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Abstrak :
Karsinoma kandung kemih merupakan keganasan nomor empat terbanyak. Dampak beban ekonomi karsinoma kandung kemih cukup nyata, sehingga diperlukan deteksi dini keganasan kandung kemih untuk menurunkan beban ekonomi. Sistoskopi merupakan pemeriksaan baku emas untuk identifikasi karsinoma kandung kemih, tetapi pemeriksaan tersebut invasif dan menyebabkan ketidaknyamanan bagi pasien. Sitologi urin tidak invasif, tetapi hasilnya tidak bisa didapatkan dengan cepat dan terdapat ketergantungan interpretasi pemeriksa.Tujuan penelitian ini adalah untuk membandingkan nilai diagnosis dua penanda tumor, yaitu ELISA NMP-22, ELISA UBC urin, serta kombinasi keduanya pada pasien karsinoma kandung kemih. Penelitian uji diagnostik ini terdiri dari 25 orang pasien dengan indikasi sistoskopi dan trans ureteral resection bladder tumor (TUR-BT)/biopsi tumor. Pasien yang memenuhi kriteria masukan dan tolakan dilakukan pengambilan urin pasien kemudian dilakukan pemeriksaan ELISA NMP-22 dan ELISA UBC urin. Hasil pemeriksaan ELISA NMP-22 dan ELISA UBC urin akan dibandingkan dengan pemeriksaan sistoskopi disertai dengan hasil histopatologi.Permeriksaaan ELISA NMP-22 urin dengan cut-off 10 U/ml mempunyai sensitivitas 62,3% dan spesifisitas 83,3%, nilai prediksi positif 81,8% dan nilai prediksi negatif71,4%,likelihood ratio positif3,73 dan likelihood ratio negatif0,45. Jika kasus sistitis dieksklusi maka didapatkan sensitivitas adalah 69,2%, spesifisitas 75%, nilai prediksi positif 81,8%, nilai prediksi negatif 60%, likelihood ratio positif 2,76 , likelihood ratio negatif0,42. Pemeriksaan ELISA UBC dengan cut-off 12 ug/Lmempunyai sensitivitas 38,5% dan spesifisitas 91,7%, nilai prediksi positif 83,3% dan nilai prediksi negatif57,9%,likelihood ratio positif4,63 dan likelihood ratio negatif0,67. Jika kasus sistitis dieksklusi maka didapatkan sensitivitas adalah 38,5%, spesifisitas 87,5%, nilai prediksi positif 83,3%, nilai prediksi negatif 46,7%, likelihood ratio positif 3,08 , likelihood ratio negatif0,70. Kombinasi pemeriksaan ELISA NMP-22 dengan UBC urin mempunyai sensitivitas 76,9% dan spesifisitas 75%, nilai prediksi positif 76,9% dan nilai prediksi negatif75%,likelihood ratio positif3,08 dan likelihood ratio negatif0,31. Jika kasus sistitis dieksklusi maka didapatkan nilai sensitivitas adalah 78,5%, spesifisitas 71,4 %, nilai prediksi positif 84,6 %, nilai prediksi negatif 62,5%, likelihood ratio positif2,74 , likelihood ratio negatif0,30. Kami menyimpulkan kombinasi pemeriksaan ELISA NMP-22 dengan ELISA UBC urin lebih baik karena mempunyai sensitivitas paling tinggi sehingga adanya tumor di kandung kemih baik primer maupun rekuren tidak akan luput dari diagnosis, meskipun harus dipastikan lagi dengan pemeriksaan sistoskopi.

