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Abstrak :
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. ......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

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ABSTRAK
Latar Belakang: Dimensi dari hiatus levator merupakan tempat atau portal yang berpotensi tinggi untuk terjadinya prolaps organ panggul POP dan memiliki hubungan statistik yang sangat kuat dengan gejala klinis POP. Penelitian ini bertujuan untuk memberikan data mengenai korelasi pengukuran area hiatus levator pada POP simtomatik mengunakan Ultrasonografi 3D/4D dengan pemeriksaan klinis yaitu panjang Gh, panjang Pb dan penjumlahannya. Metode: Analisa data sekunder sebanyak 160 pasien POP yang diperiksa dari Januari 2012 hingga April 2017 di poliklinik Uroginekologi RSCM, Jakarta. Diambil data karakteristik pasien, pengukuran Ultrasonografi 3D/4D maksimal Area Hiatal Levator, dan hasil pengukuran secara klinis dengan menggunakan pelvic organ prolapse quantification system (POP-Q). Hasil: Terdapat korelasi positif antara pemeriksaan klinis dengan pengukuran luas area hiatal menggunakan USG dengan r = 0,43 untuk panjang Gh, dan korelasi pada penjumlahan Gh dan Pb dengan r=0,51 termasuk kategori sedang, sedangkan untuk panjang Pb dengan r = 0,23 tidak didapatkan adanya korelasi. Didapatkan titik potong optimal untuk membedakan derajat 2 dengan derajat 3 adalah 7,5 cm/29,7 cm2 dan derajat 3 dan derajat 4 adalah 8,3 cm/32,1 cm2. Kesimpulan: Pemeriksaan klinis dengan menjumlahkan panjang Gh dan panjang Pb dapat dipertimbangkan untuk mencerminkan pemeriksaan area hiatal dengan mengunakan USG 3/4 dimensi transperineal pada daerah dengan sarana terbatas untuk melihat regangan pada levator ani atau yang disebut sebagai "ballooning"

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ABSTRACT
Background: The dimension of levator hiatal is a site or portal that high potentially for pelvic organ prolapse POP and has a very strong statistical relationship with clinical symptoms of POP. This study aims to provide data on the correlation of levator hiatus area measurements in symptomatic POP using 3D/4D Ultrasound with clinical examination of Gh, Pb and summation Gh Pb. Methods: Secondary data analysis of 160 POP patients examined from January 2012 to April 2017 at the Uroginekologi Clinic RSCM, Jakarta. Taken data on patient characteristics, maximum 3D 4D Ultrasound measurement of Levator Hiatus Area, and clinical measurement results using pelvic organ prolapse quantification system POP Q. Results: There was a positive correlation between clinical examination and measurement of hiatal area area using ultrasound with r=0.43 for Gh length, and the medium correlation on the sum of Gh and Pb with r=0,51. No correlation for Pb length with r 0.23. The optimal cut to differentiate degrees 2 by 3 is 7.5 cm/29.7 cm2 and degree 3 by 4 is 8.3 cm/32.1 cm2. Conclusion: Clinical examination by summing the lengths of Gh and Pb may be consider reflects the examination of the hiatal area by using transperineal ultrasound to see the strain on levator ani called ballooning in an area with limited resources.

Abstrak :
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. ......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.

