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{\info{\author mETaL}{\subject Root}{\operator GuE=AnDReNaLinE}}
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\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs
18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-213\s
lmult0 \fs18\cf0\par\pard\li1026\ri0\sl-453\slmult0 \fs24\cf0\f0\charscalex100\b
{I. PENDAHULUAN}\b0 \par\pard\li1306\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1
306\ri0\sl-333\slmult0 \fs24\cf0\f0\charscalex100 {Inkontinensia urine adalah ke
tidakmampua}\fs24\cf0\f0\charscalex100 {n menahan air kencing. Gangguan ini lebi
h}\par\pard\li1306\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {sering terjadi
pada wanita yang pernah }\fs22\cf0\f0\charscalex100 {melahirkan daripada yang b
elum pernah}\par\pard\li1306\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {mela
hirkan (nulipara). Diduga disebabkan ol}\fs22\cf0\f0\charscalex100 {eh perubahan
otot dan fasia di dasar}\par\pard\li1306\ri0\sl-426\slmult0 \fs22\cf0\f0\charsc
alex100 {panggul. Kebanyakan penderita inkontinensia }\fs22\cf0\f0\charscalex100
{telah menderita desensus dinding depan}\par\pard\li1306\ri0\sl-413\slmult0 \fs
22\cf0\f0\charscalex100 {vagina disertai sisto-uretr}\fs22\cf0\f0\charscalex100
{okel. Tetapi kadang-kadang dijumpai penderita dengan}\par\pard\li1306\ri0\sl-41
3\slmult0 \fs24\cf0\f0\charscalex100 {prolapsus total uterus dan vagina }\fs24\c
f0\f0\charscalex100 {dengan kontinensia urine yang baik.}{\super \fs16\up4\cf0\f
0\charscalex100 {1}}\par\pard\li1573\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex1
00 {Angka kejadian bervariasi, karena banya}\fs22\cf0\f0\charscalex100 {k yang t
idak dilaporkan dan diobati. Di}\par\pard\li1306\ri0\sl-413\slmult0 \fs22\cf0\f0
\charscalex100 {Amerika Serikat, diperkirakan sekitar 10-12}\fs22\cf0\f0\charsca
lex100 { juta orang dewasa }\fs22\cf0\f0\charscalex100 {mengalami gangguan ini.}
\par\pard\li1306\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {Gangguan ini bis
a mengenai wanita segala}\fs22\cf0\f0\charscalex100 { usia. Prevalensi dan berat
gangguan}\par\pard\li1306\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {mening
kat dengan bertambahnnya umur dan pa}\fs22\cf0\f0\charscalex100 {ritas. Pada us
ia 15 tahun atau lebih}\par\pard\li1306\ri0\sl-413\slmult0 \fs22\cf0\f0\charscal
ex100 {didapatkan kejadian 10%, sedang pada us}\fs22\cf0\f0\charscalex100 {ia 35
-65 tahun mencapai 12%. Prevalansi}\par\pard\li1306\ri0\sl-413\slmult0 \fs22\cf0
\f0\charscalex100 {meningkat sampai 16% pada wanita usia lebi}\fs22\cf0\f0\chars
calex100 {h dari 65 tahun. Pada nulipara didapatkan}\par\pard\li1306\ri0\sl-413\
slmult0 \fs22\cf0\f0\charscalex100 {kejadian 5%, pada wanita dengan anak sa}\fs2
2\cf0\f0\charscalex100 {tu mencapai 10% dan meningkat sampai 20%}\par\pard\li130
6\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {pada wanita dengan 5 anak}{ }\f
s16\cf0\f0\charscalex100 {2, 3, 4}\par\pard\li1573\ri0\sl-413\slmult0 \fs22\cf0\
f0\charscalex100 {Pada wanita umumnya inkontinensia me}\fs22\cf0\f0\charscalex10
0 {rupakan inkontinensia stres, artinya}\par\pard\li1306\ri0\sl-413\slmult0 \fs2
2\cf0\f0\charscalex100 {keluarnya urine semata-mata karena batuk, }\fs22\cf0\f0\
charscalex100 {bersin dan segala ge}\fs22\cf0\f0\charscalex100 {rakan lain dan j
arang}\par\pard\li1306\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {ditemukan
adanya inkontinensia desakan,}\fs24\cf0\f0\charscalex100 { dimana didapatkan}\fs
24\cf0\f0\charscalex100 { keinginan miksi }\par\pard\li1306\ri0\sl-413\slmult0 \
fs24\cf0\f0\charscalex100 {mendadak. Keinginan ini demikian mendesa}\fs24\cf0\f0
\charscalex100 {knya sehingga sebelum mencapai kamar}\par\pard\li1306\ri0\sl-413
\slmult0 \fs24\cf0\f0\charscalex100 {kecil penderita telah membasahkan celananya
}\fs24\cf0\f0\charscalex100 {. Jenis inkontinensia }\fs24\cf0\f0\charscalex100 {
ini dikenal karena}\par\pard\li1306\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex10
0 {gangguan neuropatik pada kandung kemih. Sistitis}\fs24\cf0\f0\charscalex100 {
yang sering kambuh, juga kelainan}\par\pard\li1306\ri0\sl-413\slmult0 \fs24\cf
0\f0\charscalex100 {anatomik yang dianggap sebagai penyebab }\fs24\cf0\f0\charsc
alex100 {inkontinensia stres, dapat menyebabkan}\par\pard\li1306\ri0\sl-413\slmu
lt0 \fs24\cf0\f0\charscalex100 {inkontinensia desakan. Seri}\fs24\cf0\f0\charsca
