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"Inkontinensia urin tekanan (IUT) merupakan kondisi bocornya urin saat tekananintrabdominal meningkat. Tatalaksana konservatif seperti latihan kegel (LK) yangmerupakan pilihan pertama dalam penanganan kasus IUT. Namun, terdapathambatan seperti kepatuhan yang buruk serta ketidakmampuan pasienmengontraksikan otot panggul, ketika menjalani program LK sehingga mengalamikegagalan dan berlanjut pada tindakan operasi. Penelitian ini bertujuan menyusunbuku panduan LK untuk membantu kepatuhan pasien dalam melakukan LK danmenganalisis luaran subjektif, klinis, kepatuhan, serta kekuatan kontraksi otot dasarpanggul pada pasien yang berlatih LK selama 12 minggu. Penelitian ini memilikidesain eksplorasi sequential mixed-method research yang terdiri atas penelitiankualitatif dan penelitian kuantitatif. Penelitian kualitatif bertujuan menyusun bukupanduan LK baku menggunakan tahapan analyze, design, development,implementation, and evaluation (ADDIE) dan penelitian kuantitatifmengujicobakan buku panduan LK tersebut dalam praktik klinis dan dievaluasiefektivitasnya dalam menangani IUT. Penelitian berlangsung sejak Agustus 2020sampai September 2022, di berbagai rumah sakit seperti RS dr.CiptoMangunkusumo, RS Fatmawati, RSCM Kintani, RS Buah Hati Ciputat danPamulang, RS Prikasih, dan RS YPK Mandiri. Luaran yang dievaluasi padapenelitian kuantitatif adalah gejala subjektif yang diukur berdasarkan kuesionerIIQ-7 dan UDI-6, gejala klinis yang diukur berdasarkan 1-hour pad test, kekuatanotot dasar panggul dengan perineometer, dan kepatuhan pasien. Buku panduan LKberhasil disusun menggunakan metode ADDIE dan diujicobakan pada tahappenelitian kuantitatif. Subjek penelitian adalah 178 pasien IUT dari berbagai rumahsakit dan 148 berhasil mengikuti penelitian hingga selesai. Setelah 12 minggu LKterdapat perbaikan gejala subjektif, gejala klinis, dan kekuatan otot panggul yangbermakna. Tidak ada perbedaan gejala subjektif yang bermakna antara kelompokintervensi dan kontrol. Terdapat perbedaan gejala klinis, kekuatan otot dasarpanggul, dan kepatuhan yang bermakna pada kelompok intervensi dan kontrol.Buku panduan LK yang berhasil disusun menggunakan metode ADDIE berhasilmeningkatkan gejala subjektif, klinis, kekuatan otot panggul, dan kepatuhan pasienIUT dalam melakukan LK. Jika dibandingkan kontrol, pasien yang menggunakanbuku panduan LK memiliki perbaikan gejala klinis, peningkatan kekuatan ototpanggul, dan peningkatan kepatuhan yang bermakna.

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Stress Urinary Incontinence (SUI) is a condition in which urine leaks when intraabdominal pressure increases. Worldwide, many women have suffered from SUI. Conservative management, one of which is Pelvic Floor Muscle Training (PFMT), is the first choice in handling IUT cases. However, various obstacles, such as poor compliance and the inability of women to contract the pelvic muscles, are often encountered by women undergoing the PFMT program. They would be likely to fail and undergo surgery. This study aimed to create a PFMT Guidebook and evaluate the effectiveness in improving subjective, clinical, compliance, and pelvic floor muscle contraction of SUI women after twelve weeks. This study was an exploratory sequential mixed-method research design consisting of qualitative and quantitative research. This qualitative study aims to compile a standardized PFMT guidebook using the ADDIE stage and quantitative research to test the PFMT guidebook in clinical practice and evaluate its effectiveness in dealing with SUI. This process took place from August 2020 untill September 2022 in various hospital centers such as CiptoMangunkusumo Hospital, Fatmawati Hospital, Kintani RSCM, Buah Hati Pamulang and Ciputat Hospitals, Prikasih Hospital, and YPK Mandiri Hospital. The outcomes evaluated in this quantitative study were subjective symptoms measured by the IIQ-7 and UDI-6 questionnaires, clinical symptoms measured by the 1-hour pad test, pelvic floor muscle strength using a perineometer, and patient compliance. ADDIE method helped us to create a PFMT guidebook. There were 178 SUI women from various hospitals recruited. 148 of them successfully followed this study to completion. After 12 weeks of PFMT, compared to the control group, there was no difference in clinical symptoms. There were significant differences in clinical symptoms, pelvic floor muscle strength, and adherence between the intervention and study groups. The PFMT guidebook created using the ADDIE method improved subjective, clinical symptoms, pelvic muscle strength, and SUI patient compliance in performing PFMT. Compared with controls, patients who used the PFMT manual significantly improved clinical symptoms, increased pelvic muscle strength, and increased compliance."