Abstrak :
Latar Belakang Prolaps organ panggul (POP) merupakan perubahan posisi organ-organ penyusun panggul dari posisi normal. Ballooning atau distensi otot levator ani dinilai menjadi penyebab POP. Penentuan balloning sejauh ini masih menggunakan USG 3D/4D yang tidak banyak ada di Indonesia. Diperlukan penelitian perbandingan ballooning dan non-ballooning dengan USG 2D untuk menentukan ballooning dengan panjang antero-posterior (AP) hiatus levator ani. Metode Digunakan metode deskriptif analitik menggunakan perbandingan rerata dengan desain penelitian potong lintang retrospektif dan pemilihan sampel penelitian secara konsekutif. Didapatkan sebanyak 72 subjek dengan 37 orang berada pada kelompok ballooning. Hasil Usia kelompok ballooning dan non-ballooning berada pada usia dewasa tua (60.35 ± 11.06 vs 56.54 ± 11.14 tahun, p=0.096), obesitas (26.73 ± 3.94 vs 24.53 ± 2.88 kg/m2, p=0.015), aktivitas berat (51.3% vs 65.7%, p=0.217), pekerjaan ibu rumah tangga (64.8% vs 65.7%, p=0.893), multiparitas (72.9% vs 60.0%, p=0.210), menopause (75.6% vs 74.2%, p=0.892), bayi lahir terberat ≥ 3500 gram (56.7% vs 45.7%, p=0.349), dan persalinan normal (83.7% vs 88.5%, p=0.420). Rerata anteroposterior ballooning lebih besar dibandingkan non-ballooning (7.09 ± 0.63 vs 5.56 ± 0.64 cm) dengan seluruh subjek ballooning memiliki panjang AP di atas 6 cm (<0.001). Kesimpulan Obesitas dan berat badan berhubungan dengan adanya ballooning pada pasien POP. Perbandingan AP hiatus levator ani menunjukkan perbedaan sehingga skrining ballooning berdasarkan panjang AP hiatus dapat dilakukan untuk membedakan kedua kelompok. ......Introduction Pelvic organ prolapse (POP) is a change in the position of the organs that make up the pelvis from their normal position. Ballooning or distension of the levator ani muscle is considered to cause POP. This determination of ballooning still uses 3D/4D ultrasound, which is not widely available in Indonesia. Comparative research between ballooning and non-ballooning with 2D ultrasound is needed to determine the ballooning through anteroposterior (AP) length of the levator ani hiatus. Method The analytical descriptive method was used using mean comparisons with a retrospective cross-sectional research design and consecutive research sample selection. There were 72 subjects with 37 people in the ballooning group. Results The ages of the ballooning and non-ballooning groups were older adults (60.35 ± 11.06 vs 56.54 ± 11.14 years, p=0.096), obesity (26.73 ± 3.94 vs 24.53 ± 2.88 kg/m2, p=0.015), heavy activity (51.3% vs 65.7%, p=0.217), housewife work (64.8% vs 65.7%, p=0.893), multiparity (72.9% vs 60.0%, p=0.210), after menopause (75.6% vs 74.2%, p=0.892) , the heaviest baby born ≥ 3500 grams (56.7% vs 45.7%, p=0.349), and normal delivery (83.7% vs 88.5%, p=0.420). The mean anteroposterior ballooning was greater than non-ballooning (7.09 ± 0.63 vs 5.56 ± 0.64 cm) with all ballooning subjects having an AP length above 6 cm (<0.001). Conclusion Obesity and body weight are associated with ballooning in POP patients. Comparison of the AP hiatus of the levator ani shows differences so that ballooning screening based on the length of the AP hiatus can be performed to differentiate the two groups.

