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Abstrak :
Background: overactive bladder (OAB) affects 17-41% older adults in community dwelled setting. For several years, antimuscarinics have been validated as the first-line medical treatment for OAB. Despite abundant data obtained from clinical trials provisions the use of antimuscarinics, investigation about the effect of this drug on cognitive function in elderly remains scarce. The objective of this study is to investigate the effect of antimuscarinics therapy on cognitive functions in OAB geriatric patients. Methods: this study design is a systematic review and meta-analysis. Studies were collected using several search engines; those were PubMed, Science Direct, Cochrane, and EBSCOhost using predetermined MeSH keywords with Boolean operators. Selection of studies was done by three reviewers. Studies which fulfilled the inclusion and exclusion criteria underwent full-text review. For every selected full text, we extracted the following data if available: patients demographics, types of antimuscarinics used, placebo, dose, follow-up period, and Mini-Mental State Examination (MMSE) total score. Results: a total of 8 studies from an initial 146 publications were selected. There were 8 antimuscarinic agents evaluated in the studies, including Oxybutynin, Darifenacin, Tolterodine, Trospium, Imidafenacin, Propiverine hydrochloride, Fesoterodine, and Solifenacin. Oxybutynin was shown to have largest effect towards the decline of MMSE score [Mean difference: -2.90; 95% CI: -4.07, -1.73]. Darifenacin and Tolterodine were also shown to be significant in the decline of total MMSE score, although still inferior to Oxybutynin. Conclusion: the use of most antimuscarinics medication has little to no effect towards the cognitive function in the management of overactive bladder in elderly patients. However, Oxybutynin, Darifenacin, and Tolterodine was shown to have significant decrease in cognitive functions, as shown in the decline of total MMSE score.

Abstrak :
Overactive Bladder OAB masih menjadi masalah dan mengurangi kualitas hidup pada penderitanya. Terapi akupunktur dapat dipakai sebagai terapi OAB. Penelitian ini menggunakan metode uji klinis quasi experimental, terdiri atas 23 orang diterapi dengan akupunktur, 23 orang lainnya diterapi dengan obat Tolterodine. Penilaian keberhasilan dilihat dari penurunan skor OABSS. Setelah 18 hari terapi, terjadi penuruan rerata skor OABSS pada kelompok akupunktur dari 8,045 1,863 menjadi 1.909 0.867 dan pada kelompok tolterodine dari 8,000 0,617 menjadi 2,272 0,631 p = 0,357 . Dua minggu pasca terapi pada kelompok akupunktur masih terjadi penurunan skor OABSS dari 1.909 0.867 menjadi 1.272 0.702 dan pada kelompok tolterodine terjadi peningkatan skor OABSS dari 2,272 0,631 menjadi 2,590 0,503 p = 0,003 . Akupunktur mempunyai efek terapi yang sama baiknya dengan tolterodine dalam menurunkan OABSS tanpa efek samping. Efek terapi akupunktur masih bekerja walau terapi telah dihentikan 2 minggu. ......Overactive Bladder still gives problems and reducing their quality of life. Acupunture can be used for treatment of OAB. This research using clinical trial quasi experimental, consisted of 23 participant were treated with acupuncture and 23 others were treated with Tolterodine. Assessment of therapeutic success seen from the decrease in OABSS. After 18 days therapy in Acupuncture Group from 8,045 1,863 to 1,909 0,867 and Tolterodine Group from 8,000 0,617 to 2,272 0,631 p 0,357 . After 2 weeks post therapy in Acupuncture Group OABSS was still a decline from 1.909 0.867 to 1.272 0.702 and in Tolterodine Group OABSS was still a increase from 2,272 0,631 to 2,590 0,503 p 0,003 . Acupuncture has the same therapeutic effect with tolterodine in reducing OABSS without side effect. Therapeutic effect of acupuncture was still working even though therapy had been 2 weeks discontinued.

