/kuliah pendahuluan)
2 x 1x 60 menit tugas terstruktur 2x1x50 menit (diskusi kelompok kecil/SGD)
2x1x50 menit (aktivitas kelas besar/pleno)
Metode Instrumen
Assesment
Laporan SP Observation (Q/A) Rubrik Deskriptif
Pembelajaran Quiz Presentasi Pilihan ganda dan B/S (Format Rubrik Holistik
Forum Online)
11
Pengalaaman • Belajar mandiri • Belajar dan berdiskusi dalam kelas besar
Belajar / Aktivitas • Belajar berkelompok dan berdiskusi dalam kelompok kecil didampingi
Mahasiswa fasilitator
12
• Menulis paper student project secara
berkelompok
Media On-line F2F (aktivitas kelas)
Pembelajaran On-line: perangkat computer/gadget dan Pembelajaran di kelas: Komputer, LCD projector
akses internet Pembelajaran kelas kecil: Komputer, whiteboard, textbook
Aktivitas On-line Aktivitas Kelas
• Prof. Dr. dr. Mangku Karmaya
• Prof. Dr. dr. Mangku Karmaya
Fasilitator • Dr.dr. I A Ika Wahyuniari, M.Kes
• Dr.dr. I A Ika Wahyuniari, M.Kes • Prof. dr. Ketut Tirtayasa, MS, AIF
• Prof. dr. Ketut Tirtayasa, MS, AIF • Dr. dr. Ni Wayan Winarti, SpPA
• Dr.dr. Yenni Kandarini, SpPD-KGH, Finasim
• Dr. dr. Ni Wayan Winarti, SpPA • Fasilitator Kelompok Kecil
• Dr.dr. Yenni Kandarini, SpPD-KGH, Finasim
• Fasilitator Kelompok Kecil
Hari III : Kolik, Urolithiasis, Karsinoma sel Renal, Supra Renal dan Wilm Tumor, Infeksi Saluran Kencing dengan
Komplikasi
Kemampuan Akhir • Mampu mendiagnosis, memberikan tata laksana serta merujuk kolik, urolithiasis dan ISK dengan komplikasi sesuai
Mahasiswa dengan standar kompetensi dokter Indonesia
• Mampu mendiagnosis serta merujuk Karsinoma sel renal dan Wilms Tumor sesuai dengan standar kompetensi dokter
Indonesia
• Mampu meberikan informasi, komunikasi pencegahan kolik, urolithiasis, Karsinoma sel renal dan Wilms Tumor

Capaian • Kemampuan mengkritisi/ketepatan membedakan, membandingkan
• Kemampuan mendiagnosis, management dan merujuk
• Kemampuan komunikasi dan pencegahan
Materi Sumber Pembelajaran on-line
Pembelajaran Teks Slide (ppt) Audio Video URL
13
• Study Guide • Renal colic https://www.youtube.com/watch?v
Block • Urolithiasis =kLxBks6s4M8
• Carsinoma cell Renal,
Supra Renal and Wilm https://www.youtube.com/watch?v
Tumor =N_nvSFb_2eA
• Complicated Urinary tract
Infection
14
Bentuk / Metode On-line F2F
Pembelajaran
• Belajar mandiri (membaca sumber • Aktivitas kelas/kuliah pendahuluan: Pemaparan singkat dan diskusi
Pembelajaran 2 x 1 x 60 menit belajar mandiri;
2 x 1x 60 menit tugas terstruktur 1 x 4 x 50 menit (Aktivitas Kelas besar/kuliah pendahuluan)
Metode Instrumen

Assesment
Laporan SP Observation Rubrik Deskriptif
Pembelajaran
Quiz (Q/A) Pilihan ganda dan B/S (Format
Rubrik Holistik
Forum Presentasi Online)
Pengalaaman On-line F2F
Belajar / Aktivitas • Belajar mandiri • Belajar dan berdiskusi dalam kelas besar
Mahasiswa • Menulis paper student project
akses internet
Fasilitator Aktivitas On-line Aktivitas Kelas/Praktikum
15
• Dr.dr. A A Oka, SpU (K) • Dr.dr. A A Oka, SpU (K)
• Dr. Kadek Budi Santosa, SpU (K) • Dr. Kadek Budi Santosa, SpU (K)
Hari IV: Kolik, Urolithiasis, Karsinoma sel Renal, Supra Renal dan Wilm Tumor, Infeksi Saluran Kencing dengan
Komplikasi dan Gagal Ginjal Kronis
Kemampuan Akhir • Mampu mendiagnosis, memberikan tata laksana serta merujuk kolik, urolithiasis dan ISK dengan komplikasi sesuai
Mahasiswa dengan standar kompetensi dokter Indonesia
• Mampu mendiagnosis serta merujuk Karsinoma sel renal, Wilms Tumor dan gagal ginjal kronis sesuai dengan standar
kompetensi dokter Indonesia
• Mampu meberikan informasi, komunikasi pencegahan kolik, urolithiasis, Karsinoma sel renal dan Wilms Tumor
• menjelaskan dan memahami evolusi penyakit ginjal, menghitung estimasi GFR, menentukan stadium penyakit ginjal
kronis

Capaian • Kemampuan mengkritisi/ketepatan membedakan, membandingkan
• Kemampuan mendiagnosis, management dan merujuk
• Kemampuan komunikasi dan pencegahan

Study Guide Block • Chronic Kidney https://www.yout
Disease ube.com/watch?v=
fv53QZRk4hs
Bentuk dan Metode On-line F2F

Pembelajaran
• Belajar mandiri (membaca sumber • Aktivitas kelas: Pemaparan singkat dan diskusi
pembelajaran dan melakukan penilaian • Aktivitas kelas kecil: Diskusi kelompok kecil didampingi oleh fasilitator
diri) • Aktivitas kelas: Diskusi dalam kelas besar (pleno)
On-line F2F (aktivitas kelas/Praktikum)
16
Beban Waktu 2 x 1 x 60 menit belajar mandiri; 1x1x50 menit (aktivitas kelas besar/kuliah pendahuluan)
Pembelajaran 2 x 1x 60 menit tugas terstruktur 2x1x50 menit (diskusi kelompok kecil)
Metode Instrumen
17
Assesment Laporan SP Observation Rubrik Deskriptif
Pembelajaran Quiz (Q/A) Pilihan ganda dan B/S (Format
Rubrik Holistik
Pengalaaman On-line F2F (aktivitas kelas)
Mahasiswa • Menulis paper student project • Belajar berkelompok dan berdiskusi (pengembangan inter-personal
• Mengerjakan Quiz dan Forum skills)
akses internet Pembelajaran kelas kecil: Komputer, whiteboard
• Dr.dr. A A Oka, SpU (K) • Dr.dr. A A Oka, SpU (K)

Fasilitator
• Dr. Kadek Budi Santosa, SpU (K) • Dr. Kadek Budi Santosa, SpU (K)
• Prof.Dr.dr. I Gde Raka Widiana, SpPD-KGH • Prof.Dr.dr. I Gde Raka Widiana, SpPD-KGH
• Fasilitator Kelompok Kecil • Fasilitator Kelompok Kecil
Hari V: Hipertensi sekunder, Gagal Ginjal Akut, Glomerulonephritis Akut dan kronis,
Hipertensi, sindrom nefrotik, Infeksi saluran Kencing, kelainan kongenital pada sistem urinari pada Anak
Kemampuan Akhir • Mampu mendiagnosis, memberikan tata laksana serta merujuk hipertensi pada dewasa, Glomerulonefritis akut dan
Mahasiswa kronik, ISK dan hipertensi pada anak sesuai dengan standar kompetensi dokter Indonesia
• Mampu mendiagnosis serta merujuk Gagal ginjal akut dan sindrom nefrotik sesuai dengan standar kompetensi dokter
Indonesia
• Mampu mengenali dan menjelaskan kelainan kongenital pada sistem urinary anak
• Mampu memberikan informasi, komunikasi pencegahan
Kriteria/Indikator • Kedalaman pemahaman/ketepatan penjelasan
• Kemampuan analisis/ketepatan kalkulasi
• Kemampuan mengkritisi/ketepatan membedakan, membandingkan
18
Materi Teks Slide (ppt) Audio Video uRL lainnya
Pembelajaran • Study Guide • Secondary https://youtu.be/qTk9GJ1uGXQ
Block Hypertension https://youtu.be/hVXEvHdDMhg
• Acute kidney Injury
https://youtu.be/UTRom9rUMtE
• Acute and Chronic
Glomerulonephritis, https://youtu.be/X5TknCu3RV0
Pediatric Hipertension https://youtu.be/0X5qBjNjujs
• Nephrotic Syndrome, https://youtu.be/xcrfhVYJ0kM
UTI in children,
Congenital Anomaly in
Urinary System
19
Bentuk /Metode On-line F2F
Pembelajaran • Belajar mandiri (membaca sumber Aktivitas kelas/kuliah pendahuluan: Pemaparan singkat dan diskusi
pembelajaran dan melakukan penilaian
diri)
2 x 1x 60 menit tugas terstruktur 2 x 2 x 50 menit (Aktivitas Kelas besar/kuliah pendahuluan)
Metode Instrumen
Pembelajaran Quiz (Q/A) Pilihan ganda dan B/S (Format
Rubrik Holistik
Belajar / Aktivitas • Belajar mandiri Belajar dan berdiskusi dalam kelas besar
akses internet
Fasilitator • Dr.dr. Yenni Kandarini, SpPD-KGH, Finasim • Dr.dr. Yenni Kandarini, SpPD-KGH, Finasim
• dr. G A P Nilawati, Sp.A (K), MARS • dr. G A P Nilawati, Sp.A (K), MARS
20
Hari VI: Hipertensi sekunder, Gagal Ginjal Akut, Glomerulonephritis Akut dan kronis,
Hipertensi, sindrom nefrotik, Infeksi saluran Kencing, kelainan kongenital pada sistem urinari pada Anak, Prostate
cancer and Urotelial Carsinoma
Kemampuan Akhir • Mampu mendiagnosis, memberikan tata laksana serta merujuk hipertensi pada dewasa, Glomerulonefritis akut dan
Mahasiswa kronik, ISK dan hipertensi pada anak sesuai dengan standar kompetensi dokter Indonesia
• Mampu mendiagnosis serta merujuk Gagal ginjal akut dan sindrom nefrotik sesuai dengan standar kompetensi dokter
Indonesia
• Mampu mengenali dan menjelaskan kanker prostat dan urotelial serta kelainan kongenital pada sistem urinary anak
• Mampu memberikan informasi, komunikasi pencegahan
Capaian • Kemampuan analisis/ketepatan kalkulasi

Study Guide Block • Hipertensi sekunder • https://youtu.be/U8LvtJ7 • https://youtu.be/zg3j5Ig4dJY
• Gagal Ginjal Akut cgJ0
• Glomerulonephritis • https://youtu.be/FtZNN5
Akut dan kronis, PNLlA
• Hipertensi, sindrom •
nefrotik, Infeksi
saluran Kencing,
kelainan kongenital
pada sistem urinari
pada Anak,
Prostate cancer and
Urotelial Carsinoma
Bentuk / Metode On-line F2F (aktivitas kelas)
21
Pembelajaran • Belajar mandiri (membaca sumber • Aktivitas kelas: Pemaparan singkat dan diskusi
pembelajaran dan melakukan penilaian • Aktivitas kelas kecil: Diskusi kelompok kecil didampingi oleh fasilitator
diri) • Aktivitas kelas: Diskusi dalam kelas besar (pleno)
• Tugas terstruktur (menyusun karya
ilmiah student project secara
berkelompok)
Pembelajaran 2 x 1 x 60 menit belajar mandiri; 1x1x50 menit (aktivitas kelas besar/kuliah pendahuluan)
2 x 1x 60 menit tugas terstruktur 2x1x50 menit (diskusi kelompok kecil)
Metode Instrumen
Assesment On-line F2F On-line F2F
Pembelajaran Laporan SP Observation Rubrik Deskriptif
Rubrik Holistik
Quiz (Q/A) Pilihan ganda dan B/S (Format
22
Mahasiswa • Menulis paper student project • Belajar berkelompok dan berdiskusi
akses internet Pembelajaran kelas kecil: Komputer, whiteboard
• Dr.dr. Yenni Kandarini, SpPD-KGH, Finasim • Dr.dr. Yenni Kandarini, SpPD-KGH, Finasim
• dr. G A P Nilawati, Sp.A (K), MARS • dr. G A P Nilawati, Sp.A (K), MARS
• dr. I Wayan Yudiana, SpU • dr. I Wayan Yudiana, SpU
• Fasilitator Kelompok Kecil • Fasilitator Kelompok Kecil
Hari VII: Kelainan Prostat, Testis, Inkontinensia Urin

Kemampuan Akhir • Mampu mendiagnosis, memberikan penatalaksanaan serta merujuk prostatitis, torsio testis, fimosis dan parafimosis, serta
mampu mengenali kegawatdaruratan torsio testis, fimosis dan parafimosis
Mahasiswa
• Mampu mendiagnosis dan merujuk Kelainan Prostat, Testis seperti Hipospadia, Epispadia, Undesensus testis, Rectractile
testis, Hidrokel, varikokel, Spermatokel, BPH,Stricture Urethra Neonatal hidronefrosis
• Mampu mengenali Inkontinensia Urin serta merujuk
Kriteria/Indikator • Kemampuan anamnesis/ketepatan analisis
• Kemampuan merencanakan terapi/ketepatan formulasi
• Kemampuan komunikasi
• Study Guide Block https://www.youtub
e.com/watch?v=Lyxz
• Hipospadia, NyQEbAs
Epispadia,Phimosis, https://youtu.be/ICx
Paraphimosis Uy0_NIcM
https://youtu.be/6Es
• Undesensus testis, Torsio E-vgtlGI
Testis, Rectractile testis, https://youtu.be/1iSI
Hidrokel, varikokel, 63kDbG8
23
Spermatokel https://youtu.be/qA
1Be3p2Pqc
• BPH,Stricture Urethra https://youtu.be/zBe
Neonatal hidronefrosis SSiDfLug
https://youtu.be/5IQ
rt3VMtTs
• Urinary Incontinence https://youtu.be/yxD
dQO4_bZg
Bentuk dan Metode On-line F2F (aktivitas kelas)
Pembelajaran • Simulasi kasus dengan pasien satandar
• Belajar mandiri (membaca sumber
pembelajaran dan melakukan penilaian diri) • Presentasi Mahasiswa dalam kelompok sedang
24
2 x 1x 60 menit tugas terstruktur 2 x 2 x 50 menit (Aktivitas Kelas Sedang)
Metode Instrumen
Assesment
Laporan SP Observation Rubrik Deskriptif
Pembelajaran Rubrik Keterampilan Klinik
Quiz (Q/A) Pilihan ganda dan B/S (Format Daftar Tiilik Keterampilan
Forum Presentasi Online) Klinik
Pengalaman Belajar
/ Aktivitas • Belajar mandiri Belajar dan berdiskusi dalam kelas sedang
• Bermain peran dalam kontek hubungan dokter pasien
Media
akses internet
• Dr. dr. G Wirya K Duarsa MARS, SpU (K) • Dr. dr. G Wirya K Duarsa, MARS, SpU (K)
• dr. Kadek Budi Santosa, SpU(K) • dr. Kadek Budi Santosa, SpU(K)
Hari VIII: Kelainan Prostat, Testis, Inkontinensia Urin, Pyelonefritis

Kemampuan Akhir • Mampu mendiagnosis, memberikan penatalaksanaan serta merujuk prostatitis, torsio testis, fimosis dan parafimosis,
pyelonefritis serta mampu mengenali kegawatdaruratan torsio testis, fimosis dan parafimosis
Mahasiswa
• Mampu mendiagnosis dan merujuk Kelainan Prostat, Testis seperti Hipospadia, Epispadia, Undesensus testis,
Rectractile testis, Hidrokel, varikokel, Spermatokel, BPH,Stricture Urethra Neonatal hidronefrosis
• Mampu mengenali Inkontinensia Urin serta merujuk
25
Kriteria/Indikator • Kedalaman pemahaman/ketepatan penjelasan
• Kemampuan mengkritisi/ketepatan membedakan, membandingkan, dan pendapat
26
Pembelajaran Teks • Slide (ppt) Audio • Video URL
• Study Guide Block Pyelonefritis https://youtu.be/FcRjFhMvaTo
https://youtu.be/IuHumcWwpkw
Bentuk dan On-line F2F (aktivitas kelas)

Metode •
• Belajar mandiri (membaca sumber Simulasi kasus dengan pasien standar
Pembelajaran
pembelajaran dan melakukan penilaian • Presentasi Mahasiswa dalam kelompok sedang
diri)
Beban Waktu
2 x 1 x 60 menit belajar mandiri;
Pembelajaran 2 x 1x 60 menit tugas terstruktur 2 x 2 x 50 menit (Aktivitas Kelas Sedang)
Metode Instrumen
Pembelajaran Quiz (Q/A) Pilihan ganda dan B/S (Format Rubrik Keterampilan Klinik
Forum Presentasi Online) Daftar Tiilik Keterampilan Klinik
Pengalaaman
Belajar / Aktivitas • Belajar mandiri Belajar dan berdiskusi dalam kelas sedang
Media
Pembelajaran
akses internet

• Dr. dr. G Wirya K Duarsa, MARS, SpU (K) • Dr. dr. G Wirya K Duarsa, MARS, SpU (K)
• dr. Kadek Budi Santosa, SpU(K) • dr. Kadek Budi Santosa, SpU(K)
• dr. Nyoman Paramita Ayu SpPD-KGH, • dr. Nyoman Paramita Ayu SpPD-KGH, FINASIM
• Fasilitator kelompok kecil • Fasilitator kelompok kecil
27
Hari IX: Urinalisis, Urethral Swab, Radiology pada sistem Urinary dan Obat obatan pada kelainan pada sistem urinary
Kemampuan Akhir • mampu menentukan pemeriksaan urinalisis, rontgen yang tepat untuk keluhan dan penyakit pada ginjal dan saluran kemih
Mahasiswa
• mampu menginterpretasikan hasil pemeriksaan urinalisis, rontgen dari keluhan dan penyakit pada ginjal dan saluran kemih
• mampu memberikan pilihan obat yang tepat pada Glomerulonefritis, renal Colic, urolithiasis without complication (vesika
urinaria, ureter, uretra ) prostatitis, Chancroid
• mampu memberikan komunikasi informasi dan edukasi terkait obat yang diberikan untuk keluhan saluran kemih dan ginjal
Kriteria/Indikator • Kemampuan anamnesis/ketepatan analisis
• Kemampuan merencanakan terapi/ketepatan formulasi
• Kemampuan komunikasi
Materi Pembelajaran Sumber Pembelajaran on-line

Teks Slide (ppt) Audio Video URL
• Study Guide Block Urinalisis, Urethral Swab, https://youtu.be/VM
Radiology pada sistem Urinary cQlEfkMPw
dan Obat obatan pada kelainan https://youtu.be/dT-
pada sistem urinary 6WOST3Mc
https://youtu.be/6jb
VcMgN_HI
https://youtu.be/0JJ
2a2mCDTw
https://youtu.be/Ho
K1gID3ZQY
Pembelajaran • Belajar mandiri (membaca sumber • Simulasi kasus dengan pasien satandar
28
• Presentasi Mahasiswa dalam kelompok sedang
29

Pembelajaran 2 x 1 x 60 menit belajar mandiri; 2 x 2 x 50 menit (Aktivitas Kelas Sedang)
2 x 1x 60 menit tugas terstruktur
Metode Instrumen
Assesment
Pembelajaran Laporan SP Quiz Forum Observation (Q/A) Rubrik Deskriptif Rubrik Keterampilan Klinik Daftar
Presentasi Pilihan ganda dan B/S (Format Online) Tiilik Keterampilan Klinik
Pengalaman Belajar On-line F2F (aktivitas kelas)

/ Aktivitas Mahasiswa
• Belajar mandiri Belajar dan berdiskusi dalam kelas sedang
• Menulis paper student project
Media Pembelajaran On-line F2F (aktivitas kelas)

akses internet
• Dr.dr AA Wiradewi Lestari, SpPK • Dr.dr AA Wiradewi Lestari, SpPK
• dr. Dwi Fatmawati, SpMK, PhD • dr. Dwi Fatmawati, SpMK, PhD
• dr.Sri Laksminingsih, SpRad (K) • dr.Sri Laksminingsih, SpRad (K)
• Dr. dr. I Gusti Ayu Artni, M.Sc • Dr. dr. I Gusti Ayu Artni, M.Sc
Hari X: Practicum Microscopic Structure of Urinary Tract
Kemampuan Akhir Mampu menjelaskan struktur mikroskopis dari sistem saluran kemih
Mahasiswa
30
Mampu menjelaskan struktur mikroskopis dari sistem gentalia Pria
Mampu menjelaskan konsep histologi secara komprehensif dan sistematis yang berkaitan dengan system urinary.
Menguasai konsep dan mampu menjelaskan struktur anatomi terkait Uro-genital system
Kriteria/Indikator • ketepatan analisis
• kemampuan menggunakan mikroskop mengamati sel dan jaringan persamaan dan perbedaan
• Tingkat partisipasi dan kontribusi dalam diskusi
• Kemampuan menjelaskan, sintesis, analisis, komprehensif tentang struktur anatomi terkait Uro-genital system

• Study Guide Block Praktikum histology sistem
urinary

Pembelajaran • Belajar mandiri (membaca sumber • mengamati slide histologi dengan mikroskop
31

Metode Instrumen
Assesment
Pembelajaran Laporan SP Quiz Forum Observation (Q/A) Rubrik Deskriptif Rubrik deskriptif preparate
Presentasi Pilihan ganda dan B/S (Format Online) histologi

• mengamati slide histologi dengan mikroskop oli imersi
• berdiskusi dalam kelompok kecil

akses internet
• Dr.dr AA Wiradewi Lestari, SpPK • Dr.dr AA Wiradewi Lestari, SpPK
• dr. Dwi Fatmawati, SpMK, PhD • dr. Dwi Fatmawati, SpMK, PhD
• dr.Sri Laksminingsih, SpRad (K) • dr.Sri Laksminingsih, SpRad (K)
• Dr. dr. I Gusti Ayu Artni, M.Sc • Dr. dr. I Gusti Ayu Artni, M.Sc
• Dr.dr. I A Ika Wahyuniari, M.Kes • Dr.dr. I A Ika Wahyuniari, M.Kes
• Staf Departemen Histologi • Staf Departemen Histologi

32
• fasilitator kelompok kecil • fasilitator kelompok kecil
Hari XI: Practicum Macroscopic Structure of Urinary Tract and Male Genital system dan Tumor testis and Tumor penis, infeksi genital, Priapismus,
Chancroid
Kemampuan Akhir • Menguasai konsep dan mampu menjelaskan struktur anatomi terkait Uro-genital system
Mahasiswa
• Mampu menjelaskan anatomi dari sistem saluran kemih
• Mampu menjelaskan anatomi dari sistem gentalia Pria
• Mampu menjelaskan konsep anatomi secara komprehensif dan sistematis yang berkaitan dengan system urinary.
• mampu mendiagnosis dan merujuk tumor penis dan tumor testis
• Mampu mendiagnosis, mengobati dan merujuk Priapismus, chandroid dan infeksi genital
Kriteria/Indikator • Tingkat partisipasi dan kontribusi dalam diskusi
• ketepatan analisis dan membedakan tanda dan gejala
• Kemampuan mengkritisi/ketepatan membedakan, membandingkan sediaan anatomi
• kemampuan mengamati anatomi makroskopik persamaan dan perbedaan

• Study Guide Block Praktikum Anatomy urinary
system

Pembelajaran • Belajar mandiri (membaca sumber • mengamati sediaan anatomi sistem urinary dan alat genital pria
33
34

