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"Latar belakang: Prolaps organ panggul merupakan salah satu kondisi fisik yang dapat menyebabkan terjadinya keluhan disfungsi seksual pada perempuan. Pembedahan rekonstruksi adalah salah satu pilihan yang dapat dilakukan dalam tatalaksana prolaps organ panggul pada perempuan seksual aktif. Dengan adanya perbaikan anatomis dasar panggul setelah pembedahan, diharapkan akan terjadi perbaikan gejala disfungsi seksual yang terjadi sebelum pembedahan.Objektif: Penelitian ini dilakukan untuk menganalisis adanya perubahan gejala disfungsi seksual yang dinilai dengan kuesioner FSFI-6 Indonesia sebelum dan 3 bulan sesudah pembedahan prolaps organ panggul, serta faktor yang mempengaruhinya.Metode: Kohort prospektif observasional pre-post without control study pada perempuan prolaps organ panggul seksual aktif yang direncanakan untuk pembedahan mulai Maret 2020 hingga Mei 2021 di RSUP Dr. Cipto Mangunkusumo dan RS Fatmawati Jakarta. Dari 33 pasien yang direncanakan pembedahan rekonstruksi, rerata usia 56.83 ± 7.97 tahun, telah diberikan informed consent dan menyetujui untuk mengikuti penelitian, dilakukan pemeriksaan uroginekologi dan pengisisan kuesioner FSFI-6. Tiga bulan setelah pembedahan, dilakukan pengisisan kuesioner kedua dan pemeriksaan kembali di poli uroginekologi. Terdapat 3 pasien drop out dari penelitian, sehingga jumlah data yang dapat dialanilis adalah 30. Dilakukan analisis data untuk tujuan utama yaitu analisis perubahan skor FSFI setelah pembedahan dan pengaruh dari faktor usia, paritas, indeks massa tubuh, komorbiditas dan derajat prolaps. Sebagai data tambahan dilakukan penilaian perubahan genital hiatus dan total panjang vagina sebelum dan sesudah pembedahan.Hasil: Terdapat perbaikan total skor FSFI-6 sebelum dan sesudah pembedahan prolaps organ panggul yang bermakna dari 15.00±5.42 menjadi 17.90±4.38 dengan rerata perubahan 2.9 (p=0.000). Tidak terdapat pengaruh usia, paritas, IMT, derajat prolaps dan komorbiditas terhadap perubahan total skor FSFI. Rerata perubahan total panjang vagina dari 7.97±0.77 menjadi 6.80±0.87 (p=0.003) dan genital hiatus berkurang dari 5.57 ± 1.0 menjadi 3.28 ± 0.46 (p=0.000).

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Background: Pelvic organ prolapse (POP) have an impact on sexuality. Few studies evaluate the impact of sexual function after POP surgery showed varied difference results. Reconstructive surgery as a choice to recovery anatomical of pelvic floor in POP was expected to improved sexual function.

Objective: The aim of this study to evaluate the changes of total sexual function index and all its domain after reconstructive surgery on POP and determine factors associated with this score changing.

Methods: This cohort prospective observasional pre-post without control study performed between March 2020 and May 2021 in 33 patients sexually active with POP, mean age 56.83 ± 7.97 years, underwent reconstructive surgery at Cipto Mangunkusumo Hospital and Fatmawati Hospital in Jakarta. All patients gave informed consent and completed the Female Sexual Function Index (FSFI)-6 Indonesian version’s questionnaire before surgery and underwent urogynaecological examination assessment. Three months after surgery patients repeated the FSFI questionnaire and a clinical check-up. There were 3 patients drop out from study and 30 patients complete the questionnaire. The primary end-point was post-operative sexual function as evaluated by the FSFI, the secondary end-points were determined factors associated whether the sexual function was related to age, parity, body mass index, comorbidity or severity of prolaps. The additional aim of this study was to calculate the change of objective anatomical genital hiatus and total vaginal length that measured with POPQ.