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Bladder cancer is the forth most common cancer. Bladder cancer posseses a significant economic burden so that early detection of baldder cancer may decrease the economic burden. Cystoscopy is the reference standard for identification of bladder carcinoma, but it is invasive andcauses significant discomfortto the patient. Urinary cytology is noninvasive but time consuming and hampered by inter-observer variations. The aim of this study is to compare the diagnostic value of the urine NMP-22 ELISA test, UBC-ELISA test and combination of both tests on suspect bladder carcinoma patients.This diagnostic study included25 patients who were indicated for cystoscopy and trans uretheral resection bladder tumor / tumor biopsy. From patients who met requirements for the inclusion and exclusion criteria, the urine voided sample was taken and used for NMP-22 ELISA test and UBC ELISA test. The results of NMP-22 ELISA test and UBC ELISA test were evaluated against the cystoscopy and histological findings as the reference standard.The result of diagnostic study of NMP-22 ELISA test with cut-off 10 U/mlshowed that it had a sensitivity of 62,3% and a specificity of 83,3%, a positive predictive value of 81,8% and a negative predicitive value of 71,4%, a positive likelihood ratio of 3,73 and a negative likelihood ratio of 0,45. If the cystitis case was excluded, it had a sensitivity of 69,2%, and a specificity of 75%, a positive predictive value of 81,8%, and a negative predicitive value of 60%, a positive likelihood ratio of 2,76 , and a negative likelihood ratio of0,42. Diagnostic value of UBC ELISA test with cut-off 12 ug/L had a sensitivity of 38,5% and a specificity of 91,7%, a positive predictive value of 83,3% and a negative predicitive value of 57,9%, a positive likelihood ratio of 4,63 and a negative llikelihood ratio of 0,67. If the cystitis case was excluded, it had a sensitivity of 38,5%, and a specificity of 87,5%, a positive predictive value of 83,3%, and a negative predicitive value of 46,7%, a positive likelihood ratio of 3,08 , and a negative likelihood ratio of0,70.Diagnostic value of combined NMP-22 ELISA test with UBC ELISA test had a sensitivity of 76,9% and a specificity of 75%, a positive predictive value of 76,9% and a negative predicitive value of 75%, a positive likelihood ratio of 3,08 and a negative llikelihood ratio of0,31. If the cystitis case was excluded, it had a sensitivity of 78,5%, and a specificity of 71,4%, a positive predictive value of 84,6%, and a negative predicitive value of 62,5%, a positive likelihood ratio of 2,74 , and a negative likelihood ratio of0,30.The conclusion was that the combined NMP-22 ELISA test with UBC test had the highest sensitivity, thus itwould not miss any primary or recurrent tumour in the bladder, although this neededto be confirmed by cystoscopy.

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: Studi ini bertujuan untuk mengusulkan istilah baru terkait batu kandung kemih berukuran besar pada populasi pasien anak berdasarkan stone burden, kapasitas kandung kemih, dan gangguan ginjal yang berhubungan dengan batu kandung kemih. Metode: Tiga puluh empat anak dengan batu kandung kemih di Rumah Sakit kami antara Januari 2014 hingga Agustus 2019 dimasukkan ke dalam penelitian. Data mengenai usia pasien, gejala klinis, riwayat diet, status sosial ekonomi, pemeriksaan laboratorium termasuk pemeriksaan darah lengkap, urinalisis dan kultur urin, adanya hidronefrosis, ukuran batu, status gizi, dan jenis operasi dikumpulkan. Estimasi Volume Batu (EVB) diukur dengan menggunakan rumus Ackermann, sedangkan Estimasi Kapasitas Kandung Kemih (EKKK) dihitung dengan menggunakan rumus Koff. Kurva Receiver Operating Characteristic (ROC) digunakan untuk menentukan nilai cut-off terbaik untuk menentukan nilai rasio EVB terhadap EKKK di mana batu kandung kemih menyebabkan hidronefrosis. Hasil: Hidronefrosis tercatat pada 12 pasien. Terdapat perbedaan hasil yang signifikan pada rerata EVB dan rasio EVB terhadap EKKK ditemukan pada kedua kelompok (masing-masing p <0,001 dan 0,006). Kurva ROC digunakan untuk menilai akurasi rasio EVB terhadap EKKK sebagai prediktor kejadian hidronefrosis dengan luas area di bawah kurva 0,768 (95% CI 0,624 hingga 0,949). Nilai cut-off rasio EVB terhadap EKKK adalah 0,0286 dengan sensitivitas 94,40%, spesifisitas 62,50%, nilai prediksi positif 73,91%, dan nilai prediksi negatif 90,90%. Kesimpulan: Kami mengusulkan untuk menggunakan istilah giant pada kasus batu