Metode Instrumen
Assesment
Pembelajaran Laporan SP Quiz Forum Observation (Q/A) Rubrik Deskriptif Rubrik deskriptif sediaan
Presentasi Pilihan ganda dan B/S (Format Online) anatomi dari sistem urinary
Forum (Format Online) Rubrik Keterampilan Klinik Daftar
Tiilik Keterampilan Klinik
• mengamati tulang, aringan organ dan alat genital pria
• berlatih dalam konteks dokter dan pasien

akses internet
• dr. Nyoman Gde Wardana, M. Biomed • dr. Nyoman Gde Wardana, M. Biomed
• dr. I Wayan Yudiana, SpU(K) • dr. I Wayan Yudiana, SpU(K)
• dr. Pande Made Wisnu Tirtayasa, • dr. Pande Made Wisnu Tirtayasa, SpU(K),PhD
SpU(K),PhD
• dr. Ida Bagus Putra Pramana, SpU
• dr. Ida Bagus Putra Pramana, SpU
Hari XII: Practicum Pathology Anatomy of Urinary tract and Male Genital System
35
Kemampuan Akhir • Menguasai konsep dan mampu menjelaskan struktur anatomi terkait Uro-genital system
Mahasiswa
• Mampu menjelaskan patologi anatomi dari sistem saluran kemih
• Mampu menjelaskan patologi anatomi dari sistem gentalia Pria
• Mampu menjelaskan konsep patologi anatomi secara komprehensif dan sistematis yang berkaitan dengan system urinary.
• mampu mendiagnosis dan merujuk tumor penis dan tumor testis
• Mampu mendiagnosis, mengobati dan merujuk Priapismus, chandroid dan infeksi genital
Kriteria/Indikator • Tingkat partisipasi dan kontribusi dalam diskusi
• ketepatan analisis dan membedakan tanda dan gejala
• Kemampuan mengkritisi/ketepatan membedakan, membandingkan sediaan anatomi
• kemampuan mengamati anatomi makroskopik persamaan dan perbedaan

• Study Guide Block Praktikum Anatomy urinary
system

Pembelajaran • Belajar mandiri (membaca sumber • mengamati sediaan patology anatomi sistem urinary dan alat genital pria
36

Metode Instrumen
Assesment
Pembelajaran Laporan SP Quiz Forum Observation (Q/A) Rubrik Deskriptif Rubrik Keterampilan Klinik Daftar
Presentasi Pilihan ganda dan B/S (Format Online) Tiilik Keterampilan Klinik


akses internet
• Dr. dr. Ni Wayan Winarti, SpPA • Dr. dr. Ni Wayan Winarti, SpPA
• dr. I Wayan Yudiana, SpU(K) • dr. I Wayan Yudiana, SpU(K)
• dr. Pande Made Wisnu Tirtayasa, • dr. Pande Made Wisnu Tirtayasa, SpU(K),PhD
SpU(K),PhD
• dr. Ida Bagus Putra Pramana, Sp
• dr. Ida Bagus Putra Pramana, Sp
• Fasilitator kelompok kecil
• Fasilitator kelompok kecil
37
Hari : Presentasi Student Project
Kemampuan Akhir Mahasiswa mampu menjelaskan teknis penyusunan bahan presentasi ilmiah serta melaksanakan presentasi ilmiah secara oral
Mahasiswa dengan baik
Kriteria/Indikator Kemampuan kreasi / rancangan bahan presentasi terstruktur (relevan, logic dan rasional) dengan baik
Kemampuan menyajikan / mampu berkomunikasi dalam menyajikan bahan presentasi dengan baik
Bentuk dan On-line F2F (aktivitas kelas)

Metode • Aktivitas kelas: Presentasi singkat, Diskusi dan presentasi
Belajar mandiri: Mempelajari bahan pembelajaran
Pembelajaran kelompok
tersedia dan lainnya dan self assessment
Tugas terstruktur: Menyusun bahan
presentasi ilmiah ppt
Beban Waktu
Belajar mandiri: 2 x 2 x 60 menit
Pembelajaran Aktivitas kelas: 2 x 2 x 50 menit
Tugas terstruktur: 2 x 2 x 60 menit
Metode Instrumen
Assesment • Self assessment dengan Observasi kelas dan Q/A Pilihan berganda Lembar
Tes Quiz Rubrik penilaian teman sejawat Pertanyaan
Pembelajaran Rubrik Penilaian Student Project
• Tugas pembuatan dan
bahan presentasi ilmiah Rubrik analitik
(ppt)
Pengalaman
Belajar mandiri Belajar berkelompok, berdiskusi dalam kelas
Belajar / Aktivitas
Mengerjakan tes quiz online Berlatih membuat presentasi ilmiah secara berkelompok dan
Mahasiswa
mempresentasikannya.
Pembelajaran Perangkat computer/gadget dan akses internet Komputer, head projector (in focus) dan alat tulis
38
• •
Hari XIV: Ujian CBT

Kemampuan Akhir Mampu menjawab/menjelaskan pertanyaan tertulis dari fasilitator
Mahasiswa
Kriteria/Indikator Kemampuan mengevaluasi/Ketepatan memilih dan membandingkan
Bahan Kajian Seluruh bahan kajian yang diberikan pada hari-hari sebelumnya
Bentuk dan On-line F2F (aktivitas kelas/Praktikum)
Metode Belajar mandiri: Mempelajari / mereview
Pembelajaran Aktivitas kelas: diskusi kelompok dan Q/A
bahan yang telah diberikan
Ujian online: Menjawab soal summative
Pembelajaran Belajar mandiri: 2 x 60 menit
Aktivitas kelas: 2 x 50 menit
Ujian online: 2 x 50 menit
Metode Instrumen
Assesment
Pembelajaran Test online Test online Soal pilihan berganda dan B/S -
Observasi kelas
dan Q/A
Belajar / Aktivitas • Belajar mandiri • Diskusi kelompok
Mahasiswa • Ujian summative secara online

Pembelajaran Perangkat computer/gadget dan Komputer/laptop, LCD Proyektor
39
akses internet
8. Daftar Pustaka
1. Moore KL, Agur AMR: Essential Clinical Anatomy, 2 nd ed. Philadelphia, Lippincott Williams & Wilkins, 2002.
2. Standring S. 2008. Gray’s Anatomy the Anatomical Basis of Clinical Parctice40th ed. Churchill Livingstone. Spain
3. Gartner LP, Hiatt JL. Color Textbook of Histology, International edition. Elsevier. 2007
4. Fawcett DW, Jenish RP : Bloom and Fawcett’s Concise Histology, 2nd ed. London, Arnold, 2002.
5. Guyton A. C and Jhon E. Hall: Textbook of Medical Physiology, 10th ed. Philadelpia, WB Saunders Company, 2000
6. Silverthorn DU. Human Physiology an integrated approach, 2nd edition, Prentice Hall. 2001
7. Mitchell RN, Kumar V, Abbas K, Fausto N. Robbins & Cotran, Pathologic Basis of Disease, 10th edition. New York. , W.B. Sounders Company, 2015
8. Fischbach FT, Dunning MB: A Manual of Laboratory and Diagnostic Tests, 7th ed. Philadelphia, Lippincott Williams & Wilkins, 2004.
9. Priya Pais and Ellis D.Avner. Nephrotic Syndrome. In Kliegman RM, editors. Nelson textbook of pediatrics. 20th edition. Philadelphia: Elsevier ,
2016. p. 2521-2528
10. Friedman AL. Nephrology: Fluids and electrolytes. In: Behrman RE, Kliegman RM, editors. Nelson Essentials of pediatrics. 4th edition.
Philadelphia: WB Saunders Co, 2001. p. 671-709
11. Davis ID, Avner ED. Nephrology. In: Behrman RE, Kliegman RM, Jenson HB, editors. Nelson textbook of pediatrics. 17th edition Philadelphia: WB
Saunders Co, 2004. p. 1731-1757
12. Macfarlane MT, et al. : Urology, 4th ed. Lippincott Williams & Wilkins, 2006
13. Davis ID, Avner ED. Nephrology. In: Behrman RE, Kliegman RM, Jenson HB, editors. Nelson textbook of pediatrics. 17th edition Philadelphia: WB
Saunders Co, 2004.
14. Smiths general Urology, 17th ed, 2008
15. Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group. Kidney Int Suppl. (2012);2:341-342.
16. KDOQI Commentary on KDIGO Blood Pressure Guidelines. Am J Kidney Dis. 2013;62:201-213.
17. Robbin’s Pathology Basis of Diseases 9th edition. Philadelphia: Elsevier Saunders, 2015. p. 898-956
40
9 Penilaian
Formative Assessment Proportion of Score
Small Group Discussion Assessment
Multiple Choice Based or True False Assessment (Quiz)
Tutorial Assessment
Student Project Assessment
Summative Assessment
Multiple Choice Based or True False Assessment (Quiz) : 15%
Student Project Assessment : 15%
Small Group Discussion Assessment : 10 %
Tutorial Assessment : 10 %
Computer Based Testing (CBT) Block : 50 %
41
100%
Clinical Skill Assessmet
Objective Strcutured Clincal Examination (OSCE) dilaksanakan bersamaan diakhir semester dalam Ujian Block Keterampilan Klinik
Grading Scale
80-100 A
70- <80 B+
65-<70 B
60-<65 C+
55-<60 C
45-<55 D
<45 E
10 Validasi Penelaah Penyusun RPS

Ketua Tim Kurikulum Program Studi
(I Gusti Ayu Sri Darmayani) (Dr.dr. Dewa Ayu Agus Sri Laksemi, M.Sc)
NIP. 197508172009122001 NIP. 19800830 200604 2003
Disahkan oleh
Ketua Program Studi
(Dr dr Komang Januartha Putra Pinatih, M.Kes)

NIP. 19670122 199601 1 00
42
Study Guide Urinary System and Disorder
FASILITATOR URINARY
Regular Class (Class A)
Venue
No Name Group Departement Phone
(3ndfloor)
Dr.dr.Dewa Ayu Agus Sri Laksemi, A1 Parasitology 081392017107 3rd floor:
1
M.Sc R.3.11
Dr. dr. I Putu Adiartha Griadhi, A2 Physiology 081999636899 3rd floor:
2
S,Ked., M.Fis., AIFO R.3.12
Dr. dr. Bagus Komang Satriyasa, A3 Pharmacology 081237166686 3rd floor:
3
M.Repro R.3.13
Dr.dr.Cokorda Bagus Jaya Lesmana, A4 Psychiatry 0816295779 3rd floor:
4
SKed, Sp.KJ(K), MARS R.3.14
dr. Gede Wirata, S.Ked, M.Biomed A5 Anatomy 081239791628 3rd floor:
5
R.3.15
dr. I Wayan Yudiana, Sp.U(K) A6 Urology 081338708195 3rd floor:
6
R.3.16
dr. I Made Oka Negara, S.Ked, A7 Andrology 085935054964 3rd floor:
7
M.Biomed R.3.20
dr. I Gusti Made Gde Surya Chandra A8 Pharmacology 081338367261 3rd floor:
8
Trapika, M.Sc, Ph.D R.3.21
Dr. dr. Putu Ayu Asri Damayanti, A9 Parasitology 082237396899 3rd floor:
9
M.Kes R.3.22
Dr.dr.I G A Widianti, M.Biomed A10 Anatomy 08123921765 3rd floor:
10
R.3.23
English Class (Class B)
Venue
No Name Group Departement Phone
(2ndfloor)
dr. Ni Luh Sri Apsari, M. Biomed., B1 Pediatric 081239994806 2rd floor:
1
Sp.A R.2.11
dr. I Gusti Ngurah Pramesemara, B2 Andrology and 081338605087 2rd floor:
2
S.Ked., M.Biomed., Sp.And Sexology R.2.12
dr. Putu Yuliandari, S.Ked.,Ph.D B3 Microbiology 089685415625 2rd floor:
3
R.2.13
dr. Komang Ayu Kartika Sari, MPH B4 Public Health 082147092348 2rd floor:
4
R.2.14
Dr. dr. I Made Krisna Dinata, M.Erg B5 Physiology 08174742566 2rd floor:
5
R.2.15
Dr. dr. Gede Wirya Kusuma Duarsa, B6 Urology 08155753377 2rd floor:
6
M.Kes,Sp.U(K) R.2.16
dr. Pande Putu Patria Dewi, Sp. PK B7 Clinical 081805517354 2rd floor:
7
Pathology R.2.20
Dr.dr.Dewi Sutriani Mahalini, Sp.A B8 08123641466 2rd floor:
8 Pediatric
R.2.21
dr. Pande Made Wisnu Tirtayasa, B9 Urology 082111133211 2rd floor:
9
Sp.U(K).,Ph.D R.2.22
dr. I Made Dwi Ariawan, S.Ked B10 Public Health 081339798632 2rd floor:
10
R.2.23

45
STUDENT PROJECT
Group Evaluator
Topic
discussion
A1 Parasite Infection in Urinary Tract system Dr.dr. Dewa Ayu agus
Sri Laksemi, S.Ked,
M.Sc
A2 Microscopic Structure of Nephron and Its Function Dr.dr. I A Ika
Wahyuniari, M.Kes
A3 Aspek Fisologis dan Patofisiologis Renovascular Prof. dr. Ketut Tirtayasa,
Hipertension MS, AIF
A4 Acute poststreptococcal glomerulonephritis (APSGN) Dr. dr. Ni Wayan Winarti,
Sp.PA (K)
A5 Diagnosis dan tata Laksana terkini Hipertensi pada Dr.dr. Yenni Kandarini,
Penyakit Ginjal Kronis Sp.PD-KGH, FINASIM
A6 Hydronephrosis in Pregnancy Dr. dr. Kadek Budi
Santosa, Sp.U (K)
A7 Pediatric Hypertension dr. G A P Nilawati, Sp.A
(K), MARS
A8 Fournier’s Gangrene dr. Ida Bagus Putra
Pramana, Sp.U
A9 Surgical Aspect of CAPD ( Continuous Ambulatory Dr. dr. G Wirya K
Peritoneal Dialysis) Duarsa, MARS, M.Kes,
Sp.U (K)
A10 Tata Laksana Nutrisi Pada Pasien CKD Pra-dialisis dr. Nyoman Paramita
Ayu SpPD-KGH,
FINASIM
B1 Urine Collection, Transport and Storage Prof.Dr.dr AA Wiradewi
Lestari, Sp.PK (K)
B2 Aspek Mikrobiologi Uretritis dr. I Ketut Agus Indra
Adiputra, Sp.MK
B3 Role of Intra Venous Pyelography in Urinary System dr.Putu Utami Dewi,
Disorder SpRad
B4 Antibiotic induced Renal Disorder Dr. dr. I Gusti Ayu Artini,
S.Ked, M.Sc
B5 Aspek Anatomis dari Urolithiasis dr. I Nyoman Gde
Wardana, S.Ked, M.
Biomed
B6 Urological Complications of Renal Transplantation dr. Pande Made Wisnu
Tirtayasa, Sp.U(K),Ph.D
B7 Urinary Diversion:Use of Intestinal Segments in Urinary I Wayan Yudiana, Sp.U (
Diversion, Orthotopic Urinary Diversion, Minimally Invasive K)
Urinary Diversion
B8 Update Patogenesis dan Tata Laksana Konservatif Pasien dr. Gde Wira Mahadita,
Acute Kidney Injury SpPD-KGH, FINASIM
B9 nal Insufficiency dr. I GN Tresna Erawan,
M.Biomed, SpPD-KGH,
FINASIM
B10 Obstruction of the Urinary Tract in Children dr. Bagus Ngurah
Mahakrisna, M.Biomed,
SpA

46
LEARNING ACTIVITY
There are several types of learning activity:

● Lecture
● Plenary session
● Independent learning based on the lecture’s topic
● Small group discussion to solve the learning task
● Practicing
● Student project
● Clinical skill and demonstration
● Self assessment at the end of every topic
All lectures and SGD will be presented offline and pleno will be held online using Webex
or OASE.
IMPORTANT INFORMATIONS
Meeting of the students’ representative
In the middle of the block schedule, a meeting is designed among the student
representatives of every small group discussions, facilitators, and resource persons. The meeting
will discuss the ongoing teaching learning process, quality of lecturers and facilitators as feedback
to improve the next process.

47
TITLE
(subject/topic: choose from competency list)
Name
NIM
Faculty of Medicine, Udayana University

2023
1. Introduction (Pendahuluan)
2. Content (Isi, sesuai topik yang dibahas)
3. Summary (Ringkasan)
4. References: (Daftar Pustaka) Vancouver style
References must be written in NML citation format. Full example is available at:
https://www.nlm.nih.gov/bsd/uniform_requirements.html
Student project consists of 10 -15 pages, 1.5 space, Times new romance 12.
References must be the latest reference journals that published in the last 5 years
Similarity test or Turnitin less than <18 %

50
FORM PENILAIAN STUDENT PROJECT
(FASILITATOR)
Blok :
Kelompok :
Fasilitator :
Judul :
Laporan konsultasi
No Hari/Tanggal Topik Diskusi Tanda tangan Fasilitator
Dst
Penilaian
Kriteria Skor
1 2 3 Keterangan
Keaktifan
Sopan santun
Latar Belakang/Pendahuluan dan
Isi SP
Diskusi/pembahasan dan
Simpulan SP
Kualitas SP Secara Umum
Nilai Student Project = Skor Total x 100
15
Denpasar,
Fasilitator
( )

51
FORM PENILAIAN STUDENT PROJECT
(EVALUATOR)
Blok :
Kelompok :
Evaluator :
Judul :
Penilaian
Kriteria Skor
1 2 3 Keterangan
Video Presentasi
Kerja sama dalam Kelompok
Latar Belakang/Pendahuluan dan
Isi SP
Diskusi/pembahasan dan
Simpulan SP
Kualitas SP Secara Umum
Nilai Student Project = Skor Total x 100
15
Denpasar,
Evaluator
( )

52
ASSESSMENT METHOD
Assessment in this theme consists of:
● SGD : 15%
● Final test (CBT) : 60%
● Student Project : 10%
● Quiz : 15%
Final score of 65 or more considered to pass this block. Final test (CBT) mark should be at
least 60 to pass the block. Students with CBT score <60 will not pass the block even though their
total assessment score is >65.
The value of marking:
● A : 80-100 (pass)
● B+ : 70-79.9 (pass)
● B : 65-69.9 (pass)
● C+ : 60-64.9 (fail)
● C : 55-59.9 (fail)
● D : 45-54.9 (fail)
● E : <45 (fail)

Day/ Class A
TIME Class B PIC
DATE
1
Friday
April Lecture 1
14 th Topik 1. Anatomy of Prof. Dr. dr.
08.00-08.50 The Urinary and
2023 IL (Independent Learning) Mangku
Male Genitalia
Karmaya
System
Lecture 2 Histology
of The Urinary and Dr.dr. I A Ika
09.00-09.50 Male Genitalia IL (Independent Learning) Wahyuniari,
System M.Kes
Lecture 1
IL (Independent Topik 1. Anatomy of Prof. Dr. dr.
10.00-10.50
learning) The Urinary and Male Mangku
Genitalia System Karmaya
Lecture 2 Histology of Dr.dr. I A Ika
The Urinary and Male Wahyuniari,
11.00-11.50 Break
Genitalia System
M.Kes
12.00-12.50 SP SP
13.00-13.50 Break Break
14.00-14.50 IPE IPE
15.00-15.50 IPE IPE
Lecture 3
Physiology of Prof. dr. Ketut
08.00-08.50 Urinary and Male SP Tirtayasa, MS,
Genitalia System AIF
SP Lecture 3
Prof. dr. Ketut
Physiology of Urinary
2 09.00-09.50 Tirtayasa, MS,
and Male Genitalia
Monda AIF
System
y
April SP SP
th 10.00-10.50
17
2023
11.00-11.50 SGD Lecture 1-3 SGD Lecture 1-3 Facilitator
IL IL
13.00-13.50
14.00-14.50 Pleno Lecture 1-3 Pleno Lecture 1-3 Team Lecture

( Webex) ( Webex)
Pleno Lecture 1-3 Pleno Lecture 1-3
15.00-15.50 (Webex) (Webex) Team Lecture
Lecture 4
Dr. dr. Ni Wayan
Pathogenesis of
Winarti, Sp.PA (
08.00-08.50 Glomerulonephritis IL
and Acute Tubulo- K)
Interstitial Diseases
dr. I Nyoman
Lecture 5 Gde
Practicum Wardana,M.
Macroscopic Biomed
09.00-09.50 IL
Structure of Urinary
Tract and Male
Genital system
IL Lecture 4
Pathogenesis of Dr. dr. Ni Wayan
10.00-10.50 Glomerulonephritis Winarti, Sp.PA (
and Acute Tubulo- K)
Interstitial Diseases
3
Break Lecture 5
Tuesd dr. I Nyoman
Practicum
ay Gde Wardana,
Macroscopic
April 11.00-11.50 M. Biomed
Structure of Urinary
18th Tract and Male Genital
2023 system
Dr.dr. Yenni
Lecture 6 Acute and Kandarini,
12.00-12.50 Chronic Kidney Break SpPD-KGH,
Disease, Finasim
Dr.dr. Yenni
Lecture 7
Kandarini,
Secondary
13.00-13.50 SP SpPD-KGH,
hipertension
Finasim
SP Dr.dr. Yenni
Lecture 6 Acute and Kandarini,
14.00-14.50 Chronic Kidney SpPD-KGH,
Disease, Finasim
SP Dr.dr. Yenni
Lecture 7 Secondary Kandarini,
15.00-15.50 hipertension SpPD-KGH,
Finasim
Lecture 8 Dr.dr. Yenni

Urinary Tract Kandarini,
08.00-08.50 SP
Infection SpPD-KGH,
Finasim
SP Lecture 8 Dr.dr. Yenni
Urinary Tract Infection Kandarini,
09.00-09.50
SpPD-KGH,
Finasim
4
Wedne SP SP
sday 10.00-10.50
April
26th 11.00-11.50 SGD Lecture 4-8 SGD Lecture 4-8 Facilitator
2023
IL IL
13.00-13.50
Pleno( Webex) PLeno ( Webex) Lecture

14.00-14.50 Lecture 4-8 4-8 Team Lecture
Pleno ( Webex) Pleno ( Webex) Lecture

15.00-15.50 Team Lecture
Lecture 4-8 4-8
Lecture 9 Dr. dr. Kadek

08.00-08.50 Urolithiasis IL Budi Santosa,
Sp.U (K)
5 Lecture 10 Dr. dr. Kadek

Thursd 09.00-09.50 Urinary IL Budi Santosa,
ay Incontinence and
Sp.U(K)
Over active bladder
April
27th IL Lecture 9 Dr. dr. Kadek
2023 10.00-10.50 Urolithiasis Budi Santosa,
Sp.U (K)
Break Dr. dr. Kadek
11.00-11.50 Lecture 10 Budi Santosa,
Sp.U(K)
Urinary Incontinence
and Over active
bladder
Lecture 11 Acute
and Chronic dr. G A P
12.00-12.50 Glomerulonephritis, Break Nilawati, Sp.A
Pediatric (K), MARS
Hipertension
Lecture 12
Nephrotic
Syndrome, UTI in dr. G A P
13.00-13.50 children, SP Nilawati, Sp.A
Congenital (K), MARS
Anomaly in Urinary
System
SP Lecture 11 Acute and
dr. G A P
Chronic
14.00-14.50 Nilawati, Sp.A
Glomerulonephritis,
(K), MARS
Pediatric Hipertension
SP Lecture 12 Nephrotic
Syndrome, UTI in dr. G A P
15.00-15.50 children, Congenital Nilawati, Sp.A
Anomaly in Urinary (K), MARS
System
Lecture 13 Lecture SP Dr. dr. Ni Wayan
Practicum Pathology Winarti, SpPA ( K)
08.00-08.50 Anatomy of Urinary
tract and Male Genital
System
Sp Lecture 13 Lecture Dr. dr. Ni Wayan
Practicum Pathology Winarti, SpPA ( K)
09.00-09.50
Anatomy of Urinary tract
6 and Male Genital System
Friday
April 10.00-10.50 IL SP
28 th
11.00-11.50 SGD Lecture 9-12& 13 SGD Lecture 9-12& 13
2023
12.00-12.50 SGD Lecture 9-12& 13 SGD Lecture 9-12& 13
Pleno Lecture 9-12 & Pleno Lecture 9-12 &
13.00-13.50
Lecture 13(OASE) Lecture 13 ( OASE)
14.00-14.50 IPE IPE
15.00-15.50 IPE IPE

08.00-08.50 Lecture 14
Hipospadia, Dr. dr. G Wirya
Epispadia, K Duarsa,
PHIMOSIS, MARS, M.Kes,
PARAPHIMOSIS, Sp.U (K)
09.00-09.50 Lecture 15
Dr. dr. G Wirya
BPH, Stricture
K Duarsa,
Urethra, Varicocele,
MARS, M.Kes,
Spermatokel, Sp.U (K)
10.00-10.50 IL Lecture 14
Hipospadia, Dr. dr. G Wirya
Epispadia, K Duarsa,
PHIMOSIS, MARS, M.Kes,
PARAPHIMOSIS, Sp.U (K)
11.00-11.50 Break Lecture 15