"Latar Belakang : ICS merekomendasikan latihan Kegel, sebagai terapi konservatif untuk mengatasi inkontinensia urin tekanan untuk dilakukan selama 12 minggu. Namun, beberapa penelitian menunjukkan bahwa latihan kegel selama 4, dan 8 minggu dapat memperbaiki gejala inkontinensia, kualitas hidup, dan meningkatkan kekuatan otot dasar panggul. Tujuan : Mengetahui gambaran perbaikan gejala subjektif dan objektif, peningkatan kekuatan otot dasar panggul, perbaikan derajat keparahan dan perbaikan kualitas hidup wanita penderita inkontinensia urin tekanan yang menjalani antara latihan Kegel yang 4, 8, dan 12 mingguMetode:55 subjek terdiagnosis inkontinensia urin tekanan (berdasarkan nilai (QUID >4) dan tes pembalut positif 60 menit) diberikan latihan Kegel di Poliklinik Rehabilitasi Medik RSCM selama 12 minggu. Pengumpulan data, seperti kuesioner UDI-6; tes pembalut 60 menit; dan kuesioner IIQ-7 akan dicatat oleh subjek penelitian dalam buku kegiatan 4, 8, dan 12 minggu. Selain itu, evaluasi biofeedback(Myomed 932) dari kekuatan serat otot lambat dan serat otot cepat dilakukan setiap 2 minggu untuk menilai perbaikan. Hasil:Hasil penelitian menunjukkan bahwa adanya perbedaan bermakna antara skor UDI-6 dan IIQ-7 subjek sebelum latihan dan setelah latihan 4, 8, dan 12 minggu (uji Wilcoxon; p<0.05). Selain itu, adanya perbedaan yang signifikan pada kekuatan serat otot lambat dan serat cepat antara sebelum latihan dengan pasca latihan 8 minggu dan sebelum latihan dengan pasca 12 minggu. (dengan uji Wilcoxon; p <0.05).Kesimpulan :Latihan Kegel yang dilakukan dengan durasi minimal 8 minggu dapat memperbaiki gejala, kekuatan otot dasar pangul dan kualitas hidup wanita dengan inkontinensia urin tekanan.

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Introduction :

Kegel exercise is recommended by ICS, as a conservative therapy to improve stress urinary incontinence for 12 weeks. However, several studies have shown that Kegel exercise for 4 and 8 weeks can improve symptoms of incontinence, quality of life and increase pelvic floor muscle strength.

Objective:

To identify the improvement subjective and objective symptoms, increasing pelvic floor muscle strength, and improvement quality of life among women with stress urinary incontinence who performed kegel exercise 4, 8, and 12 weeks.

Method:

55 subjects were diagnosed with stress urinary incontinence (based on (QUID score >4) and positive result of pad test 60 minutes) and were given the Kegel exercise at RSCM for 12 weeks. Datas such as UDI-6, pad test 60 minutes, and IIQ-7 will be documented by each subject in the book for 4, 8, and 12 weeks. In addition, Pelvic floor muscle (slow and fast fibers twitch) were assessed by biofeedback (myomed 932) every 2 weeks.

Result:

The results show that there is a significant difference between the UDI-6 and IIQ-7 scores before, after 4, 8, and 12 weeks Kegel exercise. (Wilcoxon testp < 0.05).

