Background: Uroflowmetry is a simple, non-invasive, feasible examination. The standard reference for uroflowmetric nomogram today is still under debate. The normal value of uroflowmetry on children is highly varied in each country, there is has not been any reference to use for normal value of uroflowmetry on children in Indonesia. We aimed to establish uroflowmetry nomograms for healthy Indonesia children in Hasan Sadikin Hospital Bandung based on healthy children uroflowmetry examination between 5 to 15 years of age. Methods: A total of 302 uroflowmetry examination were performed on healthy Indonesian children with no history of a renal, urological, or neurological disorder between the ages 5 and 15 years old. The voided volume, the maximum and average urinary flow rates were analyzed using statistical software. Linear regression analysis was used to generate nomograms. Result: Uroflowmetric parameters increased with increasing age, with the effect being more pronounced in girls. There were 2 groups, with group 1 consisting of patients 5 to 10 years old and group 2 consisting of patients 11 to 15 years old. There were 76 boys and 76 girls in group 1 and 75 boys and 75 girls in group 2. In group 1 the maximum and average flow rates were 15.07 ± 6.66 (ml/sec) and 9.29 ± 3.61 (ml/sec) for boys, and 15.23 ± 6.15 (ml/sec) and 9.43 ± 3.29 (ml/sec) respectively, for girls. In group 2 these rates were 16.14 ± 5.06 (ml/sec) and 9.77 ± 3.74 (ml/sec) for boys and 19.38 ± 7.15 (ml/sec) and 11.21 ± 3.41 (ml/sec) respectively, for girls. When comparing uroflow parameters between boys and girls, significantly higher values were obtained in girls regarding Voided volume (p<0.001), Qmax (p<0.001) and Qavg (p<0.001). Conclusion: Nomograms are important tools to asses the lower urinary tract abnormalities and to evaluate response of either surgical or medical therapy in children. Uroflowmetry is a simple, cost effective and noninvasive. This study provides uroflow parameters for mean maximum flow rate for healthy Indonesian healthy children aged 5 to 15 years old (boys and girls) in Hasan Sadikin Hospital Bandung and will hopefully promote wider application of uroflowmetry testing in the pediatric population.

Background: Ischemia/reperfusion (I/R) is often a complication of bleeding shock, renal dysfunction and renal vessel operation. Nitric oxide (NO) as an important vasodilator is produced by endothelial cells. NO stimulates the generation of cyclic guanosine monophosphate (cGMP). Phosphodiesterase (PDE) is an intracellular enzyme which hydrolyzes cGMP into an inactive metabolite. It effectively decreases cGMP level. PDE is an intracellular enzyme which hydrolyzes cGMP into an inactive metabolite. It effectively decreases cGMP level. Therefore, an inhibition of PDE can increase cGMP level. PDE5 inhibitor is a compound which inhibits or acts antagonistically against biosynthesis or act of PDE. PDE5 inhibitor is now commonly used for the treatment of pulmonary artery hypertension and erectile dysfunction. According to some latest researches, long-acting PDE5 inhibitor (Tadalafil) reduces renal I/R injury in experiments with Wistar rats. Objectives: The purpose of this study was to determine the effect of long-acting PDE5 inhibitor on renal I/R injury in Wistar rats. Materials and Methods: Rats were divided into three groups; sham group, a right nephrectomy was performed. Control group, a right nephrectomy was performed followed by an occlusion on left renal pedicle for 60 minutes and a perfusion was performed for 60 minutes. Tadalafil group; the same treatment was performed as to group control, plus administering tadalafil as a PDE5 inhibitor (10 mg/kg), given by a nasogastric tube 60 minutes before the operation. A left nephrectomy was performed on the mice to determine the value of cystatin C level and histopathology. Results: The mean necrosis of tubular renal cells indicates that highest mean necrosis of tubular renal cells was at group control (mean score, 8.6±0.84), and the lowest mean necrosis of tubular renal cells was at sham group (mean score, 4.4±0.52) which indicates a significant difference between the sham and control groups (P<0.05). For the tadalafil group mean score of renal tubular necrosis cell was 6.9±1.45, which also indicates a significant difference between this group with sham group and control (P<0.05). Highest mean cystatin C levels related to group control, mean score was 1.51 ± 0.13 mg/dL, which indicates a significant difference with the sham group (P<0.05), but there is no significant difference with the tadalafil group. Conclusion: The results of this study showed that the administration of PDE5 inhibitor (tadalafil) improves reperfusion ischemic injury. Although it did not decrease the level of cystatin C, it significantly reduced tubular necrosis.