Dr. dr. G Wirya
BPH, Stricture
7 K Duarsa,
Urethra, Varicocele,
Tuesd MARS, M.Kes,
Spermatokel, Sp.U (K)
ay,
May 2th 12.00-12.50 Lecture 16
2023 Neonatal Dr. dr. G Wirya
hidronefrosis Break K Duarsa,
MARS, M.Kes,
Sp.U (K)
13.00-13.50 Lecture 17 dr. Nyoman
Pyelonefritis Paramita Ayu
SP
SpPD-KGH,
FINASIM
14.00-14.50 SP
Lecture 16 Dr. dr. G Wirya
Neonatal K Duarsa,
hidronefrosis MARS, M.Kes,
Sp.U (K)
15.00-15.50 SP
Lecture 17 dr. Nyoman
Pyelonefritis Paramita Ayu
SpPD-KGH,
FINASIM
8 Lecture 18 Lecture
Practicum Dr.dr. I A Ika
Wedne
08.00-08.50 Microscopic SP Wahyuniari,
sday Structure of Urinary M.Kes
May 3th Tract
2023 SP Lecture 18 Lecture
Dr.dr. I A Ika
Practicum
09.00-09.50 Wahyuniari,
Microscopic Structure
M.Kes
of Urinary Tract
10.00-10.50 SP SP
SGD Lecture 14-17& SGD Lecture 14-17& 18

11.00-11.50
18
SGD Lecture 14-17& SGD Lecture 14-17& 18
12.00-12.50
18
13.00-13.50 IL IL
14.00-14.50 Pleno (Webex) Pleno ( Webex)
15.00-15.50 Pleno ( Webex) Pleno ( Webex)
Lecture 19 IL Prof.Dr.dr AA
Urinalisis Wiradewi
08.00-08.50
Lestari, Sp.PK (
K)
Lecture 20 IL dr. Pande Made
Undesensus testis, Wisnu
09.00-09.50
Rectractile testis, Tirtayasa,
Hidrokel, Sp.U(K),Ph.D
IL Lecture 19 Urinalisis Prof.Dr.dr AA
Wiradewi
10.00-10.50
Lestari, Sp.PK (
K)
9 Break Lecture 20 dr. Pande Made
Thursd Undesensus testis, Wisnu
ay, 11.00-11.50
Rectractile testis, Tirtayasa,
May 4th Hidrokel, Sp.U(K),Ph.D
2023
Lecture 21 Break
genital Infection dr. Pande Made
12.00-12.50 Prostatitis, Epididimitis, Wisnu Tirtayasa,
Uretritis, Balano Sp.U(K),Ph.D
prostitis
Lecture 22 Drug SP
Use in Renal and Dr. dr. I Gusti
13.00-13.50 Urinary tract Ayu Artini,
Disorders S.Ked, M.Sc
SP Lecture 21
dr. Pande Made
14.00-14.50 Wisnu Tirtayasa,
genital Infection Sp.U(K),Ph.D
Prostatitis, Epididimitis,
Uretritis, Balano prostitis
SP Lecture 22 Drug Use
Dr. dr. I Gusti
in Renal and Urinary
15.00-15.50 Ayu Artini,
tract Disorders
Sked, M.Sc
10 08.00-08.50 Lecture 23
Friday, Urethral swab dr. I Ketut
May5th Urine Collection Agus Indra
2023 and interpretation SP Adiputra,
of Urine culture Sp.MK
and susceptibility
test
09.00-09.50 SP Lecture 23 dr. I Ketut
Urethral swab
Agus Indra
Urine Collection and
Adiputra,
interpretation of
Urine culture and Sp.MK
susceptibility test
10.00-10.50 IL IL
11.00-11.50 SGD Lecture 19-L22& SGD Lecture 19-L22& 23
23
12.00-12.50 SGD Lecture 19-L22& SGD Lecture 19-L22& 23
23
13.00-13.50 Pleno Lecture Pleno Lecture
19-22 & 23 19-22 & 23
(OASE) (OASE)
14.00-14.50 IPE IPE
15.00-15.50 IPE IPE
IL dr. Ida Bagus
Lecture 24
08.00-08.50 Putra
11 Complicated UTI
Pramana, Sp.U
Monda
y Lecture 25 IL
May 8 th Priapismus, dr. Ida Bagus
2023 09.00-09.50 Chancroid Putra
Pramana, Sp.U
IL dr. Ida Bagus
Lecture 24
10.00-10.50 Putra
Complicated UTI
Pramana, Sp.U
Break Lecture 25
dr. Ida Bagus
Priapismus, Chancroid
11.00-11.50 Putra
Pramana, Sp.U
Lecture 26 Break
Carsinoma cell dr. I Wayan
Renal, Supra Yudiana, Sp.U
12.00-12.50
Renal and Wilm ( K)
Tumor, Urotelial
Carsinoma
Lecture 27 SP dr. I Wayan
Prostate cancer Yudiana, Sp.U
13.00-13.50
and Tumor testis ( K)
and Tumor penis
SP Lecture 26
dr. I Wayan
Carsinoma cell
Yudiana, Sp.U
14.00-14.50 Renal, Supra Renal
and Wilm Tumor, ( K)
Urotelial Carsinoma
SP Lecture 27 Prostate dr. I Wayan
cancer and Tumor Yudiana, Sp.U
15.00-15.50
testis and Tumor ( K)
penis
Lecture 28 SP
Basic and dr.Putu Utami,
08.00-08.50 advance SpRad
Radiology in
Urinary system
12 SP Lecture 28 dr.Putu Utami,
Tuesd Basic and advance SpRad
09.00-09.50
ay Radiology in Urinary dr.Putu Utami,
May 9th system SpRad
2023
10.00-10.50 IL IL
11.00-11.50 SGD Lecture 24-27 &28 SGD Lecture 24-27 &28
12.00-12.50 SGD Lecture 24-27&28 SGD Lecture 24-27&28
13.00-13.50 Break Break

Pleno( Webex) Lecture Pleno (Webex) Lecture
14.00-14.50
24-27 &28 24-27 &28
Pleno ( Webex) Pleno (Webex) Lecture
15.00-15.50
Lecture 24-27 &28 24-27 &28
13
Wedn
esday,
PreEvaluation Break
May
10th
2023
14
Thurs
day,
Examination
May
11th
2023
15
Wedn
esday
Remidial Examination
July
5th
2023
LECTURE 1
ANATOMY OF THE URINARY
SYSTEM AND MALE
GENITALIA SYSTEM
Prof.Dr.dr. I Nyoman Mangku Karmaya, M.Repro.,PA (K)
dr. I Nyoman Gede Wardana, S.Ked.,M.Biomed
Aim:
1. Comprehend the gross anatomy of the urinary and male genital system
Learning outcomes:
1. Comprehend the location of the kidneys within the abdomen, and relate the basic
superficial features
2. Comprehend internal gross anatomy of the kidneys and the flow of blood to and
through the Kidney
3. Comprehend gross anatomy of the ureters and the urinary bladders
4. Comprehend the gross anatomy of the male reproductive tract, scrotum, and penis
Curriculum content:
1. Anatomy of kidneys, ureters, urinary bladders, and male urethra
2. Anatomy the male genital organs
Abstract :
Urinary system consists of a pair of kidneys and ureter, single urinary bladder
and urethra. The urinary system developed from mesoderm at the end of 3rd week
through pronephros, mesonephros and metanephros stages.
The kidney are two reddish-brown organs situated high up in the posterior
abdominal wall, one on each side of the vertebral column. The left kidney lies
slightly higher than the right. Each kidney gives rise to a ureter that runs vertically
downward on the psoas muscle. On the upper pole of each kidney lies the
suprarenal gland.
The two ureters are muscular tubes that extend from the kidneys to the
posterior surface of the urinary bladder. The urine is propelled along the ureter by
peristaltic contractions of the muscle coat, assisted by the filtration pressure of the
glomeruli.
The urinary bladder lies in the pelvic cavity on the levator ani muscle (pelvic
diaphragm), in front of the uterus in females and in front to rectum in male. The
male urethra is longer than the female. On the first part of the urethra there is
prostate gland in male.
The development of male genitalia begins with the formation of the testes
primordial germ cell which migrates from the yolk sac wall to the dorsal mesentery
to meet the epithelial of genital ridge. The resulting hormone testosterone will trigger
the growth and development of structures that will later become prostate, vesicular
seminal, penile, and include the process of descending of testes. Male genital
function is for reproduction, sexual activity and part of the urinary tract.
Standard References:
1. Moore KL, Agur AMR: Essential Clinical Anatomy, 2 nd ed. Philadelphia, Lippincott
Williams & Wilkins, 2002.
2. Standring S. 2008. Gray’s Anatomy the Anatomical Basis of Clinical Practice 40th
ed. Churchill Livingstone. Spain
Self Directing Learning
Basic knowledge that must be known:
1. Basic anatomy kidney, urinary and male genital system
2. Anatomy Abdomen
Case 1
A 54-year-old man came to the general practitioner's office complaining of severe
pain in his right flank below the ribs. The pain is sharp and radiates from the lower
abdomen to the groin. Previously, he had experienced this problem and had a
history of kidney stones.
Learning task:
1. Identify the kidneys. Describe their normal positions, relations, and
neurovascular supplies. Trace the flow of urine from the gross collecting
structures in the kidney to the urinary bladder.
2. Describe the description of the pain felt by the patient. How can this pain occur
3. Identify the ureters and the urinary bladder. Describe their gross features and
relationships to the peritoneal cavity. Describe the position of the bladder in
the pelvis in both full and empty states, the nature and source of its innervation,
and its means of filling and drainage in males
Case 2
A general practitioner was visited by three well-built men. Tall stature, and body
covered in tattoos. Age around 45-48 years. They complain that their penis is
swollen and painful. This complaint was felt a month after they injected their penis
with hair oil “orang-aring” with a 5 cc syringe for about 20 injections.
Learning task:
1. Trace the courses of the male reproductive tracts. Identify accessory glands
or organs in the pathway. Note the relationships of the individual components.
Describe the nerves, and vasculature that are responsible for normal
functioning in males genital
2. Describe the gross features of the scrotum and the penis
LECTURE 2
HISTOLOGY OF URINARY AND MALE GENITALIA SYSTEM
Dr. dr. Ida Ayu Ika Wahyuniari, M.Kes
AIMS:
1. Describe the microscopic structure of the urinary system and male genitalia system
LEARNING OUTCOME:
1. Describe the microscopic structure of the urinary system
2. Describe the microscopic structure of the male genital system
CURRICULUM CONTENS:
1. The microscopic structure of the kidney, nephron, glomerular filtration, juxtaglomerular
apparatus, ureter, urinary bladder, urethra
2. The microscopic structure of testes, genital ducts, accessory genital glands, and penis
ABSTRACT :
The urinary system (urinary tract) consists of two kidneys, two ureters, a urinary
bladder, and the urethra. The kidney is subdivided into cortex and medulla. The cortex
contains renal corpuscles, convoluted tubules, and medullary rays, whereas the medulla
contains renal pyramids which are separated by cortical columns. Each kidney contains
around 1 million functional units called nephron that consist of simple, single-layered
epithelium along their entire lengths. Nephron consists of renal corpuscle (glomerulus and
bowman’s capsule), proximal tubule, loop of henle, distal tubule, and connecting tubule.
In glomerular filtration is composed of three main cellular barriers that are critical in
ultrafiltration process, i.e. the fenestrated epithelium, basal lamina, and highly specialized
podocytes (filtration slit).
Several nephrons are drained by a single collecting tubule, and multiple collecting
tubules join in the deeper aspect of the medulla to form larger ducts until ducts of Bellini
that perforate the renal papilla at the area cribrosa. It is surrounded by minor calyx and
form major calyx into renal pelvis. Urine enters the renal pelvis, a structure that connects
the kidney with ureter. The ureters deliver urine from the kidneys to urinary bladder. Urine
will be excreted from urinary bladder through the urethra. The excretory passages consist
of mucosa, muscular coat, and fibrous outer coat. Beside its’ excretion function, kidney
also involve in controlling blood pressure. This function is provided by juxtaglomerular
apparatus, which consists of juxtaglomerular cell, extraglomerular mesangial cell, and
macula densa cell. This complex secretes hormones and contains receptors that can
modify vasoconstriction and vasodilatation of blood vessels.
The male reproductive system consists of the testes, genital ducts, accessory
glands, and penis. Each testis is surrounded by a dense connective tissue capsule and
consist of testicular lobules that contains sparse connective tissue with highly convoluted
seminiferous tubule in which sperm production occurs and interstitial cell (or Leydig cells)
secreting testosterone. The genital duct consists of Intratesticular ducts (straight tubules,
rete testis, and the efferent ductule) and extra testicular genital ducts (epididymis, ductus
(or vas) deferens, urethra). The accessory genital glands are the seminal vesicles, the
prostate, and the bulbourethral glands. The penis contains two dorsal corpora cavernosa
and a periurethral corpus spongiosum, all composed of vascular cavernous tissue and
small amounts of surrounding smooth muscle and helicine arteries.
Mescher, A.L. Junqueira’s Basic Histology. McGraw-Hill Education
Self Directed Learning:

Functional structure of kidney, nephron, glomerular filtration, juxtaglomerular apparatus,
ureter, urinary bladder, urethra, testes, genital ducts, accessory genital glands, penis and
Its clinical correlation.
Case
A 55 year old women came to the doctor with complaint of frequent urination,
always feeling hungry, and thirsty since 1 month ago. Patient also feel their weight
decreased. On physical examination, vital sign were found within normal limits. From
laboratory examination there were a glucose level of 300 mg/dL and proteinuria.
Learning Task (SGD 1)
1. What structure in the urinary system are damaged in this patient? Explain its
microscopic structure!
2. Explain the structure of the functional unit of the kidney!
3. Explain the microscopic structure of the juxtaglomerular apparatus and its
function!
4. Expkain the microscopic structure of testes and prostat!
LECTURE 3
PHYSIOLOGY OF URINARY AND MALE GENITALIA

SYSTEM
Prof.dr. Ketut Tirtayasa, MS, AIF
AIMS:
1. Comprehend the mechanism of filtration, reabsorption, secretion and
excretion
2. Comprehend the mechanism of body fluid balance
3. Comprehend the mechanism of acid-base balance
LEARNING OUTCOME:
1. Can describe the mechanism of filtration
2. Can describe the mechanism in producing dilute urine
3. Can describe the mechanism in producing concentrated urine
4. Can describe the mechanism to maintain body acid-base balance.
CURRICULUM CONTENS:
1. Some factors that influence the filtration process
2. Some factors that involve in producing dilute urine
3. Some factors that involve in producing concentrated urine
4. The function of buffer system and kidney in maintaining acid-base balance.
ABSTRACT :
Nephron is the smallest functional unit of the kidney where take places the
process of urine formation. There are about one million nephrons in each kidney.
All nephrons perform their first process by filtering the blood or plasma
in the glomerulus and the filtrate as the result of filtration flow through the lumen
of tubules. For maintain normally filtration rate, there are auto regulation system.
Along the tubules there are reabsorption, secretion p ro ce ss o f su
bs tan c es d e pe n d in g th e need o f th e b od y.
In re g u la t i o n o f b od y wa te r b a la n ce , k id ne y c ou ld p e r fo rm
d i lu te o r c o nc en t ra ted u r in e . Th i s fu n c t ion d u e to s o m e fa ct o rs
i . e. th e d i f fe re n c e o s mo la r i t y o f k id ne y t i s su e be twe e n cor te x an
d me d u l la r ; c ou n ter ccu r re n t m u l t i f l i c a t io n s ys te m ; c o unt e r c u r re
n t e xc h ange s ys tem ; u re a cy c le a n d som e h o rm on e s .
Beside body buffers system and respiratory system, kidney also have
function in maintaining body acid-base balance.
Standard References :
Hall John E. (2019). Guyton dan Hall Buku Ajar FISIOLOGI KEDOKTERAN Edisi
ke-13 Elsevier, Singapore Pte Ltd
SELF DIRECTING LEARNING

1. Factors influence filtration process
2. Urine as the last product that processed along the nephron
3. Mechanism in producing dilute urine
4. Mechanism in producing concentrated urine
5. Mechanism in maintaining acid-base balance.
LEARNING TASK:
1. How the kidney maintain the body water balance in case of overhydration?
2. How the kidney maintain the body water balance in case of dehydration?
3. Describe the implication of counter-current system and counter-current
exchange
system in kidney.
4. Describe the kidney in maintaining acid base balance.
SELF ASSESMENT:
1. Describe the mechanism of filtration process
2. Describe the autoregulation process in maintaining GFR
3. Describe The mechanism and factors related to producing diluted urine
4. Describe The mechanism and factors related to producing concentrated
urine
5. Describe the counter-current system and counter-current exchange
system.
6. Describe the function of kidney in maintaining acid-base balance
LECTURE 4
PATHOGENESIS OF GLOMERULONEPHRITIS AND TUBULO-INTERSTITIAL
DISEASES
Dr. dr. Ni Wayan Winarti, Sp.PA(K)
AIMS:
Describe pathogenesis of common glomerulonephritis and tubulo-interstitial
diseases.
LEARNING OUTCOME:
1. Describe the general mechanism of glomerular injury
2. Describe the morphological alteration of common glomerular diseases
3. Describe the correlation between morphological alteration and clinical
manifestation of common glomerular diseases
4. Describe the general mechanism of tubulo-interstitial diseases
5. Describe the morphological alteration of common tubulo-interstitial diseases
6. Describe the correlation between morphological alteration and clinical
manifestation of common tubulo-interstitial diseases
CURRICULUM CONTENS:
1. Glomerulonephritis
2. Tubulo-interstitial diseases
ABSTRACT:
The kidney is a structurally complex organ that has evolved to carry out a number of
important functions. Diseases of the kidney are as complex as its structure, but their
study is facilitated by dividing them into those that affect its four components:
glomeruli, tubules, interstitium, and blood vessels. This approach is useful because
the early manifestations of diseases that affect each of these compartments tend to
be distinctive, and some structures seem to be more vulnerable to specific forms of
renal injury. However, some disorders affect more than one structure, and functional
interdependence of structures in the kidney means that damage to one component
almost always affects the others.
Glomeruli may be injured by diverse causes and mechanisms. Those in the course
of a number of systemic diseases, named secondary glomerular diseases; whereas
the glomerular diseases which the kidney is the only or predominant organ involved
called primary glomerular diseases. The mechanism of glomerular injury may involve
immune or non-immune, with varying type and severity of glomerular alterations
microscopically (light, immunofluorescent and electron microscopes examinations).
The clinical manifestations are also vary, i.e. nephrotic syndromes, nephritic
syndromes, and etc.
Most forms of tubular injury also involve the interstitium, lead to tubulo-interstitial
diseases. These diseases characterized by (1) inflammatory involvement of the
tubules and interstitium (tubulointerstitial nephritis) and (2) ischemic or toxic tubular
injury, leading to acute tubular injury and the clinical syndrome of acute kidney injury.
The morphological alteration and common clinical manifestation share some
differences among diseases, based on the cause and pathogenesis.
Kumar V, Abbas AK, and Aster JC: Robbins Basic Pathology, 10 th ed. Philadelphia,
Elsevier, 2018. p. 549-81.
LEARNING TASK
A 48-year-old man has had increased swelling in the extremities for 2 months.
Physical examination showed generalized edema. A 24-hour urine collection yielded
4.1 g of protein (albumin and globulins). He did not respond to a course of
corticosteroid therapy. A renal biopsy was done, and microscopic examination
showed diffuse thickening of the basement membrane. Immunofluorescence staining
with antibody to the C3 component of complement was positive in a granular pattern
in the glomerular capillary loops. Two years later, he experiences increasing malaise.
Laboratory studies now show serum creatinine level of 4.5 mg/dL and urea nitrogen
level of 44 mg/dL.
1. Explain common clinical syndromes related to glomerular diseases!

2. Explain the general pathogenesis of glomerular diseases!
3. What type of GN occurs in the patient above, and which mechanism is
responsible for its occurrence?
A 51-year-old woman has had dysuria and urinary frequency for the past week. On
physical examination, her temperature is 38° C, and she has pain on palpation over
the left costovertebral angle. Laboratory findings show glucose, 177 mg/dL;
hemoglobin A1c, 9.8%; hemoglobin, 13.1 g/dL; platelet count, 232,200/mm3; and
WBC count, 11,320/mm3. Urinalysis shows a pH of 6.5; specific gravity, 1.016; 2+
glucosuria; and no blood, protein, or ketones. Microscopic examination of the urine
shows numerous neutrophils, and a urine culture is positive for Escherichia coli.
1. Explain the differences in the pathogenesis of tubule-interstitial nephritis and

ATI!
2. Based on clinical and laboratory findings in the above case, describe the
microscopic alteration that is most likely to occur in this patient!
Basic knowledge that must be understood:

1. Pathogenesis, morphological alteration, and clinical syndromes of
Glomerulonephritis
2. Pathogenesis, morphological alteration, and clinical syndromes of tubulo-
interstitial disease
LECTURE 5
PRACTICUM MACROSCOPIC STRUCTURE OF URINARY TRACT AND MALE
GENITAL SYSTEM
Lecture Practicum macroscopic structure of urinary tract and male genital system
will be held and organized by dr. I Nyoman Gde Wardana, S.Ked, M. Biomed.
Students will be shown videos of cadaveric dissection and the macroscopic
structure of the human body.