Abstrak :
Latar belakang: Karsinoma urotelial merupakan keganasan kandung kemih tersering pada laki-laki. Faktor risikonya adalah merokok, pajanan bahan kimia, radiasi, infeksi Schistosoma hematobium. Mutasi p53 merupakan mutasi tersering pada karsinoma urotelial kandung kemih yang menyebabkan akumulasi protein p53 di inti dan terlihat dengan imunohistokimia. Tujuan penelitian adalah untuk melihat perbedaan ekspresi p53 pada karsinoma urotelial kandung kemih derajat rendah dan derajat tinggi serta hubungan ekspresi p53 dengan^{: "}stadium tumor. Bahan dan cara: Penelitian menggunakan desain potong lintang. Sampel terdiri atas 47 kasus yang terbagi menjadi 22 kasus karsinoma urotelial derajat rendah dan 25 kasus karsinoma urotelial derajat tinggi di Departemen Patologi Anatomik Fakultas Kedokteran Universitas Indonesia/Rumah Sakit Cipto Mangunkusumo (FKUI/RSCM) tahun 2009-2017. Dilakukan pulasan imunohistokimia p53 dengan menggunakan cut off positif ≥ 20% berdasarkan penelitian Thakur et al, Ong et al, dan Saint et al. Hasil: Ekspresi p53 positif pada 33 sampel (70,21%), terbanyak pada karsinoma urotelial derajat tinggi 20 kasus (80%), sedangkan pada karsinoma urotelial derajat rendah terdapat 13 kasus (59,1%). Sebanyak 22 kasus (68,8%) Nonmuscle invasive bladder cancer dan 11 kasus (73,3%) Muscle invasive bladder cancer menunjukkan ekspresi positif. Ekspresi p53 cenderung lebih banyak ditemukan pada karsinoma urotelial derajat tinggi dan stadium tinggi. Kesimpulan: Tidak ada perbedaan ekspresi p53 pada karsinoma urotelial kandung kemih derajat rendah dan derajat tinggi. Tidak ada hubungan antara ekspresi p53 dengan stadium tumor. Kata kunci: Karsinoma urotelial, kandung kemih, p53, imunohistokimia. ......Background : Urothelial carcinoma is the most common malignancy in the bladder and mainly occurs in older men. Risk factors for bladder cancer include smoking, exposure to chemicals, radiation and schistosoma hematobium infection. P53 is a tumor suppressor gene that is involved in the cell cycle and plays a role in the occurrence of apoptosis in response to DNA damage. P53 gene mutation is one of the most common genetic changes in urothelial bladder carcinoma. The p53 gene mutation will cause accumulation of p53 protein in the nuclei which can be detected through immunohistochemical examination. The aim of this study is to see differences of p53 expression in low grade and high grade urothelial carcinoma and to see the association of p53 expression with tumor stage. Material and method : This study uses a cross sectional study design. The sample consisted of 47 cases of urothelial bladder carcinoma divided into 22 cases of low grade urotelial carcinoma and 25 cases of high grade urotelial carcinoma originating from the archives of the Anatomical Pathology Department Faculty Medicine of Universitas Indonesia/Cipto Mangunkusumo Hospital (FKUI/ RSCM) in 2009-2017. The study was carried out by p53 immunohistochemical examination and assessment of p53 expression using a percentage with a positive cut off value of ≥ 20%. Result : This study obtained positive p53 expression in 33 samples from 47 samples studied (70,21%). Most are found in high grade urothelial carcinoma as many as 20 cases (80%). Whereas in low grade urothelial carcinoma there are 13 cases (59,1%) with positive p53 expression. As many as 22 cases (68,8%) of Non muscle invasive bladder cancer (NMIBC) and 11 cases (73,3%) of Muscle invasive bladder cancer (MIBC) showed positive p53 expression. There was no difference between p53 expression in low grade and high grade bladder urothelial carcinoma (p=0,118). This study also showed no association between p53 expression with tumor stage (p=1,000). Conclusion : P53 expression was not significantly different with tumor grade. P53 expression was not significantly associated with the tumor stage.

Abstrak :
Latar Belakang Disfungsi saluran kemih bawah (LUTD) adalah istilah yang merujuk pada gangguan penyimpanan dan pengosongan urin, atau disfungsi kandung kemih, termasuk gejala saluran kemih bawah (LUTS). Arus interferensial digunakan untuk memberikan arus frekuensi rendah yang diperlukan untuk stimulasi transkutan struktur internal tanpa menyebabkan ketidaknyamanan. Elektroterapi interferensial (IET) telah banyak digunakan untuk mengobati LUTD. Namun, IET belum banyak diteliti dalam hal evaluasi klinisnya, terutama pada anak-anak dengan LUTD. Penelitian ini bertujuan untuk mengkaji efektivitas dan efek IET terhadap kualitas hidup pasien disfungsi kandung kemih dibandingkan dengan terapi konservatif konvensional. Metode Basis data PubMed, Cochrane Library, Scopus, EBSCOhost EMBASE, dan CINAHL dicari secara sistematis termasuk semua studi dengan data primer yang membandingkan kualitas hidup dan hasil urodinamik terapi listrik interferensial dan terapi konservatif konvensional. Risiko bias untuk studi yang termasuk dievaluasi. Meta-analisis