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"Latar belakang: Prolaps organ panggul (POP) merupakan suatu permasalahan utama kesehatan dengan risiko seumur hidup pada perempuan yang menjalani paling sedikitnya satu kali intervensi pembedahan prolaps. Retensio urin pasca operasi rekonstruksi prolaps organ panggul disebabkan oleh beberapa faktor mulai dari pemeriksaan hingga penanganan pasca operasi yang berkontribusi terhadap terjadinya retensio urin. Penelitian di RSCM tentang penggunaan kateter 24 jam pada pasien pasca operasi prolapse organ panggul terhadap insiden retensio urin adalah sebesar 29,5%. Penelitian ini akan melakukan perbandingan penggunaan kateter 24 jam yang dibandingkan kateter 48 jam terhadap insiden retensio urin yang nantinya akan menjadi standar baku terbaru di RSCM dan RSUD Arifin Achmad Pekanbaru. Tujuan: Untuk mengetahui mana di antara kateter 24 jam dan 48 jam yang lebih baik untuk mengurangi angka kejadian retensio urin pascaoperasi prolaps organ panggul. Metode: Penelitian diagnosa, uji klinis acak, pengambilan sampel berturut-turut. Perbandingan antara kateter 24 jam dan 48 jam setelah operasi prolaps organ panggul Hasil: Total 54 subjek dalam penelitian ini, 3 subjek (11,1%) di antara 27 subjek dengan kateter 24 jam mengalami retensio urin. 1 subjek (3,7%) di antara 27 subjek dengan kateter 48 jam mengalami retensio urin. Kesimpulan: Penggunaan kateter 48 jam pascaoperasi prolaps organ panggul lebih baik daripada kateter 24 jam dalam mengurangi angka kejadian retensio urin.

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Background: Pelvic organ prolapse (POP) is a major health problem with a lifetime risk in women who undergo at least one prolapse surgical intervention. Postoperative retention of urine pelvic organ prolapse reconstruction is caused by a number of factors ranging from examinations to postoperative clients that

contribute to the occurrence of urinary retention. Research at the RSCM about 24- hour catheter use in postoperative pelvic organ prolapse patients for the incidence of urinary retention was 29.5%. This study will compare the use of a 24-hour catheter compared to a 48-hour catheter against the incidence of urinary retention which will later become the latest standard in RSCM and RSUD Arifin Achmad Pekanbaru. Objective: To know which one among 24-hour and 48-hour catheter is better to decrease incidence of urinary retention after pelvic organ prolapse surgery. Methode: Diagnosis research, randomized clinical trial, consecutive sampling. Comparison between 24-hour and 48-hour catheter after pelvic organ prolapse surgery Result: Total 54 subjects in this research, 3 subjects (11.1%) among 27 subjects with 24-hour catheter experienced urinary retention. 1 subject (3.7%) among 27 subjects with 48-hour catheter experienced urinary retention. Conclussion: The application of 48-hour catheter after pelvic organ prolapse surgery is beter than 24-hour catheter to decrease the incidence of urinary retention."