LECTURE 6
ACUTE KIDNEY INJURY
Dr.dr. Yenny Kandarini, SpPD-KGH, FINASIM
AIMS:
1. Diagnose and manage patient with acute kidney injury

2. Diagnose and refer special patient with acute kidney injury
3. Plan patient, family, and community education about acute kidney injury
LEARNING OUTCOME:
1. Able to diagnose and manage patient with acute kidney injury
2. Able to diagnose and refer special patient with acute kidney injury
3. Able to plan patient, family, and community education about acute kidney injury
CURRICULUM CONTENTS:
1. Definition acute kidney injury
2. Etiology acute kidney injury
3. Sign and Symptom acute kidney injury
4. Management and treatment acute kidney injury
ABSTRACT:
The syndrome of acute renal failure (ARF) is defined as a reduction of glomerular
filtration rate (GFR) that is often reversible. The syndrome may occur in three clinical
settings: (1) as an adaptive response to severe volume depletion and hypotension with
structurally ang functionally intact nephrons, (2) in response to cytotoxic insults to the
kidney when both renal structure and function are abnormal, and (3) when the passage
of urine is blocked. Thus ARF may be classified as prerenal, intrinsic, or postrenal.
References:
1. Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work
Group. Kidney Int Suppl. (2012);2:341-342.
2. KDOQI Commentary on KDIGO Blood Pressure Guidelines. Am J Kidney Dis.
2013;62:201-21
SCENARIO CASE 1 :
A 36 year old man is admitted for an increased serum creatinine level. He has
been taking intravenous antibiotics at home for the past 2 weeks for osteomyelitis caused
by Staphylococcus aureus. He reports no change in his urine output. On physical
examination, his blood pressure was 124/76 mmHg and his pulse was 82 beats per
minute while he was supine and 126/74 mmHg 86 beats per minute while he was
standing. He has a diffuse red maculopapular rash on his trunk and limbs. The remainder
of the examination is normal. His serum creatinine level is 2,4 mg/dl today and it was 1,0
mg/dl a week ago. Other blood laboratory findings include the following: WBC count
11.00 /ml; sodium 142 mmol/L; potassium 4,2 mmol/L; and blood urea nitrogen 34 mg/dl.
His urine showed a sodium level of 54 mmol/L and creatinine level of 39 mg/dl. The
urinalysis with dipstick testing showed +1 protein; the microscopic analysis showed 5-10
leucocytes/HPF (high power field). And an occasional leucocytes cast. Kidney ultrasound
showed no hydronephrosis.
LEARNING TASK:
1. What is the most likely diagnosis for this patient’s AKI? Give your reason!
2. Explain your answer! What kind of abnormality findings was found in the patient
supports your conclusion?
3. Explain the management for this patient!
SCENARIO CASE 2 :
A 79 year old white man comes to emergency unit with the symptom: not being able
to urinate this day. He recently saw his primary care physician for an upper respiratory
infection, and began taking diphenhydramine (anti-histamine) for relief the nasal
congestion. He reports a history that is significant for benign prostatic hyperplasia (BPH)
and hypertension. A Foley catheter was placed, with the return of 1200 ml of urine.
Urinalysis was within normal limit. His blood urea nitrogen (BUN) level was 21 mg/dl and
his creatinine level was 1,5 mg/dl (base line creatinine level, 1.0 mg/dl).
LEARNING TASK:
1. What is the most likely diagnosis for this patient?
2. Explain your answer! What kind of abnormality findings was found in the patient
supports your conclusion?
SELF-ASSESSMENT:
1. Explain about acute kidney disease and its classification!
2. Explain about the RIFLE criteria!
3. Explain the pathophysiology of acute kidney disease due to gastroenteritis with
dehydration!
4. Explain the management of acute kidney disease!
5. Describe the complication of acute kidney injury!
CHRONIC KIDNEY DISEASE
Dr. dr. Yenny Kandarini, SpPD-KGH, FINASIM
AIMS:
The students are expected able to explain and comprehend the evolution of kidney
disease, calculate estimated GFR, defined stage of chronic kidney disease (CKD. The
students are also expected able manage the objective and basic treatment CKD
LEARNING OUTCOMES
At the end of the lectures, the students are able to:
1. Able to calculate estimated GFR using the accurate formula
2. Define stage of CKD
3. Plan strategic approach of long-term management of CKD
4. Aspects and abnormalities of CKD have to be controlled to delay disease progression
CURRICULUM CONTENTS
1. Definition and staging of CKD
2. Pathophysiology of progressive reduced kidney function in CKD
3. Hemodynamic and metabolic abnormalities in CKD
4. Aims of the management of CKD.
5. Target of treatment of Hemodynamic and metabolic abnormalities in CKD
ABSTRACT:
Chronic kidney disease (CKD) is a world wide problem, due to dialysis economic
burden and high mortality from cardiovascular disease. High blood pressure and diabetes
mellitus are major contributors to chronic kidney disease. In Indonesia, CKD was reported
in 12,5% among patients with high blood pressure and diabetes mellitus in the
community.
In general CKD patients presents sign and symtomps of hematuria, flank pain,
edema, hypertension, uremic syndrome, lethargy and fatigue, loss of appetite. If
asymptomatic may have elevated serum creatinine concentration or an abnormal
urinalysis. In early stage risk factor of CKD should be identified both modifiable (diabetes,
hypertension, history of acute kidney injury, frequent NSAID use) and managed properly,
and non-modifiable (family history of kidney disease, diabetes, or hypertension, age 60
or older (GFR declines normally with age), race/ethnic status). CKD is defined as
structural or functional abnormalities of the kidneys for >3 months, as manifested by
either: 1). Kidney damage, with or without decreased GFR, as defined by pathologic
abnormalities; markers of kidney damage, including abnormalities in the composition of
the blood or urine or abnormalities in imaging tests, and 2). GFR <60 ml/min/1.73 m2, with
or without kidney damage. 1Target blood pressure less than 130/80 mm Hg. Angiotension
converting enzyme inhibitors (ACEI) or angiotension receptor blocker (ARB) for diabetic
or non-diabetic kidney disease with spot urine total protein-to-creatinine ratio of greater
than 200 mg/g.
Proteinuria in an important marker of kidney damage and prognosis of deterioration
of kidney function. The rate of proteinuria by measuring quantitative urinary excreion is
important especially in diabetic kidne disease
High blood pressure is an important comorbidity. Hypertension has to be controlled
because it contributes ti rapid deterioration of kidney fuction. Target, and compelling use
of particular type of antihypertensive drugs may results in delaying reduced rate of kidney
function decline in CKD.
Screening of CKD should be considered the best overall index of kidney function,
normal GFR which varies according to age, sex, and body size, and declines with age.
The NKF recommends using the CKD-EPI Creatinine Equation (2009) to estimate GFR.
Other useful calculators related to kidney disease include MDRD and Cockroft Gault. GFR
calculators are available online at www.kidney.org/GFR. Screening Tools, including:
1) albumin creatinine ratio (ACR) whereas albumin concentration in milligrams devided
by creatinine concentration in grams. Creatinine assists in adjusting albumin levels for
varying urine concentrations, which allows for more accurate results versus albumin
alone. Spot urine sampel can be use to measure albumin-to-creatinine ratio for
quantification of proteinuria. New guidelines will classify albuminuria as mild, moderately
or severely increased using first morning void preferable and 24hr urine test rarely
necessary. In general CKD can be defined if abnormalities of kidney structure or function,
present for >3 months, with implications for health and either of the following must be
present for >3 months: 1) ACR >30 mg/g, 2). Markers of kidney damage (one or more as
follows: markers of kidney damage can include nephrotic syndrome, nephritic syndrome,
tubular syndromes, urinary tract symptoms, asymptomatic urinalysis abnormalities,
asymptomatic radiologic abnormalities, hypertension due to kidney disease), and 3) GFR
<60 mL/min/1.73 m2. This classification of CKD is Defined by Kidney Disease Outcomes
Quality Initiative (KDOQI) Modified and Endorsed by KDIGO
Goals of care in CKD is aiming to slow decline in kidney function, blood pressure
control: targeting blood pressure ≤140/90 mm Hg if ACR <30 mg/g; ≤130/80 mm Hg if
ACR 30-300 mg/g: ≤130/80 mm Hg if ACR >300 mg/g. Individualize targets and agents
according to age, coexistent CVD, and other comorbidities. Compelling antihypertensive
agents are ACE or ARB. It ia reasonable to select a goal of 140/90 mm Hg, especially for
moderate albuminuria (ACR 30-300 mg/g.).
Slowing CKD progression using ACEi or ARB has to be considered: risk/benefit of
these drugs and should be carefully assessed in the elderly and medically fragile. Check
labs after initiation of treatment; if less than 25% SCr increase, continue and monitor and
if more than 25% SCr increase, stop ACEi and evaluate for RAS acting drugs. Avoid
volume depletion and avoid ACEi and ARB in combination. Monitor risk of adverse events
(impaired kidney function, hyperkalemia)
Glucose Control, is important: targeting HbA1c ~7.0% and c an be extended above
7.0% with comorbidities or limited life expectancy, and risk of hypoglycemia. Attention
should be paid the risk of hypoglycemia increases as kidney function becomes impaired
and declining kidney function may necessitate changes to diabetes medications and
renally-cleared drugs
Modification of Other CVD Risk Factors in CKD should be managed, including: smoking
cessation, exercise, weight reduction to optimal targets, lipid lowering therapy. In adults
>50 years, statin is indicated when eGFR ≥ 60 ml/min/1.73m2; statin or statin/ezetimibe
combination when eGFR < 60 ml/min/1.73m2 and in adults < 50 yrs, statin if history of
known CAD, MI, DM, stroke. Aspirin is indicated for secondary but not primary prevention
Other aspect of CKD management is to detect and manage CKD Complications,
including:
Anemia
– Initiate iron therapy if TSAT ≤ 30% and ferritin ≤ 500 ng/mL (IV iron for dialysis,
Oral for non-dialysis CKD)
– Individualize erythropoiesis stimulating agent (ESA) therapy: Start ESA if Hb

<10 g/dl, and maintain Hb <11.5 g/dl. Ensure adequate Fe stores.
– Appropriate iron supplementation is needed for ESA to be effective
CKD-Mineral and Bone Disorder (CKD-MBD)

– Treat with D3 as indicated to achieve normal serum levels
– 2000 IU po qd is cheaper and better absorbed than 50,000 IU monthly dose.
– Limit phosphorus in diet (CKD stage 4/5), with emphasis on decreasing

packaged products - Refer to renal RD
– May need phosphate binders
Metabolic acidosis
– Usually occurs later in CKD
– Serum bicarb >22mEq/L
– Correction of metabolic acidosis may slow CKD progression and improve
patients functional status1,2
Hyperkalemia
– Reduce dietary potassium
– Stop NSAIDs, COX-2 inhibitors, potassium sparing diuretics (aldactone)
– Stop or reduce beta blockers, ACEi/ARBs
– Avoid salt substitutes that contain potassium
1. KDIGO. Clinical Practice Guideline For The Management Of Blood Pressure In
Chronic Kidney Disease. Kidney International. 2021
2. Feehally J et al, Comprehensive Clinical Nephrology 6th Edition. 2019
3. Almoznino-Sarafian D, Shteinshnaider M, Tzur I, Bar-Chaim A, Iskhakov E,
Berman S, et al. Anemia in diabetic patients at an internal medicine ward: clinical
correlates and prognostic significance. Eur J Intern Med. 2010 Apr;21(2):91–6.
4. Dioguardi M, Caloro GA, Troiano G, Giannatempo G, Laino L, Petruzzi M, et al.
Oral manifestations in chronic uremia patients. Ren Fail. 2016 Feb;38(1):1–6.
5. Fouque D, Kalantar-Zadeh K, Kopple J, Cano N, Chauveau P, Cuppari L, et al. A
proposed nomenclature and diagnostic criteria for protein-energy wasting in acute
and chronic kidney disease. Kidney Int. 2008 Feb;73(4):391–8.
6. Hollenberg NK. Renal function in patient with hypertension. The Medical Clinics of
North America. Elsevier Saunders; 2004. p.131–40.
7. Mandayam S, Mitch WE. Dietary factors in the treatment of chronic kidney disease.
In: Schrier RW. Disease of the kidney and urinary tract. 8th ed. Vol II. Philadelphia:
Wolters Kluwer Lippincott William & Wilkins; 2007. p.2672–96.
8. Meyer TW, Hostetter TH. The pathophysiology of uremia. In: Brenner BM, ed.
Brenner & Rector’s The Kidney. 10th ed. Vol 2. Philadelphia: Elsevier; 2016.
p.1807–21.
9. Muscaritoli M, Molfino A, Bollea MR, Rossi Fanelli F. Malnutrition and wasting in
renal disease. Curr Opin Clin Nutr Metab Care. 2009 Jul;12(4):378–83.
LEARNING TASK :
1. Explain the staging of CKD
2. Explain Pathophysiology of progressive reduced kidney function in CKD
3. Explain Hemodynamic and metabolic abnormalities found in CKD
SELF ASSESSMENT :
1. Describe formula that been used to calculate accurate GFR using the accurate
formula
2. Define stage of CKD
3. Explain strategic approach of long-term management of CKD
4. Explain Aspects and abnormalities of CKD have to be controlled to delay disease
progression
LECTURE 7
SECONDARY HYPERTENSION
Dr.dr Yenny Kandarini, Sp.PD-KGH, FINASIM
AIMS:
1. Diagnose and manage patient with secondary hypertension
2. Diagnose and refer special patient with secondary hypertension
3. Plan patient, family, and community education about secondary hypertension
LEARNING OUTCOME:
1. Able to diagnose and manage patient with secondary hypertension
2. Able to diagnose and refer special patient with secondary hypertension
3. Able to plan patient, family, and community education about secondary
hypertension
CURRICULUM CONTENT:
1. Definition secondary hypertension
2. Etiology secondary hypertension
3. Sign and Symptom secondary hypertension
4. Management and treatment secondary hypertension
ABSTRACT:
Renovascular hypertension is the most common cause of secondary hypertension in the
United States. Renovascular hypertension is an elevation of blood pressure due to
activation of the renin-angiotensin system in the setting of renal artery occlusive diseases.
The diagnosis of renovascular hypertension can be made only if blood pressure improves
following intervention, thereby making renovascular hypertension a retrospective
diagnosis. The presence of anatomic renal artery stenosis is not synonymous with
renovascular hypertension. Progressive and occlusive renovascular disease may lead to
impaired kidney function, termed “ischemic nephropathy”.
References:
1. KDIGO. Clinical Practice Guideline For The Management Of Blood Pressure In
Chronic Kidney Disease. Kidney International. 2021
2. Feehally J et al, Comprehensive Clinical Nephrology 6th Edition. 2019
3. KDOQI Commentary on KDIGO Blood Pressure Guidelines. Am J Kidney Dis.
2013;62:201-213
SCENARIO CASE :
A 50-year-old African–American man has severe hypertension despite compliance with
four medications including a diuretic. No symptoms of headaches, palpitations, or
sweating. His BP is 178/96 mm Hg, HR 66 per minute, BMI = 26. Serum creatinine is
1.0 mg/dL, K is 3.3 mg/dL. Physical examination is unremarkable.
LEARNING TASK :
1. What kind of abnormality findings was found in the patient supports your conclusion?
2. Describe the pathophysiology of Renovascular hypertension?
3. Describe the principle management for the patient with secondary hypertension?
SELF-ASSESSMENT :
1. In a patient with bilateral renal artery stenosis, drugs that inhibit ACE inhibitors or
that block angiotensin receptors can have a negative impact of renal function.
Which renal function can be made worse?
A. The ability to secrete renin
B. The ability to concentrate urine
C. Glucose-reabsorbing ability
D. Glomerular filtration
2. Which of the following clinical symptoms and signs is not seen in patient with
primary hyperaldosterinism
A. Edema of the ankles
B. Weakness of the muscle
C. Systolic blood pressure of more than 180 mmHg
D. Muscle cramps
3. A physician is practicing in a third world region with no radiology or nuclear

medicine support and a laboratory that can only measure blood counts, electrolytes
and simple blood chemistries. A young patient with hypertension who has no family
history of hypertension presents to the clinic. Which of the following tests would
the physician request to investigate the possibility that the patient has primary
hyperaldosteronism?
A. Serum sodium concentration
B. Serum and 24-hour urine potassium
C. 24-hour urine sodium and creatinine
D. Urine sodium concentration and pH
LECTURE 8
UNCOMPLICATED URINARY TRACT INFECTION
Dr. dr. Yenny Kandarini, SpPD-KGH, FINASIM
AIMS:
1. Diagnose and manage patient with uncomplicated urinary tract infection
2. Diagnose and refer special patient with uncomplicated urinary tract infection
3. Plan patient, family, and community education about uncomplicated urinary tract
infection
LEARNING OUTCOME:
1. Able to diagnose and manage patient with uncomplicated urinary tract infection
2. Able to diagnose and refer special patient with uncomplicated urinary tract infection
3. Able to plan patient, family, and community education about uncomplicated urinary
tract infection
CURRICULUM CONTENS:
1. Definition Uncomplicated UTI
2. Etiology Uncomplicated UTI
3. Sign and Symptom Uncomplicated UTI
4. Management and treatment Uncomplicated UTI
ABSTRACT :
Urinary tract infection (UTI) refers to a symptomatic bacterial infection within the
urinary tract. This includes a lower urinary tract infection – cystitis (symptomatic infection
of the bladder), or an upper urinary tract infection – acute pyelonephritis (symptomatic
infection of the kidney). These definitions are based upon a grouping of symptoms.
However, the bacterial infection may extend beyond the anatomical area suggested by
the terminology. Asymptomatic bacteriuria is present if a patient has two consecutive
urine cultures showing >100 000 cfu/mL urine, but does not have any symptoms of a UTI.
This is only treated in certain cases, such as prior to a urological operation, in pregnant
women, or in immunocompromised patients. UTIs may be considered complicated if
symptoms of pyelonephritis emerge, or if a UTI is found in certain patient populations,
including the immunosuppressed, men, pregnant women, diabetics, those with a history
of pyelonephritis, or those with structural abnormalities of the urinary tract.
Etiology of UTI is various, most commonly due to infection with Escherichia coli
species (80-90% of cases). Other causes include Klebsiella, Enterococcus, Proteus
mirabilis and Staphylococcus saprophyticus. Periurethral colonization by the invading
pathogen appears to be the initiating step in a cascade of events leading to a UTI. Most
of the causative organisms are naturally present in the GI tract, which acts as a natural
reservoir for potential UTIs.
Symptoms of UTI are (1) Dysuria, which are due to acute inflammation of the
bladder, resulting in discomfort upon contraction during voiding, (2) Frequency and
urgency : reduced bladder capacity due to inflammatory edema causing decreased
compliance and pain due to bladder distension, (3) Hematuria : irritated, edematous
urinary tract bleeding with voiding, (4) Suprapubic tenderness which are due to palpation
and compression of an inflamed, edematous bladder, (5) Chills and sweats are
inflammatory cascade resulting in a febrile response, (6) Flank pain (may radiate to groin,
often dull and constant), and costovertebral angle (CVA) tenderness are caused by
sudden renal edema, resulting in increased pressure and capsular distension.
While UTIs may be classified in the literature according to location and symptoms,
it is clinically very difficult to determine the extent of infection based on symptoms. Elderly
women
may present with only urinary incontinence and no other symptoms. Urine dipstick test
showing positive nitrites or leukocyte esterase are suggestive of UTI, raising the pretest
probability by 25%. Nitrite: positive due to bacterial reduction of endogenous nitrates to
nitrites; classically positive in Gram-negative Enterobacteriaceae family of enteric
uropathogens. However, nitrite dipstick may also be clinically useful in detecting
Enterococcus and Staphylococcus bacteria. Leukocyte esterase: positive as neutrophil
granules contain enzymes with esterase activity; presence of neutrophils in urine due to
inflammation and leukocyte migration into the urinary tract. Only a positive urine culture
is considered truly diagnostic of a UTI, however, urine should only be cultured in the
setting of clinical infection or infective symptoms; as previously mentioned, asymptomatic
bacteriuria is common and does not require treatment.
Treatment with antimicrobials aims to eradicate the bacteria causing infection. The
chosen antimicrobials depend on extent of infection (uncomplicated or complicated),
common local pathogens, and resistance patterns. Examples of antibiotics for
uncomplicated UTI include: (1) Trimethoprim-sulfamethoxazole : Inhibition of microbial
DNA synthesis by inhibiting the folic acid synthesis and consequently the purines required
for DNA, (2) Fluoroquinolones: Inhibition of microbial DNA synthesis by blocking DNA
gyrase and topoisomerase IV needed for successful DNA replication and transcription,
(3) Nitrofurantoin: The mechanism is not fully understood, but it directly causes selective
damage to microbial DNA, which metabolizing the toxic intermediates of nitrofurantoin
more rapidly than human cells.
1. Jameson., Pauci., Kasper, Hauser., Longo., and Loscalzo. Harrisson's Principles
of Internal Medicine 20th edition, McGraw-Hill Professional, 2018
2. Feehally, J., Floege, J., Tonelli, M., Johnson, R. Comprehensive Clinical
Nehprology. 6th edition. Elsevier. 2019
3. Brenner & Rector's The Kidney. 10th edition by Barry M. Brenner, Floyd C. Rector,
Elsevier Health Sciences, 2016.
4. Papadakins, M and McPhee, S. Current Medical Diagnosis and Treatment. 15th
ed. McGraw-Hill.
SCENARIO CASE :
Gabrielle Llewelyn is a 25 -year -old woman who presents with a 4 -day history of
urinary frequency and dysuria. On examination, her temperature is 37.7 ° C, pulse 90
bpm and BP 125/75 mmHg. She is mildly tender in the right flank and supra pubic but
there is no rebound or guarding. Urine dipstick shows protein -, blood+, nitrite+++,
leucocyte +++.
LEARNING TASK:
1. What investigations would you perform?
2. What is the most likely causative organism?
3. Is the presence of leucocytes always indicative of urinary tract infection?
SELF-ASSESSMENT :
1. Describe how do people get UTI!
2. Describe symptom of UTI
3. Describe people at risk for UTI
4. Describe pathogenesis of UTI
5. Describe diagnosis of UTI
6. Define management of UTI
7. Define prevention UTI
LECTURE 9
UROLITHIASIS
Dr.dr. Kadek Budi Santosa Sp.U(K)
AIMS:
This study guide helps students understand comprehensively urolithiasis, including
epidemiology, risk factors, clinical diagnoses, further examination needed, and modalities
of therapy in urolithiasis, both in an emergency setting and non-emergency.
LEARNING OUTCOME:
1. Able to describe the basic pathogenesis associated with signs and symptoms of
urolithiasis.
2. Able to decide on physical examination and laboratory examination needed to
make an appropriate diagnosis of urolithiasis based on the location of the stone.
3. Able to treat urolithiasis patients in both emergency settings and non-emergency.
4. Able to educate the patients about healthy lifestyles and routine follow-up to reduce
the progression of existing stones and prevent forming the new stone
CURRICULUM CONTENT:
1. Prevalence, Etiology, and risk factor, Classification of stones
2. Diagnostic Evaluation
3. Urolithiasis Management
4. Metabolic Evaluation and Recurrence Prevention.
ABSTRACT :
Urolithiasis, the most common urology problem in Indonesia, is defined as urinary
stones forming in the urinary system. In the United States, the medical cost for urolithiasis
was up to 2.1 billion USD per year. Renal colic affects approximately 1.2 million people
yearly in the USA, approximately 1% of all hospital admissions. Most active emergency
departments (EDs) manage patients with acute renal colic daily.
Urinary stones can be classified according to the etiology of stone formation, stone
composition (mineralogy), stone size, stone location, and X-ray characteristics of the
stone. The stone incidence depends on geographical, climatic, ethnic, dietary, and
genetic factors. The recurrence risk is determined by the disease or disorder causing the
stone formation. The prevalence rates vary from 1% to 20%. Emerging evidence links
nephrolithiasis to the risk of chronic kidney disease.
Diagnosis clinic of urolithiasis may present symptoms of pain or haematuria
(microscopic or occasionally macroscopic). Classically struvite staghorn calculi present
with recurrent UTIs, malaise, weakness, and loss of appetite. Diagnosis Imagining were
ultrasound (US), KUB radiography, intravenous radiography, intravenouspyelogram(IVP),
and CT scan. Laboratory test based on EUA recommendations: Urinarysediment/dipstick
test, serum creatinine, and additional laboratory test included CBC in febrile patients,
serum electrolyte assessment in vomiting patients, and 24-Hour urine profile.
Management for urolithiasis in emergency renal colic: Intra-Vena (IV) Fluid, analgesics,
and in infection case: Urine culture, blood culture accordingly (e.g., febrile), and
antibiotics. Alpha-blockers for ureteral stone. Surgical management for obstruction relief
included Ureteral stent insertion and Percutaneous nephrostomy. Definitive surgical
treatment consists of ESWL, Ureteroscopy, PCNL, Pyelo-lithotomy, Ureterolithotomy,
and Cystolithotomy.
STANDARD REFERENCES:
1. EAU Guidelines. Edn. presented at the EAU Annual Congress Milan 2023. ISBN
978-94-92671-19-6
CASE SCENARIO :
A 36-year-old woman came to the primary healthcare facility with severe left flank pain.
She also feels nauseous and febrile. She has felt the pain intermittently since one month
ago. She had a history of passing stone two years ago. Physical examination found
increasing body temperature Tax 38,5.
LEARNING TASKS
1. What is your clinical diagnosis in this case, and what are the differential diagnoses
2. Explain what diagnostic tests you recommend to confirm your diagnosis
3. How do you manage this patient
4. What information do you need to look for possible risk factors for urolithiasis in this
patient to make a possible prevention plan
Self Assessment
1. What is the pathophysiology of urinary tract stones
2. How to make a diagnosis of urolithiasis
3. How do you manage urolithiasis in the acute setting
4. Describes a definitive treatment plan and provides advice on preventing recurrence
LECTURE 10
URINARY INCONTINENCE AND OVERACTIVE BLADDER
Dr.dr.Kadek Budi Santosa Sp.U(K)
Aims:
This study guide provides a general overview of urinary incontinence (UI) and overactive
bladder (OAB), including the definition, prevalence, classification, risk factors, and
management.
Learning outcome:
1. Able to describe the type, pathogenesis, and management of UI
2. Able to describe the pathogenesis and management of OAB
Curriculum content:
1. Epidemiology, Etiology, Pathophysiology, and Classification of UI
2. Epidemiology, Etiology, and Pathophysiology of OAB
3. Diagnostic Evaluation of UI and OAB
4. UI and OAB Management
Abstract 
Urinary incontinence is a medical condition characterized by an involuntary loss of

urine during the day or the night. It is a global health issue that affects 400 million citizens
worldwide. Urinary incontinence is divided into stress, urge, and mixed incontinence.
Stress incontinence is characterized by urine leakage associated with increased
abdominal pressure from laughing, sneezing, coughing, climbing stairs, or other physical
stressors on the abdominal cavity and, thus, the bladder. Urge urinary incontinence is
involuntary leakage accompanied by or immediately preceded by urgency. Mixed urinary
incontinence is a combination of stress and urges incontinence; it is marked by
involuntary leakage associated with urgency and exertion, effort, sneezing, or coughing.
Regardless of the form and severity of the condition, it affects patient’s daily life, and it
can have repercussions on their physical, financial, social, and emotional well-being. Not
an irrelevant issue is a negative influence on their sexual health.
It is not a simple condition with straightforward treatment protocols, which also can
be treated by different medical and nonmedical professionals, either alone or as members
of a multidisciplinary team. Deciding on a treatment regimen is a multifactorial decision
process according to urinary incontinence subtype and symptom severity.
Based on ICS, overactive bladder syndrome is defined as urinary urgency, usually

accompanied by frequency and nocturia, with or without urinary incontinence, in the
absence of urinary tract infection or other obvious pathology. Overactive bladder is a
chronic condition that can have debilitating effects on QoL.
The primary pathophysiology theory is those imbalances in inhibitory and

excitatory neural pathways to the bladder and the urethra or sensitivity of bladder muscle
receptors. However, no definite identifiable causes have been established. Overactive
bladder is generally classified into wet and dry based on the presence or absence of
associated urinary incontinence.
The diagnosis of OAB is exclusively based on symptoms. Evaluation of symptoms

of OAB follows the general pathway, including bladder diaries, urodynamics, and urinary
marker. The therapy modalities have varied from non-invasive management, consisting
of conservative and pharmacological, to surgical management. In clinical practice, non-
surgical therapies are recommended first because they usually carry the lowest risk of
harm.
1. F.C. Burkhard (Chair), J.L.H.R. Bosch, F. Cruz, G.E. Lemack, A.K. Nambiar, N.
Thiruchelvam, A. Tubaro Guidelines Associates: D. Ambühl, D.A. Bedretdinova, F. Farag,
R. Lombardo, M.P. Schneider: http://www.uroweb.org/guideline/urinary-incontinence.
2. EAU Guidelines. Edn. presented at the EAU Annual Congress Amsterdam, 2020. ISBN
978-94-92671-07-3.
Case scenario 1
A 62-year-old female came to the hospital for a 2-year history of incontinence. She
leaks with cough and sneeze. Reports urinary urgency, frequency, and urge
incontinence. No difficulty emptying the bladder, no pelvic fullness, no pelvic pain. OB
history: 2 difficult vaginal deliveries PMH: Diabetes. SH: Homemaker, married, sexually
active. She has a 20-pack-year smoking history. Medication: Metformin
Learning Task
1. Describe your clinical diagnoses
2. What do you suggest for further examination
3. Describe the comprehensive management of this patient
Self-assessment:
1. Explain the pathogenesis of each type of UI
2. Describe the subjective and objective assessment of UI
3. Explain the principle difference in treatment between stress UI and urge UI
Case scenario 2
A 42-year-old female came to the hospital with a complaint of urinary frequency
and urgency for three months. She also experienced urge incontinence. She feels no
difficulty emptying her bladder and no pelvic pain. Urinalysis and kidney-bladder
ultrasound found no abnormality
Learning Task
1. Describe your clinical diagnoses
2. What do you suggest for further examination
3. Describe the comprehensive management of this patient
Self-assessment:
1. Explain the pathogenesis of overactive bladder
2. Explain the algorithm treatment of overactive bladder
LECTURE 11
ACUTE AND CHRONIC GLOMERULONEPHRITIS, PEDIATRIC HYPERTENSION
dr. Gusti Ayu Putu Nilawati, Sp.A(K), MARS
AIMS:
1. Describe the etiology, diagnosis, and management of acute and chronic
glomerulonephritis.
2. Describe the etiology, diagnosis classification, and management of pediatric
hypertension.
LEARNING OUTCOME:
1. Describe the morphology, etiology, and clinical manifestation of acute and chronic
glomerulonephritis.
2a. Describe the etiology and pathophysiology of pediatric hypertension.
2b. Describe the evaluation and diagnosis classification of pediatric hypertension.
2c. Describe the management and drug of choice in pediatric hypertension.
1. Morphology, etiology, and clinical manifestation of acute and chronic
glomerulonephritis.
2a. Etiology and pathophysiology of pediatric hypertension.
2b. Evaluation and diagnosis classification of pediatric hypertension.
2c. Management and drug of choice in pediatric hypertension.
ABSTRACT ACUTE AND CHRONIC GLOMERULONEPHRITIS :