In addition, there is a significant difference in the pelvic floor muscle strength (slow and fast fibers twitch) between before with after exercise for 8 weeks Kegel exercise and between before and after 12 weeks Kegel exercise. (Wilcoxon test; p <0.05).

Conclusion:

Performing Kegel exercise with a minimum duration of 8 weeks can improve symptoms, pelvic floor muscle strength and quality of life for women with stress urinary incontinence."

"ABSTRAKICS merekomendasikan latihan Kegel, sebagai terapi konservatif untuk mengatasi inkontinensia urin tekanan untuk dilakukan selama 12 minggu. Namun, beberapa penelitian menunjukkan bahwa latihan kegel selama 4, dan 8 minggu dapat memperbaiki gejala inkontinensia, kualitas hidup, dan meningkatkan kekuatan otot dasar panggul. Tujuan : Mengetahui gambaran perbaikan gejala subjektif dan objektif, peningkatan kekuatan otot dasar panggul, perbaikan derajat keparahan dan perbaikan kualitas hidup wanita penderita inkontinensia urin tekanan yang menjalani antara latihan Kegel yang 4, 8, dan 12 mingguMetode: 55 subjek terdiagnosis inkontinensia urin tekanan (berdasarkan nilai (QUID >4) dan tes pembalut positif 60 menit) diberikan latihan Kegel di Poliklinik Rehabilitasi Medik RSCM selama 12 minggu. Pengumpulan data, seperti kuesioner UDI-6; tes pembalut 60 menit; dan kuesioner IIQ-7 akan dicatat oleh subjek penelitian dalam buku kegiatan 4, 8, dan 12 minggu. Selain itu, evaluasi biofeedback(Myomed 932) dari kekuatan serat otot lambat dan serat otot cepat dilakukan setiap 2 minggu untuk menilai perbaikan. Hasil: Hasil penelitian menunjukkan bahwa adanya perbedaan bermakna antara skor UDI-6 dan IIQ-7 subjek sebelum latihan dan setelah latihan 4, 8, dan 12 minggu (uji Wilcoxon; p<0.05). Selain itu, adanya perbedaan yang signifikan pada kekuatan serat otot lambat dan serat cepat antara sebelum latihan dengan pasca latihan 8 minggu dan sebelum latihan dengan pasca 12 minggu. (dengan uji Wilcoxon; p <0.05).Kesimpulan : Latihan Kegel yang dilakukan dengan durasi minimal 8 minggu dapat memperbaiki gejala, kekuatan otot dasar pangul dan kualitas hidup wanita dengan inkontinensia urin tekanan.

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ABSTRACTKegel exercise is recommended by ICS, as a conservative therapy to improve stress urinary incontinence for 12 weeks. However, several studies have shown that Kegel exercise for 4 and 8 weeks can improve symptoms of incontinence, quality of life and increase pelvic floor muscle strength. Objective: To identify the improvement subjective and objective symptoms, increasing pelvic floor muscle strength, and improvement quality of life among women with stress urinary incontinence who performed kegel exercise 4, 8, and 12 weeks.Method: 55 subjects were diagnosed with stress urinary incontinence (based on (QUID score >4) and positive result of pad test 60 minutes) and were given the Kegel exercise at RSCM for 12 weeks. Datas such as UDI-6, pad test 60 minutes, and IIQ-7 will be documented by each subject in the book for 4, 8, and 12 weeks. In addition, Pelvic floor muscle (slow and fast fibers twitch) were assessed by biofeedback (myomed 932) every 2 weeks. Result: The results show that there is a significant difference between the UDI-6 and IIQ-7 scores before, after 4, 8, and 12 weeks Kegel exercise. (Wilcoxon testp < 0.05).In addition, there is a significant difference in the pelvic floor muscle strength (slow and fast fibers twitch) between before with after exercise for 8 weeks Kegel exercise and between before and after 12 weeks Kegel exercise. (Wilcoxon test; p <0.05).Conclusion: Performing Kegel exercise with a minimum duration of 8 weeks can improve symptoms, pelvic floor muscle strength and quality of life for women with stress urinary incontinence"