"ABSTRAK Latar belakang: Tesis ini bertujuan untuk mengetahui insidens retensio urin pasca rekonstruksi POP dan faktor-faktor yang berhubungan.Retensio urinmerupakan komplikasi akut tindakan rekonstruksi dan banyak dijumpai padaprosedur operasi, termasuk operasi POP (POP). Untuk menghindari morbiditaslebih lanjut, penelitian ini bertujuan untuk mengetahui insidens rertensio urinpasca rekonstruksi POP faktor-faktor risiko yang berhubungan.Metode: Penelitian ini adalah penelitian kohort prospektif yang dilaksanakan diRS Cipto Mangunkusumo dan RS Fatmawati dengan mengikutsertakan wanitayang hendak mengalami rekonstruksi POP dalam rentang waktu April 2013hingga April 2015. Kriteria inklusi dan eksklusi subjek meliputi wanita denganPOP derajat 2,3 dan 4 tanpa riwayat retensio urin sebelumnya, konsumsi obatobatanyangdapat menyebabkan retensio urin dan tanpa cedera kandung kemih.Pasca rekonstruksi, subjek dilakukan pemasangan kateter urin selama 24 jam.Kemudian, enam jam pasca pelesapan kateter, dilakukan pengukuran residu urinpada kandung kemih. Retensio urin didefinisikan dengan didapatkannya residuurin >100 ml.Hasil: Dari 200 subjek, ditemukan 59 subjek (29,5%) mengalami retensio urin.Tidak ada hubungan antara faktor risiko umur, Indeks Massa Tubuh (IMT),derajat POP, derajat sistokel, kejadian infeksi saluran kemih, dan durasi operasiterhadap retensio urin. Jenis prosedur total vagina hysterectomy + kolporafianterior + kolpoperineorafi + sacrospinous fixation dan durasi operasi > 130menit berhubungan dengan retensio urin dengan RR 3,66 95% IK 2,91-4,60p<0,001 dan 1,66 95%IK 1,07-2,59 p=0,02, berturut-turutKesimpulan: Insidens retensio urin cukup tinggi pasca rekonstruksi POP. Jenistindakan rekonstruksi tertentu dan semakin lamanya durasi rekonstruksiberhubungan dengan kejadian retensio urin.ABSTRACT Background: The objective of this study was to know the incidence of post operativeurinaryretention after pelvic organ prolapse surgery and associatedfactors.Post operative urinary retention (POUR) is considered as an acutecomplication after a surgey in many operative procedures, including pelvic organprolpase (POP) surgery. To avoid further morbidity, this study aimed to know theincidence of POUR after POP surgery and its risk factors. Methods: This is a prospective cohort study conducted in Cipto Mangunkusumohospital and Fatmawati Hospital from April 2013 to April 2015. Subjects werewomen who wanted to undergo POP surgery with two to four degree of POP.Subjects with history of urinary retention, drugs consumption that tend to causeurinary retention or bladder unjury were excluded. After the reconstruction,urinary catheter was placed for 24 hours. Then, after six hours, catheter wasremoved and residual urine was measured. Urinary retention was defined asresidual urine more than 100 ml. Results: Of 200 subjects recruited, 59 (29.5%) had POUR. There were noassociation between age, body mass index, degree of uterine POPe, degree ofcystocele, urinary tract infectionand POUR. Duration of surgery > 130 minute andTotal vagina hysterectomy +anterior colporraphy + colpoperineorraphy +sacrospinous fixation procedure and duration of surgery > 130 minute were associated with POUR (RR 3.66, 2.91-4.60 95% CI, p<0.001 and 1.66 , 072.5995%CI,p=0.02;respectively)Conclusion: POUR incidence after POP surgery was quite high. Type of theprocedure and duration of surgery were associated with POUR.;Background: The objective of this study was to know the incidence of post operativeurinaryretention after pelvic organ prolapse surgery and associatedfactors.Post operative urinary retention (POUR) is considered as an acutecomplication after a surgey in many operative procedures, including pelvic organprolpase (POP) surgery. To avoid further morbidity, this study aimed to know theincidence of POUR after POP surgery and its risk factors. Methods: This is a prospective cohort study conducted in Cipto Mangunkusumohospital and Fatmawati Hospital from April 2013 to April 2015. Subjects werewomen who wanted to undergo POP surgery with two to four degree of POP.Subjects with history of urinary retention, drugs consumption that tend to causeurinary retention or bladder unjury were excluded. After the reconstruction,urinary catheter was placed for 24 hours. Then, after six hours, catheter wasremoved and residual urine was measured. Urinary retention was defined asresidual urine more than 100 ml. Results: Of 200 subjects recruited, 59 (29.5%) had POUR. There were noassociation between age, body mass index, degree of uterine POPe, degree ofcystocele, urinary tract infectionand POUR. Duration of surgery > 130 minute andTotal vagina hysterectomy +anterior colporraphy + colpoperineorraphy +sacrospinous fixation procedure and duration of surgery > 130 minute were associated with POUR (RR 3.66, 2.91-4.60 95% CI, p<0.001 and 1.66 , 072.5995%CI,p=0.02;respectively)Conclusion: POUR incidence after POP surgery was quite high. Type of theprocedure and duration of surgery were associated with POUR.;Background: The objective of this study was to know the incidence of post operativeurinaryretention after pelvic organ prolapse surgery and associatedfactors.Post operative urinary retention (POUR) is considered as an acutecomplication after a surgey in many operative procedures, including pelvic organprolpase (POP) surgery. To avoid further morbidity, this study aimed to know theincidence of POUR after POP surgery and its risk factors. Methods: This is a prospective cohort study conducted in Cipto Mangunkusumohospital and Fatmawati Hospital from April 2013 to April 2015. Subjects werewomen who wanted to undergo POP surgery with two to four degree of POP.Subjects with history of urinary retention, drugs consumption that tend to causeurinary retention or bladder unjury were excluded. After the reconstruction,urinary catheter was placed for 24 hours. Then, after six hours, catheter wasremoved and residual urine was measured. Urinary retention was defined asresidual urine more than 100 ml. Results: Of 200 subjects recruited, 59 (29.5%) had POUR. There were noassociation between age, body mass index, degree of uterine POPe, degree ofcystocele, urinary tract infectionand POUR. Duration of surgery > 130 minute andTotal vagina hysterectomy +anterior colporraphy + colpoperineorraphy +sacrospinous fixation procedure and duration of surgery > 130 minute were associated with POUR (RR 3.66, 2.91-4.60 95% CI, p<0.001 and 1.66 , 072.5995%CI,p=0.02;respectively)Conclusion: POUR incidence after POP surgery was quite high. Type of theprocedure and duration of surgery were associated with POUR."