Acute glomerulonephritis (AGN) is a complex of findings which is marked histologically
by a generalized glomerular inflammation. Frequently, renal biopsy is not available, but
AGN can usually be recognized by the clinical picture of hematuria, fluid overload (edema
and hypertension), and some evidence of renal insufficiency (elevation of BUN and
creatinine). In some situations, AGN is a primary process, and virtually, all of the clinical
findings are a consequence of the renal lesion. In other cases, the AGN is but one
manifestation of a systemic illness which has targeted multiple organs, each of which may
be independently injured. Fortunately, most cases of AGN in children are either self-
limited or amenable to therapy although there may be devastating complications of the
illness during the acute phase. Less commonly, what begins as an apparent AGN may
presage the development of a chronic process, which ultimately may progress into
irreversible end-stage renal disease (ESRD).
ABSTRACT PEDIATRIC HYPERTENSION:

The problem of hypertension in children is assuming increasing importance because of
the possible relationship of mild hypertension in older children and adolescents to
essential hypertension in adults. It is important to identify childhood predictors of
essential hypertension and plan intervention strategies. In clinical practice, however,
most cases of symptomatic hypertension in children are secondary and a treatable
cause can be identified in a large proportion. Such patients require careful diagnostic
evaluation.
The Key points Measurement of blood pressure in children
• Severe hypertension is usually secondary to an underlying cause; essential
hypertension is increasingly detected in obese children
• All children >3-year-old who are seen in a medical setting should have their blood
pressure measured
• The preferred method of measurement is auscultation
• Correct measurement requires a cuff that is appropriate to the size of the child’s
upper arm
• Measures obtained by oscillometry that exceed the 90th percentile should be
verified on auscultation.
Blood Pressure standard in children and adolescent based on gender, age and height
provide a precise classification of blood pressure according to body size. The child is
normotensive if the systolic and diastolic blood pressure is <90th percentile. If the blood
pressure is >90th percentile, it should be repeated to verify an elevated blood pressure.
Blood pressure values between the 90 and 95th percentiles indicate prehypertension.
Blood pressure values >120/80 mm Hg is also considered prehypertensive. Systolic or
diastolic blood pressure values more than the 95th percentile should be repeated on at
least 2 more occasions to confirm the diagnosis of hypertension. All children showing
systolic or diastolic blood pressure values above the 95th percentile need evaluation.
However, those with blood pressure values 5 mmHg above the 99th percentile (severe
hypertension) need more prompt evaluation and pharmacologic therapy.
CASE SCENARIO
A 12-year-old female present with three days history of the red urine and puffiness of her
face. The patient was having fever and sore throat in previous 2 week. Examination
reveals minimal puffiness with pitting edema of the lower limbs. Her blood pressure is
140/100 mmHg with pulse 88 bpm. Chest, cardiovascular and abdominal examination are
normal.
LEARNING TASK:
1. What are the diagnosis and differential diagnosis for this case?
2. Describe characteristic features of PSAGN.
3. Describe the laboratory investigation to diagnose PSAGN.
4. Explain the mechanism of hypertension in PSAGN and it complication.
5. Described classification of Hypertension in children.
SELF ASSESSMENT ( TRUE/ FALSE)

1. PSAGN predominantly affects children less than 2 years
2. PSAGN usually follows type 12 streptococcal infection of the pharynx.
3. The chronicity of glomerulonephritis can be predicted if the microscopic hematuria,
proteinuria, and a low serum complement C3 level are present for a period
exceeding than six months after initial onset of illness.
4. All children >3-year-old who are seen in a medical setting should have their blood
pressure measured.
5. The child is normotensive if the systolic and diastolic blood pressure is between
90th- 95th.
STANDARD REFERENCES :
1. Andreoli SP. Chronic glomerulonephritis in childhood. Pediatric Nephrology.
1995;42(6):1487-1503.
2. Lau KK, Wyatt JR. Glomerulonephritis. Adolesc Med. 2005;16:67-85.
3. Lestari HI, Bahrun D. Hipertensi pada Anak. In : Rachmadi D, Sekarwana N,
Hilmanto D, Garna H, editors. Buku Ajar Nefrologi Anak. 3 rd ed. Jakarta, Badan
Penerbit Ikatan Dokter Anak Indonesia, 2017. p. 557-585.
4. Noer MS. Glomerulonefritis. In : Rachmadi D, Sekarwana N, Hilmanto D, Garna H,
editors. Buku Ajar Nefrologi Anak. 3rd ed. Jakarta, Badan Penerbit Ikatan Dokter
Anak Indonesia, 2017. p. 191-211.
5. Swinford RD, Portman RJ. Evaluation of the Hypertensive Pediatric Patient. In:
Flynn JT, Ingelfinger JR, Portman RJ, editors. Pediatric Hypertension. 2nd ed. New
York, Humana Press, 2011. p. 499-513.
6. Wenderfer SE, Samuel JP, Braun MC. Acute Glomerulonephritis. In: Douglass MS,
Jordan MS, Uri SA, editors. Pediatrics Nephrology A handbook for Training Health
Care Providers: New Jersey: World Scientific,2012. p. 249-274
7. Tassic V. Post Infectious Glomerulonephritis. In: Geary DF, Schaefer F, editors.
Comprehensive Pediatric Nephrology: Philadelphia, Mosby Elsevier, 2008. p. 309-
315
8. UKK Nefrologi Ikatan Dokter Anak Indonesia. Konsensus Tata Laksana
Hipertensi. Jakarta, Badan Penerbit Ikatan Dokter Anak Indonesia, 2011. p. 1-20.

1. Etiology and clinical manifestations of acute and chronic glomerulonephritis
2. Diagnosis, management and drug of choice of pediatric hypertension.
LECTURE 12
NEPHROTIC SYNDROME, URINARY TRACT INFECTION IN CHILDREN,
CONGENITAL ANOMALY IN URINARY SYSTEM
dr. Gusti Ayu Putu Nilawati, Sp.A(K), MARS
AIMS:
1. Describe the etiology, diagnosis and management of children with nephrotic
syndrome.
2. Describe the clinical course, diagnosis, and management of children with urinary tract
infection.
3. Describe the epidemiology and pathophysiology of congenital anomaly in urinary
system.
LEARNING OUTCOME:
1a. Describe the etiology and pathophysiology of nephrotic syndrome.
1b. Describe the diagnosis and classification of nephrotic syndrome.
1c. Describe the therapy, referral indication and prognosis.
2a. Describe the epidemiology and clinical course of urinary tract infection in children.
2b. Describe the urinalysis diagnosis and therapy of urinary tract infection in children.
3. Describe the epidemiology and pathophysiology of congenital anomaly in urinary
system.
CURRICULUM CONTENS:
1a. Epidemiology and pathophysiology of nephrotic syndrome.
1b. Etiology and clinical manifestation of nephrotic syndrome.
1c. Diagnosis and classification of nephrotic syndrome.
1d. Therapy, referral indication and prognosis of nephrotic syndrome.
2a. Etiology and epidemiology of urinary tract infection.
2b. Classification and clinical manifestation of urinary tract infection.
2c. Diagnostic evaluation and diagnosis of urinary tract infection.
2d. Therapy and complication of urinary tract infection.
3. Epidemiology and pathophysiology of congenital anomaly in urinary system.
ABSTRACT NEPHROTIC SYNDROME:

Nephrotic syndrome is primarily a pediatric disorder and is 15 times more common in
children than adults. The incidence is 2-3/100,000 children per year, and the vast majority
of affected children will have steroid sensitive with minimal change disease. The
characteristic features of nephritic syndrome are heavy proteinuria (> 40 mg/m 2/hour in
children), hypoalbuminemia (< 2.5 g/dL), edema, and hyperlipidemia.
Most children (90 %) with nephrotic syndrome have a form of the idiopathic nephrotic
syndrome. The causes of idiopathic nephrotic syndrome include minimal change disease
(85%), mesangial proliferation (5%), and focal segmental glomerulosclerosis (10%). The
remaining 10% of children with nephrotic syndrome have secondary nephrotic syndrome
related to glomerular diseases such as membranous nephropathy or
membranoproliferative glomerulonephritis.
The underlying abnormality in nephrotic syndrome is an increase permeability of the
glomerular capillary wall, which leads to massive proteinuria and hypoalbuminemia. The
cause of the increase permeability is not yet fully understood.
Although the mechanism of edema formation in nephrotic syndrome is incompletely
understood, it seems likely that, in most instances, urinary protein loss that lead to
hypoalbuminemia, which lead to decrease in the plasma oncotic pressure and
transudation of fluid from the intravascular compartment to the interstitial space.
The diagnoses of nephrotic syndrome based on clinical manifestation that usually
present with edema which initially noted around the eyes and in the lower extremities.
With the time, the edema became generalized with the development of ascites, pleural
effusions, and genital edema. Anorexia, irritability, abdominal pain, and diarrhea are
common; hypertension and gross hematuria are uncommon.
The urinalysis reveals 3+ or 4+ proteinuria; microscopic hematuria may be present in
20% of children.
Urinary protein exceeds > 40 mg/m2/hour in children. The serum albumin level isgenerally
less than 2.5 g/dL and the serum cholesterol and triglyceride levels areelevated. C3 and
C4 levels are normal. Treatment of children with the first episode of nephrotic syndrome
and mild to moderate edema may be managed as outpatient. Children with onset of
nephrotic syndrome between 1 and 8 year of age are likely to havesteroid responsive
minimal change disease; therefore, steroid therapy may be initiated without renal biopsy.
The majority of children with steroid-responsive nephritic syndromehave repeated.
ABSTRACT URINARY TRACT INFECTION:

Urinary tract infection (UTI) is an infection (there is growth and development of bacteria)
in the urinary tracts, including infection in the renal parenchyma until bladder with the
number of bacteriuria. It can be divided to upper UTI, especially the renal parenchyma
called pyelonephritis and lower UTI, if the infection is in the urinary bladder (cystitis) or
urethra. The boundary between the upper and lower UTI is the vesico-ureter. It also can
be divided to simplex UTI (uncomplicated) and complex UTI (complicated). In some
cases, urinary tract infections can cause kidney scarring, hypertension, and kidney failure.
Infection can reach the urinary tract by hematogenous or ascending from the external
urethral orificium into the urinary tract and finally to the kidney. The diagnosis of UTI can
be established if the urine culture qualitatively shows a significant number of bacteria. In
general, if urine culture shows a single species of bacteriuria of 105 colonies/ml, it is
definitive for a UTI. Treatment with antibiotics depends on the results of urine culture and
antibiotic sensitivity tests. The response to treatment depends on the level of drugs in the
urinary tract and not in the blood. One of the antibiotic choices is cotrimoxazole that more
effective for E. Coli, Klebsiella pneumonia, while nitrofurantoin is more effective for E.
Coli. Ampicillin and amoxicillin can be given in neonates and babies with simplex urinary
tract infections and cotrimoxazole can be given in children aged 2 years or more. Duration
of treatment is 7-10 days. The effectiveness of therapy can be seen from clinical
symptoms that disappear and the urine culture becomes negative no more than 4 days
after treatment.
ABSTRACT CONGENITAL ANOMALY IN URINARY SYSTEM :
Congenital anomaly of urinary tract or congenital uronephropathy still cause problems in
pediatric nephrology because it is one of the causes of morbidity and mortality in children.
One third of terminal kidney failure in children is caused by this disorder. Congenital
uronephropathy disorders are divided into two groups, include congenital nephropathy
and congenital uropathy, each consisting of various disorders. Genetic, hereditary, and
familial factors, teratogenic by the use of drugs and herbs, radiation, and maternal age
during pregnancy are thought to play a role in causing this disorder. Congenital
uronephropathy disorders can occur alone or together with other congenital abnormalities
or can be part of certain syndromes, such as Meckel syndrome, Turners, Vater, etc.
CASE SCENARIO 1
Three years old boy was admitted to the outpatient clinic with swollen on both eyelids and
followed on both legs. No symptom like this previously. Urination was decreased with
cloudy yellow color since swelling was begun. Make the diagnosis, treatment and
education for this patient.
LEARNING TASK:
1. What are the diagnosis and differential diagnosis for this case?
2. Explain the characteristic features of Nephrotic syndrome.
3. Explain edema mechanism for this case.
CASE SCENARIO 2
Seven years old boy come to emergency ward with complaint of five days fever, decrease
appetite, and pain when urinated. Physical examination finding were temperature: 38,5 O
C, pulse 110 x/ min, Respiration Rate 28x/ min, Phimosis (+). Urinalysis revealed: Specific
gravity 1,025, pH: 5,5, Nitrit (+), WBC: 10-20/ hpf.
LEARNING TASK:
1. What is the gold standard of laboratory test to make the diagnosis for this case?
2. What are the diagnosis for this case?
SELF ASSESSMENT ( TRUE/ FALSE)
1. Nephrotic syndrome is a syndrome with symptoms massive proteinuria.
2. In case of congenital nephrotic syndrome, edema and proteinuria will be found in
the age of children more than 3 months.
3. The most common cause of urinary tract infections is bacteria.
4. Confirmed diagnose for urinary tract infection is fever.
5. Hydronephrosis is always congenital disease.
STANDARD REFERENCES :
1. Davis ID, Avner ED. Nephrology. In: Behrman RE, Kliegman RM, Jenson HB,
editors. Nelson textbook of pediatrics. 17th ed. Philadelphia, WB Saunders Co,
2004. p. 1731-1757.
2. Friedman AL. Nephrology: Fluids and electrolytes. In: Behrman RE, Kliegman RM,
editors. Nelson Essentials of pediatrics. 4th ed. Philadelphia, WB Saunders Co,
2001. p. 671-709.
3. Murugapoopathy V, Gupta IR. A primer on congenital of the kidneys and urinary
tracts (CAKUT). CJASN. 2020;15:723-31.
4. Pais P, Avner ED. Nephrotic Syndrome. In Kliegman RM, editors. Nelson textbook
of pediatrics. 20th ed. Philadelphia, Elsevier, 2016. p. 2521-2528.
5. Stonebrook E, Hoff M, Spencer JD. Congenital anomalies of the kidney and urinary
tract: a clinical review. Curr Treat Options Pediatr. 2019;5(3):223-235.

1. Diagnosis classification and management of nephrotic syndrome.
2. Diagnosis and therapy of urinary tract infection.
3. Epidemiology and clinical course of congenital
LECTURE 13
PRACTICUM ANATOMICAL PATHOLOGY
Dr. dr. Ni Wayan Winarti, Sp.PA(K)
AIMS:
Describe morphology of glomerulonephritis, tubulo-interstitial disease, and common
tumor and tumor like lesion of urinary and Male Genital Organs
LEARNING OUTCOME:
1. Describe morphology of glomerulonephritis
2. Describe morphology of acute tubular injury and pyelonephritis
3. Describe morphology of renal cell carcinoma
4. Describe morphology of bladder urothelial carcinoma
5. Describe morphology of prostate cancer, BPH and prostatitis
6. Describe morphology of penile cancer and condyloma accuminata
7. Describe morphology of testicular tumor
CURRICULUM CONTENS:
3. Glomerulonephritis
4. Tubulo-interstitial diseases
5. Tumor and tumor like lesion of urinary and male genital organ
ABSTRACT:
Morphology is an important aspect in understanding a disease, either neoplastic or non-

neoplastic diseases. In clinical practice, anatomical pathology examination plays an
important role as a determinant of diagnosis, even in cases of tumors it is the gold
standard for diagnosis. Morphological features can sometimes explain the cause,
pathogenesis and clinical symptoms of a disease.
Kumar V, Abbas AK, and Aster JC: Robbins Basic Pathology, 10th ed. Philadelphia,
Elsevier, 2018. p. 549-81.
LEARNING TASK
1. A 4-year-old girl has complained of abdominal pain for the past month. On physical
examination, she is febrile, and palpation of the abdomen shows a tender mass on the
right. Bowel sounds are present. Laboratory studies show hematuria without
proteinuria. Abdominal CT scan shows a 12-cm, circumscribed, solid mass in the right
kidney. A right nephrectomy is done; the gross appearance of the mass is shown in
the figure.
A. What is the most likely diagnosis?
B. Explain the classic microscopic feature of this tumor!
2. A 53-year-old woman has had dysuria and urinary frequency for the past week. On
physical examination, her temperature is 38°C, and she has pain on palpation over the
left costovertebral angle. Laboratory findings show glucose, 177 mg/dL; hemoglobin
A1c, 9.8%; hemoglobin, 13.1 g/dL; platelet count, 232,200/mm 3; and WBC count,
11,320/mm3. Urinalysis shows a pH of 6.5; specific gravity 1.016; 2+ glucosuria; and
no blood, protein, or ketones. Microscopic examination of the urine shows numerous
neutrophils, and a urine culture is positive for Escherichia coli.
A. What is the most likely diagnosis?
B. Explain the macroscopic and microscopic feature of this disease!
Basic knowledge that must be understood:

3. Morphology of Glomerulonephritis
4. Morphology of Tubulo-Interstitial Ds
5. Morphology of tumor and tumor like lesion of urinary and male genital organ
LECTURE 14
HIPOSPADIA, EPISPADIA,PHIMOSIS, PARAPHIMOSIS
AIMS:
Able to understand and diagnose hipospadia, epispadia,phimosis, paraphimosis
LEARNING OUTCOME:
Can describe and diagnose hipospadia, epispadia,phimosis, paraphimosis
Able to identify and manage hipospadia, epispadia,phimosis, paraphimosis
1. Hipospadia
2. Epispadia
3. Phimosis
4. Paraphimosis
ABSTRACT:
Malformations of the penis are hypospadia, epispadia, priapism. Hypospadia is more
common than epispadia. These malformations may result in lower urinary tract
problem and failure to impregnate women.
In phimosis, where prepuce cannot be retracted, smegma are deposited between
glans penis and prepuce. Therefore most cases of phimosis accompanied by
balanoosthitis. When phimosis is forcibly retracted it may result in paraphimosis. In
this condition, the circulation to the glans penis may be strangulated by the stenotic
prepuce. This may cause congestion, swelling and pain. In severe case, urinary
retention may occur.
Standard Reference:
SELF DIRECTED LEARNING

