A N N O U N C E M E N T

T h e I n d o n e s i a n F o u n d a ti o n o f U r o l o g y D e v e l o p m e n t
( Yaya s a n P e n g e m b a n g a n U ro lo g i I n d o n e s i a )

The 34th Fiesta Urologi 2017

Andro-Urology
& Mens Health
Wyndham Hotel Surabaya, July 26th - 30th, 2017

PCNL Workshop
InaSAU Microsurgery Workshop
Muktamar Luar Biasa IAUI

edita
accr

tion
 GREETING

Dear Colleagues,

Content We are delighted to welcome you to city of heroes,

Surabaya, in 26th 30th July, 2017. Symposium will
be held in the new 5-star hotel in town, Wyndham
1
GREETING Hotel, which is located in the heart of the city.

2 34th Fiesta Urology is about Andro-urology and

COMMITTEE
Mens Health. We will have panel discussion, lecture,
3 symposium highlighting new guideline, breakthrough
SECRETARIAT
research and technology in Mens Health. In this
4 week, we will have workshop in PCNL as a regular
GENERAL INFORMATION basis of Fiesta Urology and Microsurgery to enhance
the skill of andro-urology procedure.
5
PRE SYMPOSIUM - WORKSHOP
We hope this annual Fiesta Urology can improve not
6 only our skill and knowledge, but also our bond as
SYMPOSIUM
family in Indonesian Urological Association.
7
REGISTRATION & ACCOMMODATION Best regards,
INFORMATION

8
REGISTRATION FORM
Fikri Rizaldi, MD (Urol.)
9 Chairman
ACCOMMODATION FORM

The 34th Fiesta Urologi 2017 The 34th Fiesta Urologi 2017 1
 COMMITTEE SECRETARIAT

pelIndung :
pengurus pusat Ikatan ahli urologi Indonesia
penasehaT :
Ketua departemen urologi FK unair surabaya
ORGANIZER
Ketua IauI cabang Jawa Timur

sTeerIng commITTee :
dr. Wahjoe djatisoesanto,dr., spu-K
prof. dr. sunaryo hardjowijoto, dr., spb, spu-K
prof. dr. doddy m. soebadi, dr., spb, spu-K
prof. dr. soetojo, dr., spu-K
Sekretariat
dr. adi santoso, spb, spu-K
Departemen/SMF Urologi
dr. Tarmono, dr., spu-K
dr. lukman hakim, spu, mars FK. UNAIR/RSUD dr. Soetomo Surabaya
dr. m. ayodhia soebadi, sp.u Jl. Mayjend. Prof. dr. Moestopo no. 6-8 Surabaya 60286
dr. Johan renaldo, sp.u Telp: +62 31 5501318; Fax: +62 31 5024971
dr. Fikri rizaldi, sp.u HP: +6285731333449
CP: Hadi
Ketua Penyelenggara : dr. Fikri rizaldi, spu
Email: fiesta.urology2017@gmail.com
Wakil : dr. rheza maulana putra

sekretaris : dr. dian Kartika rezia CO ORGANIZER

Bendahara : dr. yohan affendi

sie acara/Protokoler/Malam Keakraban : dr. Ferdyan rachmad e l dr. aditya pramanta

l Dr. Ramzie Nendra D l Dr. M. Surya Negara

Sie Ilmiah : Dr. Ahmad Aniq Kamal l Dr. Aril Rizaldi l Dr. Ida Bagus Putra P
l Dr. Randa Halfian l dr. arifai lumbangaol PT. GPD Indonesia
Jl. Kebalen V No. 24 A Kebayoran Baru
sie Workshop : dr. prasastha dedika u l dr. bangun oktavian
l Dr. Joseph Hartanta P l Dr. Andrie Rhomdhon l Dr. Zuhri Sawal l Dr. Riza Mazidu Jakarta Selatan 12180
Telp: +62 21 7254424, +62 21 7229339
Sie Publikasi & Dokumentasi : Dr. Ardian Bayu W l Dr. Ari Alauddin M
Reg by SMS: +628111332664, +628111662664
l Dr. Anggana Suryatama l Dr. Suryo Prasetyo T
Fax: +62 21 7396261
Sie Perijinan & Perlengkapan : Dr. Sofyan Rais l Dr. Eldien M. Shidqy l Dr. Andri Harmaya Email: gpd@gpdindonesia.com / erlin@gpdindonesia.com
l Era Poeloeng Andreas l Dr. Puruhito Eko N l Pudji Hartono l Dr. Ahmad Nugroho
CP: Erlin
Sie Transportasi : Dr. Arley Telussa l Dr. Widya Sakti Pratama l Dr. Medianto P
l Dr. Ido Putra Ramadhan