"Latar Belakang: Inkontinensia urin (IU) menurut ICS didefinisikan sebagai keluarnya urin yang tidak dapat dikendalikan atau dikontrol, yang secara obyektif dapat diperlihatkan dan merupakan suatu masalah sosial dan higienis. Pada perempuan, gangguan fungsi berkemih ini sering kali didapatkan pasca-operasi koreksi kelainan Prolaps Organ Panggul (POP). Inkontinensia Urin Tekanan de novo (IUT de novo) adalah IU yang terjadi pada pasien POP pasca-operasi pervaginam yang tidak didapatkan sebelum operasi.Tujuan: Untuk mengetahui kejadian IUT de novo dan faktor risiko yang berhubungan pada pasien POP pasca-operasi pervaginam di Divisi Uroginekologi dan Rekonstruksi Departemen Obstetri dan Ginekologi RSCM Jakarta.Metode: Studi klinis potong lintang yang dilakukan pada 75 orang pasien POP pasca-operasi pervaginam di Divisi Uroginekologi dan Rekonstruksi Departemen Obstetri dan Ginekologi RSCM Jakarta pada bulan Januari 2016 sampai Juli 2017. Penilaian kejadian IUT de novo dan faktor risiko yang berperan dilakukan berdasarkan data Rekam Medik, lembar penilaian Kuesioner QUID (Questionnaire for Urinary Incontinence Diagnosis) versi Indonesia dan dikonfirmasi dengan pemeriksaan Cough Stress Test secara kualitatif dan tes pembalut pad test secara kuantitatif.Hasil: Dari 75 subyek penelitian didapatkan angka kejadian IUT de novo sebesar 8% (6/75). Uji analisis statistik menunjukkan hanya 2 faktor risiko yang berperan secara bermakna (p < 0,05) terhadap kejadian IUT de novo pada pasien POP pasca-operasi pervaginam di RSCM Jakarta, yaitu derajat POP yang berat dan penyakit Diabetes Mellitus dengan nilai OR 0,13 (95% CI 0,02-1,63) dan 23,75 (95%CI 2,29-590,2).Kesimpulan: Pada penelitian ini, angka kejadian IUT de novo pada pasien POP pasca-operasi pervagnam adalah 8% dengan faktor risiko yang berperan adalah derajat POP preoperatif yang berat dan penyakit Diabetes Mellitus.

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Background: Stress Urinary Incontinence remains a main women's health problem due to its devastating impacts to the quality of life. Some patients with pelvic organ prolapse (POP) may suffer from stress urinary incontinence (SUI) named de novo SUI after pelvic floor reconstruction2. The epidemiology study of de novo SUI in Indonesia is not known yet. In the world, a few studies have reported a wide range (2-43%) in incidence of de novo SUI following surgical repair of POP in previously continent patients. This study aimed to investigate the occurrence of de novo SUI and determined related risk factors after vaginal surgery on POP patients in Ciptomangunkusumo Hospital Jakarta. Methods: This is a cross-sectional study of 108 patients who underwent pelvic floor vaginal surgery due to pelvic organ prolapse (POP) at the Department of Obstetry and Gynecology, Urogynecology and Recontruction Division in Indonesian University-Ciptomangunkusumo Hospital from January 2016 to December 2017. According to the inclusion and exclusion criteria, 75 patients were enrolled in the study with consecutive sampling technique. The occurrence of de novo SUI was determined 6-12 months postoperatively by using Indonesian version of Questionnaire for Urinary Incontinence Diagnosis (QUID), and objectively by positive Cough Stress Test (CST) during gynecological examination after negative Preoperative Prolapse Reduction Stress Test (PPRST). The clinical characteristic of positively de novo SUI patients identified were age, parity, Body Mass Index, menopause periode before surgery, degree of Pelvic Organ Prolapse based on POP-Q system, type of vaginal surgery and clinical result of Diabetes Mellitus. Thes significant risk factors that contribute for the occurrence of de novo SUI determined by multivariate statistical analysis (95% CI and 𝛼 0.05).Results: The occurrence of de novo SUI was 8% or 6 from 75 patiens 6-7 month postoperative for pelvic floor reconstruction due to POP. Average of age, parity, BMI, menopause periode before surgery, respectively were 56.17 ± 4.67, 3.17 ± 1.07, 28.58 ± 5.18, and 12,8 ± 7,0. There were 50,0% (3/6) patients with severe degree of POP and 50% (3/6) with mild degree of POP with most of them 66,7% (4/6) had underwent non colpocleisis procedure for POP reconstruction. All of the patient but one were positively Diabetes Mellitus according to clinical hystory and laboratory finding, and most of them about 83,3% (5/6) were in menopause state. There were two significant risk facors that contribute to the occurrence of de novo SUI which are severe degree of preoperative POP (p 0.038; OR 0.13 95% CI 0,02-0,63) and Diabetes Mellitus (p 0.02; OR 23.75 95% CI 2.29-590.2).Conclusion: The occurrence of de novo SUI after vaginal surgery of Pelvic Organ Prolapse patients in Ciptomangunkusumo Hospital Jakarta was 8%. Most of them were average of age < 60 years old, parity < 4, non- obese women, in menopausal periode, and diabetic patient. The determinant significant risk factors contribute to the occurrenceof de novo SUI were evere degree of preoperative POP and Diabetes Mellitus."