The basic knowledge that must be known:
1. Anatomy of Urinary and Male Genital system
2. Physiology of Urinary and Male Genital system
SCENARIO
CASE :
Two years old boy came with complaint of left scrotal enlargement since he was
born. The enlargement is cystic form and trans illuminated. No scrotal pain. No
complaint on erectile capability. He has a good general condition, composmentis, and
normal blood pressure 120/80, pulse 88x/minutes. Normal right and left testicles. Both
of epydidimis are normal.
LEARNING TASK:
1. What is the diagnosis of this patient?
2. What are the anamnesis, signs, symptoms and examination to support the
diagnosis?
3. What is your planning to complete the diagnosis?
SELF ASSESSMENT
1. What is the complication of the long term phimosis and poor hygiene of the
male external genital?
2. What is the definition and etiology of hypospadia?
3. What is the caused and complication than can be caused by balanopostitis?
What is the correlation between phymosis and penile cancer
LECTURE 15
BPH, STRICTURE URETHRA, VARICOCELE, SPERMATOKEL
AIMS:
1. Able to understand and diagnose BPH, Stricture Urethra, Varicocele,
Spermatokel
LEARNING OUTCOME:
1. Can describe and diagnose BPH, Stricture Urethra, Varicocele, Spermatokel
2. Able to identify and manage BPH, Stricture Urethra, Varicocele, Spermatokel
CURRICULUM CONTENT:
1. Benign Prostate Hiperplasia
2. Stricture Urethra
3. Varicocele
4. spermatokel
ABSTRACT:
Benign Prostatic Hyperplasia (BPH) is one of the most common degenerative
diseases among older men, which diagnosed based on histological examination.
Alleviation of social welfare and health care services, accumulatively, will cause an
increasing amount of geriatry. Thus increasing number of geriatric people will surely
contribute to the increase of BPH cases. The gold standard of surgical therapy for
BPH these days is transurethral resection of the prostate (TURP).
According to WHO, the incident of BPH is approximately between 0,5 to 1,5 per
100000 world population, which have been increasing over ages, with an immensely
low mortality rate. There is 20% male aged between 41-50 years old who suffer BP,
50% male age 51-60 years old, and more than 90% male above 80 years old have
been suffering from BPH (McVary, 2010; Oelke, 2013). To date, there are no studies
in Indonesia which concerned in national prevalence of BPH. As a reference, hospital
prevalence of BPH in Cipto Mangunkusumo Hospital from 1994 until 2013 are 3,084
cases, with age 66,61 years old in average (Mochtar, 2015). A study in Sanglah
Hospital Denpasar revealed that from 1,161 urology operations which has performed,
there are 103 cases of TURP (Duarsa & Lesmana, 2016; Rosadi & Duarsa, 2015).
Inflammation of the skin of scrotum may cause by fungi, predisposed by moist
condition and poor local hygiene. Some disorder may cause scrotal enlargement,
those are hydrocele, hematocele, spermatocele, varicocele etc. Varicocele may result
in sterility
LEARNING TASK:
1. What is the cause of BPH, Stricture Urethra, Varicocele, Spermatokel?
2. How is the management of that condition?
3. How are the diagnostic and treatment management of BPH, Stricture Urethra,
Varicocele, Spermatokel
SELF ASSESSMENT:
1. What are the symptoms of Varicocele that make patients visit the doctor?
2. When does the varicocele need an operation
LECTURE 16
NEONATAL HIDRONEFROSIS
AIMS:
1. Able to understand Neonatal hidronefrosis
LEARNING OUTCOME:
1. Can describe Neonatal hidronefrosis
2. Able to identify Neonatal hidronefrosis
CURRICULUM CONTENT:
1. Neonatal hidronefrosis
ABSTRACT:
Antenatal hydronephrosis (ANH) is a dilation of fetal renal collecting system which
can be detected by prenatal ultrasonography (US). US screening during pregnancy
has resulted in increasing recognition of fetal abnormalities especially in fetal
hydronephrosis (Longpre et al 2012, Piepsz 2007, Belarmino & Kogan 2006, Sinha
et al 2013). The detection of urinary anomalies has changed significantly since the
inception of fetal sonography. Urinary tract abnormalities reportedly account for 30-
50% of fetal anomalies. Incidence of ANH is reported in approximately 1-5% of all
pregnancies and one of the most common birth defects. Transient or mild in nature
hydronephrosis without any clinical sequale is the most common, accounting for 50-
70% of the cases ANH.
LEARNING TASK:
1. What is the cause of Neonatal hydronefrosis?
2. How are the diagnostic and treatment of Neonatal hydronefrosis
SELF ASSESSMENT:
1. How is the management of that condition?
LECTURE 17
ACUTE PYELONEPHRITIS
dr. Nyoman Paramita Ayu, SpPD, K-GH, FINASIM
AIMS:
1. Comprehend the diagnosis and management of Acute Pyelonephritis
LEARNING OUTCOME:
1. Able to make diagnosis and comprehensive management of Acute Pyelonephritis
CURRICULUM CONTENT:
1. Definition
2. Etiology
3. Sign and Symptom
4. Management and treatment
ABSTRACT:
Acute pyelonephritis is an infectious inflammatory disease involving the kidney
parenchyma and renal pelvis. Gram-negative bacteria are the most common causative agents
including E coli, Proteus, Klebsiella, Enterobacter, and Pseudomonas. Gram positive bacteria are
less commonly seen but include Enterococcus faecalis and Staphylococcus aureus. The infection
usually ascends from the lower urinary tract with the exception of S aureus, which usually is
spread by a hematogenous route.
Symptoms include fever, flank pain, shaking chills, and irritative voiding symptoms
(urgency, frequency, dysuria). Associated nausea and vomiting and diarrhea are common. Signs
include fever and tachycardia. Costovertebral angle tenderness is usually pronounced.
Complete blood cell count shows leukocytosis and a left shift. Urinalysis shows pyuria,
bacteriuria, and varying degrees of hematuria. White cell casts may be seen. Urine culture
demonstrates heavy growth of the offending organism, and blood culture may also be positive.
In complicated pyelonephritis, renal ultrasound may show hydronephrosis from a stone or
other source of obstruction. CT scan may demonstrate decreased perfusion of the kidney or focal
areas within the kidney and nonspecific perinephric fat stranding.
The differential diagnosis includes acute cystitis or a lower urinary source. Acute
intraabdominal disease such as appendicitis, cholecystitis, pancreatitis, or diverticulitis must be
distinguished from pyelonephritis. A normal urinalysis is usually seen in gastrointestinal disorders;
however, on occasion, inflammation from adjacent bowel (appendicitis or diverticulitis) may result
in hematuria or sterile pyuria. Abnormal liver biochemical tests or elevated amylase levels may
assist in the differentiation. Lowerlobe pneumonia is distinguishable by the abnormal chest
radiograph. In males, the main differential diagnosis for acute pyelonephritis also includes acute
epididymitis and acute prostatitis. Physical examination and the location of the pain should permit
this distinction.
Sepsis with shock can occur with acute pyelonephritis. In diabetic patients,
emphysematous pyelonephritis resulting from gas-producing organisms may be lifethreatening if
not adequately treated. Healthy adults usually recover complete kidney function, yet if coexistent
kidney disease is present, scarring or chronic pyelonephritis may result. Inadequate therapy could
result in abscess formation.
Urine and blood cultures are obtained to identify the causative agent and to determine
antimicrobial sensitivity. In the inpatient setting, intravenous ampicillin/ ceftriaxone/ ciprofloxacin
are initiated prior to obtaining sensitivity results. In the outpatient setting, empiric therapy may be
initiated. Antibiotics are adjusted according to sensitivities. If local antibiograms demonstrate local
resistance rates for the oral regimen exceed 10%, an initial 24-hour intravenous dose of antibiotic
is required. Fevers may persist for up to 72 hours even with appropriate antibiotics; failure to
respond within 48 hours warrants imaging (CT or ultrasound) to exclude complicating factors that
may require intervention. Catheter drainage may be necessary in the face of urinary retention and
nephrostomy drainage if there is ureteral obstruction. In inpatients, intravenous antibiotics are
continued for 24 hours after the fever resolves, and oral antibiotics are then given to complete a
14-day course of therapy.
With prompt diagnosis and appropriate treatment, acute pyelonephritis carries a good
prognosis. Complicating factors, underlying kidney disease, and increasing patient age may lead
to a less favorable outcome.
When to refer? If there are evidence of complicating factors (urolithiasis, obstruction) or
absence of clinical improvement in 48 hours. And when to admit?. If there are severe infections
or complicating factors, evidence of sepsis, or need for parenteral antibiotics or need for
radiographic imaging or drainage of urinary tract obstruction.
STANDARD REFERENCE
1. Jameson., Pauci., Kasper, Hauser., Longo., and Loscalzo. Harrisson's Principles of
Internal Medicine 20th edition, McGraw-Hill Professional, 2018
2. Feehally, J., Floege, J., Tonelli, M., Johnson, R. Comprehensive Clinical Nehprology. 6th
edition. Elsevier. 2019
3. Brenner & Rector's The Kidney. 10th edition by Barry M. Brenner, Floyd C. Rector, Elsevier
Health Sciences, 2016.
4. Papadakins, M., McPhee, S. Current Medical Diagnosis and Treatment. 57th ed. McGraw-
Hill Lange. 2018
5. Papadakins, M., McPhee, S. Current Medical Diagnosis and Treatment. 58th ed. McGraw-
Hill Lange. 2020

Basic knowledge that must be known
1. Definition and Etiology of Acute Pyelonephritis.
2. Pathogenesis of. Acute Pyelonephritis.
3. Clinical Manifestation of Acute Pyelonephritis.
4. Physical Findings of Acute Pyelonephritis.
5. Diagnostic Techniques for Acute Pyelonephritis.
6. Prevention and Treatment of Acute Pyelonephritis.
SCENARIO: CASE 1
Male usia 46 years old, came to ER with chief complaint flank pain, worsening since 3
days prior to admission. Patients also complaint about fever since 2 days ago. The fever
accompanied with nausea-vomitting since 1 days prior to admission. Patients also said about
recurrent disuria conditions since 1 month ago. From physical examination we found severy ill
appearance; T=150/90 mmHg; N=98x/menit; Tax=39,8C; Visual analog scale (4/10) and there
was pain on CVA (costo vertebral angle). From plain abdominal photo there was radioopaque
appearance looklike a widening pelvic renalis on right side.
LEARNING TASK
1. Describe the positive finding from the anamnesis, physical examination!
2. Define differential diagnosis and other examination to support the diagnosis. What further
investigation/s (if any) would you order?
3. Define management of this case!
SELF-ASSESSMENT
1. Describe how do people get acute pyelonephritis!
2. Describe symptom of acute pyelonephritis?
3. Describe people at risk for acute pyelonephritis
4. Describe pathogenesis of acute pyelonephritis
5. Describe diagnosis of acute pyelonephritis
6. Define management of acute pyelonephritis
7. Define prevention and prognosis of acute pyelonephritis
LECTURE 18
LECTURE PRACTICUM Microscopic Structure of Urinary Tract
Lecture Practicum microscopic structure of urinary tract and male genital system will be
held and organized by Dr.dr. I A Ika Wahyuniari, M.Kes
Practicum in the form of lectures will be held in class room where the lecturer will
present picture of histological features of urinary tract and male genital system.
The purpose of this learning process and method is to strengthen the theory of
histological aspect of urinary tract and male genital system that students have learned
LECTURE 19
URINALYSIS
Prof.Dr. dr. AA Wiradewi Lestari Sp.PK (K)
AIMS:
Apply and interpret special studies in diagnosis urogenital system disorders, including laboratory
and imaging examination.
LEARNING OUTCOME:
Recognize the potential uses of common diagnostic and therapeutic procedure in urogenital
system disorders.
CURRICULUM CONTENS:
Urine specimens collection
physical analysis.
chemical analysis.
microscopic analysis.
ABSTRACT :
Urinalysis is primarily requested for the diagnosis of renal disorders. Urine specimens must be
collected properly and carefully in order to provide meaningful information. Urinalysis consist of
physical, urine chemical and urine microscopic analysis. Physical examination of urine includes
measurement of the volume of the urine discharge, examination of colour and appearance,
detecting the odour and recording the specific gravity. Chemical analysis of urine is performed by
using reagent strips. Some information can determined using these strips including pH, protein,
glucose, ketones, bilirubin, urobilinogen, blood, nitrites, leukocyte esterase, specific gravity. The
reagent strips are wetted by urine, a chemical reaction takes place which results in change of
color. Results are reported as one of the following : concentration, small/moderate/large,
1+/2+/3+/4+,+/-/normal. Specific gravity and pH always given as numerical value. Urine
microscopic analysis is meaningful only when the specimen is a freshly voided, first morning
sample of urine. Urine microscopic analysis reveals celluler structures, non-celluler structures,
cast and microorganisms. If the specimen is cloudy, it may be due to the presence of bacteria,
pus cells and red cells. Presence of cast is associated with renal disorder, and the presence of
bacteria, protozoa or parasites may indicate renal infection. Increased leucocyte count of urine is
an indication of renal infection
LEARNING TASK :
1. Please explain about urine physical examination and the pathologic result of urine physical
examination
2. Please explain about the technic of urine microscopic analysis
3. Please explain about the pathologic result of urine microscopic analysis
SELF ASSESSMENT
1. Please explain about the pathologic result of urine chemical analysis
2. Please explain about the technic of urine chemical analysis
LECTURE 20
UNDESCENSUS TESTIS, RETRACTILE TESTIS AND HYDROCELE
dr. Pande Made Wisnu Tirtayasa, Sp.U(K), PhD
Department of Urology
Aim
Students are expected to comprehend the definition, etiology, significance,
examination and therapy of undescensus testis and retractile testis and also the
definition, etiology, and examination of hydrocele.
Learning outcomes
At the end of the lectures, the students are expected to:
1. Appreciate the etiology of undescensus testis, retractile testis and hydrocele
2. Explain the examination of undescensus testis, retractile testis and hydrocele
3. Suggest the therapy needed to repair undescensus testis, retractile testis and
hydrocele
Abstract
Undescensus testis is a condition whereby the testis is not in the scrotum or cannot
be brought to the scrotum during physical examination. Another medical term for
undescensus testis is cryptorchidism. Crypthorchidism means hidden or obscure
testis in Greek and is often used interchangeably with the term “undescended testis”.
However, a crypthorchid testis may be atrophic or ectopic as opposed to truly
undescended. From a clinical point of view, the testis may be palpable or
nonpalpable.
A testis which is not in the scrotum on physical examination is either palpable
elsewhere or non-palpable. A palpable testis may be found along the normal
descending pathway (truly undescended, exiting the abdomen at the internal inguinal
ring in the direction of the external inguinal ring), or ectopic outside the normal
pathway (perineal, femoral, prepenile).
A testis outside the scrotum but palpable, can be retractile (not truly undescended),
incompletely descended (within the inguinal canal or just outside), or ectopic
(following a different pathway, e.g., perineal, femoral). The inability to palpate a testis
(non-palpable) means the testis is beneath the external oblique fascia (unusual), in
the abdomen, or atrophic/absent.
A boy with a unilateral normal descended testis has the same paternity chance as
a boy with bilateral normal descended testis (90%). Paternity rate in bilateral
undescended testes is 62%. The incidence of bilateral undescended testes is 5% to
15% of all boys with undescended testes.
A retractile testis is not truly undescended and is mostly palpated in the inguinal
area. A retractile testis has an extrascrotal position intermittently because of an active
cremasteric reflex. By definition, retractile testes function normally and do not require
any form of treatment. In rare cases, a retractile testis can become “ascended” and
may eventually require treatment.
Many theories have been proposed to explain the etiology of cryptorchid testes,
such as abnormality of gubernaculum testis, reduced intra-abdominal pressure,
abnormal testis (inborn error), endocrine abnormality (at testicular level). Patients with
history of cryptorchidism or a truly undescended testis have an 8 to 30 times
increased risk of testis cancer. A cryptorchid testis is more mobile and therefore more
prone to torsion. In addition, the majority (up to 80%) of children with a cryptorchid or
undescended testis will have a patent processus vaginalis (indirect inguinal hernia).
The diagnosis of cryptorchidism is made after physical examination and
consideration of the patient’s medical history. If a child has no testis in the scrotum,
the most important task of the examining physician is to determine whether the testis
is palpable (retractile and not truly undescended, inguinal, or ectopic) or nonpalpable
(abdominal, inguinal, or absent-atrophic).
The rationale for treatment of patients with cryptorchidism is based on limiting
complications and correcting the associated findings. Preservation of germ cell
deterioration and reducing the chance of developing malignancy are the main
considerations, although the chance of torsion, trauma, and the psychological aspect
of missing a testis also play a role. In general, the treatment of undescensus testis is
mainly divided into two approaches, hormonal therapy and surgery.
Hydrocele is a condition in which there is an accumulation of fluid around the
testicle. There are two types of hydrocele: communicating (persistence of a patent
processus vaginalis) and noncommunicating (no connection to the peritoneum). The
diagnosis is made, in most cases, by observation, often by the parents. A lump or
bulge will be present in the groin, scrotum, or labia. The lesion is noted particularly at
times of increased intra-abdominal pressure (e.g., crying or straining). The persistent
hydroceles that do not resolve during the first or second year of life need surgical
correction.
Case study
A 1.5-year-old boy brings to the clinic by his parents. The mother complained about
the left testis of her son is disappeared. The mother believes that both testes were in
the scrotum when his son was a newborn. She also said that this is not the first time
his son showing this symptom. A couple of months ago his testis was disappeared
but back to normal after some time. In addition, there is a bulge present in the left
groin every time he cries.
Learning Task
- What is the diagnosis of this patient?
- What is another condition that accompanies the main diagnosis?
- How you will educate the parent regarding the treatment?
References
1. Baskin LS, Kogan BA, Stock JA. Handbook of Pediatric Urology, 3rd Ed. Wolters
Kluwer, 2019.
2. Duarsa GWK. Kelainan Testis: Anatomi, Fisiologi dan Tatalaksana. Udayana
University Press, 2019.
3. Partin AW, Dmochowski RR, Kavoussi LR, Peters CA. Campbell-Walsh-Wein
Urology, 12th Ed. Elsevier, 2021.
4. Tanagho EA, McAninch JW. Smith’s General Urology, 19th Ed. Lange, 2020.
5. Wilcox DT, Thomas DFM. Essentials of Pediatric Urology, 3rd Ed. Taylor and
Francis, 2022.
LECTURE 21
GENITAL INFECTION, PROSTATITIS, EPIDIDIMITIS, URETRITIS, BALANO
PROSTITIS
Dr. Pande Made Wisnu Tirtayasa, SpU(K), PhD
Aims
Students are expected to appreciate the definition, etiology, signs and symptoms,
examinations, differential diagnosis and treatment of several types of genital
infections such as prostatitis, epididymitis, urethritis and balano-postitis.
Learning outcomes
At the end of the lectures, the students are able to:
1. Comprehend the etiologies of genital infection
2. Explain the signs and symptoms of several types of genital infection
3. Order the examinations needed to diagnose the genital infection
4. Differentiate the differential diagnoses regarding genital infections
5. Decide the proper management on genital infections
Abstract
Prostatitis is the condition in which prostate become inflamed and swelling. The
disease usually causes difficult and painful on micturition. Depending on the cause,
prostatitis may improve quickly, while the other type of prostatitis may last for months
or keep recurring. There are some risk factors and complications of prostatitis that
have to be informed to the patients in order to minimize recurrencies as well as
complications.
Epididymitis is defined as an inflammation of the epididymis with or without
infection, that can be classified as acute, subacute and chronic condition. Epididymitis
is the most common cause of intra-scrotal inflammation. Several pathogens can
cause epididymitis such as Neisseria Gonorrhoeae, Chlamydia trachomatis, and
Escherichia Coli. Risk factors for epididymitis including high-risk sexual activity,
intense physical activity, and long-term sitting position. Epididymitis as well as orchitis
must be differentiated with another entity such as testicular torsion, which can be
achieve by proper physical and additional examination. Therapy on epididymitis must
be focused on the improvement of infection, symptoms and complications by the
delivery of empirical and definitive antibiotics.
In general, orchitis is defined as an inflammation on the testicular. Orchitis as a
stand-alone entity is uncommon as this condition commonly found concurrently with
epididymitis. The prevalence of orchitis peaked on sexually active men, majority in
the group age of 20-40 years old. Bacterial orchitis might exist as a result from
bacterial spreading of bacterial epididymitis, which may cause from several
pathogens as mentioned above. The management of orchitis including supportive
and symptomatic treatment.
Balanopostitis is a condition defined by the inflammation of both penile glans and
preputium, which usually occur on uncircumcised men. The term balanitis referring to
inflammation on penile glans, while postitis on preputium. Balanopostitis can affect
men in every age group and ethnicity. Several pathogens can cause this condition,
which S. hemoliticus A is the commonest one. Balanitis usually affects the
uncircumcised men due to the poor hygienity and aeration. Balanopostitis may
appear as various conditions and symptoms. Treatment of balanopostitis has to
address the sexual and urinary function, and predisposing factors have to be explored
as well.
Urethritis is defined as the inflammation and irritation of the urethra, which typically
increased the urge to urinate and can causes pain during urination. Urethritis can
affect all age groups and both genders. Patient with urethritis may experience some
symptoms related to the inflammation and irritation. There are several types of
urethritis and the treatment based on the etiology of the disease.
Case study
A 22-year-old man admit to hospital due to enlargement of left hemi-scrotum since 4
days prior. The symptom accompanied with fever and worsening pain on the affected
testis. Physical examination reveals axillary temperature was 38.1C, Redness,
swelling and tenderness on left hemiscrotum with negative illumination test.
Learning Task
- What are the differential diagnoses?
- What examination you will order to diagnose the patient?
- Explain the imaging exam you will order and what you will expect on the
imaging?
- How you will treat the patient?
References
6. Duarsa, GWK. Buku Ajar Infeksi Genitalia Pria: Etiopatogenesis dan Tata
Laksana. Airlangga University Press, 2018.
7. Hanno PM, Malkowicz SB, Wein AJ. Penn Clinical Manual of Urology. Elsevier,
2007.
8. Tanagho EA, McAninch JW. Smith’s General Urology, Lange, 2020.
9. Partin AW, Dmochowski RR, Kavoussi LR, Peters CA. Campbell-Walsh-Wein
Urology, 12th Ed. Elsevier, 2021.
LECTURE 22
DRUG USE IN RENAL AND URINARY TRACT DISORDERS
Dr. dr. I Gusti Ayu Artini, M.Sc
AIMS:
The students are expected able to explain and comprehend the basics and principles
of pharmacological changes in renal and urinary tract disorders, and able to apply
these knowledge into rational drug use in renal and urinary tract disorders.
LEARNING OUTCOME:
At the end of the lecture, the students are able to:
1. Comprehend the role of kidney on drug disposition.
2. Describe the pharmacokinetic and pharmacodynamic changes of drugs in renal
disorders.
3. Describe the types of drug-induced renal disease and the pathogenesis
mechanism.
4. Comprehend drug dosage adjustment in renal disorders.
5. Describe the mechanism of action, clinical indication, adverse effects of several
types of diuretics.
6. Comprehend the types of urinary antiseptics, the mechanism of action and
adverse effects.
CURRICULUM CONTENTS
1. The role of kidney on drug disposition.
2. The pharmacokinetic and pharmacodynamic changes of drugs in renal disorders.
3. Types of drug-induced renal disease and the pathophysiological mechanism.
4. Drug dosage adjustment in renal disorders.
5. Mechanism of action, clinical indication, adverse effects of several types of
diuretics.
6. Types of urinary antiseptics, the mechanism of action and adverse effects.
ABSTRACT
Kidney performs a number of essential functions in the body including clearance of
waste product, drug or other substances, control of volume status, maintenance of
electrolyte and acid base balance. Renal impairment (disorders) frequently alters the
pharmacokinetic and pharmacodynamic of certain drugs. Absorption, bioavailability,
protein binding, distribution volume and clearance (metabolism) of several drugs can
be affected, as well as pharmacodynamic processes. Alterations in pharmacokinetic
and pharmacodynamic of drugs in renal disorders (diseases) potentially cause
increased risk of adverse drug reaction. In addition, multiple medical problems in
patient with kidney disease frequently result in polypharmacy and consequently
increased drug interaction. Careful attention should also be taken for drug use in renal
disease. Many drugs potentially cause drug-induced renal disease, thus their uses in
renal impairment should be avoided or the dosage should be adjusted. Drug-induced
renal disease may result from immunological or non-immunological process, and may
affect pre renal, renal or post renal. Dosage adjustment in renal disorders commonly
required for drugs which eliminated mainly by renal excretion or drugs with narrow
safety margin. Diuretic is group of drugs that increase the secretion of urine (water,
electrolytes and waste products) by the kidney. Diuretics inhibit renal sodium
reabsorption by several mechanisms. Each type of diuretic acts upon a single
anatomic segment of the nephron, which has a distinctive transport function. There
are several types of diuretics available recently, carbonic anhydrase inhibitors, loop
diuretics, thiazides, potassium sparing diuretics, and osmotic diuretics. Urinary
antiseptics are oral drugs that are rapidly excreted into the urine and act there to
suppress bacteriuria. Types of urinary antiseptic available are nitrofurantoin, nalidixic
acid and methenamine.
STANDARD REFERENCES
1. Katzung, B.G., Masters, S.B., and Trevor, A.J. 2012. Basic and Cinical
Pharmacology, 12th Ed. New York: McGraw-Hill.
2. Brunton, L. and Hilal-Dandan, R. 2013. Goodman and Gilman’s Manual of
Pharmacology and Therapeutics. 2nd Ed. New York: McGraw-Hill.