Results: Preoperatively, the total FSFI score was 15.00 ± 5.42 and postoperatively 17.90 ± 4.38, giving a significant difference of 2.90 ± 1.04 (p<0.001). The median post-operative scores of all domains showed positive improvements. Twenty two women (76.6%) improved their FSFI-6 score postoperatively, six (20%) had an equal score, and one (3.3%) reported a lower score. There was no significant related factors associated the change of sexual function index to age, parity, body mass index, comorbidity and severity of prolapse in this study. In regards to vaginal anatomy, vaginal length was a lite shortly postoperatively from 7.97±0.77 to 6.80±0.87 (p=0.003), and vaginal caliber was significantly narrowed from 5.57 ± 1.0 to 3.28 ± 0.46 width (p=0.000).

Conclusions: Our study results demonstrate that reconstructive surgery of POP resulting an improvement of total score sexual function index."

"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"

"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) merupakan kondisi kompleks yang terjadi akibat defek pada struktur penyokong vagina. Kondisi ini dapat disebabkan oleh proses trauma pada otot penyokong levator ani yang menyebabkan melebarnya luas hiatus genital. Pelebaran hiatus genital ini disebut ballooning. Prevalensi POP berkisar antara 20-50%, dengan insidensi mencapai 1,5 – 1,8 per 1000 wanita per tahun dengan puncak usia 60 – 69 tahun. Kondisi POP memberi dampak terhadap kualitas hidup seorang wanita dan sering dikaitkan dengan gangguan berkemih, buang air besar hingga disfungsi seksual. Tatalaksana definitif dalam penanganan POP adalah tindakan pembedahan. Tindakan levatorplasty dapat dilakukan pada kasus penurunan kompartemen posterior, terutama pada pasien POP dengan hiatal ballooning. Tindakan ini bertujuan untuk mengurangi risiko prolaps berulang di masa mendatang. Pasien dengan rencana operasi POP di RS Cipto Mangunkusumo (RSCM) Jakarta yang disertai ballooning pada pemeriksaan USG pre-operatif dilakukan tambahan tindakan levatorplasty, namun belum ada penilaian pasca operasi mengenai perbaikan kondisi ballooning tersebut.Objektif:Penelitian ini bertujuan untuk mengetahui perbaikan ballooning sebelum dan setelah dilakukannya tindakan levatorplasty pada pasien dengan POP. Perbaikan yang dinilai berupa perbaikan luas dan panjang diameter anterioposterior hiatus levator, perbaikan panjang Gh + Pb, serta perubahan skor keluhan disfungsi dasar panggul sebelum dan sesudah tindakan. Penilaian dilakukan dengan menggunakan USG 3 dan 2 dimensi untuk hiatus levator, pemeriksaan klinis Pelvic Organ Prolapse Quantification System (POP-Q) untuk panjang Gh + Pb, serta kuisioner Pelvic Floor Distress Inventory-20 (PFDI-20) untuk penilaian keluhan klinis disfungsi dasar panggul.Metode:Studi analitik komparatif berpasangan dengan desain gabungan kohort retrospektif dan kohort prospektif yang dilakukan di Poliklinik Kebidanan dan Kandungan Divisi Uroginekologi dan Rekonstruksi Departemen Obstetri dan Ginekologi RSUPN dr. Cipto Mangunkusumo. Pengumpulan data retrospektif dilakukan dari Oktober 2021 hingga April 2022, dengan pengumpulan data prospektif untuk dilakukan tindakan levatorplasty dilakukan dari Oktober 2021 hingga Januari 2022. Sampel penelitian adalah wanita dengan POP dan ballooning yang dinilai dengan pemeriksaan USG Transperineal serta POP-Q, dan akan menjalani operasi levatorplasty.Hasil:Tingkat keberhasilan levatorplasty pada pasien POP dengan ballooning dilihat dari penurunan derajat ballooning berdasarkan kategori Lh max pada 28 pasien (87,5%), Ap hiatal pada 26 pasien (81,25%), dan panjang Gh + Pb pada 25 pasien (78,1%). Parameter PFDI yang diukur juga mengalami perbaikan dengan penurunan nilai median PFDI mencapai 31,2 (p = 0,009), serta penurunan pada nilai median sub-bagian POPDI-6 hingga 20,8 (p = 0,009), CRADI-6 hingga 6,2 (p = 0,096), dan UDI-6 hingga 10,4 (p = 0,360).Kesimpulan:Prosedur levatorplasty ditemukan dapat memperbaiki kondisi ballooning pada pasien POP yang dinilai dari perbaikan nilai luas dan panjang diameter anteroposterior hiatus levator, perbaikan klinis secara objektif (yang dinilai dengan pemeriksaan POP-Q) serta secara subjektif (yang dinilai dengan kuisioner PFDI-20). Hasil penelitian ini diharapkan mampu menjadi bukti untuk penerapan prosedur levatorplasty untuk dapat dilakukan pada pasien-pasien POP yang disertai dengan ballooning di tempat praktik klinis di semua penjuru Indonesia.