"Latar Belakang: Prolaps Organ Panggul (POP) dikelompokkan menjadi prolaps dinding anterior, posterior dan puncak vagina. 40% wanita dengan POP dinding anterior vagina memiliki elongasio serviks yang akan mempengaruhi tatalaksana pembedahan POP. Terdapat beberapa alat untuk mengukur panjang serviks, diantaranya Pelvic Organ Prolapse Quantifications System (POP-Q), dengan mengukur perbedaan titik C dan D. Sampai saat ini belum terdapat penelitian yang menguji sensitivitas, spesifisitas dan akurasi pemeriksaan POP-Q dalam mengukur panjang serviks untuk mendiagnosis elongasio serviks pada pasien POP. Tujuan: Diketahuinya nilai sensitivitas, spesifisitas dan akurasi POP-Q untuk menilai panjang serviks sebagai diagnosis elongasio serviks pada pasien POP dengan baku emas pengukuran anatomi serviks dari hasil histerektomi. Metode: Uji diagnosis, potong lintang, consecutive sampling. Data diambil dari pemeriksaan POP-Q dan pengukuran anatomi serviks dari hasil histerektomi. Hasil: 66 subjek, 1.5% POP derajat 2, 45.5% POP derajat 3 dan 53.0 % POP derajat 4. Rerata (± sb) usia dan indeks massa tubuh (IMT) berturut-turut 59.88 tahun (± 9.347) dan 24.41 (± 3.67) kg/m2. Median (min-maks) PS POPQ dan PS Anatomi berturut-turut 4 cm (1-12) dan 5 cm (3-10). Sensitivitas, Spesifisitas dan Akurasi POP-Q berturut-turut 79%, 58% dan 68%. Kesimpulan: Pemeriksaan POPQ memiliki spesifitas yang baik (79%) tetapi dengan sensitivitas yang kurang baik (58%) dan akurasi 68% untuk diagnosis elongasio serviks pada prolaps organ panggul.

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Background: Pelvic Organ Prolapse (POP) categorized as anterior, posterior and apical prolapse. 40% women with anterior POP have cervical elongation. Cervical elongation will make difference in surgical POP treatment. There are several tool for measure cervical length, one of them is Pelvic Organ Prolapse Quantifications System (POP-Q), by measure difference in point C and D. Until now, there is no research to measure sensitivity, specificity and accuracy of POP-Q to measure cervical length for cervical elongation diagnose in POP patients. Objective: To know sensitivity, specificity and accuracy of POP-Q to measure cervical length for cervical elongation diagnose in POP patients with gold standard was anatomical cervical length from hysterectomy result. Methode: Diagnosis research, cross sectional, consecutive sampling. POP-Q was taken before operation and anatomi cervical length was from hysterectomy result. Result: 66 subject, 1.5% 2nd degree POP, 45.5% 3rd degree POP, and 53.0 % 4th degree POP. Mean (± sd) age and body mass index consecutively 59.88 years (± 9.347) and 24.41 (± 3.67) kg/m2. Median (min-max) cervical length POP-Q and anatomy consecutively 4 cm (1-12) and 5 cm (3-10). Sensitivity, Spesifisity dan Accuracy POP-Q consecutively 79%, 58% dan 68%. Conclussion: POPQ has good specificity (79%) but with less sensitivity (58%) with accuracy 68% to diagnose cervical elongation in POP."

"ABSTRAK Tesis ini membahas insidens retensi urin pascahisterektomi total per vaginam, dan per abdominam, serta menilai perbandingan insidens retensi urin pada prosedur per vaginam dan per abdominam. Penelitian ini adalah penelitian analitik komparatif dengan desain kohort prospektif dan retrospektif. Hasil penelitian menunjukkan insidens retensi urin tidak meningkat pada histerektomi per vaginam. Dengan hasil ini diharapkan memperbaiki tatalaksana pascahisterektomi per vaginam yang lebih baik. Namun penelitian ini menyarankan bahwa dilakukan penelitian lebih lanjut dengan jumlah sampel yang lebih besar, menggunakan desain kohort prospektif, dan mengukur volume urin pascaberkemih (PVR) preoperatif.

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ABSTRAK The focus of this study is to establish the incidence of postoperative urinary retention after performing vaginal hysterectomy, and abdominal hysterectomy, also to compare postoperative urinary retention between vaginal and abdominal hysterectomy. This research is comparative analytic interpretive, using design of prospective and retrospective cohort study. The study result is postoperative urinary retention did not increase by vaginal hysterectomy. Knowing this will improve management of postoperative hysterectomy cases. The researcher suggests for the next research will be using prospective cohort, with large amount of samples, and evaluate post-void residual volume (PVR) preoperatively."