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ABSTRAK
Latar belakang: Tesis ini bertujuan untuk mengetahui insidens retensio urin pasca rekonstruksi POP dan faktor-faktor yang berhubungan.Retensio urin merupakan komplikasi akut tindakan rekonstruksi dan banyak dijumpai pada prosedur operasi, termasuk operasi POP (POP). Untuk menghindari morbiditas lebih lanjut, penelitian ini bertujuan untuk mengetahui insidens rertensio urin pasca rekonstruksi POP faktor-faktor risiko yang berhubungan. Metode: Penelitian ini adalah penelitian kohort prospektif yang dilaksanakan di RS Cipto Mangunkusumo dan RS Fatmawati dengan mengikutsertakan wanita yang hendak mengalami rekonstruksi POP dalam rentang waktu April 2013 hingga April 2015. Kriteria inklusi dan eksklusi subjek meliputi wanita dengan POP derajat 2,3 dan 4 tanpa riwayat retensio urin sebelumnya, konsumsi obatobatan yang dapat menyebabkan retensio urin dan tanpa cedera kandung kemih. Pasca rekonstruksi, subjek dilakukan pemasangan kateter urin selama 24 jam. Kemudian, enam jam pasca pelesapan kateter, dilakukan pengukuran residu urin pada kandung kemih. Retensio urin didefinisikan dengan didapatkannya residu urin >100 ml. Hasil: Dari 200 subjek, ditemukan 59 subjek (29,5%) mengalami retensio urin. Tidak ada hubungan antara faktor risiko umur, Indeks Massa Tubuh (IMT), derajat POP, derajat sistokel, kejadian infeksi saluran kemih, dan durasi operasi terhadap retensio urin. Jenis prosedur total vagina hysterectomy + kolporafi anterior + kolpoperineorafi + sacrospinous fixation dan durasi operasi > 130 menit berhubungan dengan retensio urin dengan RR 3,66 95% IK 2,91-4,60 p<0,001 dan 1,66 95%IK 1,07-2,59 p=0,02, berturut-turut Kesimpulan: Insidens retensio urin cukup tinggi pasca rekonstruksi POP. Jenis tindakan rekonstruksi tertentu dan semakin lamanya durasi rekonstruksi berhubungan dengan kejadian retensio urin.ABSTRACT
Background: The objective of this study was to know the incidence of post operativeurinaryretention after pelvic organ prolapse surgery and associated factors.Post operative urinary retention (POUR) is considered as an acute complication after a surgey in many operative procedures, including pelvic organ prolpase (POP) surgery. To avoid further morbidity, this study aimed to know the incidence of POUR after POP surgery and its risk factors. Methods: This is a prospective cohort study conducted in Cipto Mangunkusumo hospital and Fatmawati Hospital from April 2013 to April 2015. Subjects were women who wanted to undergo POP surgery with two to four degree of POP. Subjects with history of urinary retention, drugs consumption that tend to cause urinary retention or bladder unjury were excluded. After the reconstruction, urinary catheter was placed for 24 hours. Then, after six hours, catheter was removed and residual urine was measured. Urinary retention was defined as residual urine more than 100 ml. Results: Of 200 subjects recruited, 59 (29.5%) had POUR. There were no association between age, body mass index, degree of uterine POPe, degree of cystocele, urinary tract infectionand POUR. Duration of surgery > 130 minute and Total vagina hysterectomy +anterior colporraphy + colpoperineorraphy + sacrospinous fixation procedure and duration of surgery > 130 minute were associated with POUR (RR 3.66, 2.91-4.60 95% CI, p<0.001 and 1.66 , 072.5995%CI, p=0.02; respectively) Conclusion: POUR incidence after POP surgery was quite high. Type of the procedure and duration of surgery were associated with POUR. ;Background: The objective of this study was to know the incidence of post operativeurinaryretention after pelvic organ prolapse surgery and associated factors.Post operative urinary retention (POUR) is considered as an acute complication after a surgey in many operative procedures, including pelvic organ prolpase (POP) surgery. To avoid further morbidity, this study aimed to know the incidence of POUR after POP surgery and its risk factors. Methods: This is a prospective cohort study conducted in Cipto Mangunkusumo hospital and Fatmawati Hospital from April 2013 to April 2015. Subjects were women who wanted to undergo POP surgery with two to four degree of POP. Subjects with history of urinary retention, drugs consumption that tend to cause urinary retention or bladder unjury were excluded. After the reconstruction, urinary catheter was placed for 24 hours. Then, after six hours, catheter was removed and residual urine was measured. Urinary retention was defined as residual urine more than 100 ml. Results: Of 200 subjects recruited, 59 (29.5%) had POUR. There were no association between age, body mass index, degree of uterine POPe, degree of cystocele, urinary tract infectionand POUR. Duration of surgery > 130 minute and Total vagina hysterectomy +anterior colporraphy + colpoperineorraphy + sacrospinous fixation procedure and duration of surgery > 130 minute were associated with POUR (RR 3.66, 2.91-4.60 95% CI, p<0.001 and 1.66 , 072.5995%CI, p=0.02; respectively) Conclusion: POUR incidence after POP surgery was quite high. Type of the procedure and duration of surgery were associated with POUR. ;Background: The objective of this study was to know the incidence of post operativeurinaryretention after pelvic organ prolapse surgery and associated factors.Post operative urinary retention (POUR) is considered as an acute complication after a surgey in many operative procedures, including pelvic organ prolpase (POP) surgery. To avoid further morbidity, this study aimed to know the incidence of POUR after POP surgery and its risk factors. Methods: This is a prospective cohort study conducted in Cipto Mangunkusumo hospital and Fatmawati Hospital from April 2013 to April 2015. Subjects were women who wanted to undergo POP surgery with two to four degree of POP. Subjects with history of urinary retention, drugs consumption that tend to cause urinary retention or bladder unjury were excluded. After the reconstruction, urinary catheter was placed for 24 hours. Then, after six hours, catheter was removed and residual urine was measured. Urinary retention was defined as residual urine more than 100 ml. Results: Of 200 subjects recruited, 59 (29.5%) had POUR. There were no association between age, body mass index, degree of uterine POPe, degree of cystocele, urinary tract infectionand POUR. Duration of surgery > 130 minute and Total vagina hysterectomy +anterior colporraphy + colpoperineorraphy + sacrospinous fixation procedure and duration of surgery > 130 minute were associated with POUR (RR 3.66, 2.91-4.60 95% CI, p<0.001 and 1.66 , 072.5995%CI, p=0.02; respectively) Conclusion: POUR incidence after POP surgery was quite high. Type of the procedure and duration of surgery were associated with POUR.