sie Konsumsi : dr. poppy desra l dr. dimas visa aditya l dr. hajid rahmadianto

2 The 34th Fiesta Urologi 2017 The 34th Fiesta Urologi 2017 3
 GENERAL INFORMATION PRE SYMPOSIUM - WORKSHOP

Venue : PCNL Workshop,

PCNL WORKSHOP, July
JULY 26TH - 27TH26th
2017 - 27th, 2017
Wyndham Surabaya Hotel Department
(Limited of Urology 2F, Prostate Room / GBPT Dr. Soetomo Hospital Surabaya
12 Participants)
(Limited 12 Participants)
Jl. Basuki Rahmat No.67, Embong Kaliasin
Surabaya Jawa Timur Wednesday, July 26th 2017
TIME DETAIL INSTRUCTOR
07.00 - 07.45 Re-Registration
Important Date: 07.45 - 08.00 Opening Remarks Dr. dr. Wahjoe Djatisoesanto, SpU (K)
08.00 - 08.20 Instrumentations and Surgical Techniques Dr. dr. Tarmono, SpU (K)
Wednesday Sunday, July 26th 30th 2017 08.20 - 08.40 Access to Kidney and Complications Prof. Dr. dr. Doddy M. Soebadi, SpB, SpU (K)
08.40 - 09.00 Case Selection Dr. dr. Wahjoe Djatisoesanto, SpU (K)
09.00 - 09.10 Q&A
Theme: Coffee Break
09.10 - 09.30
Andro-urology and Mens Health Transfer to OR
09.30 - 15.00 PCNL Workshop

DETAIL PROGRAMME:
Thursday, July 27th 2017
Rabu - Kamis, 26 - 27 Juli 2017 : Workshop PCNL
TIME DETAIL
Jumat, 28 Juli 2017 : Workshop Microsurgery 07.30 - 08.00 Re-Registration
Sabtu-Minggu, 29 - 30 Juli 2017 : Simposium Coffee Break
08.00 - 08.25
Transfer to OR
Sabtu, 29 Juli 2017 : Malam Keakraban 08.25 - 15.00 PCNL Workshop
Sabtu, 29 Juli 2017 : Muktamar Luar Biasa IAUI

Exhibition:
July 29th 30th, 2017 MICROSURGERY WORKSHOP,
microsurgery JULY 27TH - 28TH
Workshop, July2017
28th, 2017
Department of Urology, Dr. Soetomo Hospital Surabaya
(Limited
(Limited 12 Participants)
12 Participants)
Bank Name : CIMB Niaga Cab. Dharmahusada Surabaya Friday, JulyJuly
28th, 2017
Thursday, 27th 2017
Account number : 7025 - 3525 - 4000 TIME DETAIL INSTRUCTOR
Account name : Yayasan Pengembangan Urologi Indonesia 08.00 - 08.15 Registration
08.15 - 08.30 Welcome and Introduction
08.30 - 09.00 Course of Overview - Exercises in Microsurgery Doddy M. Soebadi
iNTerNaTioNal sPeaKer: 09.00 - 09.30
Percutaneous Epididymal Aspiration (PESA) and Needle
Rupin Shah
Aspiration Biopsy. When and How
asif muneer (london, uK) 09.30 - 10.00 Coffee Break
Asif Muneer
du geon moon (Korea) 10.00 - 10.30 Vasovasostomy and Vasoepididymostomy Doddy M. Masaki
Soebadi Kimura

masaki Kimura (Japan)

10.30 - 11.00 Microsurgery Varicocelectomy. The gold Standard Rupin Shah
Fikri Rizaldi
11.00 - 11.30 Microdenervation of the Spermatic Cord Masaki Kimura
nam cheol park (Korea) 11.30 - 12.00 Micro-TESE, Indication and Technique InaSAU
Asip Muneer
12.00 - 13.00 Lunch and Pray
rupin shah (India) Paired Mentored Stations in Microsurgical Procedures
13.00 - 16.00 InaSAU
sae Woong Kim (Korea)