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Background:

Pelvic Organ Prolapse (POP) is a complex condition resulting from defects in the supporting structures of the vagina. This condition can be caused by a traumatic process to the supporting muscles of the levator ani which causes the widening of the genital hiatus. This widening process is called ballooning. The prevalence of POP ranges from 20-50%, with an incidence reaching 1.5-1.8 per 1000 women each year with a peak age of 60-69 years. POP conditions may have an impact on a woman's quality of life and are often associated with urinary and defecation disorders, and also sexual dysfunction. The definitive treatment for POP is surgery. Levatorplasty can be performed in cases of posterior compartment descent, especially in POP patients with Hiatal ballooning. This action aims to reduce the risk of recurrent prolapse in the future. At Dr. Cipto Mangunkusumo Hospital (RSCM) Jakarta, patients with POP who are found with Hiatal ballooning during pre-operative ultrasound examination will be planned for an additional levatorplasty procedure. But there was no postoperative assessment regarding the improvement of the ballooning condition.

Objective:

This study aims to determine the improvement of ballooning after the levatorplasty procedure in patients with POP. The improvements assessed were the area and length of the anteroposterior diameter of the levator hiatus, the length of Gh + Pb, and complaints improvement for pelvic floor dysfunction. The assessment was done using 3- and 2-dimensional ultrasound for levator hiatus, clinical examination of the Pelvic Organ Prolapse Quantification System (POP-Q) for length Gh + Pb, and the Pelvic Floor Distress Inventory-20 (PFDI-20) questionnaire to assess clinical complaints of pelvic floor dysfunction.

Methods:

A paired comparative analytic study with a combined retrospective and prospective cohort design was carried out at the Obstetrics and Gynecology Outpatient Unit, Division of Urogynecology and Reconstruction, Department of Obstetrics and Gynecology, dr. Cipto Mangunkusumo Central General Hospital Jakarta. Retrospective data was collected from October 2021 to April 2022, with prospective data for levatorplasty performed from October 2021 to January 2022. The study sample was women with POP and ballooning who were assessed by transperineal ultrasound examination and POP-Q examination and will undergo levatorplasty procedure.

Result:

The success rate of levatorplasty in POP patients with ballooning was seen from the decrease in the degree of ballooning by the measurement of Lh max in 28 patients (87.5%), Ap hiatal in 26 patients (81.25%), and the length of Gh + Pb in 25 patients (78, 1%). The measured PFDI parameters also improved with a decrease in the median value of PFDI reaching 31.2 (p = 0.009), as well as a decrease in the median value of the POPDI-6 subsection to 20.8 (p = 0.009), CRADI-6 to 6.2 (p = 0.096), and UDI-6 to 10.4 (p = 0.360).