"ABSTRAKInkontinensia urin sering ditemukan pada 50% wanita yang berusia dibawah 60. Yang terbanyak adalah inkontinensia urin jenis tekanan (IUT) sebesar 49%. Diketahui bahwa kelemahan otot dasar panggul merupakan salah satu penyebab inkontinensia urin jenis tekanan. Penelitian ini bertujuan untuk mengkaji hubungan antara kekuatan otot dan ketebalan otot levator ani dengan keluhan IU-T pada perempuan. Penelitian ini menggunakan desain Comparative Cross Sectional dengan melibatkan wanita yang berkunjung di poliklinik Obstetri dan Ginekologi RSUPN Dr. Cipto Mangunkusumo dengan kelompok studi adalah subyek dengan tes batuk positif sedangkan kelompok kontrol adalah subyek dengan tes batuk negative. Data yang diperoleh berupa hasil anamnesis, Questionnaire for Urinary Incontinence Diagnosis (QUID), pemeriksaan fisik (POPQ), tes batuk. perineometer, dan USG. Sampel berjumlah 82 orang. Hasil penelitian ini didapatkan tidak ada perbedaan bermakna antara ketebalan otot levator ani terhadap kejadian IUT dengan median ketebalan otot levator ani 0,63 cm (range 0,31-1,02 dan p=0,897). Sedangkan kekuatan otot levator ani terhadap IUT memiliki median 19,5 (range 4,6-88,6 dan p=0,001). Pada analisis multivariat didapatkan bukti bahwa secara murni IUT, prolap dan usia tidak mempunyai pengaruh bermakna terhadap kekuatan otot levator ani dengan nilai p masing-masing 0,243; 0,844; 0,903.

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ABSTRACTUrinary incontinence is often found in 50% of women under the age of 60. The most common is pressure type urinary incontinence (IUT) of 49%. It is known that pelvic floor muscle weakness is one of the causes of pressure type urinary incontinence. This study aims to examine the relationship between muscle strength and levator ani muscle thickness with IU-T complaints in women. This study uses a Comparative Cross Sectional design by involving women visiting the Obstetrics and Gynecology clinic of RSUPN Dr. Cipto Mangunkusumo with the study group were subjects with positive cough tests while the control group were subjects with negative cough tests. The data obtained in the form of history taking, Questionnaire for Urinary Incontinence Diagnosis (QUID), physical examination (POPQ), cough test. perineometer, and ultrasound. A sample of 82 people. The results of this study found no significant difference between the levator ani muscle thickness to the incidence of IUT with the median levator ani muscle thickness 0.63 cm (range 0.31-1.02 and p = 0.897). While levator ani muscle strength against IUT has a median of 19.5 (range 4.6-88.6 and p = 0.001). In multivariate analysis it was found that purely IUT, prolapse and age had no significant effect on the strength of levator ani muscles with a p value of 0.243 each; 0.844; .903."

"Inkontinensia urin tekanan sering ditemukan padakehamilan dengan prevalensi tertinggi pada empat minggu terakhir kehamilan. Diketahui bahwa kelemahan otot dasar panggul merupakan salah satu penyebab inkontinensia urin tekanan. Penelitian ini bertujuan untuk mengetahui hubungan kekuatan otot dasar panggul dengan inkontinensia urin tekanan pada perempuan hamil trimester ketiga akhir, dan faktor-faktor yang mempengaruhinya. Penelitian ini menggunakan desain potong lintang dengan melibatkan perempuan hamil 36-40 minggu di poli Obstetri dan Ginekologi RSUK TebetJakarta. Data yang diperoleh berupa hasil anamnesis, Questionnaire for Urinary Incontinence Diagnosis QUID , pemeriksaan fisik, perineometer, dan tes batuk. Sampel berjumlah 142 orang dengan 54,2 diantaranya mengalami inkontinensia urin tekanan. Diketahui bahwa kekuatan otot dasar panggul dan taksiran berat janin memiliki perbedaan bermakna dengan inkontinensia urin tekanan p = 0,002, < 0,001, secara berurutan . Uji multivariat menunjukkan bahwa kekuatan otot dasar le; 25,5 cmH2O panggul dan TBJ ge; 3.100 gram paling mempengaruhi kejadian inkontinensia urin tekanan OR = 2,52, p= 0,021 dan OR = 3,34, p= 0,001, secara berurutan . Uji probabilitas menunjukkan bahwa apabila TBJ >3.100 gram dan kekuatan otot dasar panggul