buli pasien anak dengan menggunakan rasio EVB terhadap EKKK di atas 0,028. Kami berharap penelitian kami akan mendorong peneliti lain untuk secara prospektif mengevaluasi implikasi terapeutik dari terminologi baru. ......Introduction: This current study aims to propose a new term related to giant bladder stones in pediatric patient populations concerning the stone burden, bladder capacity, and renal impairment related to the bladder stone. Methods: Thirty-four children with bladder stones in our center between January 2014 to August 2019 were admitted to the study. Data regarding patient's age, clinical symptoms, dietary history, socioeconomic status, laboratory investigations include complete blood examination, urinalysis and urine culture, presence of hydronephrosis, stone size, nutritional status, and type of procedure were collected. Estimated stone volume (ESV) was measured using Ackermann's formula, while estimated bladder capacity (EBC) was calculated using Koff formulas. Receiver operating characteristic (ROC) curve was constructed to determine the best cut-off value for determining what ESV to EBC ratio value at which a bladder stone cause hydronephrosis. Results: Hydronephrosis was noted in 12 patients. A significant difference in the mean ESV and ESV to EBC ratio was found between those two groups (p < 0.001 and 0.006 respectively). ROC curve was used to assess the accuracy of the ESV to EBC ratio as a predictor of hydronephrosis incidence with the area under the curve 0.768 (95% CI 0.624 to 0.949). Cut-off value of this ESV to EBC ratio is 0.0286 with a sensitivity 94.40%, specificity 62.50%, positive predictive value 73.91%, and negative predictive value 90.90%. Conclusion: We propose to use the term giant in pediatric cases using the EBV to EBC ratio above 0.028. We hope that our work will stimulate other researchers to prospectively evaluate the therapeutic implications of the new terminology.

Abstrak :
Latar Belakang Radikal sistektomi (radical cystectomy / RC) merupakan standar pengobatan untuk muscle-invasive bladder carcinoma. Diperlukan faktor prediksi untuk pendekatan agresif karena dapat menyebabkan pengobatan berlebihan. Hitung darah tepi (BCC) dilaporkan memiliki hubungan yang signifikan dengan beberapa jenis keganasan. Penelitian ini bertujuan untuk menentukan BCC sebagai faktor prediktor terhadap tingkat keselamatan umum (OS) pada pasien karsinoma kandung kemih (BC) setelah menjalani RC. Metode Studi kohort retrospektif dibuat terhadap 26 pasien yang menjalani RC. Karakteristik demografis dan BCC seperti hemoglobin (Hb), NLR, PLR, dan rasio limfosit/monosit (LMR). Analisis kesintasan Kaplan-Meier dilakukan untuk menentukan overall survival (OS) pada penanda pemeriksaan hitung darah. Hubungan antara karakteristik pasien dengan kesintasan satu tahun juga dilakukan dengan menggunakan metode Mantel-Cox (Log-rank). Hasil Dari 26 pasien, usia rata-rata adalah 55,6 ± 12,9 tahun. Pada analisis univariat, tidak ada karakteristik demografis yang ditemukan sebagai prediktor signifikan dari kelangsungan hidup satu tahun dan keseluruhan (p>0,05). Hb, NLR, PLR, dan LMR tidak menjadi prediktor signifikan dari kelangsungan hidup satu tahun dan OS (p>0,05). Kesimpulan BCC bukan merupakan faktor prediktor yang signifikan terhadap kelangsungan hidup pada pasien dengan kanker kandung kemih setelah menjalani radikal sistektomi. ......Background Radical cystectomy (RC) is the gold standard treatment for muscle-invasive bladder carcinoma. A predictive factor is needed for the aggressive approach as it could lead to overtreatment. Elevated blood cell count (BCC) markers are reported to have a significant association with poor outcomes in several types of malignancy. Neutrophil-to-lymphocyte-ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are a well-known inexpensive and effective representative marker of inflammatory condition. This study aims to determine the BCC as a predictor factor of overall survival (OS) in bladder carcinoma (BC) after RC patients Methods A retrospective cohort study was designed to investigate 26 patients undergone RC. The demographic characteristics and BCC such as hemoglobin (Hb). NLR, PLR and lymphocyte/monocyte ratio (LMR) were collected. The patients were categorized based on the CBC markers value (≥Median and 0.05). Hb, NLR, PLR and LMR were not a significant predictor of one year survival and OS (p>0.05). Conclusions The BCC was not a significant predictor factor survival in patients with bladder cancer after radical cystectomy.