Conclusion:

The levatorplasty procedure is proven to repair the ballooning conditions in POP patients as assessed by improvements in the area and length of the anteroposterior diameter of the levator hiatus, clinical improvement objectively (as assessed by the POP-Q examination), and subjectively (as assessed by the PFDI-20 questionnaire). The results of this study are expected to be evidence for the application of the levatorplasty procedure to be performed on POP patients accompanied by ballooning in many clinical practices throughout Indonesia.

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"Disfungsi seksual perempuan merupakan gangguan yang terjadi pada fungsi seksual perempuan sehingga dapat mengganggu kegiatan seksual dan menyebabkan tekanan intrapersonal. Disfungsi seksual perempuan secara umum memiliki prevalensi sebesar 40,9% pada perempuan pre-menopause di dunia. Disfungsi seksual pasca persalinan dapat terjadi setelah proses persalinan dan mengganggu fungsi seksual perempuan serta berdampak pada psikologis dan hubungan dengan pasangan. Disfungsi seksual pasca persalinan dipengaruhi oleh banyak faktor, salah satunya adalah operasi Caesar. Penelitian ini bertujuan untuk mengidentifikasi hubungan disfungsi seksual dengan pasca operasi Caesar. Penelitian ini menggunakan desain studi potong lintang. Pengambilan sampel dilakukan secara consecutive sampling menggunakan Female Sexual Function Index (FSFI-6) dan pengolahan data dilakukan menggunakan SPSS versi 20. Uji analisis menggunakan uji Chi Square dan Fisher’s exact test. Secara statistik, hubungan disfungsi seksual dengan metode persalinan secara Caesar tidak signifikan (OR=2,750; IK 95%=0,771-9,808; P=0,111). Faktor lain yang diteliti (usia, status pendidikan, dan status pekerjaan) juga secara statistik tidak signifikan (p>0,05). Hubungan disfungsi seksual dengan metode persalinan secara operasi Caesar secara statistik tidak signifikan. Namun, berdasarkan nilai OR operasi Ceasar memiliki risiko 2,750 kali lipat meningkatkan kejadian disfungsi seksual.

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Female sexual dysfunction is a disorder that occurs in a woman's sexual function that can interfere with sexual activity and cause intrapersonal distress. Female Sexual dysfunction has a prevalence of 40.9% in pre-menopausal women in the world. Postpartum sexual dysfunction can occur after childbirth and have an impact on psychological and relationships with partners. Postpartum sexual dysfunction is influenced by many factors, one of which is the Caesarean section.

This study aims to identify the relationship between sexual dysfunction and post- Caesarean section.

This study uses cross-sectional study design. Sample is obtained by consecutive sampling using Female Sexual Function Index (FSFI-6) questionnaire and the data is processes through SPSS version 20. Statistical analysis test used in this study are Chi Square test and Fisher’s exact test.

Statistically the relationship between sexual dysfunction and delivery method by Caesarean isnot significant (OR = 2.750; 95% CI = 0.771-9.808; P = 0.111). Other factors studied (age, educational status, and employment status) are also statistically insignificant (p> 0.05).

The relationship between sexual dysfunction and delivery method by caesarean section is not statistically significant. However, based on the OR value, Caesarean surgery has a 2,750-fold risk to increased the accident of female sexual dysfunction."