Friday, July 28th 2017

TIME DETAIL INSTRUCTOR

4 The 34th Fiesta Urologi 2017 The 34th Fiesta Urologi 2017 5
 SYMPOSIUM REGISTRATION & ACCOMMODATION INFORMATION

REGISTRATION BY EMAIL HOTEL RESERVATION

To get a registration form can contact the
secretariat at +62 21 7254424 or +62 21
7229339 after filling the registration form
can email to erlin@ gpdindonesia.com and
gpd@gpdindonesia.com
REGISTRATION BY FAX
Complete the registration form to the
Secretariat Fax number at +62 21 7396261
and then reconfirm to secretariat at +62 21
7254424 or +62 21 7229339
ON SITE REGISTRATION
Those who have not registered in advance
may register at onsite registration desk. Only
cash payment in Rupiah will be accepted
during onsite registration. No refund will be
made for onsite registration fees.
REGISTRATION PAYMENT
All registration fees must be paid by bank
transfer. Registrant should bear all bank
charges. Please send a copy of the transaction
along with the registration to the Organizing
Committee.
HOTEL POLICY
Due to high demand on the hotel room at the
time of congress, the congress secretariat
strongly recommended early reservations.
Hotel assignment will be made on a
FIRST COME FIRST SERVE BASIS.
REGISTRATION AND ACCOMMODATION
SECRETARIAT
Department of Urology Airlangga University
School of Medicine Dr. Soetomo Hospital
Surabaya
Mayjend Moestopo 6-8 Surabaya 60286,
Indonesia
Phone : +62 31 5501318
Fax : +62 31 5024971
Contact : Mr. Hadi (+62 857 31333449)
Email : fiesta.urology2017@gmail.com
PT. GPD Indonesia
Kebalen V No. 24 A, Jakarta 12180
Phone : (+62 21) 7229339, 7254424
Fax : (+62 21) 7396261
Mobile : +62 8111 332664, +62 8111 662664
Contact : Erlin
Email : erlin@gpdindonesia.com
gpd@gpdindonesia.com
PAYMENT BY
Bank Name :
CIMB Niaga Cab. Dharmahusada Surabaya
Account number :
7025 - 3525 - 4000

ROOM RATE Account name :

Hotel rooms at special congress rate are Yayasan Pengembangan Urologi Indonesia
being held for the congress participants at
Wyndham Hotel Surabaya. Room rates are Swift Code :
in Rupiah, per night and per room included BNIAIDJA
breakfast for two persons. Reservations must
be made through the congress secretariat to
guarantee the indicated rate negotiates for
the congress.

6 The 34th Fiesta Urologi 2017 The 34th Fiesta Urologi 2017 7
 REGISTRATION FORM ACCOMMODATION FORM

The 34th Fiesta Urologi 2017 - Wyndham Hotel Surabaya, July 26th - 30th, 2017 The 34th Fiesta Urologi 2017 - Wyndham Hotel Surabaya, July 26th - 30th, 2017

PARTICIPANT (Kindly Completed) PARTICIPANT (Kindly Completed)

Title : q Prof q DR q Dr
Full Name :
Organization/Hospital/Institution :
Mailing Address :
Country :
Zip Code :
Mobile Phone :
Email :
Sponsor :
Mobile Phone :
q Specialist q Other Title : q Prof q DR q Dr q Specialist q Other
Full Name :
Organization/Hospital/Institution :
Mailing Address :
Country :
Zip Code :
Mobile Phone :
Email :
Sponsor :
Mobile Phone :

Please Mark () on Workshop / Symposium you choose Please Mark () on Hotel you choose

WORKSHOP
NO WORKSHOP DATE REGISTRATION FEE Hotel ROOM TYPE RATE
Wyndham Hotel Surabaya q DELUXE q Rp. 1.300.000
q 1 PCNL (Limited 12 Participants) Check in Date: Check out Date: T otal Night (s):
q Specialist JULY 26TH-27TH, 2017 q Rp. 10.000.000
q Nurse JULY 26TH-27TH, 2017 q Rp. 3.000.000 TOTAL ACCOMMODATION PAYMENT: IDR
q 2 MICROSURGERY (Limited 12 Participants)
q Specialist Urology/ Residen JULY 28TH, 2017 q Rp 10.000.000