1. The role of kidney on drug disposition.
2. The pharmacokinetic and pharmacodynamic changes of drugs in renal disorders.
3. Types of drug-induced renal disease and the pathophysiological mechanism.
4. Drug dosage adjustment in renal disorders.
5. Mechanism of action, clinical indication, adverse effects of several types of
diuretics.
6. Types of urinary antiseptics, the mechanism of action and adverse effects.
CASE 1
A 38 years old man was admitted to emergency unit due to bloody urine and flank
pain since last week. Patient had history of hypertension since 4 years. Physical
examination revealed BP=180/100 mmHg, edema (+) in both lower extremities,
anemia (+), t =38˚C. Laboratory result revealed WBC= 13.0; Hb= 8.5; BUN= 201;
SC= 16.4. Doctor decided to give several drugs to manage patient’s disease. The
medications planned to be given are antibiotic and anti-inflammatory drug.
LEARNING TASK
1. Mention some considerations for antibiotic and antiinflammatory treatment in
patient with renal disorders.
2. What are the basic concepts of drug dosage adjustment in renal disorders?
SELF-ASSESSMENT
1. Mention several drugs that potentially induce renal disorders!
2. Mention the possible mechanisms of drug-induced renal disorders!
3. Mention pharmacokinetic changes possibly occur in renal disorders!
4. Mention pharmacodynamic changes possibly occur in renal disorders!
CASE 2
A 40 years old man was admitted to emergency unit due to swelling on both legs
since 2 weeks before. After complete physical and laboratory examination patient was
diagnosed as having chronic kidney disease. Doctor decided to give furosemide for
relieving the edema. After several days of furosemide treatment, patient was suffered
from hypokalemia.
LEARNING TASK
1. Mention the adverse effects of furosemide.
2. How was the possible mechanism of hypokalemia resulted from furosemide
treatment?
SELF-ASSESSMENT
1. How is the mechanism of action for each type of diuretics?
2. What is the effect of each class of diuretics in acid base balance and serum
potassium level?
3. Why spironolactone would not cause potassium wasting?
4. What adverse effects might occur in diuretic treatment?
5. Mention some clinical indications of diuretics!
LECTURE 23
COMPLICATED UTI
dr. Ida Bagus Putra Pramana, Sp.U
Aims:
1. Students understand and comprehend the definition, epidemiology, etiology,
pathogenesis, anamnesis, clinical picture, and treatment for patients with
complicated UTI.
2. Students understand and comprehend acute pyelonephritis, renal abscess,
perirenal abscess, and pararenal abscess, acute cystitis, prostatitis,
epididymitis, UTI in high-risk patients (pregnant patients, elderly patients, and
patients with diabetes mellitus), Fournier gangrene disease and urosepsis.
Learning Outcome
1. Students are able to explain the definition, epidemiology, etiology,
pathogenesis, anamnesis, clinical picture, and treatment for patients with
complicated UTI.
2. Students are able to explain acute pyelonephritis, renal abscess, perirenal
abscess, and pararenal abscess, acute cystitis, prostatitis, epididymitis, UTI in
high-risk patients (pregnant patients, elderly patients, and patients with
diabetes mellitus), Fournier gangrene disease and urosepsis.
Curriculum Contents
1. Complicated UTI (Epidemiology, Etiology, Pathogenesis, Clinical Picture)
2. Acute pyelonephritis
3. Renal abscess
4. Perirenal abscess
5. Pararenal abscess
6. Acute cystitis
7. UTI in high-risk patients (pregnant patients, elderly patients, and patients with
diabetes mellitus)
8. Fournier gangrene disease
9. Urosepsis.
Abstract
Basically, this infection starts with an infection in the urinary tract (UTI) which
then spreads to the genital organs and even to the kidneys and has the potential to
cause serious excretory system problems. UTI itself is an inflammatory reaction of
the urothelial cells lining the urinary tract. Acute infections of solid organs (testes,
epididymis, prostate, and kidneys) are usually more severe than those of hollow
organs (bladder-ureters, or urethra); this is indicated by complaints of pain or a more
severe clinical condition. Outpatient antibiotics usually are the first treatment for this
infection, or sometimes we can get rid of this infection naturally by resting, drinking
water, giving the infection some times to heal without any medicine needed. However,
for chronic infections which have caused damage to various organs, it requires
supportive therapy and adequate antibiotics given by healthcare professional. The
goal of urogenital organ infections therapy is to prevent or stop the dissemination of
germs and products produced by germs in the systemic circulation and prevent
damage to the urogenital organs.
• Uncomplicated UTIs (simple) refers to urinary tract infections in patients
without anatomic abnormalities or structural anomalies in the urinary tract.
• Complicated UTI is any urinary tract infection that occurs in patients who suffer
from anatomic/structural abnormalities in the urinary tract, or have systemic
disease. These anomalies can lead to treatment failure in getting rid of germs
and require different antibiotics.
Urinary tract infections can affect patients of all ages from newborn baby to the
elderly. In general, women tend to get UTI episodes more frequently than men
because the female urethra is shorter than the male. However, in the neonatal period,
UTIs are more common in male infants (2.7%) who do not undergo circumcision than
female infants (0.7%).
Urinary tract infection occurs when microorganisms enter the urinary tract and
begin to multiply in the urine medium. Microorganisms enter the urinary tract by: (1)
ascending, (2) hematogenous as in M tuberculosis or S aureus transmission, (3)
lymphogenic, and (4) directly from surrounding organs that have previously been
infected.
The ability of the host to restrain microorganisms from entering the urinary tract is
caused by several factors, including: (1) local defence of the host, and (2) the role of
the immune system which consists of humoral immunity and cellular immunity.
The protein in the urine which acts as a bactericidal is uromucoid or Tamm-
Horsfall protein (THP). This protein is synthesized by epithelial cells of the ascending
loop of Henle and distal tubular epithelium. After being secreted in the urine, these
uromucoids bind to the fimbriae of type I and S bacteria thereby preventing bacteria
from attaching to the urothelium.
Actually, the best defence of the urinary system from infection is the urine wash
out mechanism, which refers to the flow of urine that is able to clean the germs in the
urine. Disruption of this mechanism causes germs to easily replicate and attach to
the urothelium.
Most bacteria have long filamentous structures known as pili or fimbriae which
extend from their surface. Pili has a role in attaching cells to the urothelium through
receptors on the surface of the urothelium. In terms of its type, there are 2 types of
bacteria which have different virulence, namely type 1 pili bacteria (which often cause
infections in cystitis) and type P pili (which often cause severe infections including
acute pyelonephritis).
Pyuria is a condition in which urine contain high levels of white blood cells or
leukocytes. Urine is considered to have pyuria if microscopically there are > 10
leukocytes per mm3 of urine or there are > 5 leukocytes per high-power field of unspun
urine.
A complete blood count test is necessary to help detect and reveal problems like
the presence of an inflammatory or infectious process. The presence of leucocytosis,
an increase of erythrocyte sedimentation rate, or the presence of immature blood
cells in the blood smear indicates an acute inflammatory process. In cases of chronic
infection, it is necessary to examine and evaluate kidney function, liver function,
hemostasis function, blood electrolytes, blood gas analysis, and bacterial culture for
intensive treatment of UTI.
Radiological investigations that can be carried out are BOF, IVP, voiding
urethrocystography (VCUG), ultrasound, and CT scan. Most patients with UTI who
do not give clinical symptoms (asymptomatic bacteriuria) have no adverse
consequences and derive no benefit from antibiotic therapy, yet if people have
symptoms of UTI, the healthcare provider need to give treatment by immediately
giving antibiotics. Even if the infection is severe enough, hospitalization is needed for
bed rest, hydration, and intravenous medical administration in the form of analgesics
and antibiotics. Antibiotics are given based on bacterial culture and antibiotic
sensitivity tests.
Urinary tract infections can cause possible complications, including: (1) acute
kidney failure, (2) urosepsis, (3) necrosis of the renal papillae, (4) formation of urinary
tract stones, (5) suppuration or abscess formation, and (6) granuloma.
Some diseases that must be studied in urinary tract infections such as acute
pyelonephritis, renal abscess, perirenal abscess, and pararenal abscess, acute
cystitis, prostatitis, epididymitis, UTI in high-risk patients (pregnant patients, elderly
patients, and patients with diabetes mellitus), Fournier gangrene disease and urosepsis.
References:
1. Basuki B Purnomo. Dasar – Dasar Urologi Edisi ketiga. Sagung Seto. 2015
2. G. Bonkat (Chair), R. Bartoletti, F. Bruyère, T. Cai, S.E. Geerlings, B. Köves,
S. Schubert, A. Pilatz, R. Veeratterapillay, F. Wagenlehner Guidelines
Associates: W. Devlies, J. Horváth, G. Mantica, T. Mezei, B. Pradere,
Guidelines Office: E.J. Smith. Urological Infection. EAU Guidelines. 2022
Self-Directing Learning
1. Complicated UTI (Epidemiology, Etiology, Pathogenesis, Clinical Picture)

2. Acute Pyelonephritis
3. Renal abscess
4. Perirenal abscess
5. Pararenal abscess
6. Acute cystitis
7. UTI in high-risk patients (pregnant patients, elderly patients, and patients with
diabetes mellitus)
8. Fournier gangrene disease
9. Urosepsis
Scenario / cases:
1. A male patient aged 65 years came with complaints of pain during urination,
namely weak urine stream for 1 month ago. For 2 days ago, the patient has
been complaining of his painful urination (dysuria) with increased frequency
along with incomplete urination. The patient also complained of pain in the
suprapubic area and got fever for the past 2 days.
2. A 43-year-old male patient came to the emergency room with complaints of
intermittent right flank pain radiating to the right front abdomen for 4 hours
before hospitalizing. The pain comes on suddenly. Patient has been suffering
from fever and chills for 1 day ago. Patient had history of urinary tract stones
3 years ago and had surgery.
Learning Task
For Case no 1
1. What are additional anamnesis and physical examination performed on this
patient?
2. What are the possible diagnosis and differential diagnosis in this patient?
3. What is the etiology of the case?
4. What supporting examinations do you propose in this case, mention the
reasons?
5. Explain the examination procedure of this case!
For Case no 2
6. What are additional anamnesis and physical examination performed on this
patient?
7. What are the possible diagnosis and differential diagnosis in this patient?
8. What are the possible etiologies of this case?
9. Explain the supporting examinations that you propose in this case and
describe the reasons?
10. Explain the examination procedure of this case!
Self-Assessment:
1. Be able to explain the Etiology of Complicated UTI
2. Be able to explain the Epidemiology of Complicated UTI
3. Be able to describe the Pathogenesis of Complicated UTI
4. Be able to explain and perform anamnesis for Complicated UTI, acute
pyelonephritis, renal abscess, perirenal abscess, and pararenal abscess,acute
cystitis, UTI in high-risk patients (pregnant patients, elderly patients, and
5. Able to explain and perform physical examination for Complicated UTI, acute
6. Be able to explain supporting examination for Complicated UTI, acute
7. Be able to explain treatment procedures for Complicated UTI, acute
LECTURE 24
CHANCROID AND PRIAPISM
dr. Ida Bagus Putra Pramana, Sp. U
Aims:
3. The students understand the epidemiology, etiology, pathogenesis,
anamnesis, Clinical Illustration, and the treatment of Chancroid
4. The students understand the clinical illustration of Priapism, the type and
etiology of Priapism, and priapism diagnosis and management.
Learning Outcomes
3. The students are able to explain the epidemiology, etiology, Pathogenesis,
anamnesis, clinical illustration, and Chancroid management
4. The students are able to explain the clinical illustration of Priapism, the type
and etiology of Priapism, and priapism diagnosis and management.
Abstract
Chancroid is a bacterial infection causing genital ulcers due to Stem-Shaped
Gram-Negative Bacteria known as Haemophilus ducreyi (H. Ducreyi) characterized
by a clinical symptom in the form of ulcers around the genitals and often accompanied
by suppuration of the regional lymph node. Infection in females is started by papules
(skin lesions) or vesicopustulars in the perineum, cervix, or vagina, 3 – 5 days after
being exposed. The lesions have been grown for 48 – 72 hours into very soft dish-
shaped ulcers with uneven edges. Thick discharge produced by ulcers is smelly or
infectious. The epidemiology of this disease can infect both males and females and
it can spread through sexual intercourse; besides, it can also spread through skin
contact with chancroid-infected wounds. Bacterial toxins of H. Ducreyi result in
stopping the regeneration up to the death of cells or tissues (necrosis). The time
needed by bacteria from being exposed to causing symptoms is around 1- 2 weeks.
The initial symptoms of chancroid are usually characterized by the existence of one
soft erythematous papule or more in the genital area after 3 or 7 days after the
infection. The genital papules may be broken after several days and are developed
into superficial ulcers with rough and uneven edges. It can be followed by Inguinal
lymphadenitis characterized by inflammation (the swelling) of the lymph nodes in the
groin area accompanied by pain. The diagnostic criteria of chancroid based on the
Ministry of Health in 2015 are as follows: Anamnesis: the painful wounds in the
genital, a history of having sexual contact before, physical examination for multiple
ulcers, irregular edges, reverberated walls, and a dirty bottom. Lesions in males are
usually limited in the frenulum, coronary sulcus, and preputium. Meanwhile, lesions
in females are mostly in the vagina or vaginal introitus. The diagnosis of chancroid is
established using several methods, namely, culture, microscopic with gram staining
procedure, serology testing, and Nucleic Acid Amplification Test (NAAT). Several
antibiotics are recommended for chancroid treatment. They are the first line,
Ceftriaxone as a single intramuscular injection of 250 mg or a single oral dose of
azithromycin of 1 g. The responses are generally good even though it also reports
failures, especially in patients with HIV. The second line is Ciprofloxacin 500 mg per
oral twice a day for 3 days or Erythromycin 500 mg per oral four times a day for 7
days.
Priapism is a condition where there is a prolonged erection for more than 4 hours
without any sexual stimulation. It consists of two types of priapism, namely Ischemic
priapism (Low-Flow or Veno-Occlusive) and non-Ischemic priapism or high-flow
priapism. Low-Flow (Ischemic) priapism will show a hard penis shaft, soft glands of
the penis, and it is followed by pain; this is usually caused by Leukemia, Sickle Cell
Anemia or disseminated intravascular coagulation, drugs, or pelvic malignancy. The
analysis of penile blood gas will indicate pO2 of < 30, pCO2 of > 60, and pH of < 7.25.
Meanwhile, the High-Flow (Non-Ischemic) priapism is usually not painful and caused
by trauma in the perineum area, or spinal cord. Other causes are spinal canal
stenosis, sacral tumors, transverse myelitis, epidural hematoma, transurethral
surgery, or spinal anesthesia. The result of the penile blood gas analysis in patients
with high-flow priapism will indicate pO2 of >90, pCO2 of < 40, and pH of < 7.4.
References:
3. Gede Wirya Kusuma Duarsa. Infeksi Genitalia Pria, Etiopatogenesis dan
Tatalaksana. Airlangga University Press. 2018
4. K. Hatzimouratidis (Chair), F. Giuliano, I. Moncada, A. Muneer, A. Salonia
(Vice-chair), P. Verze Guideline Associates: A. Parnham, E.C. Serefoglu.
Erectile Dysfunction, Premature Ejaculation, Penile Curvature and Priapism.
European Urology Association Guideline 2019.
Curriculum Content
1. The Epidemiology, Etiology, and the Pathogenesis of Chancroid
2. The Anamnesis and Physical Examination of Chancroid
3. Chancroid Management
4. The Epidemiology, Etiology, and the Pathogenesis of Priapism
5. The Anamnesis and Physical Examination of Priapism
6. Priapism Management
Scenario/case:
1. A male patient came to a hospital with a complaint of a wound in the coronary
sulcus with a round shape and a higher edge and it sometimes feels painful.
The wound appeared after 4 days of having sexual intercourse without having
any contraceptives and doing it with another person (not his wife)
2. A 43-year-old man came to the hospital Emergency Unit with a complaint of
having a prolonged erection of more than 4 hours accompanied by pain. There
no history of trauma nor blood-related diseases.
Learning Tasks
1. For the first case, what is the possible diagnosis for the patient?
2. What are the Anamnesis and physical examination that can be obtained in that
case (case 1)?
3. What are the etiological causes of the case (case 1)?
4. Explain the management for the first case (case 1)?
5. For case no 2, what is the diagnosis for the patient (case 2)?
6. What are the Anamnesis and physical examination that can be obtained in that
case (case 2)?
7. What are the possible etiological causes of the case (case 2)?
8. Explain the supporting examination established in this patient and the result
interpretation (case 2)!
9. Explain the management in the patient (case 2)?
Self-Directing Learning:
1. The students learn the etiology, epidemiology, pathogenesis, Anamnesis,
physical examination, supporting examination, and the management of
Chancroid
2. The students learn the etiology, pathogenesis, Anamnesis, physical
examination, supporting examination, and the management of Priapism.
Self-Assessment:
8. Explaining the etiology of Chancroid
9. Explaining the epidemiology of Chancroid
10. Explaining the pathogenesis of Chancroid
11. Able to explain and perform the anamnesis of Chancroid
12. Able to explain and perform the physical examination for Chancroid
13. Able to explain the supporting examination for Chancroid
14. Able to explain the management and the treatment for Chancroid.
15. Explaining the etiology of Priapism
16. Explaining the pathogenesis of Priapism
17. Able to explain and perform the anamnesis of Priapism
18. Able to explain and perform the physical examination for Priapism
19. Able to explain the supporting examination for Priapism
20. Able to explain the management and the treatment for Priapism
LECTURE 25
RENAL CELL CARSINOMA, SUPRA RENAL AND WILMS TUMOR, UROTHELIAL
CARCINOMA
Aims
To describe the epidemiology, risk factors, clinical manifestation, diagnosis and
staging, principles of treatment as well as the prognosis of each cancer or disorders.
Learning Outcome
• Describe the epidemiology, risk factors, clinical feature, diagnosis and staging,
treatment and prognosis of renal cell carcinoma in early and metastatic disease.
• Describe the epidemiology, classification, clinical feature (symptoms and signs),
metabolic evaluation, diagnosis and treatment of supra renal or adrenal gland
disorders.
• Describe the epidemiology, classification, clinical manifestation, diagnosis and staging,
treatment dan prognosis of Wilms tumor in children
• Describe the epidemiology, classification, risk factors, clinical feature, diagnosis and
staging, as well as the treatment and prognosis of urothelial carcinoma, both of upper
tract and lower tract UC.
Curriculum Contents
• Epidemiology (incidence rate, peak incidence) of renal cell carcinoma, Wilms tumor
and urothelial carcinoma, especially bladder cancer.
• Clinical manifestation (symptoms and signs) of each cancer and metabolic evaluation
of supra renal or adrenal gland disorders.
• Classification, diagnosis and staging of each cancer based on clinically, histopathology
type, tumor markers or metabolic disorders and imaging.
• Principles of treatment and prognosis of each cancer for early and advanced stage as
well as adrenal gland disorders.
Abstract
Renal cell carcinoma (RCC) accounts for 2-5% of adult cancers and constitutes
approximately 70-80% of all primary malignant renal tumor. Most commonly in the sixth
to seventh decades and has a male-female ratio of 2:1. RCC is a heterogenous disease
with multiple exposure-related such as smoking cigarette and occupational as well as
genetics etiologies. The classically triad of gross hematuria, flank pain and flank mass
occurs in only 7-10% of patients and frequently a manifestation of advanced disease.
Another systemic manifestation are associated with a wide spectrum of paraneoplastic
syndromes (10-40%) and reversible of Stauffer’s syndromes (3-20%). Simple radiologic
technique like ultrasonography and high-quality, multiphase with contrast-enhanced,
cross-sectional imaging like CT or MRI can be used to detection, differential diagnosis
and staging of renal masses (solid or cystic and benign or malignant lesions). Local
treatment for localized disease or locally advanced such as thermal ablation, surgical
resection (partial or radical nephrectomy) or angiography-embolization and for metastatic
disease is systemic therapy like targeting therapy or immunotherapy. Unfortunately, this
RCC is radio-chemo resistance.
Wilms tumor or nephroblastoma is the most common solid renal tumor of childhood,
accounting for roughly 5% of childhood cancers. The peak age for presentation is during
the third year of life. In 5% of cases the tumors are bilateral. Approximately 10% of
patients have recognized congenital anomalies or malformations, like WAGR syndrome
(more common) and Beckwith-Wiedemann syndrome. The most common signs and
symptoms are asymptomatic abdominal mass with distention, anorexia, nausea and
vomiting, fever and hematuria. The diagnosis and staging based on clinically, imaging
(ultrasonography and abdominal CT), sometime need to preoperative needly biopsy and
surgical as well as pathological finding; with the NWTS or ISOP staging system for
disease classification. With multimodality approach to the treatment such as surgery
(radical nephrectomy), chemotherapy and radiation therapy, patients with Wilms tumors
has significantly improved outcomes.
The adrenal gland consist of adrenal cortex (90%) and adrenal medulla (10%) with
distinct endocrine functions. Adrenal cortex is composed of three zones: zona
glomerulosa (mineralocorticoids), zona fasciculata (glucocorticoids) and zona reticularis
(sex androgen), whereas adrenal medulla is composed of chromaffin cells that secrete
catecholamines. Most of the unsuspected adrenal mass or tumor detected on cross-
sectional imaging performed for an unrelated reason (incidentalomas) or there are
metabolic disorders or metabolic evaluation after sign and symptoms of some disorders
such as Cushing’s syndrome, Conn’s syndrome (primary aldosteronism), congenital
bilateral adrenal hyperplasia (CAH) or pheochromocytoma. Generally adrenal mass
divided into functional and non-functional, based on the presence or absence of metabolic
disturbances as well as into benign or malignant mass, such as adrenal adenoma,
myelolipoma, neurofibroma, adrenal hyperplasia, adrenal cyst, hemangioma (benign
lesion) and adrenocortical carcinoma, adrenal metastasis (malignant lesion).
Urothelial carcinoma (UC) or transitional cell carcinoma (TCC) is the most epithelial
carcinoma in the urinary tract (90-95%) and the rest is non-urothelial carcinoma such as
squamous cell carcinoma, adenocarcinoma and undifferentiated carcinoma (5-10%). UC
can occur in the upper urinary tract (UTUC) like ureter and pelvicalyceal system with
accounts approximately 5-10% and in the lower urinary tract like bladder and urethra
constitutes approximately 90-95%. UTUC can be developing to bladder cancer by 30-
35% and to contralateral side by 2-4%. Conversely bladder cancer can be up-spreading
and developing to UTUC approximately less than 2%. Some risk factors already identified
for UC such as cigarette smoking, exposure of carcinogenic from occupational orchemical
agents consist of aromatic amines, naphthylamine, benzidine and also chronic
local inflammation. Specific manifestation is intermittent painless hematuria and the
diagnosis can be made based on imaging and tissue biopsy from urinary tract. Decision
of treatment according the TNM cancer staging system, included the surgery, radiation
therapy and chemotherapy (local or systemic).
Learning Task and Self Assessment

Case 1 (Renal Cell Carcinoma)
65-years old man in primary health care with left flank mass since 2 years. He had
history of intermittent haematuria and left flank pain, weight loss up to 10 kg in 6
months, looks pale and there is erythrocyte in urinalysis.
a. Try to make some differential diagnosis for this patient !
b. What will you plan to fine a final diagnose ?
c. When will you refer this patient (indication) to a referral top hospital ?
d. My you have one example definitive treatment options, based on your diagnosis
?
Self Assessment :
a. The risk factors of renal cell carcinoma !
b. Characteristics of triad classic feature, paraneoplastic syndrome, and metastatic
symptoms of renal cell carcinoma !
c. Treatment options and follow-up !
Case 2 (Wilms Tumor)