Abstrak :
Latar Belakang: Prolaps organ panggul (POP) pada wanita menimbulkan morbiditas. Untuk mengurangi angka re-operasi dan meningkatkan kualitas hidup pasien dibutuhkan peningatan kualitas pelayanan secara terus menerus. Guideline yang saat ini secara luas dipakai dalam penatalaksanaan POP di Indonesia adalah Panduan Penatalaksanaan POP PB HUGI-POGI pada tahun 2013. Penelitian ini dilakukan bertujuan untuk mengetahui insidensi POP dan melakukan audit kesesuaian pada penatalaksanaan kasus POP di RSUPN Cipto Mangunkusumo tahun 2016-2018. Metode: Penelitian ini merupakan penelitian deskriptif dengan menggunakan desain penelitian cross-sectional menggunakan data sekunder. Sampel yang digunakan dalam penelitian ini adalah pasien POP yang didiagnosis dan mendapat tatalaksana di Polikinik Uroginekologi RSUPN Cipto Mangunkusumo pada bulan Januari 2016 sampai dengan Desember 2018, diikuti oleh wawancara pasien yang dipilih secara acak tentang follow up pasca operasi. Hasil: Terdapat 252 kasus prolaps organ pelvis di tahun 2016-2018 dengan prevalensi 15,96%. Proporsi kesesuaian anamnesis tatalaskana POP konservatif dan operatif adalah 88,1% dan 82,8%, pemeriksaan fisik 93,1% dan 97,3%, 100% pada informasi pemilihan tatakasana dan informed consent. Kepatuhan follow up 6 bulan dan 12 pasca operasi adalah masing-masing 40,4% dan 26,5%. Ketidakcocokan dalam anamnesis dan pemeriksaan fisik disebabkan oleh beberapa formulir penilaian yang harus diisi serta formulir penilaian uroginekologi yang tidak terlampir dengan catatan medis pasien. Kesimpulan: Panduan usulan pelayanan asesmen pasien POP dengan penulisan pada formulir asesmen uroginekologi yang telah diperbaharui dan mengintegrasikan ke dalam rekam medik menjadi usulan berdasarkan hasil audit. ......Background: Pelvic organ prolapse (POP) in women causes significant morbidity. In order to reduce the number of re-operations and improve the quality of life of patients, consistent quality of patient care is required. The Executive Board of the Urogynecology Association of the Indonesian Obstetrics & Gynecology Associations 2013 POP guideline is widely used in Indonesia, but compliance to the guidelines needed to be evaluated. This study aimed to investigate the incidence of POP and to audit POP management in Cipto Mangunkusumo General Hospital, Indonesia, in 2016-2018. Method: This was a cross-sectional study on the medical records of POP patients who were diagnosed and treated at the Urogynecology Outpatient Clinic, Cipto Mangunkusumo General Hospital in January 2016 to December 2018, followed by randomly selected patient interview about follow-up discrepancy. Results: There were 252 cases of POP in 2016-2018, with a prevalence of 15.96%. Proportion of conformities in POP management with conservative and operative management was 88.1% and 82.8% in history taking, 93.1% and 97.3% in physical examination, both 100% in examinations and informed consent. Compliance of 6 months and 12 months follow up in operative management was 40.4% and 26.5%, respectively. Mismatches in history taking and physical examination were due to multiple assessment forms that have to be completed as well as unintegrated urogynecology assessment form with patients medical record. Conclusion: Our audit suggests that urogynecology assessment form should be integrated into patients medical records is needed to improve patient care. A patient book should be provided to improve follow-up rates.