*Term & Condition

SYMPOSIUM Hotel room rate is net including 2 (two) breakfast
NO PARTICIPANT date REGISTRATION FEE Please note that official check in time is 15.00 local time and check out time is 12.00 local time
Approval of early check-in and late check-out is at discretion of the hotel.
1 Specialist JULY 29TH-30TH, 2017 q Rp. 2.500.000 No reservation will be made without full deposit of nights booking due to room availability.
Any changes and cancellations regarding to room reservation in pre-registration period must be done in writing to the Secretariat at least
2 General Practitioner JULY 29TH-30TH, 2017 q Rp. 1.000.000
168 hours prior to arrival. After the date, guaranteed payment for 1 night will be charged.
TOTAL REGISTRATION SYMPOSIUM IDR No Show will be applied on the first night for delayed or postpone staying that causes the loss of 1 night room deposit made.
In the event of materialization, the hotel will charge the full amount duration of stay upon check-out that causes the loss of mentioned deposit made
Refund may only be made after the event by bank transfer. Official letter should be submitted to Secretariat address mentioning its payers
Bank Account.

CANCELLATION AND REFUND POLICY CANCELLATION AND REFUND POLICY

Written Cancellation notice is required. Cancellation must be received before July 1ST 2017 a 50% refund will be returned after Written Cancellation notice is required. Cancellation must be received before July 1ST 2017 a 50% refund will be returned after
congress ended. No refund will be allowed thereafter congress ended. No refund will be allowed thereafter

PAYMENT BY PAYMENT BY
S I GNA T URE S I GNA T URE
q BANK TRANSFER q BANK TRANSFER
Bank Name : CIMB Niaga Cab. Dharmahusada Surabaya Bank Name : CIMB Niaga Cab. Dharmahusada Surabaya
Account number : 7025 - 3525 - 4000 Account number : 7025 - 3525 - 4000
Account name : Yayasan Pengembangan Urologi Indonesia Account name : Yayasan Pengembangan Urologi Indonesia

Please quote the senders name on the bank transfer statement Please quote the senders name on the bank transfer statement
When transmitting, please make sure who send the money possibly by fax. When transmitting, please make sure who send the money possibly by fax.

q CASH TO SECRETARIAT q CASH TO SECRETARIAT

This form, together with the requisite payment and/or documentation should be emailed/faxed
to:
Secretariat at GPD INDONESIA Jl. Kebalen V No. 24A Kebayoran Baru, Jakarta 12180
Telp. +6221 7254424 | 7229339 Reg by, SMS +628111332664 | +628111662664 Fax. +6221 7396261
Email. gpd@gpdindonesia.com / erlin@gpdindonesia.com / fiesta.urology2017@gmail.com
This form, together with the requisite payment and/or documentation should be emailed/faxed
to:
Secretariat at GPD INDONESIA Jl. Kebalen V No. 24A Kebayoran Baru, Jakarta 12180
Telp. +6221 7254424 | 7229339 Reg by, SMS +628111332664 | +628111662664 Fax. +6221 7396261
Email. gpd@gpdindonesia.com / erlin@gpdindonesia.com / fiesta.urology2017@gmail.com
ORGANIZER

Sekretariat
Departemen/SMF Urologi
FK. UNAIR/RSUD dr. Soetomo Surabaya
Jl. Mayjend. Prof. dr. Moestopo no. 6-8 Surabaya 60286
Telp: +62 31 5501318; Fax: +62 31 5024971
HP: +6285731333449
CP: Hadi
Email : fiesta.urology2017@gmail.com

CO ORGANIZER

PT. GPD Indonesia

Jl. Kebalen V No. 24 A Kebayoran Baru
Jakarta Selatan 12180
Telp: +62 21 7254424, +62 21 7229339
Reg by SMS: +628111332664, +628111662664
Fax: +62 21 7396261
Email: gpd@gpdindonesia.com / erlin@gpdindonesia.com
CP: Erlin