"ABSTRAKLatar belakang:Berdasarkan International Continence Society(ICS), inkontinensia urin merupakan keluhan dari kebocoran urin sebagai hasil dari abnormalitas fungsi saluran kemih bagian bawah atau sekunder dari penyakit tertentu yang dapat mengganggu kehidupan perempuan secara fisik, psikologis, dan sosial. Pada tahun 2003, prevalensi inkontinensia urin pada perempuan di seluruh dunia sebesar 17-50% dengan jenis yang paling sering adalah jenis tekanan (50%). Hipermobilitas leher kandung kemih merupakan salah satu dasar patologi dari inkontinensia tipe tekanan. Kondisi hipermobilitas leher kandung kemih dan uretra dapat membantu lebih memahami patofisiologi dari inkontinensia urin tipe tekanan yang terjadi. Penelitian ini ditujukan untuk menilai hubungan profil pergerakan leher kandung kemih dengan prolaps kompartemen anterior vagina pada pasien dengan inkontinensia urin jenis tekanan pada pasien dengan prolaps organ panggul.Metode:Studi ini memiliki desain potong lintang pada 112 subjek dengan riwayat POP yang memenuhi kriteria inklusi dan eksklusi. Data yang diambil pada penelitian ini adalah bladder neck descent(BND), retrovesical angle(RVA), Rotational urethra(RoU), funneling, titik Aa dan Ba pada POP-Q. Hasil:Data penelitian menunjukan inkontinensia tipe tekanan terjadi pada 50% subjek dengan POP. Pada analisis data didapatkan perbedaan yang signifikan antara funneling, sudut RVA dan sudut RoU dengan kejadian inkontinensia urin. Cutoff sudut RVA didapatkan bernilai 130.570dengan sensitivitas 64,3% dan spesifisitas 55.4%. Cutoff sudut RoU didapatkan bernilai 41.560dengan sensitivitas 76,8% dan spesifisitas 67,9%. Hasil yang didapatkan menunjukan hubungan yang bermakna pada analisis multivariat. Kesimpulan:Terdapat perbedaan yang bermakna antara sudut RVA, sudut RoU, dan riwayat funneling terhadap inkontinensia urin tipe tekanan pada perempuan dengan POP. Tidak terdapat perbedaan nilai penurunan Titik Aa, titik Ba, dan penurunan leher kandung kemih antara perempuan kontinensia dengan inkontinensia jenis tekanan. Sudut RVA, sudut RoU, dan riwayat funneling dapat digunakan untuk memprediksi terjadinya inkontinensia tipe tekanan pada subjek dengan POP.

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ABSTRACTBackground:Stress type urinary incontinence is a pressure induced urinary leakage caused by functional abnormality of lower urinary tract or other disease that cause physical, psychological, and social disturbance in female. The prevalence of urinary incontinence is 17-50% around the world with 50% of them are stress type urinary incontinence. Bladder neck mobility is one of the main pathology of stress type urinary incontinence. Observation of bladder neck mobility and urethra in stress type incontinence may increase the understanding of the urinary incontinence pathophysiology. This study is aimed to quantify the relation between bladder neck mobility profile and anterior compartment vaginal prolapse with stress-type urinary incontinence in patient with pelvic organ prolapse.Method:The study is a cross-sectional study with 112 subjects with history of pelvic organ prolapse and suits inclusion and exclusion criteria. Data obtained in this study are bladder neck descent (BND), retrovesical angle (RVA), rotational urethra (RoU), funneling, point Aa and Ba from POP-Q.Results:This study found stress-type urinary incontinence in 50% subjects with POP. In this study, significant difference found in funneling, RVA, and RoU between female with and without urinary incontinence. Cutoff of RVA obtained from this study are 130.570with 64.3% sensitivity and 55.4% specificity. Cutoff of RoU obtained from this study are 41.560with 76,8% sensitivity and 67,9% specificity. Cutoff result shows significant correlation with stress type urinary incontinence on multivariate analysis. Conclusion:There are significant difference in RVA, RoU, and funneling between female with and without stress type urinary incontinence. There are no significant difference in point Aa, point Ba, and bladder neck descent between female with and without urinary incontinence. Funneling, RVA, and RoU can predict incidence of stress type urinary incontinence in female with POP. "