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Stess urinary incontinence is the most frequent found during pregnancy with the highest prevalence in the last four weeks of pregnancy. It is known that weaken pelvic floor muscle is one of the causes of stress urinary incontinence. This study aims to know the relationship between the strength of pelvic floor muscle and stress urinary incontinence in late third trimester of pregnancy and its associated factors.A cross sectional study was conducted involving women with 36 until 40 weeks of pregnancy at Obstetric and Gynecology clinic of Tebet Subdistrict Hospital, Jakarta. Collected data included medical interview, Questionnaire for Urinary Incontinence Diagnosis QUID , physical examination, perineometer, and cough test. Among 142 samples, 54.2 had stress urinary incontinence. Discovered that pelvic floor muscle, and estimated fetal weight had significant differences with SUI p 0.002, 0.001, respectively . Multivariate analysis showed the strength of pelvic floor muscle le 25.5 cmH2O , and EFW ge 3,100 gram were the most influenced factors for SUI OR 2.52, p 0.021 dan OR 3.34, p 0.001, respectively . The likelihood of SUI was 75.39 if the strength of PFM was le 25.5 cmH2O,and EFW ge 3,100 gram. Weaken pelvic floor muscle, and EFW were the factors influencing SUI. "

"ABSTRAK Inkontinensia urin tekanan sering ditemukan padakehamilan dengan prevalensi tertinggi pada empat minggu terakhir kehamilan. Diketahui bahwa kelemahan otot dasar panggul merupakan salah satu penyebab inkontinensia urin tekanan. Penelitian ini bertujuan untuk mengetahui hubungan kekuatan otot dasar panggul dengan inkontinensia urin tekanan pada perempuan hamil trimester ketiga akhir, dan faktor-faktor yang mempengaruhinya. Penelitian ini menggunakan desain potong lintang dengan melibatkan perempuan hamil 36-40 minggu di poli Obstetri dan Ginekologi RSUK TebetJakarta. Data yang diperoleh berupa hasil anamnesis, Questionnaire for Urinary Incontinence Diagnosis QUID , pemeriksaan fisik, perineometer, dan tes batuk. Sampel berjumlah 142 orang dengan 54,2 diantaranya mengalami inkontinensia urin tekanan. Diketahui bahwa kekuatan otot dasar panggul dan taksiran berat janin memiliki perbedaan bermakna dengan inkontinensia urin tekanan p = 0,002, < 0,001, secara berurutan . Uji multivariat menunjukkan bahwa kekuatan otot dasar le; 25,5 cmH2O panggul dan TBJ ge; 3.100 gram paling mempengaruhi kejadian inkontinensia urin tekanan OR = 2,52, p= 0,021 dan OR = 3,34, p= 0,001, secara berurutan . Uji probabilitas menunjukkan bahwa apabila TBJ >3.100 gram dan kekuatan otot dasar panggul ABSTRACT Stess urinary incontinence is the most frequent found during pregnancy with the highest prevalence in the last four weeks of pregnancy. It is known that weaken pelvic floor muscle is one of the causes of stress urinary incontinence. This study aims to know the relationship between the strength of pelvic floor muscle and stress urinary incontinence in late third trimester of pregnancy and its associated factors.A cross-sectional study was conducted involving women with 36 until 40 weeks of pregnancy at Obstetric and Gynecology clinic of Tebet Subdistrict Hospital, Jakarta. Collected data included medical interview, Questionnaire for Urinary Incontinence Diagnosis QUID , physical examination, perineometer, and cough test. Among 142 samples, 54.2 had stress urinary incontinence. Discovered that pelvic floor muscle, and estimated fetal weight had significant differences with SUI p = 0.002, < 0.001, respectively . Multivariate analysis showed the strength of pelvic floor muscle le; 25.5 cmH2O , and EFW ge; 3,100 gram were the most influenced factors for SUI OR = 2.52, p = 0.021 dan OR = 3.34, p = 0.001, respectively . The likelihood of SUI was 75.39 if the strength of PFM was le; 25.5 cmH2O,and EFW ge; 3,100 gram. Weaken pelvic floor muscle, and EFW were the factors influencing SUI."