"ABSTRAKLatar Belakang: Avulsi levator ani merupakan lepasnya otot puborektalis dari insersinya pada dinding pelvis. Kejadian ini seringkali terjadi akibat trauma persalinan pervaginam dan dapat menyebabkan gejala uroginekologi beberapa tahun kemudian. Tujuan: Untuk mengetahui proporsi avulsi levator ani menggunakan ultrasonografi 3D/4D dan menentukan faktor-faktor persalinan pervaginam yang berkontribusi pada terjadinya avulsi levator ani diantara pasien dengan gejala prolaps organ panggul. Metode: Studi potong-lintang dilakukan pada pasien dengan gejala prolaps organ panggul di Poliklinik Uroginekologi RSUPN Cipto Mangunkusumo Jakarta. Secara retrospektif dan prospektif dilakukan pengumpulan data sejak Januari 2012 hingga April 2017 dengan pemeriksaan klinis menggunakan POP-Q dan ultrasonografi 3D/4D transperineal untuk menilai otot levator ani.Hasil: Dari total 127 pasien prolaps organ panggul yang dimasukkan sebagai subjek memiliki median usia 61 26-80 tahun, median paritas 3 0-13 dengan 2 pasien nuligravida dan 2 pasien menjalani persalinan hanya dengan seksio sesarea. Sebanyak 10 subjek 7.9 , IK95 3.1-12.6 terdeteksi adanya avulsi levator ani menggunakan USG 3D/4D transperineal. Diantara kelompok avulsi tersebut dilakukan analisis dengan mengeksklusi 4 pasien tanpa persalinan pervaginam. Dari total 123 pasien, median usia pertama melahirkan adalah 26 18-31 tahun, p=0.156; median jumlah persalinan pervaginam adalah paritas 3 1-9 , p=0.19; riwayat persalinan dengan forsep hanya terdapat 1 kasus 10 , p=0.081; riwayat persalinan dengan vakum 10 , p=0.35, dari total 5 kasus vakum; dan berat lahir bayi terbesar dengan median 3470 3100-3700 gram, p=0.752.Kesimpulan: Proporsi avulsi levator ani pada pasien prolaps organ panggul di Poliklinik RSUPN Dr. Cipto Mangunkusumo sebesar 7.9 . Faktor risko obstetri seperti usia pertama melahirkan, jumlah persalinan pervaginam, riwayat persalinan dengan forsep, riwayat persalinan dengan vakum dan berat lahir bayi terbesar tidak dapat disimpulkan hubungannya dengan terjadinya avulsi levator ani.

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ABSTRACTBackground Avulsion of levator ani could arise from detachment of puborectalis muscle form its insertion on the pelvic sidewall. This manifest is a common consequence of vaginal childbirth trauma and could represent urogynecological symptoms many years later. Objective To estimate the proportion of levator ani avulsion using 3D or 4D ultrasound and determine the vaginal birth factors that contribute to levator ani avulsion among the symptomatics of pelvic organ prolapse women. Methods Cross sectional study was conducted among women with symptomatic pelvic organ prolapse in Urogynecology Clinic RSUPN Cipto Mangunkusumo Jakarta. Patients were retrospective and prospectively investigated from January 2012 until April 2017 by clinical examination using POP Q system and 3D 4D imaging of levator ani muscle.Results A total 127 women with pelvic organ prolapse were included in this study, median age was 61 26 80 years, median parity was 3 0 13 with 2 patients were nulligravid and 2 patients have giving birth by c section only. There were 10 cases 7.9, IK95 3.1 12.6 levator avulsion by transperineal 3D 4D US exam. In the group of levator avulsion, 4 cases without history vaginal birth were excluded. Of total 123 patients, first age delivery median was 26 18 31 years, p 0.156 vaginal birth parity median was 3 1 9, p 0.19 1 case forceps delivery 10, p 0.081 vacuum delivery 10, p 0.35, from total vacuum history was 5 cases and maximum birthweight median mas 3470 3100 3700 gram, p 0.752.Conclusion Proportion of levator avulsion in women with pelvic organ prolaps at RSUPN Dr. Cipto Mangunkusumo was 7.9 . First age delivery, vaginal birth parity, forceps delivery, vacuum delivery, dan maximum birth weight as obstetric factors cannot be concluded these association to levator avulsion."