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Latar belakang: Prolaps organ panggul (POP) merupakan suatu permasalahan utama kesehatan dengan risiko seumur hidup pada perempuan yang menjalani paling sedikitnya satu kali intervensi pembedahan prolaps. Retensio urin pasca operasi rekonstruksi prolaps organ panggul disebabkan oleh beberapa faktor mulai dari pemeriksaan hingga penanganan pasca operasi yang berkontribusi terhadap terjadinya retensio urin. Penelitian di RSCM tentang penggunaan kateter 24 jam pada pasien pasca operasi prolapse organ panggul terhadap insiden retensio urin adalah sebesar 29,5%. Penelitian ini akan melakukan perbandingan penggunaan kateter 24 jam yang dibandingkan kateter 48 jam terhadap insiden retensio urin yang nantinya akan menjadi standar baku terbaru di RSCM dan RSUD Arifin Achmad Pekanbaru. Tujuan: Untuk mengetahui mana di antara kateter 24 jam dan 48 jam yang lebih baik untuk mengurangi angka kejadian retensio urin pascaoperasi prolaps organ panggul. Metode: Penelitian diagnosa, uji klinis acak, pengambilan sampel berturut-turut. Perbandingan antara kateter 24 jam dan 48 jam setelah operasi prolaps organ panggul Hasil: Total 54 subjek dalam penelitian ini, 3 subjek (11,1%) di antara 27 subjek dengan kateter 24 jam mengalami retensio urin. 1 subjek (3,7%) di antara 27 subjek dengan kateter 48 jam mengalami retensio urin. Kesimpulan: Penggunaan kateter 48 jam pascaoperasi prolaps organ panggul lebih baik daripada kateter 24 jam dalam mengurangi angka kejadian retensio urin. ......Background: Pelvic organ prolapse (POP) is a major health problem with a lifetime risk in women who undergo at least one prolapse surgical intervention. Postoperative retention of urine pelvic organ prolapse reconstruction is caused by a number of factors ranging from examinations to postoperative clients that contribute to the occurrence of urinary retention. Research at the RSCM about 24- hour catheter use in postoperative pelvic organ prolapse patients for the incidence of urinary retention was 29.5%. This study will compare the use of a 24-hour catheter compared to a 48-hour catheter against the incidence of urinary retention which will later become the latest standard in RSCM and RSUD Arifin Achmad Pekanbaru. Objective: To know which one among 24-hour and 48-hour catheter is better to decrease incidence of urinary retention after pelvic organ prolapse surgery. Methode: Diagnosis research, randomized clinical trial, consecutive sampling. Comparison between 24-hour and 48-hour catheter after pelvic organ prolapse surgery Result: Total 54 subjects in this research, 3 subjects (11.1%) among 27 subjects with 24-hour catheter experienced urinary retention. 1 subject (3.7%) among 27 subjects with 48-hour catheter experienced urinary retention. Conclussion: The application of 48-hour catheter after pelvic organ prolapse surgery is beter than 24-hour catheter to decrease the incidence of urinary retention.