"Latar Belakang: Inkontinensia urin (IU) merupakan salah satu masalah kesehatan dengan prevalensi dan beban yang cukup tinggi di dunia. Inkotinensia urin tekanan (SIU) merupakan salah satu bentuk inkontinensia urin dengan prevalensi di Indonesia berkisar antara 14,57-52%. Latihan otot dasar panggul merupakan salah satu pencegahan dan tatalaksana yang direkomendasikan untuk inkontinensia urin. Namun, perbandingan antara efektivitas latihan yang dilakukan selama masa kehamilan dan pasca persalinan belum pernah dilakukan sebelumnya.Tujuan: Penelitian ini bertujuan untuk mengetahui efektivitas latihan otot dasar panggul pada masa kehamilan dan setelah persalinan sebagai pencegahan dan pengobatan terhadap terjadinya inkontinensia urin tekanan yang menetap pasca persalinan.Metode: Dilakukan penelitian dengan desain uji klinis acak terkontrol dan kerangka konsep etiologik. Populasi penelitian yaitu semua ibu hamil dengan gejala inkontinensia urin tekanan. Dalam kurun waktu penelitian didapatkan sampel sebanyak 70 ibu hamil dengan gejala inkontinensia urin tekanan pasca persalinan yang dibagi dalam kelompok tanpa intervensi, kelompok latihan otot dasar panggul sejak masa kehamilan, dan kelompok latihan otot dasar panggul pasca persalinan. Data dianalisis dengan metode analisis bivariat kategorik tidak berpasangan dua kelompok.Hasil: Dari hasil penelitian ini, didapatkan adanya hubungan yang bermakna pada ibu hamil yang diberikan latihan otot dasar panggul baik sejak masa kehamilan (p-value = 0.002) maupun pasca persalinan (p-value = 0.006) dengan penurunan proporsi kejadian inkontinensia urin tekanan menetap pasca persalinan. Namun, tidak didapatkan adanya perbedaan hasil yang bermakna secara statistik antara kelompok ibu hamil yang diberikan latihan otot dasar panggul sejak masa kehamilan dengan yang diberikan latihan pasca persalinan (p-value = 1.000).Kesimpulan: Pada penelitian ini tidak didapatkan adanya perbedaan yang bermakna antara latihan otot dasar panggul pada masa kehamilan dan setelah persalinan. Namun, latihan otot dasar panggul pada masa kehamilan dan setelah persalinan terbukti efektif dalam pencegahan dan pengobatan terhadap terjadinya inkontinensia urin tekanan yang menetap pasca persalinan dibandingkan dengan yang tidak melakukan.

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Background: Urinary incontinence (UI) is one of the problematic health problems with high prevalence and monetary burden in the world. Stress urinary incontinence is one form of UI with a prevalence of 14.57 -52% in Indonesia. Pelvic floor muscle training (PFMT) is one of its recommended preventive and curative measures. Nevertheless, comparison between PFMT initiated during pregnancy period and postpartum period has never been studied before.

Objective: This study aims to determine the effectiveness of pelvic floor muscle exercises during pregnancy and after childbirth as prevention and treatment of the occurrence of persistent postpartum urinary incontinence.

Method: A randomized controlled trials with an etiological conceptual framework was done in this study. The study population were all pregnant women with symptoms of urinary incontinence. In the study period, a sample of 70 pregnant women with symptoms of postpartum urinary incontinence consisting of no-intervention group, pregnancy PFMT group, and postpartum PFMT group. The data were analyzed by two groups of unpaired categorical bivariate analysis methods.