Abstrak :
Latar belakang: Batu buli merepresentasikan sekitar 5% dari semua kasus batu saluran kemih. Banyak kondisi medis yang berperan dalam pembentukan batu tersebut. Penanganan batu buli terus berkembang dari sectio alta, intracorporeal lithotripsy dan extracorporeal shock wave lithotripsy (ESWL). ESWL adalah sebuah modalitas yang menjanjikan dalam penanganan batu buli karena dapat ditoleransi dengan baik dan lebih sederhana. Penelitian ini dilakukan untuk mengumpulkan data yang dapat menggambarkan keamanan dan efektifitas dari ESWL dalam penanganan batu buli Metode: Studi ini merupakan sebuah studi retrospektif yang mengambil data dari rekam medis 92 pasien yang didiagnosa batu buli di Rumah Sakit Cipto Mangunkusumo (RSCM) dari Januari 2011 sampai April 2015. Data yang dikumpulkan meliputi usia pasien, jenis kelamin, jenis batu, prosedur yang dilakukan dan status disintegrasi batu, lama rawat dan komplikasi yang mungkin terjadi. Semua data dianalisa secara statistik menggunakan IBM SPSS versi 20. Hasil: Mayoritas pasien menjalani prosedur ESWL (49 dari 92, 53,3%). Angka bebas batu untuk tindakan ESWL, intracorporeal lithotripsy, dan sectio alta adalah 93,9%, 97,0% dan 100% secara berurutan. Salah satu pasien harus mengulang prosedur ESWL. Rerata ukuran batu ditemukan paling kecil pada kelompok ESWL bila dibandingkan dengan kelompok intracorporeal lithotripsy dan sectio alta (2,5±2,0 vs 4,8±3,7 vs 7,4±5,4 secara berurutan). Perbedaan rerata batu ditemukan signifikan secara statistik antara kelompok ESWL dan intracorporeal lithotripsy (p=0,014). Prosedur ESWL dilakukan pada klinik rawat jalan. Kesimpulan: ESWL dapat direkomendaasikan sebagai modalitas terapi yang efektif dan non-invasif dalam penanganan batu buli dengan angka bebas batu yang cukup baik (93,9%) dan bisa dilakukan di poliklinik rawat jalan dengan komplikasi yang minimal. ...... Background: Bladder stone accounts for 5% of all cases of urolithiasis. Many conditions play a role in its formation. Bladder stones management has evolved over the last decades from open bladder surgery (sectio alta) to intracorporeal cystholithotripsy as well as extracorporeal shock wave lithotripsy (ESWL). ESWL presents to be a promising modality in the management of bladder calculi due to its simplicity and well tolerability. This study is thus conducted to present data on the safety and effectiveness of ESWL in the management of bladder stone patients. Methods: This is a retrospective study evaluating the medical records of 92 bladder calculi patients admitted to Cipto Mangunkusumo General Hospital (RSCM) from January 2011 to April 2015. Patient’s age, gender, type of stone and procedure being done, status of stone disintegration, length of hospital stay, and any complications that may occur are noted down and statistically analyzed using IBM SPSS v. 20. Results: Majority of the patients underwent ESWL (49 out of 92, 53.3%). The stone free rates for ESWL, intracorporeal lithotripsy, and sectio alta are 93.9%, 97.0% and 100% respectively. One patient had to repeat ESWL. The ESWL group had the smallest stone size average compared to the intracorporeal lithotripsy and section alta group (2.5±2.0 vs 4.8±3.7 vs 7.4±5.4 respectively). This difference in average stone size was statistically significant compared to the ESWL and intracorporeal lithotripsy group (p=0.014). The ESWL sessions were conducted in the outpatient clinic, and thus no hospital stay was required. Conclusion: ESWL can be suggested as an effective non-invasive approach in the disintegration of bladder stone of £25 mm with a promisingly high stone-free rate (93.9%) that can be performed on an outpatient basis with minimal complications.