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Latar belakang:Berdasarkan International Continence Society(ICS), inkontinensia urin merupakan keluhan dari kebocoran urin sebagai hasil dari abnormalitas fungsi saluran kemih bagian bawah atau sekunder dari penyakit tertentu yang dapat mengganggu kehidupan perempuan secara fisik, psikologis, dan sosial. Pada tahun 2003, prevalensi inkontinensia urin pada perempuan di seluruh dunia sebesar 17-50% dengan jenis yang paling sering adalah jenis tekanan (50%). Hipermobilitas leher kandung kemih merupakan salah satu dasar patologi dari inkontinensia tipe tekanan. Kondisi hipermobilitas leher kandung kemih dan uretra dapat membantu lebih memahami patofisiologi dari inkontinensia urin tipe tekanan yang terjadi. Penelitian ini ditujukan untuk menilai hubungan profil pergerakan leher kandung kemih dengan prolaps kompartemen anterior vagina pada pasien dengan inkontinensia urin jenis tekanan pada pasien dengan prolaps organ panggul.

Metode:Studi ini memiliki desain potong lintang pada 112 subjek dengan riwayat POP yang memenuhi kriteria inklusi dan eksklusi. Data yang diambil pada penelitian ini adalah bladder neck descent(BND), retrovesical angle(RVA), Rotational urethra(RoU), funneling, titik Aa dan Ba pada POP-Q.

Hasil:Data penelitian menunjukan inkontinensia tipe tekanan terjadi pada 50% subjek dengan POP. Pada analisis data didapatkan perbedaan yang signifikan antara funneling, sudut RVA dan sudut RoU dengan kejadian inkontinensia urin. Cutoff sudut RVA didapatkan bernilai 130.570dengan sensitivitas 64,3% dan spesifisitas 55.4%. Cutoff sudut RoU didapatkan bernilai 41.560dengan sensitivitas 76,8% dan spesifisitas 67,9%. Hasil yang didapatkan menunjukan hubungan yang bermakna pada analisis multivariat.

Kesimpulan:Terdapat perbedaan yang bermakna antara sudut RVA, sudut RoU, dan riwayat funneling terhadap inkontinensia urin tipe tekanan pada perempuan dengan POP. Tidak terdapat perbedaan nilai penurunan Titik Aa, titik Ba, dan penurunan leher kandung kemih antara perempuan kontinensia dengan inkontinensia jenis tekanan. Sudut RVA, sudut RoU, dan riwayat funneling dapat digunakan untuk memprediksi terjadinya inkontinensia tipe tekanan pada subjek dengan POP.

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ABSTRACT
Background:Stress type urinary incontinence is a pressure induced urinary leakage caused by functional abnormality of lower urinary tract or other disease that cause physical, psychological, and social disturbance in female. The prevalence of urinary incontinence is 17-50% around the world with 50% of them are stress type urinary incontinence. Bladder neck mobility is one of the main pathology of stress type urinary incontinence. Observation of bladder neck mobility and urethra in stress type incontinence may increase the understanding of the urinary incontinence pathophysiology. This study is aimed to quantify the relation between bladder neck mobility profile and anterior compartment vaginal prolapse with stress-type urinary incontinence in patient with pelvic organ prolapse.

Method:The study is a cross-sectional study with 112 subjects with history of pelvic organ prolapse and suits inclusion and exclusion criteria. Data obtained in this study are bladder neck descent (BND), retrovesical angle (RVA), rotational urethra (RoU), funneling, point Aa and Ba from POP-Q.

Results:This study found stress-type urinary incontinence in 50% subjects with POP. In this study, significant difference found in funneling, RVA, and RoU between female with and without urinary incontinence. Cutoff of RVA obtained from this study are 130.570with 64.3% sensitivity and 55.4% specificity. Cutoff of RoU obtained from this study are 41.560with 76,8% sensitivity and 67,9% specificity. Cutoff result shows significant correlation with stress type urinary incontinence on multivariate analysis.

Conclusion:There are significant difference in RVA, RoU, and funneling between female with and without stress type urinary incontinence. There are no significant difference in point Aa, point Ba, and bladder neck descent between female with and without urinary incontinence. Funneling, RVA, and RoU can predict incidence of stress type urinary incontinence in female with POP.

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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.

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Latar 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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ABSTRACT
Background 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.