"Latar belakaog : Prevalensi penderita prolaps organ panggul (POP) terus bertambah, seiring dengan angka harapan hidup yang meningkat. Berbagai studi telah dilakukan untuk melihat terapi pasien POP. Pesarium merupakan pitihan utama terapi POP, tetapi sampai saat ini sangat sedikit literatur yang membahas evaluasi penggunaan jangka panjangnya. Tujuan : Mengetahui perbaikan kualitas hidup pasien POP yang diterapi dengan pesarium, dibandingkan sebelum pemasangan dengan bulan ketiga dan keenam pasca pemasangan. Metode : Pasien POP yang bersedia ikut penelitian akan diberikan kuesionar dengan cara anamnesis terpimpin. Kuesioner yang digunakan adalah Pelvic Floor Distress 111Ventoryshort form 20 (PFDI-20) dan Pelvic Floor Impact Questionnaire-shortform 7 (PFIQ-7) yang sudah diterjemahkan. Setelah pemasangan berhasil, akan dilakukan follow up pada bulan ketiga dan keenam pasca pemasangan, serta dilakukan penilaian efek samping penggunaan pesarium, yaitu keluhan saluran kemih bagian bawah, vaginitis, dan erosi vagina. Basil : Terdapat 51 SP ikut serta dalam penelitian, dengan 45 SP meneruskan penggunaan pesarium setelah menyelesaikan penelitian dan 6 SP melanjutkan terapi operasi. Penilaian kualitas hidup mendapatkan hasil bermakna pada bulan ketiga dan keenam dibandingkan dengan awal penelitian, baik dengan kuesioner PFDI-20 maupun PFIQ-7. Kesimpulan : Terdapat perbaikan kualitas hidup pasien POP setelah penggunaan pesarium selama 6 bulan.

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Background: Prevalence of womens with pelvic organ prolapse have increased by day, correspond to higher life expectancy. There are many study that observe the best treatment for pelvic organ prolapse. Pessary is one of them, but until now only few literature tells about the effect of this treatment for improving quality of live. Objective: To understand the improvement of quality of life in women with pelvic organ prolapse, before and after six months pessary treatment. Methods: Womens presenting for pessary insertion completed both Pelvic Floor Distress Inventory-short form 20 (PFDI-20) and Pelvic Floor Impact Questionnaire-short form 7 (PFIQ-7). After successful pessary insertion, subjects were reviewed after 3 and 6 months treatment. Result: There were 51 subjects enrolled in this study, with 45 subjects continued the used of pessary after fmished the study and 6 subjects were changed into surgery. There were statistically and clinically significant improvements of quality of life, after 3 and 6 months treatment with pessary, both using PFDI-20 and PFIQ-7 questionnaire. Conclusion: The use of pessary for 6 months reduces symptoms and improves the quality of life in women with pelvic organ prolapse."

"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."