"Latar Belakang Prolaps organ panggul (POP) merupakan perubahan posisi organ-organ penyusun panggul dari posisi normal. Ballooning atau distensi otot levator ani dinilai menjadi penyebab POP. Penentuan balloning sejauh ini masih menggunakan USG 3D/4D yang tidak banyak ada di Indonesia. Diperlukan penelitian perbandingan ballooning dan non-ballooning dengan USG 2D untuk menentukan ballooning dengan panjang antero-posterior (AP) hiatus levator ani. Metode Digunakan metode deskriptif analitik menggunakan perbandingan rerata dengan desain penelitian potong lintang retrospektif dan pemilihan sampel penelitian secara konsekutif. Didapatkan sebanyak 72 subjek dengan 37 orang berada pada kelompok ballooning. Hasil Usia kelompok ballooning dan non-ballooning berada pada usia dewasa tua (60.35 ± 11.06 vs 56.54 ± 11.14 tahun, p=0.096), obesitas (26.73 ± 3.94 vs 24.53 ± 2.88 kg/m2, p=0.015), aktivitas berat (51.3% vs 65.7%, p=0.217), pekerjaan ibu rumah tangga (64.8% vs 65.7%, p=0.893), multiparitas (72.9% vs 60.0%, p=0.210), menopause (75.6% vs 74.2%, p=0.892), bayi lahir terberat ≥ 3500 gram (56.7% vs 45.7%, p=0.349), dan persalinan normal (83.7% vs 88.5%, p=0.420). Rerata anteroposterior ballooning lebih besar dibandingkan non-ballooning (7.09 ± 0.63 vs 5.56 ± 0.64 cm) dengan seluruh subjek ballooning memiliki panjang AP di atas 6 cm (<0.001). Kesimpulan Obesitas dan berat badan berhubungan dengan adanya ballooning pada pasien POP. Perbandingan AP hiatus levator ani menunjukkan perbedaan sehingga skrining ballooning berdasarkan panjang AP hiatus dapat dilakukan untuk membedakan kedua kelompok.

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Introduction Pelvic organ prolapse (POP) is a change in the position of the organs that make up the pelvis from their normal position. Ballooning or distension of the levator ani muscle is considered to cause POP. This determination of ballooning still uses 3D/4D ultrasound, which is not widely available in Indonesia. Comparative research between ballooning and non-ballooning with 2D ultrasound is needed to determine the ballooning through anteroposterior (AP) length of the levator ani hiatus. Method The analytical descriptive method was used using mean comparisons with a retrospective cross-sectional research design and consecutive research sample selection. There were 72 subjects with 37 people in the ballooning group. Results The ages of the ballooning and non-ballooning groups were older adults (60.35 ± 11.06 vs 56.54 ± 11.14 years, p=0.096), obesity (26.73 ± 3.94 vs 24.53 ± 2.88 kg/m2, p=0.015), heavy activity (51.3% vs 65.7%, p=0.217), housewife work (64.8% vs 65.7%, p=0.893), multiparity (72.9% vs 60.0%, p=0.210), after menopause (75.6% vs 74.2%, p=0.892) , the heaviest baby born ≥ 3500 grams (56.7% vs 45.7%, p=0.349), and normal delivery (83.7% vs 88.5%, p=0.420). The mean anteroposterior ballooning was greater than non-ballooning (7.09 ± 0.63 vs 5.56 ± 0.64 cm) with all ballooning subjects having an AP length above 6 cm (<0.001). Conclusion Obesity and body weight are associated with ballooning in POP patients. Comparison of the AP hiatus of the levator ani shows differences so that ballooning screening based on the length of the AP hiatus can be performed to differentiate the two groups."

"ABSTRAKLatar belakang: Selama beberapa hari setelah persalinan, retensio urin dengan distensi kandung kemih adalah fenomena yang umum terjadi. Jika pasien tidak dapat berkemih spontan dalam waktu 4 jam setelah bersalin, besar kemungkinan bahwa dia mengalami Retensio Urin Post Partum RUPP . Di beberapa tempat pengukuran residu urin dilakukan 4 jam post partum, sementara di tempat lain dilakukan 6 jam post partum. Ketidakseragaman waktu pengukuran ini akan mempengaruhi diagnosis, tata laksana, serta prognosis. Waktu pengukuran yang lebih lama akan menyebabkan kandung kemih akan terisi lebih banyak urin, sehingga akan terdistensi dalam waktu yang lebih lama, sehingga waktu pemulihan akan lebih lama.Objektif: Diketahuinya lama pemulihan dan volume residu urin pada kelompok pasien dengan retensio urin pasca persalinan dengan beda waktu pengukuran,Desain penelitian dan metode: Penelitian ini menggunakan desai uji klinis acak di RSUPN Cipto Mangunkusumo dan RSUD Karawang bulan Maret-Desember 2017. Perermpuan pasca salin dengan risiko retensio urin pasca persalinan, bersedia mengikuti penelitian, dan terdiagnosis retensio urin dibagi menjadi dua kelompok. Kelompok pertama diukur residu urinnya dalam 4 jam, kelompok kedua dalam 6 jam. Pasien lalu diberikan tatalaksana retensio urin sesuai protokol RSUPNCM dan dicatat waktu pulihnya.Hasil: Karakteristik pasien pada kedua kelompok dianggap setara. Median lama pemulihan pasien retensio urin yang diukur residu urin 4 jam adalah 30 jam, berbeda 21 jam dengan pasien yang diukur resiudnya 6 jam, yaitu 51 jam p