Seven years old boy referred from primary health care with left flank mass since 1
year, become worsening, enlargement of his abdomen, with nausea and sometime until
vomiting as well as loss of appetite. He had no history of haematuria and febrile. Normal
urinalysis.
a. What are differential diagnosis of this case?
b. What are the further examination to definitive diagnosis?
c. How to clinical staging of this case?
d. What are the most possibility treatment for the patient?
Self Assessment :
a. The classification and staging of Wilms tumor !
b. The diagnostic tool (laboratory and imaging) for Wilms tumor diagnosis !
c. Treatment options and prognosis patients with Wilms tumor !
Case 3 (Adrenal Gland Disorders)
Forty years old woman who presented to private hospital with complaints of
repeated symptoms of flatulence and epigastric discomfort over a few months. After being
evaluated with ultrasonography and then confirmed by abdominal CT scan showed a
large solid mass measuring approximately 16 cm in its greatest dimension that originated
from her right adrenal gland and occupied her right abdomen.
a. Try to make some differential diagnoses of this patient !
b. What metabolic evaluation tests are needed ?
c. When will you refer patients to a referral hospital ?
d. My you have one example definitive treatment options, based on your diagnosis?
Self Assessment :
a. The metabolic function of adrenal or supra renal gland !
b. Classification of adrenal gland disorder and their clinical manifestations !
c. Diagnosis and treatment option for this disorders !
Case 4 (Urothelial Carcinoma)
54-years old man with heavy cigarette smoking came to outpatient clinic with chief
complaints of intermittent painless hematuria since 8 months, sometime there was blood
clot when urinating. Wight loss up to 8 kg in 3 months.
a. What are the differential diagnoses of this patient !
b. What are any tests needed to support the definitive diagnosis ?
c. When will you refer patients to a referral hospital ?
d. Could you explain the principle treatment for this patient ?
Self Assessment :
a. The risk factors of urothelial carcinoma !
b. Tumor marker for urothelial carcinoma and specific finding in clinical
manifestations as well as some imaging !
c. Treatment options and follow-up !
Standard References
1. Babjuk, M., Burger, M., Comperat, E., et.al. EAU Guidelines on Non-Muscle-
Invasive Bladder Cancer (TaT1 and CIS). EAU 2021 Edition.
2. Ljungberg, B., Albiges, L., Bedke, J., et.al. EAU Guidelines on Renal Cell
Carcinoma. EAU 2021 Edition.
3. McDonald, M.L. and Kane, C.J. Disorders of The Adrenal Glands (Chapter 31). In:
McAninch, J.W. and Lue, T.F. Smith & Tanagho’s General Urology, 19th Edition, 2020;
p509-520.
4. Odisho, A.Y. and Greene, K.L. Renal Parencymal Neoplasms (Chapter 20). In:
McAninch, J.W. and Lue, T.F. Smith & Tanagho’s General Urology, 19th Edition, 2020;
p329-350.
5. Roupret, M., Babjuk, M., Burger, M., et.al. EAU Guidelines on Upper Urinary Tract
Urothelial Carcinoma. EAU 2021 Edition.
6. Witjes, J.A., Bruins, H.M., Cathomas, R., et.al. EAU Guidelines on Muscle-Invasive
and Metastatic Bladder Cancer. EAU 2021 Edition
LECTURE 26
PROSTATE, TESTICULAR AND PENILE CANCER
Aims
To describe the epidemiology, risk factors, clinical manifestation, diagnosis and
staging, principles of treatment as well as the prognosis of each cancer.
Learning Outcome
• Describe the epidemiology and risk factors of prostate, testicular and penile cancer.
• Describe the clinical feature (symptoms and signs) of early and advanced stage of
prostate, testicular and penile cancer.
• Determine the classification, diagnosis and staging of prostate, testicular and penile
cancer.
• Determine principles of treatment and prognosis of early and advanced stage of
prostate, testicular and penile cancer.
Curriculum Contents
• Epidemiology (incidence rate, peak incidence) and risk factors of each cancer.
• Clinical manifestation (symptoms and signs) of each cancer in early and advanced
stage.
• Classification, diagnosis and staging of each cancer based on clinically, histopathology
type, tumor markers and imaging.
• Principles of treatment and prognosis of each cancer for early and advanced stage.
Abstract
Male genital tumors are malignant diseases in male genital organ, consist of
testicular cancer, penile cancer and prostate cancer. Testicular and penile cancer are
rarely, accounting for 1-2% (0,4-0,6%) of malignant diseases in men and less than 5 %
of urological tumors; otherwise prostate cancer is most common of male neoplasms
besides lung, colorectal, liver and nasopharynx cancer.
Testicular cancer occurs most often in younger individual, usually in the second
until fourth decade of life, but it is a most curable solid neoplasms with multimodality
treatment or multidisciplinary approach because tumor operable (for the primary tumor
and regional lymph nodes) and chemo-radio sensitive (for the primary tumor, regional and
distance metastasis). Risk factors for development of testicular cancer included
cryptorchidism, familial history of testicular cancer, personal history of contralateral
testicular cancer or suffer from precursor lesion such as germ cell neoplasm in situ or
intra-testicular germ cell neoplasm (GCNIS/ITGCN). The most histology type is germ cell
tumors (seminoma and non-seminoma GCTs). Result of serum tumor markers (AFP, ß-
HCG and LDH) are very important for diagnosis, staging and follow-up treatment.
Penile cancer is uncommon in western country (0,4-0,6%), but still a lot ofincidence
in development country (Asia, Africa and South America) especially with people who
uncircumcised (2-10%). There are some predisposition-risk factors for penile cancer
included phimosis with chronic irritation of smegma, HPV infection and chronic penile
inflammation with premalignant lesion such as leukoplakia, erythroplasia of Queyrat,
Bowen’s disease, balanitis xerotica obliterans or lichen sclerosis and condyloma
acuminata. Squamous cell carcinoma (SCC) is the most common histology type and most
occurs in old patients above 50 years old (sixth decade) or increases with age. Treatment
of primary lesion (penile preserving treatment or amputation) and management of
regional lymph node involvement such as lymphadenectomy, radiotherapy or systemic
therapy are standard management for penile cancer. The most important for prognostic
factors or survival is regional or inguinal lymph node metastasis.
Prostate cancer is most prevalence malignancy in men besides lung, colorectal,
liver and nasopharynx cancer; and increases with age (age dependent neoplasms). The
risk factors include age, ethnics or racial background and family history or genetic.
Screening for prostate cancer by digital rectal examination and serum PSA level is very
important to finding early prostate cancer, because the clinical manifestation almost the
same with benign prostate hyperplasia. More than 10 years survival rate will be achieved
if prostate cancer patients found in early stage and can be curative treatment with radical
prostatectomy or radiotherapy. Otherwise if they found in advanced stage or metastatic
disease, the treatment only for palliative purposes with multimodal and multidisciplinary
approach (hormonal combinations with supporting therapy) to increase the quality of life
patients. Prostate cancer is the only urological cancer whose the disease journey can be
predicted.
Learning Task
Case 1
35 years old man, unmarried, was suffer from testicle enlargement since 6 months,
not progressively and painless. There wasn’t history of trauma before, dysuria nor fever.
b. What are the diagnostic tool to definitive diagnosis?
c. What are the education, information and communication to patient according the
diagnosis (treatment and prognosis)?
Case 2
53 years old man came to outpatient clinic with chief complained of penile mass
(like cauliflower) on prepuce since a month. He was treated by some doctor with cream
and antibiotic but didn’t become better. He had a wife with two children, but not yet
circumcised and there was not complained about the passing urine.
b. What are the examination to definitive diagnosis?
c. How to clinical staging of this case?
d. What are the most possibility treatment for the patient?
Case 3
75 years old man came to private hospital with complained of LUTS (lower urinary
tract symptoms), without hematuria or fever. On DRE was found hard prostate,
asymmetric and multiple nodule.
a. What are the diagnostic tool and further examination to definitive diagnosis?
b. What are the appropriate treatment for this case?
c. How to follow-up after give the treatment?
Self Directing Learning
• Explain the classification of testicular tumor!
• Explain the indication of serum tumor marker examination for testicular and prostate
cancer!
• Explain the principles management of penile cancer!
• How to prostate cancer screening in primary health care?
• Explain the management of prostate cancer based on staging!
Standard References
1. Cooperberg, M.R., Washington III, S.L., Carroll, P.R. Cancer of The Prostate Gland
(Chapter 21). In: McAninch, J.W. and Lue, T.F. Smith & Tanagho’s General Urology,
19th Edition, 2020; p351-376.
2. Hakenberg, O.W., Comperat, E., Minhas, S., et. al. EAU Guidelines on Penile
Cancer. EAU 2021 Edition.
3. Laguna, M.P., Albers, P., Algaba, F., et. al. EAU Guidelines on Testicular Cancer.
EAU 2021 Edition.
4. Mottet, N., Ven Den Bergh, R.C.N., Cornford, P., et. al. EAU-EANM-ESTRO-ESUR-
ISUP-SIOG Guidelines on Prostate Cancer. EAU 2021 Edition.
5. Porten, S.P. and Presti, J.C. Genital Tumor (Chapter 22). In: McAninch, J.W. and
Lue, T.F. Smith & Tanagho’s General Urology, 19th Edition, 2020; p377-390.
LECTURE 27
URETHRAL SWAB URINE COLLECTION AND INTERPRETATION OF URINE
CULTURE AND SUSCEPTIBILITY TEST
dr. I Ketut Agus Indra Adhiputra, Sp.MK
AIMS:
Able to describe the procedure of urethral swab dan urine collection along with the
interpretation of urine culture.
LEARNING OUTCOME:
1. Able to describe the procedure of urethral swab
2. Able to describe the procedure of urine collection
3. Able to interpret the results of urine culture
CURRICULUM CONTENS:
1. Urethral swab
2. Urinary tract specimen collection
3. Urine culture
ABSTRACT:
Urinary tract infections (UTIs) are extremely common. They account for 8 million visits
to physicians’ offices and over 100,000 hospital admissions per year, with an
estimated cost of $1.6 billion in the United States alone. The etiologic agents of UTIs
often comprise organisms populating the patient’s own intestinal microbiota.
Escherichia coli represents a majority of isolates from both hospitalized patients and
out- patients; Enterococcus, Klebsiella, Enterobacter, and Proteus spp. make up a
large proportion of the remainder. Urine is normally considered a sterile body fluid.
However, it is easily contaminated with microbiota from the perineum, urethra, or
vagina. As a result, the colony count is critical in establishing the microbiological
significance of bacteriuria, and urine cultures are always reported with an
accompanying colony count. There has been a substantial amount of investigation to
determine what threshold of colony count is considered significant. Early
epidemiological studies showed that urine bacterial counts of ≥10 5 CFU/ml of a pure
culture of Gram-negative bacilli were associated with acute bacterial infections of the
urinary tract, and a recent study has supported this threshold in hospitalized patients.
Other studies have supported the significance of lower colony counts, with counts as
low as 102 CFU/ml being associated with infection in symptomatic adult females,
infants, and catheterized patients. Clinical guidelines vary on significant colony count
threshold in different contexts, ranging anywhere from ≥103 to ≥105 CFU/ml depending
on the context. Laboratories may thus choose to tailor workups at different colony
counts based on patient age, sex, and specimen type. The diagnosis of a UTIrequires
both significant bacteriuria and symptoms consistent with infection of the urinary tract,
such as dysuria or urgency. In the absence of symptoms, positive urine cultures
represent asymptomatic bacteriuria. Pyuria may also be a helpful factor in
establishing the presence of a UTI, although it can be nonspecific.
• Leber, Amy L. Clinical Microbiology Procedures Handbook. 4th ed. Washington,
DC: ASM Press; 2016.
• Mahon C, Lehman D. Textbook of Diagnostic Microbiology. 6th ed. St. Louis,
Missouri: Elsevier Saunders; 2019.
• Tille, Patricia M. Bailey & Scott’s Diagnostic Microbiology. 14th ed. St. Louis,
Missouri: Elsevier; 2017.

1. Tools, preparation, and method for urethral swab
2. Tools, preparation, and method for urine collection
3. How to interpret urine culture results
LEARNING TASK
CASE 1:
The patient was a 19-year-old female with a history of a urinary tract infection (UTI) 4
months prior to admission for which she was treated with oral ampicillin without
complications. Five days prior to this admission she began to note nausea without
vomiting. One day later she developed left flank pain, fevers, and chills and noted
increased urinary frequency. She noted foul-smelling urine on the day prior to
admission. She presented with a temperature of 38.8°C, and physical examination
showed left costovertebral angle tenderness. Urinalysis of a clean-catch urine sample
was notable for >50 white blood cells per high-power field, 3 to 10 red blood cells per
high-power field, and 3+ bacteria. Urine culture was subsequently positive for >10 5
CFU of an organism per ml.
Question:
1. What do the urinalysis findings indicate? Explain your answer.

2. Why were the numbers of organisms in her urine quantitated on culture? How
would you interpret the culture results in this case?
3. Did this woman have cystitis or pyelonephritis? why is it important to
differentiate between the two?
CASE 2:
The patient was a 15-year-old male who was brought to the emergency room by his
sister. He gave a 24-hour history of dysuria and noted some “pus-like” drainage in his
underwear and on the tip of his penis. Urine appeared clear, and urine culture was
negative although urinalysis was positive for leukocyte esterase and multiple white
cells were seen on microscopic examination of urine. He gave a history of being
sexually active with five or six partners in the past 6 months. He claimed that he and
his partners had not had any sexually transmitted infections. His physical exam was
significant for a yellow urethral discharge and tenderness at the tip of the penis. He
was given antimicrobial agents and scheduled for a follow-up visit 1 week later. He
did not return.
Question:
1. How do perform urethral swab? Please explain.

2. Are his urinalysis and urine culture findings consistent with his illness?
Please explain.
LECTURE 28
BASIC AND ADVANCE RADIOLOGY IN URINARY SYSTEM
dr. Putu Utami Dewi, Sp.Rad
AIMS: 1. Apply imaging examination in diagnosis urogenital system disorders
LEARNING OUTCOME:
1. Students know the role of radiological examination in diagnosing urinary tract disease
2. Students know the various types of radiological examinations for the urinary tract system
3. Students know the advantages and disadvantages of each radiology modality in making a
diagnosis
4. Students can choose the appropriate imaging examination for various cases of the urinary
tract
Curriculum content:
1. Role of radiology examination
2. Basic and advance radiology examination in urinary system
3. Advantages and disadvantages of each procedure
4. Various cases examination
Abstract
Radiology examination play an important role in diagnosing urinary tract cases, treatment
planning and follow-up/evaluation of therapy. There are various modalities of radiological
examination to evaluate the urinary tract system, ranging from simple ones such as X-ray
examination and contrast studies, to the advance such as ultrasound, CT scan, MRI and
nuclear medicine. Each of these modalities has advantages and disadvantages in evaluating
urinary tract cases.
Learning task
1. A male 30 y.o come to emergency department due to an acute abdominal pain and
hematuria since last night. On the physical examination, left flank pain (+). Urinalysis
finding : crystal (++), eritrosit (+++)
a. Mention the radiological examination that you suggest to evaluate this case
b. Mention the advantage and disadvantage of each imaging modality
c. Mention the expected radiology finding on this case
2. A boy 4 y.o come to the outpatient clinic with repeated urinary tract infection. The
doctor suspected a vesicourethral reflux problem.
a. Mention the radiological examination that you suggest to evaluate this case
b. Mention the advantage and disadvantage of each imaging modality
c. Mention the expected radiology finding on this case
d. Mention the grading of VUR
References:
1. Soetikno, Ristaniah D. Prosedur pemeriksaan radiologi gastrointestinal dan urogenital.
PT.Refika Aditama : 2014
2. Connor Owen J, Maher Michael M. CT Urography. AJR 2010; 195:W320–W324
3. Connor Owen J, Mc Laughin Patrick, Maher Michael M. MR Urography. AJR 2010;
195:W201–W206
EVALUATION FORM OF THE URINARY SYSTEM AND DISORDERS
Please fill the form according to the real condition. This evaluation will not influence your final
block result.
Please cross on the score column that suitable with your judgment
N SCORE
O Point being evaluated 1 2 3 4 5
1 Anatomy of The Urinary and Male Genitalia System
2 Histology of The Urinary and Male Genitalia System
3 Physiology of The Urinary and Male Genitalia System
4 Pathogenesis of Glomerulonephritis and Acute Tubulo-Interstitial Diseases
5 Urinary Tract Infection
6 Acute and Chronic Kidney Disease
7 Secondary hipertension
8 Macroscopic Structure of Urinary Tract and Male Genital system
9 Urolithiasis
10 Urinary Incontinence and Over active bladder
11 Acute and Chronic Glomerulonephritis, Pediatric Hipertension
Nephrotic Syndrome, UTI in children, Congenital Anomaly in Urinary
12 System
13 Hipospadia, Epispadia,PHIMOSIS, PARAPHIMOSIS,
14 BPH, Stricture Urethra, Varicocele, Spermatokel,
15 Neonatal hidronefrosis
16 Pyelonefritis
17 Pathology Anatomy of Urinary tract and Male Genital System
18 Microscopic Structure of Urinary Tract
19 Urinalysis
20 Undesensus testis, Rectractile testis, Hidrokel,
21 genital Infection, Prostatitis, Epididimitis, Uretritis, Balano prostitis
22 Drug Use in Renal and Urinary tract Disorders
23 Complicated UTI
24 Priapismus, Chancroid
25 Carsinoma cell Renal, Supra Renal and Wilm Tumor, Urotelial Carsinoma
26 Prostate cancer and Tumor testis and Tumor penis
27 Urethral swab Urine Collection and interpretation of Urine culture and susceptibility test
28 Basic and advance Radiology in Urinary system
B LEARNING STRATEGY
1 independent learning
2 small group discussion
3 practical
4 problem based learning
5 learning task
6 self assessment
C LECTURER
1 Dr. dr. G. Wirya K Duarsa, MARS, M.Kes, Sp.U (K),
2 dr. I Nyoman Gde Wardana, S.Ked, M.Biomed
3 Prof. Dr. dr. I N. Mangku Karmaya, M.Repro
4 Prof. dr. K. Tirtayasa, MS, AIF

5 dr. G A P Nilawati, Sp.A (K), MARS
6 Dr.dr Wayan Winarti, Sp.PA ( K)
7 dr. Nyoman Paramita Ayu, Sp.PD-KGH, FINASIM
8 Dr. dr. I A Ika Wahyuniari, M.Kes
9 Dr.dr. I Gusti Ayu Artini, S.Ked, M.Sc
10 Dr. dr. Yenny Kandarini, Sp.PD-KGH, FINASIM
11 dr. I Wayan Yudiana, Sp.U ( K)
12 Dr. dr. Kadek Budi Santosa, Sp.U (K)
13 Prof.Dr. dr. A A Wiradewi Lestari, Sp.PK ( K)
14 dr. Putu Utami Dewi, Sp Rad
15 Dr. Ni Nengah Dwifatmawati, Sp.MK, PhD
16 dr. Pande Made Wisnu Tirtayasa, Sp.U(K),Ph.D
17 dr. Ida Bagus Putra Pramana, Sp.U
D Facilitator
1 Name of your group facilitator:
E Assessment
1 time provide
2 Suitability of question with topic given
Score:
1. Bad or not suitable with expectation
2. Insufficient or inadequate with expectation
3. Sufficient or inadequate with expectation
4. Good or suitable with expectation
5. Excellent or exceed expectation
Problem you found during Block Urinary System and Disorders for each point evaluated above:
Topic
Learning strategy
Lecturer
Facilitator
Assessment
Your suggestion/ input:
Topic
Learning strategy
Lecturer
Facilitator
Assessment

154
Blueprint Assessment
NO TOPIC
jumlah
soal
1 Anatomy of The Urinary and Male Genitalia System 4
2 Histology of The Urinary and Male Genitalia System 4
3 Physiology of The Urinary and Male Genitalia System 4
4 Pathogenesis of Glomerulonephritis and Acute Tubulo-Intersititial 3
Diseases
5 Urinary Tract Infection 4
6 Acute and Chronic Kidney Disease 4
7 Secondary hipertension 4
8 Macroscopic Structure of Urinary Tract and Male Genital system 4
9 Urolithiasis 4
10 Urinary Incontinence and Over active bladder 3
11 Acute and Chronic Glomerulonephritis, Pediatric Hipertension 4
12 Nephrotic Syndrome, UTI in children, Congenital Anomaly in Urinary 3
System
13 Hipospadia, Epispadia,PHIMOSIS, PARAPHIMOSIS, 4
14 BPH, Stricture Urethra, Varicocele, Spermatokel, 4
15 Neonatal hidronefrosis 3
16 Pyelonefritis 4
17 Pathology Anatomy of Urinary tract and Male Genital System 2
18 Microscopic Structure of Urinary Tract 4
19 Urinalysis 4
20 Undesensus testis, Rectractile testis, Hidrokel, 3
21 genital Infection, Prostatitis, Epididimitis, Uretritis, Balano prostitis 4
22 Drug Use in Renal and Urinary tract Disorders 4
23 Complicated UTI 3
24 Priapismus, Chancroid 4
25 Carsinoma cell Renal, Supra Renal and Wilm Tumor, Urotelial 3
Carsinoma
26 Prostate cancer and Tumor testis and Tumor penis 3
27 Urethral swab Urine Collection and interpretation of Urine culture and 3
susceptibility test
28 Basic and advance Radiology in Urinary system 3
100
REFERENCES
A. Student Standard References :

1. Moore KL, Agur AMR: Essential Clinical Anatomy, 3rd ed. Philadelphia, Lippincott &
Wilkins, 2007.
2. Sadler TW: Langman’s Medical Embryology, 10thed. Philadelphia, Lippincott & Wilkins,
2006.
3. Gartner LP, Hiatte JL: Color Textbook of Histology, 2nd ed. Philadelphia, WB Saunders
Company, 2001.
4. Guyton AC: Textbook of Physiology, 11st ed. Philadelphia, WB.Saunders Company, 2006
5. Fox S.I.: Human Physiology, 9th ed. New York, McGraw-Hill, 2006
6. Kumar V, Cotran R S, Robbins SL: Robbin’s Basic Pathology, 7th ed. Philadelphia,
Saunders, 2003
7. Trevor AJ, Katzung BG, Masters: Katzung & Trevor’s Pharmacology, 7th ed. New York,
Lange Medical Book’s/Mc.Graw-Hill, 2005.
8. Park MK. Pediatric Cardiology for Practioners. 4th Ed. Philadelphia, Mosby. 2002.
9. McPhee, S.J., Papadakis, M.A., Current Medical Diagnosis & Treatment. 47th ed. New
York, Lange Mecical Book`s/The McGraw-Hill Companies, 2008.
B. Additional Student References :

1. A2: Moore KL, Dalley AF: Clinically Oriented Anatomy, 4th ed. Philadelphia Lippincott &
Wilkins, 1999.
2. H2: Fowcett DW, Jensh RP: Bloom & Fawcett’s Concise Histology, 2nd ed. London,
Arnold. 2002.

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STUDY GUIDE

THE URINARY AND MALE GENETALIA SYSTEM AND DISORDERS

MEDICAL FACULTY OF UDAYANA UNIVERSITY

I Gusti Ayu Sri Darmayani

Department of Medical Education - Faculty of Medicine - Universitas Udayana, 2023

Department of Medical Education - Faculty of Medicine - Universitas Udayana, 2023

Department of Medical Education - Faculty of Medicine - Universitas Udayana, 2023

GENERAL CURRICULUM OF URINARY AND MALE GENITAL SYSTEM AND

• Diagnose and manage patient with common urogenital system disorders.

• Diagnose and refer special patient with urogenital system disorders.

• Manage urogenital system disorders:

• Diagnose and manage independently phymosis and paraphymosis.

NO NAME DEPARTMENT PHONE

21 dr. Bagus Ngurah Mahakrisna, M.Biomed, Sp A Pediatric 082144630623

NO DAFTAR PENYAKIT SESUAI SKDI 2012 TINGKAT KEMAMPUAN

GANGGUAN DAN KELAINAN PADA GINJAL

Nama Kode Durasi/Bobot Semester Block Syarat

CPL-KU17 Mampu memanfaatkan keterampilan pengelolaan Indikator: Ketepatan identifikasi, analisis,

CPL CPL- CPL- CPL-

Mampu menjelaskan dasar-dasar abnormalitas CPB/MK-3

Mampu menjelaskan konsep dasar CPB/MK-4

Mampu menjelaskan implikasi klinik struktur- CPB/MK-6

1. Struktur fungsional sistem urogenital.

Bentuk /Metode On-line F2F

On-line F2F On-line F2F

Kriteria /Indikator • Kedalaman pemahaman/ketepatan penjelasan

On-line F2F On-line F2F

Kriteria /Indikator • Kedalaman pemahaman/ketepatan penjelasan

Materi Sumber Pembelajaran on-line

Bentuk dan Metode On-line F2F

• Dr.dr. A A Oka, SpU (K) • Dr.dr. A A Oka, SpU (K)

Materi Sumber Pembelajaran on-line

Hari VII: Kelainan Prostat, Testis, Inkontinensia Urin

Hari VIII: Kelainan Prostat, Testis, Inkontinensia Urin, Pyelonefritis

Bentuk dan On-line F2F (aktivitas kelas)

Fasilitator Aktivitas On-line Aktivitas Kelas/Praktikum

Kriteria/Indikator • Kemampuan anamnesis/ketepatan analisis

• Kemampuan merencanakan terapi/ketepatan formulasi

• Kemampuan mengkritisi/ketepatan membedakan, membandingkan

Materi Pembelajaran Sumber Pembelajaran on-line

Beban Waktu On-line F2F (aktivitas kelas/Praktikum)

Pengalaman Belajar On-line F2F (aktivitas kelas)

• Mengerjakan Quiz dan Forum

Media Pembelajaran On-line F2F (aktivitas kelas)

Hari X: Practicum Microscopic Structure of Urinary Tract

Kriteria/Indikator • ketepatan analisis

• Kemampuan mengkritisi/ketepatan membedakan, membandingkan

• Tingkat partisipasi dan kontribusi dalam diskusi

Materi Pembelajaran Sumber Pembelajaran on-line

Bentuk dan Metode On-line F2F (aktivitas kelas)

Beban Waktu On-line F2F (aktivitas kelas/Praktikum)

Pengalaman Belajar On-line F2F (aktivitas kelas)

Media Pembelajaran On-line F2F (aktivitas kelas)

• dr.Sri Laksminingsih, SpRad (K) • dr.Sri Laksminingsih, SpRad (K)

• Dr.dr. I A Ika Wahyuniari, M.Kes • Dr.dr. I A Ika Wahyuniari, M.Kes

• Staf Departemen Histologi • Staf Departemen Histologi

• Mampu menjelaskan anatomi dari sistem gentalia Pria

• mampu mendiagnosis dan merujuk tumor penis dan tumor testis

Kriteria/Indikator • Tingkat partisipasi dan kontribusi dalam diskusi

• ketepatan analisis dan membedakan tanda dan gejala

• Kemampuan mengkritisi/ketepatan membedakan, membandingkan sediaan anatomi

• kemampuan mengamati anatomi makroskopik persamaan dan perbedaan

Materi Pembelajaran Sumber Pembelajaran on-line