dilakukan dengan menggunakan Review Manager (Revman 5.4). Hasil Delapan studi yang memenuhi kriteria inklusi, dengan sebagian besar menunjukkan risiko bias rendah, telah dimasukkan dalam tinjauan ini. Dari delapan studi yang termasuk, lima studi dapat dianalisis lebih lanjut menggunakan meta-analisis. Hasil meta-analisis menunjukkan bahwa IET secara signifikan mengurangi kejadian inkontinensia siang hari (RR: 0,27, 95% CI: 0,14-0,50), dan pola pengosongan abnormal (RR: 0,44, 95% CI: 0,22-0,91) dibandingkan dengan CCT. Namun, tidak ada perbedaan signifikan yang diamati dalam kejadian inkontinensia malam hari, waktu pengosongan, volume pengosongan, PVR, Qmax, atau Qave dengan IET dibandingkan dengan CCT. Kesimpulan Studi ini mengkonfirmasi IET sebagai modalitas yang efektif dalam pengobatan disfungsi kandung kemih dengan beberapa LUTS pada anak-anak. ......Background Lower urinary tract dysfunction (LUTD) is an exclusive term that refers to impairments in urine storage and voiding, or bladder dysfunction, including lower urinary tract symptoms (LUTS). During recent decades, inferential electrotherapy (IET) has been expanded and extensively used to treat LUTD in both adults and children. Despite some prior studies, to our knowledge IET has not been studied much in terms of its clinical evaluation, especially in children with LUTD. This systematic review and meta-analysis aims to address the efficacy and effect of IET on the quality of life for bladder dysfunction patients compared to conventional conservative therapy (CCT). Methods PubMed, Cochrane Library, Scopus, EBSCOhost EMBASE and CINAHL databases were systematically searched including all studies with primary data that compared the quality of life and urodynamic outcomes of interferential electric and conventional conservative therapy. The risk of bias for included studies was assessed. Meta-analysis was performed in Review Manager (Revman 5.4). Results Eight Studies were included that meet the eligibility criteria, with the majority exhibiting a low risk of bias. Of the eight studies included, five studies were able to be further analyzed using meta-analysis. The meta-analysis results show that IET significantly reduced the incidence of daytime incontinence (RR: 0.27, 95% CI: 0.14-0.50), and abnormal voiding patterns (RR: 0.44, 95% CI: 0.22–0.91) compared to CCT. However, no significant difference was observed in the incidence of nighttime incontinence, voiding time, voiding volume, PVR, Qmax or Qave with IET compared to CCT. Conclusion Overall, studies confirm IET as an effective modality in the treatment of bladder dysfunction with several LUTS in children. IET is safe, with no significant adverse events reported promising results in bowel and urinary disorders in children.

Abstrak :
Pendahuluan dan tujuan: Overactive bladder (OAB) terjadi pada sekitar 17-41% pada lansia di lingkungan tempat tinggal komunitas. Selama beberapa tahun, antimuskarinik telah divalidasi sebagai pilihan pertama untuk tata laksana OAB. Meskipun banyak data yang diperoleh dari uji klinis terkait penggunaan antimuskarinik. Penelitian terkait efek samping dari obat antimuskarinik terhadap fungsi kognitif pada lansia masih jarang dilakukan. Tujuan dari penelitian ini adalah untuk mengetahui efek dari terapi antimuskarinik terhadap fungsi kognitif pada pasien lanjut usia dengan OAB. Metode: Desain penelitian ini adalah tinjauan sistematis dan meta-analisis. Studi dikumpulkan menggunakan beberapa mesin pencari; diantaranya adalah PubMed, Science Direct, Cochrane, and EBSCOhost menggunakan kata kunci MeSH yang sudah ditentukan sebelumnya dengan operator Boolean. Pemilihan studi dilakukan oleh 3 pengulas. Seluruh studi yang memenuhi kriteria inklusi selanjutnya melalui proses review full-text. Untuk setiap artikel full-text yang terpilih, ekstraksi data dilakukan pada data: demografis pasien, tipe antimuskarinik yang digunakan, placebo, dosis, follow-up, dan skor total Mini Mental State Examination(MMSE). Hasil: Total sebanyak 8 studi yang terpilih dari 146 publikasi yang ada sebelumnya. Terdapat 8 jenis antimuskarinik yang dievaluasi dari studi-studi yang ada, yaitu: Oksibutinin, Darifenacin, Tolterodin, Trospium, Imidafenacin, Propiverin hidroklorida, Fesoterodin, dan Solifenacin. Oksibutinin menunjukkan efek yang paling besar pada penurunan skor MMSE [Perbedaan rerata: -2,90; 95% CI: -4,07, -1,73]. Darifenacin dan Tolterodin juga menunjukkan penurunan yang signifikan pada skor total MMSE, namun lebih inferior daripada Oksibutinin Kesimpulan: Penggunaan obat-obatan antimuskarinik hanya memiliki efek yang minimal terhadap fungsi kognitif dalam penanganan OAB pada pasien usia lanjut. Akan tetapi, Oksibutinin, Darifenacin, dan Tolterodin menunjukkan penurunan yang signifikan terhadap fungsi kognitif, ditunjukkan dari penurunan total skor MMSE. ......Introduction: Overactive bladder (OAB) affects 17-41% older