"LATAR BELAKANG. Prolaps organ panggul menimbulkan keluhan kelemahan dasar panggul yang dapat mempengaruhi kualitas hidup seorang wanita. Prolaps organ urogenital dialami oleh 30-50 wanita yang berusia 20-59 tahun. Penanganan yang tepat dan dini untuk mengatasi gangguan tersebut menjadi salah satu upaya efektif. Untuk dapat melakukan penanganan dini maka diperlukan pengenalan awal terhadap penilaian prolaps organ panggul dengan keluhan minimal pada pasien. Sebelumnya studi yang dilakukan pada 296 wanita usia diatas 40 tahun, didapatkan penurunan vagina 0,5 cm di bawah himen dapat memprediksi secara akurat gejala penonjolan atau penurunan organ. Di Indonesia belum terdapat penelitian mengenai ambang batas prolaps organ panggul yang dapat memperkirakan munculnya keluhan kelemahan dasar panggul. Oleh karena itu, penelitian ini bertujuan untuk memperkirakan ambang batas timbulnya keluhan kelemahan dasar panggul, diketahuinya prevalensi kasus POP di RSCM dan diketahuinya sensitifitas dan spesifisitas kuesioner PFDI-20 dalam menilai keluhan POP. METODE. Penelitian ini merupakan suatu studi potong lintang. Data diambil dari pemeriksaan langsung POP-Q dan wawancara kuesioner PFDI-20 . Dilakukan di Poli ginekologi dan uroginekologi RSCM sejak bulan Juli 2017 hingga November 2017. HASIL. Pada penelitian ini disimpulkan bahwa dari 385 orang subyek penelitian didapat 13 mengalami prolaps organ panggul dengan proporsi masing-masing 11.2 mengalami prolaps uteri, 12.3 sistokel, dan 11.7 mengalami rektokel. Uji validitas dengan Pearson test dan reliabilitas dari kuesioner PFDI-20 menunjukan hasil valid dan reliabel. Penurunan sejauh 2.5 cm diatas himen yaitu prolapse derajat 1 sudah bisa menimbulkan keluhan penurunan organ panggul. Sedangkan untuk komponen keluhan pada kuesioner didapat PDFI-16 AUC 0.828 ndash; 0.860, IK 95 dan PFDI-19 AUC 0.831 - 0.854, IK 95 yaitu keluhan sulit menahan kemih dan sulit berkemih dianggap sebagai keluhan penurunan organ panggul yang lebih dini dirasakan oleh subyek penelitian. KESIMPULAN. Kuesioner PFDI-20 dapat digunakan sebagai skrining keluhan prolaps organ panggul. Ambang batas prolaps organ panggul yaitu jarak 2,5 cm diatas himen didalam vagina mulai menunjukkan adanya keluhan. Kata Kunci. Prolaps organ panggul, prolaps uteri, sistokel, rektokel.

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BACKGROUND. Prolaps of pelvic organs lead to complaints of pelvic floor weakness that may affect a woman 39;s quality of life. Urogenital organ prolapse is experienced by 30-50 of women aged 20-59 years. Proper treatment and early diagnosis of these disorders become one of effective efforts. To be able to perform early treatment is required early recognition of the assessment of pelvic organ prolapse with minimal complaints in patients. Previous studies conducted on 296 women over the age of 40 years, resulted a 0.5 cm vaginal protruded under the hymen can accurately predict symptoms of protrusion or prolapse of pelvic organ. In Indonesia there has been no research on pelvic organ prolapse thresholds that can estimate complaints of pelvic floor weakness. This study is aim to reveal of pelvic organ prolapse thresholds that can estimate complains of pelvic floor weakness, the prevalence of POP cases in RSCM and the sensitivity and specificity of PFDI-20 questionnare in assessing POP complaints. METHOD. This study is a cross sectional study. Data was taken from direct examination POP-Q and interview PFDI-20 questionnaire . Performed in the Gynecology and Urogynecology outpatient clinic at Cipto Mangunkusumo Hospital from July 2017 to November 2017 RESULTS. From 385 subjects, 13 had pelvic organ prolapse with proportion of 11.2 having uterine prolapse, 12.3 cystocele, and 11.7 had rectocele. Validity test with Pearson test and reliability of PFDI-20 questionnaire showed valid and reliable results. A decrease of 2.5 cm above the hymen ie 1st degree of prolapse can lead to early complaints of pelvic organ descent. As for the complaint component of the questionnaire revealed that PDFI-16 AUC 0.828 - 0.860, 95 IK and PFDI-19 AUC 0.831 - 0.854, 95 IK , that is difficult to resist urinary complaints and difficult in micturition, is considered an early complaint of pelvic organ felt by subjects. CONCLUSION. The PFDI-20 questionnaire can be used as a screening for pelvic organ prolapse complaints. The pelvic organ pelvic prolapse threshold of 2.5 cm above the hymen inside the vagina begins to show a complaint. Keywords. Pelvic organ prolapse, uterine prolapse, cystocele, rectocele"