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 :
[ABSTRAK
Latar Belakang : Inkontinensia urin sampai saat ini masih menjadi masalah bagi masyarakat dunia. Telah ada tiga penelitian yang membandingkan penurunan leher kandung kemih pada kelompok inkontinensia urin jenis stres dan kontinensia. Namun penelitian mengenai perbandingan tersebut belum ada di Indonesia sementara hasil penelitian yang telah ada belum dapat digeneralisir pada populasi di Indonesia. Berdasarkan hal tersebut peneliti ingin mengetahui apakah terdapat perbedaan rerata penurunan leher kandung kemih kelompok inkontinensia urin jenis stres dan kontinensia di Indonesia dengan perbedaan pada tiga buah aspek, yaitu aspek penegakan diagnosis, kelompok pembanding, dan pengukuran. Tujuan : Menganalisis perbedaan rerata mobilitas leher kandung kemih pada inkontinensia urin jenis stres dan kontinensia. Metode : Penelitian ini merupakan penelitian observasional. Untuk menjawab pertanyaan penelitian utama dan tambahan digunakan desain deskriptif potong lintang. Populasi target dalam penelitian ini adalah semua perempuan yang mengalami inkontinensia urin jenis stres dan kontinensia di Indonesia. Populasi terjangkau penelitian ini adalah semua perempuan yang mengalami inkontinensia urin jenis stres dan kontinensia masing-masing 37 orang yang berobat ke Unit Rawat Jalan Poliklinik Ginekologi RSCM periode Februari 2014 sampai Januari 2015. Hasil : Rerata jarak leher kandung kemih ke simfisis pubis saat istirahat, saat valsava dan mobilitas leher kandung kemih pada inkontinensia urin jenis stres berturut-turut adalah 26,9 ( SB 3,2) mm, 5 ( -29 - 22) mm dan 24,3 (SB 7,9) mm. Rerata jarak leher kandung kemih ke simfisis pubis saat istirahat, saat valsava dan mobilitas leher kandung kemih pada kontinensia berturut-turut adalah 26,9 (SB 3,2) mm, 17,6 (SB 5,3) mm dan 10 (SD 4,1) mm. Rerata jarak leher kandung kemih ke simfisis pubis saat valsava pada inkontinensia urin jenis stres lebih kecil dibandingkan kontinensia 6,3 (SB 7,1) mm VS 16,3 (SB 5,2) mm, p=0,0001. Rerata mobilitas leher kandung kemih pada inkontinensia urin jenis stres lebih besar dibandingkan kontinensia 20,8 ( SB 7,0) mm VS 10,0 (SD 4,8) mm, p=0,0001. Kesimpulan : Rerata jarak leher kandung kemih ke simfisis pubis saat valsava pada inkontinensia urin jenis stres lebih kecil dibandingkan kontinensia. Rerata mobilitas leher kandung kemih pada inkontinensia urin jenis stres lebih besar dibandingkan kontinensia.

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ABSTRACT
Background : Stress urinary incontinence still be the world problem. Various studies compared decreasing bladder neck on stress urinary incontinence and continence have been done. Research with the same purpose has not been done in Indonesia. Based on that, need to study how the comparison decreasing of bladder neck between stress urinary incontinence and continence groups in Indonesia with a difference in three aspects, such as diagnostic criteria, comparised group, and the observer. Aim : To analize difference bladder neck mobility on stress urinry incontinence and continence. Methods : This study was an observational study. Main and additional research questions using a cross-sectional design . The target population in this study were all women who undergo stress urinary incontinence and continence in Indonesia . The population of this study was affordable to all women who undergo stress urinary incontinence and continence were treated to the Outpatient Clinic of Gynecology Unit of Ciptomangunkusumo Hospital in the period Februari 2014 to January 2015. Results : Mean of distance of bladder neck to the symphysis pubic at rest, valsava and bladder neck mobility on stress urinary incontinence were 26,9 (SD 3,2) mm, 5 (-29 - 22) mm and 24,3 (SD 7,9) mm. Mean of distance of bladder neck to the symphysis pubic at rest, at valsalva and bladder neck mobility on continence were 26,9 (SD 3,2) mm, 17,6 (SD 5,3) mm and 10,0 (SD 4,1) mm. There was no differences between the distance of bladder neck to the symphysis pubic at rest on stress urinary incontinence and continence 27,1 (SD 3,3) mm VS 26,3 (SD 3,5) mm, p=0,523. Mean of distance of bladder neck to the symphysis pubic at valsava on stress urinary incontinenc