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ABSTRACTIntroduction Few days after delivery, urinary retention with bladder distention commonly happens. If patient unable to void spontaneously 4 hours after delivery, most likely she will develops post partum urinary retention PPUR . In some hospitals, the urinary residual volume was measured at 4th hour, other measures at 6th hour post delivery. This will affects the diagnosis, management, and prognosis. The longer the measurement will make the bladder filled with much more urine volume, thus the bladde will be distended in longer period, so the recovery time will be prolonged.Objective To know the differrence of recovery time and the urinary residual volume between group of patient with different time of urinary residual collecting.Study design and methode A randomized controlled trial was held at Cipto Mangunkusumo central general hospital and central Karawang hospital between March and Desember 2017. Post partum women with urinary retention risks, willing to contribute to the trial, and diagnosed as post partum urinary retention were divided into 2 groups. Urinary residual volume was meassured in 4th hour and 6th hour in each group. Patient then treated according to RSCM guideline, and the time of recovery was documented.Result Both group have similar characteristic. The median length of recovery in the group which the urinary residual was measured in 4th hour was 30 hours, 21 hours shorter than 6th hour group, 51 hours p 0.001 . The median of urinary residual volume of the 4th hour group was 600 ml, 400 ml lesser than the 6th hour group, 1000 ml p 0.001 Conclussion time of recovery are shorter in the 4th hour group and the urinary residual volume are less in the 4th hour group compared to the 6th hour group.Keywords post partum urinary retention, urine residual, urinary residual collecting time"

"Latar belakang: Prolaps organ panggul (POP) didefinisikan sebagai turunnya visera pelvis (uterus, kandung kemih, uretra, dan rektum) dari posisi normal. Otot levator ani merupakan penopang panggul yang berperan penting dalam patogenesis POP. Studi sebelumnya menunjukkan terdapat perbedaan luas area hiatus dan panjang anteroposterior hiatus levator ani pada setiap derajat keparahan POP. Diagnosis POP dapat ditegakkan dengan POP-Q, namun pelaksanannya masih terbatas sehingga dibutuhkan alat pemeriksaan lain untuk skrining pasien. Metode: Penelitian ini adalah penelitian potong lintang dengan metode consecutive sampling. Peneliti mengidentifikasi subjek POP dengan dan tanpa keluhan benjolan. Subjek yang bersedia ikut serta dalam penelitian ini menjalani pemeriksaan POP-Q, panjang genital hiatus (Gh) dan perineal body (Pb), dan pemeriksaan USG translabial 3D/4D. Data dianalisis menggunakan SPSS Statistics 20 dengan uji T tidak berpasangan untuk membandingkan rerata parameter luas area hiatus dan panjang anteroposterior levator ani. Selanjutnya dilakukan analisa ROC untuk mendapatkan nilai titik potong dengan estimasi sensitifitas dan spesifisitas terbaik untuk membedakan prolaps bergejala dan tidak bergejala benjolan. Hasil: Sebanyak 109 subjek ikut serta dalam penelitian ini. Terdapat perbedaan bermakna luas hiatus (28,9+5,59 vs 19,6+4,63, p < 0,05 saat valsalva, 15,2+4,08 vs 12,5+3,15, p <0,005 saat kontraksi) dan panjang anteroposterior levator ani (8,6+1,06 vs 6,8+1.13, p<0,05) antara kelompok dengan keluhan benjolan dan kelompok tanpa keluhan benjolan. Titik potong luas area hiatus dan panjang anteroposterior levator ani untuk membedakan subjek dengan keluhan benjolan dan tanpa keluhan benjolan adalah 25,1 cm2 [sensitifitas 84,6%, spesifisitas 92,9%, AUC 0,925 (0,864-0,986)] dan 7,75 cm [sensitifitas 87,2%, spesifisitas 77,1%, AUC 0,859 (0,787-0,932)].Kesimpulan: Terdapat perbedaan bermakna luas hiatus dan panjang anteroposterior levator ani antara kelompok dengan keluhan benjolan dan tanpa keluhan benjolan. Titik potong luas hiatus 25,1 cm dan panjang anteroposterior 7,75 cm memiliki sensitifitas dan spesifisitas yang baik untuk membedakan kedua kelompok.

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Introduction: Pelvic organ prolapse (POP) is defined as descent of the pelvic viscera (uterus, bladder, urethra, and rectum) from its normal position. Levator ani muscle is the largest component of pelvic floor that plays an important part in POP pathogenesis. Previous study showed that there was difference in levator hiatus area and anteroposterior length on every grade of POP. The diagnosis of POP can be established from POP-Q tool, however its use is still very limited within its subspecialist practice causing the need of a new screening tool.

Methods: This was a cross-sectional study with consecutive sampling method. We classified POP subject with bulge symptom and without bulge symptom. Subjects that were willing to participate in this study under underwent POP-Q examination and 3D/4D transperineal ultrasonography. Data were analyzed using SPSS Statistics 20 with student’s t-test to compare levator hiatus area and anteroposterior length mean between 2 group.

Results: A total of 109 subjects were included in this study. There was a significance difference in levator hiatus area (28.9+5.59 cm2 vs 19.6+4.63 cm2, p < 0/05 during valsalva maneuver, 15.2+4.08 cm2 vs 12.5+3.15 cm2, p <0.05 during contraction) and anteroposterior length (8.6+1.06 c, vs 6.8+1.13 cm, p<0,05) between group with bulge symptom and without bulge symptom. Levator hiatus area and anteroposterior length cutoff to differentiate between subject with and without bulge symtoms was respectively 25,1 cm2 [sensitivity 84,6%, specificity 92,9%, AUC 0,925 (0,864-0,986)] and 7,75 cm [sensitivity 87,2%, specificity 77,1%, AUC 0,859 (0,787-0,932)].