Results: It was found that there was a significant association between pregnant women given pelvic floor muscle training (PFMT) both during pregnancy (p-value = 0.002) and postpartum (p-value = 0.006) with decline of persistent postpartum urinary incontinence proportion. However, there was no statistically significant difference of outcome found in the group of pregnant women given PFMT since pregnancy with those who were given after childbirth, p-value = 1,000.

Conclusion: In this study there was no significant difference of outcome between PFMT during pregnancy and after delivery. However, PFMT during pregnancy and after childbirth have been proven effective in the prevention and treatment of the occurrence of postpartum urinary incontinence compared with those who did not."

"Latar belakang: Inkontinensia urin tekanan (IUT) atau Stress Urinary Incontinence (SUI) didefinisikan sebagai kebocoran urin yang tidak disengaja saat aktivitas fisik atau saat bersin atau batuk. Jenis inkontinensia urin ini merupakan yang paling umum terjadi, dengan prevalensi sebesar 23–35% pada kelompok wanita dewasa. Biaya perawatan IUT diperkirakan lebih dari 16 milliar US dollar per tahunnya. Saat ini, terdapat beberapa pilihan terapi IUT, baik bedah hingga non–bedah. Jenis prosedur yang ditanggung oleh sistem Jaminan Kesehatan Nasional (JKN) di Indonesia adalah teknik Plikasi Kelly dengan efektifitas yang rendah dan rekurensi yang tinggi. Kemampuan regenerasi dari PRP (Platelet–Rich Plasma) menjadi salah satu pertimbangan yang dapat diberikan bagi pasien–pasien IUT yang dilakukan pembedahan Plikasi Kelly. Kemampuan PRP sebagai perekat, diharapkan mampu mengembalikan struktur dan fungsi Ligamentum Pubouretralis melalui aktivasi fibroblas untuk memacu pembentukan kolagen baru dengan biaya yang cukup murah menjadi pertimbangan untuk meningkatkan efektivitas tindakan Plikasi Kelly di Indonesia. Objektif: Penelitian ini bertujuan untuk mengetahui perbedaan–perbedaan perbaikan gejala klinis berupa perbaikan kualitas hidup (dinilai menggunakan kuisioner IIQ–7), penurunan berat Tes Pembalut serta kenaikan kadar serum IGF–1 pada pasien IUT yang diberikan penambahan PRP pada saat prosedur pembedahan Plikasi Kelly. Metode: Uji klinis acak tersamar tunggal yang berlangsung di 2 center penelitian, yaitu di RSUPN Dr. Cipto Mangunkusumo Jakarta dan RSUP Dr. Kariadi Semarang. Penelitian berlangsung dari bulan Maret 2021 hingga Desember 2021. Sampel penelitian adalah wanita dengan IUT yang menjalani prosedur pembedahan Plikasi Kelly.Hasil: Tidak terdapat perbedaan kualitas hidup (berdasarkan skor kuisioner IIQ–7) antara kelompok studi yang menerima adjuvan PRP dengan kelompok kontrol (4,8 vs 14,3; p=0,104). Rerata perubahan delta Tes Pembalut pada kelompok studi didapatkan lebih tinggi bermakna dibanding kelompok kontrol (49,8 vs 10,8; p=0,03), namun perbedaan hasil ini dipengaruhi oleh derajat keparahan IUT. Rerata kenaikan kadar serum IGF–1 pada kelompok studi ditemukan lebih tinggi bermakna dibanding kelompok kontrol pasca 3 bulan tindakan operatif (33,5 vs 13; p = 0,000). Kesimpulan: Pemberian PRP sebagai terapi adjuvan pada pasien IUT yang menjalani tindakan Plikasi Kelly memberikan manfaat perbaikan Ligamentum Pubouretralis yang dinilai berdasarkan perbaikan klinis (penurunan berat Tes Pembalut), kenaikan kadar IGF–1, dan peningkatan kualitas hidup (kuisioner IIQ–7). Prosedur injeksi PRP dinilai relatif aman dan efektif dalam meningkatkan efektifitas tindakan Plikasi Kelly. Hasil ini diharapkan dapat memberi bukti klinis untuk rejimen baru terapi IUT yang dapat dilakukan di Indonesia.