was lower than continence 6,3 (SD 7,1) mm VS 16,3 (SD 5,2) mm, p=0,0001. Mean of bladder neck mobility on stress urinary incontinence was greater than continence 20,8 ( SD 7,0) mm VS 10,0 (SD 4,8) mm, p=0,0001. Conclusion : Mean of distance of the bladder neck to the symphysis pubic at valsava on stress urinary incontinenc was lower than continence. Mean of bladder neck mobility on stress urinary incontinence was greater than continence, Background : Stress urinary incontinence still be the world problem. Various studies compared decreasing bladder neck on stress urinary incontinence and continence have been done. Research with the same purpose has not been done in Indonesia. Based on that, need to study how the comparison decreasing of bladder neck between stress urinary incontinence and continence groups in Indonesia with a difference in three aspects, such as diagnostic criteria, comparised group, and the observer. Aim : To analize difference bladder neck mobility on stress urinry incontinence and continence. Methods : This study was an observational study. Main and additional research questions using a cross-sectional design . The target population in this study were all women who undergo stress urinary incontinence and continence in Indonesia . The population of this study was affordable to all women who undergo stress urinary incontinence and continence were treated to the Outpatient Clinic of Gynecology Unit of Ciptomangunkusumo Hospital in the period Februari 2014 to January 2015. Results : Mean of distance of bladder neck to the symphysis pubic at rest, valsava and bladder neck mobility on stress urinary incontinence were 26,9 (SD 3,2) mm, 5 (-29 - 22) mm and 24,3 (SD 7,9) mm. Mean of distance of bladder neck to the symphysis pubic at rest, at valsalva and bladder neck mobility on continence were 26,9 (SD 3,2) mm, 17,6 (SD 5,3) mm and 10,0 (SD 4,1) mm. There was no differences between the distance of bladder neck to the symphysis pubic at rest on stress urinary incontinence and continence 27,1 (SD 3,3) mm VS 26,3 (SD 3,5) mm, p=0,523. Mean of distance of bladder neck to the symphysis pubic at valsava on stress urinary incontinenc was lower than continence 6,3 (SD 7,1) mm VS 16,3 (SD 5,2) mm, p=0,0001. Mean of bladder neck mobility on stress urinary incontinence was greater than continence 20,8 ( SD 7,0) mm VS 10,0 (SD 4,8) mm, p=0,0001. Conclusion : Mean of distance of the bladder neck to the symphysis pubic at valsava on stress urinary incontinenc was lower than continence. Mean of bladder neck mobility on stress urinary incontinence was greater than continence]

Abstrak :
ABSTRAK
Sistektomi radikal merupakan penanganan standar pada pasien tumor buli yang telah menembus otot, Perdarahan merupakan salah satu morbiditas yang ditemukan pada prosedur ini. Tujuan penelitian ini untuk mengetahui rata-rata jumlah kehilangan darah pada prosedur sistektomi radikal. Merupakan penelitian non-eksperimental retrospektif-deskriptif-analitik yang mengambil data Rekam Medis dari Januari 2012 Desember 2015 di RSUP H. Adam Malik Medan. Berdasarkan variable yang diperiksa terdapat perbedaan signifikan pada jumlah perdarahan berdasarkan diversi urin yang digunakan, yaitu ureterocutaneostomy dan neobladder. Diperlukan persiapan darah sekitar 951,5 ml sebagai standar persiapan operasi di radikal sistektomi di RSUP H. Adam Malik Medan"

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ABSTRACT
Radical cystectomy is a standard management for patients with bladder tumor which has penetrated muscles. Bleeding is one of the morbidity associated with the procedure. This study aims to measure mean blood loss during radical cystectomy. This study was a retrospective analytic study, data was collected using medical records from January 2012 to December 2015 At Haji Adam Malik General Hospital Medan. Variables that affected amount of blood loss staging, type of anesthesia used, and urine diversion, there are no significant differences except on amount of blood loss according to urine diversion method used, which were ureterocutaneostomy and neobladder. Blood preparation is needed about 951.5 ml as standard preparation for surgery in radical sistektomi in RSHAM

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.