Conclusion: There was a significant difference in levator hiatus area and anteroposterior length between group with and without bulge symptom. Levator hiatus area cut off at 25,1 cm2 anteroposterior length cut off at 7.75 cm showed good sensitivity and specificity to differentiate between 2 group."

"ABSTRAKLatar Belakang: Prolaps Organ panggul POP adalah tonjolan atau penonjolan organ panggul dan segmen yang terkait vagina ke dalam atau melalui vagina.1 POP Sering dijumpai pada wanita dewasa dan usia lanjut.1-3 Umumnya wanita yang menderita POP datang dengan keluhan adanya benjolan pada vaginanya.9,10 Gangguan pada fungsi seksual jarang dikeluhkan, namun dari kepustakaan diketahui bahwa pasien prolaps stage 3-4 terkait dengan sulitnya pencapaian orgasme.13 Sedangkan Roovers dkk melaporkan prevalensi disfungsi seksual sebesar 68 pada pasien POP. Sayangnya, Di Indonesia sendiri penelitian mengenai disfungsi seksual pada penderita POP cukup jarang, bahkan peneliti sendiri belum mendapatkan datanya. Oleh karena itu penting dilakukan penelitian mengenai prevalensi disfungsi seksual pada pasien prolaps organ panggul.Tujuan : Mengetahui prevalensi disfungsi seksual pada penderita prolaps organ panggulMetode: Dengan desain potong lintang, di dua rumah sakit pusat rujukan di Jakarta RSUPN Ciptomangunkusumo dan RSUP Fatmawati . Semua pasien POP yang memenuhi kriteria inklusi mengisi kuesioner indeks fungsi seksual FSFI-19 , kemudian dilakukan analisis data univariat untuk karakteristik data subjek, dan bivariat untuk mengetahui hubungan antara variable dependen dan independen.Hasil: Dari 82 data yang dianalisis, prevalensi disfungsi seksual pada pasien POP mencapai 57,3 . Sedangkan sebagian besar pasien POP juga sudah mengalami menopause dengan prevalensi sebesar 76.8 . Prevalensi disfungsi seksual pada pasien POP yang sudah menopause sebesar 66,7 . Dari hasil analisis bivariat, usia, menopause, obesitas dan stadium prolaps adalah faktor risiko yang signifikan terhadap kejadian disfungsi seksual pada pasien POP. Variabel usia, merokok, menopause, obesitas dan stadium prolaps, memiliki nilai p 60 dengan OR 8 IK95 2,45- 26,12 , dan obesitas IMT 30 kg/m2 dengan OR 0,30 IK 95 0,09-0,98 .Kata kunci : prolapse organ panggul, disfungsi seksual, fungsi seksual, seksual aktif

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ABSTRACTAbstractBackground Pelvic Organ Prolapse POP is a bulge or protrusion of pelvic organs and related segments into or through the vagina vagina.1 POP often be found in adult women and older people.1 3 Generally, women who suffer from POP present with a lump vaginal .9,10 Disturbances in sexual function rarely complained, but from the literature it is known that patients with stage 3 4 prolapse associated with difficulty in achieving a orgasme.13 While Roovers et al reported the prevalence of sexual dysfunction was 68 in patients with POP. Unfortunately, in Indonesia, research on sexual dysfunction in patients with POP quite rare, even the researchers themselves do not get the data. It is therefore important to do research on the prevalence of sexual dysfunction in patients with pelvic organ prolapse and factors associated with sexual dysfungtion among them.Objective To determine the prevalence of sexual dysfunction in patients with pelvic organ prolapse and factors associated with sexual dysfungtion among them.Methods A cross sectional design, in two referral hospitals in Jakarta RSUPN Ciptomangunkusumo and Fatmawati Hospital All patients who met the inclusion criteria POP fill out a questionnaire of sexual function index FSFI 19 , then performed univariate analysis of data on the characteristics of the data subject, bivariate and multivariate analysis to know the relationship between the dependent and independent variablesResults Of the 82 analyzed data, the prevalence of sexual dysfunction in patients with POP reached 57.3 . While most of the patients had experienced menopause POP also with a prevalence of 76.8 The prevalence of sexual dysfunction in patients who are menopausal POP by 66.7 . From the results of the bivariate analysis, age, menopause, obesity and stage of prolapse is a significant risk factor on the incidence of sexual dysfunction in patients with POP. The variables of age, smoking, menopause, obesity and stage of prolapse, p 60 with an OR 8 IK95 2,45 26.12 , and obesity BMI 30 kg m2 with an OR of 0.30 CI 95 0.09 to 0.98 . Keywords pelvic organ prolapse, sexual dysfunction, sexual function, sexually active"