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Background: Stress urinary incontinence (SUI) is defined as involuntary urine leakage that occurs during physical activity, sneezing, or coughing. It is the most common type of urinary incontinence, with a prevalence of 23–35% in adult women. The treatment cost for SUI was approximately more than 16 billion US dollars each year. There are plenty of choices for SUI management, from surgical to non–surgical therapies. The procedure covered by Indonesia’s National Health Insurance is Kelly Plication surgery with a low rate of effectiveness and a high chance of recurrent. The Platelet–Rich Plasma (PRP), with its regenerative ability, is considered to be given for patients with SUI that underwent Kelly Plication surgery. The PRP injection, with its ability to act as an adhesive agent, is expected to help restore the Pubourethal Ligament’s structure and function through fibroblast activation to help trigger new collagen formation. Due to it’s low cost required, the PRP injection could be considered to help improve the effectiveness of Kelly Plication Surgery in Indonesia.

Objective: The aim of this study was to find the differences in clinical improvements, including the quality of life (measured with IIQ–7 questionnaire), decreased in weight of Pad test results, and increase in IGF–1 serum level in patients with SUI that were given the PRP injection as an adjuvant during Kelly Plication surgery.

Methods: Experimental single–blind randomized control trial study in a group of women with SUI that underwent the Kelly Plication Surgery. The study was conducted at 2 study centers in Dr. Cipto Mangunkusumo Central General Hospital, Jakarta, and Dr. Kariadi Central General Hospital, Semarang, from March 2021 to December 2021.

Result: There was no significant difference in the quality of life (measured with IIQ–7 questionnaire scores), between the study group which received the PRP adjuvant with the control group (4,8 vs 14,3; p = 0,104). The mean difference score for the weight of Pad test results in the study group was significantly higher than the control group (49,8 vs 10,8; p = 0,03). But this result was influenced by the severity of IUT. The mean increased score for the IGF–1 serum level in the study group was significantly higher than the control group, 3 months after the surgery (33,5 vs 13; p = 0,000).

Conclusion: The PRP injection as adjuvant therapy is considered to give more benefits for patients with SUI that underwent Kelly Plication surgery. The repair of the Pubouretral Ligament is measured by the improvement of the symptom (decreased of the Pad Test score), increased IGF–1 serum level, and quality of life improvement (increased of IIQ–7 Questionnaire). The procedure is considered safe and helps improve the effectiveness of the surgery. This result helps to provide clinical evidence for a new therapy regimen that could be applied in Indonesia."

"Inkontinensia urin merupakan masalah kesehatan yang umum terjadi pada lansia. Lansia mengalami penurunan fungsi sistem tubuh salah satunya adalah perkemihan. Permasalahan ini dapat ditangani dengan berbagai macam intervensi diantaranya adalah intervensi senam kegel dan bladder training yang menjadi terapi lini pertama dalam penanganan masalah inkontinensia urin. Tujuan dari penelitian ini adalah peneliti dapat memberikan gambaran asuhan keperawatan masalah inkontinensia urin dengan senam kegel dan bladder training. Hasil yang didapatkan selama 3 minggu melakukan intervensi adalah terdapat penurunan derajat inkontinensia urin dari sedang ke ringan dengan menggunakan kuesioner ISI dan perubahan interval serta frekuensi berkemih sebelum dan sesudah dilakukannya intervensi. Intervensi ini dapat dilakukan di panti werdha untuk mengurangi angka kejadian inkontinensia urin di panti werdha.

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Urinary incontinence is a common health problem in the elderly. The elderly experience a decline in body system functions, one of which is urination. This problem can be treated with various interventions, including Kegel exercises and bladder training, which are the first line therapy in treating urinary incontinence problems. The aim of this research is that researchers can provide an overview of nursing care for urinary incontinence problems using Kegel exercises and bladder training. The results obtained during the 3 weeks of intervention were a decrease in the degree of urinary incontinence from moderate to mild using the ISI questionnaire and changes in the interval and frequency of urination before and after the intervention. This intervention can be carried out in nursing homes to reduce the incidence of urinary incontinence in nursing homes."

"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."