adults in community dwelled setting. For several years, antimuscarinics have been validated as the first-line medical treatment for OAB. Despite abundant data obtained from clinical trials provisions the use of antimuscarinics, investigation about the effect of this drug on cognitive function in elderly remains scarce. The objective of this study is to investigate the effect of antimuscarinics therapy on cognitive functions in OAB geriatric patients. Methods: This study design is a systematic review and meta-analysis. Studies were collected using several search engines; those were PubMed, Science Direct, Cochrane, and EBSCOhost using predetermined MeSH keywords with Boolean operators. Selection of studies was done by three reviewers. Studies which fulfilled the inclusion and exclusion criteria underwent full-text review. For every selected full text, we extracted the following data if available: patients demographics, types of antimuscarinics used, placebo, dose, follow-up period, and Mini-Mental State Examination (MMSE) total score. Results: A total of 8 studies from an initial 146 publications were selected. There were 8 antimuscarinic agents evaluated in the studies, including Oxybutynin, Darifenacin, Tolterodine, Trospium, Imidafenacin, Propiverine hydrochloride, Fesoterodine, and Solifenacin. Oxybutynin was shown to have largest effect towards the decline of MMSE score [Mean difference: -2.90; 95% CI: -4.07, -1.73]. Darifenacin and Tolterodine were also shown to be significant in the decline of total MMSE score, although still inferior to Oxybutynin. Conclusion: The use of most antimuscarinics medication has little to no effect towards the cognitive function in the management of overactive bladder in elderly patients. However, Oxybutynin, Darifenacin, and Tolterodine was shown to have significant decrease in cognitive functions, as shown in the decline of total MMSE score.

Abstrak :
Inkontinensia urin atau hilangnya kontrol kandung kemih, sangat umum terjadi akibat perubahan terkait usia. Perubahan terkait usia ini dapat mempengaruhi fungsi berkemih pada lansia. Seiring bertambahnya usia, hipertrofi otot kandung kemih dan penebalan dinding kandung kemih mengganggu kemampuan kandung kemih untuk mengembang. Saat kandung kemih meregang mencapai kapasitas maksimum, detrusor berkontaksi dan dapat menyebabkan inkontinensia urin. Prompted voiding merupakan intervensi dimana perawat atau caregiver secara konsisten dalam interval waktu tertentu mengajak dan membantu lansia untuk berkemih. Prompted voiding memiliki tiga prinsip utama yaitu prompt, puji, dan monitor. Prompt dilakukan untuk mendorong dan membantu lansia menggunakan toilet secara berkala. Pujian artinya pengasuh memberikan pujian saat lansia mampu menahan urin sampai jadwal selanjutnya. Serta monitor secara berkala apakah pasien perlu menggunakan toilet dan intake cairan lansia. Tujuan karya ilmiah ini adalah untuk memberikan gambaran mengenai penerapan prompted voiding pada pasien dengan inkontinensia urin. Hasil yang didapatkan selama lima belas hari melakukan intervensi, menunjukan adanya penurunan skor Incontinence Scale Index (ISI) dari 8 menjadi 3. Sehingga terdapat penurunan skor inkontinensia urin sebesar 62,5%. Tingkat keparahan klien menurun dari inkontinensia parah menjadi inkontinensia sedang. Intervensi ini dapat di terapkan pada lansia yang tinggal di panti werdha sebagai intervensi untuk menurunkan tingkat keparahan inkontinensia urin pada lansia. ......Urinary incontinence or loss of bladder control, is very common as a result of age-related changes. These age-related changes can affect urinary function in the elderly. As people age, bladder muscle hypertrophy and bladder wall thickening will impair the bladder's ability to expand. When the bladder is stretched to its maximum capacity, the detrusor contracts and can cause urinary incontinence. Prompted voiding is an intervention where the nurse or caregiver consistently invites and helps the elderly to urinate. Prompted voiding has three main principles prompt, praise, and monitor. Prompts are carried out to encourage and help the elderly to use the toilet regularly. Praise means that caregivers give praise when the elderly are able to hold urine until the next schedule. Last, monitor regularly whether the patient needs to use the toilet and the elderly fluid intake. This scientific paper aimed to provide an overview of prompted voiding application in elderly with urinary incontinence. The results obtained after fifteen day intervention, showed a decrease in the Incontinence Scale Index (ISI) score from 8 to 3. So there was a decrease in urinary incontinence score by 62.5%. The severity of the client decreased from severe incontinence to moderate incontinence. Therefore, this intervention can be applied to the elderly living in nursing homes to reduce the severity of urinary incontinence in the elderly.