lex100 {ng didapati inkontinensia stres dan desakan secara}\par\pard\li1306\ri0\

sl-413\slmult0 \fs24\cf0\f0\charscalex100 {bersamaan.}{ }\fs16\cf0\f0\charscalex

100 {1,3, 4}\par\pard\li1573\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Tuju
an penyajian referat ini adalah untuk mengetahui lebih lanjut mengenai}\par\pard
\li1306\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {inkontinensia urine, jeni
s-jenis dan cara }\fs24\cf0\f0\charscalex100 {penanganannya. Pemahaman yang lebi
h baik}\par\pard\li1306\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {akan memb
antu usaha mengatasi gangguan ini.}\par\pard\sect\sectd\sbkpage\pgwsxn12240\pghs
xn15840\marglsxn666\margrsxn133\margtsxn666\margbsxn240\cols2\colno1\colw9760\co
lsr-0\colno2\colw1680\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\r
i0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\par
d\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-453\slmult0 \fs24\c
f0\f0\charscalex100\b {II. FUNGSI NORMAL K}\b0 \fs24\cf0\f0\charscalex100\b {AND
UNG KEMIH DAN URETRA}\b0 \par\column\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\p
ard\li0\ri0\sl-360\slmult0 \fs24\cf0\f0\charscalex100 {2}\par\pard\sect\sectd\sb
knone\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133\pard\li1306\ri0\sl-413\slm
ult0 \*\tx9493\fs24\cf0\f0\charscalex100 {Pada orang dewasa sehat, kerja kandung
}\fs24\cf0\f0\charscalex100 {kemih dapat dibagi dalam dua fase;}\tab \fs24\cf0\
f0\charscalex100\i {fase }\i0 \par\pard\li1306\ri0\sl-413\slmult0 \fs24\cf0\f0\c
harscalex100\i {pengisian,}\i0 { }\fs24\cf0\f0\charscalex100 {dengan kandung kem
ih berfungsi sebagai}{ }\fs24\cf0\f0\charscalex100\i {reservoar urine}\i0 { }\fs
24\cf0\f0\charscalex100 {yang masuk secara}\par\pard\li1306\ri0\sl-413\slmult0 \
fs24\cf0\f0\charscalex100 {berangsur-angsur dari ureter, dan}{ }\fs24\cf0\f0\cha
rscalex100\i {fase miksi}\i0 \fs24\cf0\f0\charscalex100 { dengan kandung kemih b
efungsi sebagai}\par\pard\li1306\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {
pompa serta menuangkan urine melalui }\fs24\cf0\f0\charscalex100 {uretra dalam w
aktu relatif singkat.}\fs16\cf0\f0\charscalex100 {1,4,11}\par\pard\li1573\ri0\sl
-413\slmult0 \fs24\cf0\f0\charscalex100 {Pada keadaan normal selama fase pengisi
an}\fs24\cf0\f0\charscalex100 { tidak terjadi kebocoran urine, walaupun}\par\par
d\li1306\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {kandung kemih penuh atau
tekanan intraabdo}\fs24\cf0\f0\charscalex100 {men meningkat seperti sewaktu bat
uk,}\par\pard\li1306\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {meloncat-lon
cat atau kencing dan pe}\fs24\cf0\f0\charscalex100 {ningkatan isi kandung kemih
memperbesar}\par\pard\li1306\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {kein
ginan ini. Pada keadaan normal, dalam }\fs24\cf0\f0\charscalex100 {hal demikian
pun tidak terjadi kebocoran di}\par\pard\li1306\ri0\sl-413\slmult0 \fs24\cf0\f0\
charscalex100 {luar kesadaran.}\par\pard\li1573\ri0\sl-413\slmult0 \fs24\cf0\f0\
charscalex100 {Pada fase pengosongan, isi seluruh ka}\fs24\cf0\f0\charscalex100
{ndung kemih dikosongkan sama sekali. Orang}\par\pard\li1306\ri0\sl-426\slmult0
\fs24\cf0\f0\charscalex100 {dewasa dapat mempercepat atau memperla}\fs24\cf0\f0\
charscalex100 {mbat miksi menurut kehendaknya secara}\par\pard\li1306\ri0\sl-400
\slmult0 \fs24\cf0\f0\charscalex100 {sadar, tanpa dipengaruhi kua}\fs24\cf0\f0\c
harscalex100 {tnya rasa ingin kencing.}\par\pard\li1573\ri0\sl-426\slmult0 \fs24
\cf0\f0\charscalex100 {Cara kerja kandung kemih yaitu sewaktu fa}\fs24\cf0\f0\ch
arscalex100 {se pengisian otot }\fs24\cf0\f0\charscalex100 {kandung kemih tetap}
\par\pard\li1306\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {kendor sehingga
meskipun volume kandung kemih meningkat, tekanan di dalam}\par\pard\li1306\ri0\s
l-413\slmult0 \fs24\cf0\f0\charscalex100 {kandung kemih tetap rendah. Sebaliknya
ot}\fs24\cf0\f0\charscalex100 {ot-otot yang merupakan mekanisme }\par\pard\li13
06\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {penutupan selalu dalam keadaan
tegang. Denga}\fs24\cf0\f0\charscalex100 {n demikian maka uretra tetap tertutup
.}\par\pard\li1306\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Sewaktu miksi,
tekanan di dalam kandung ke}\fs24\cf0\f0\charscalex100 {mih meningkat karena ko
ntraksi aktif otot-}\par\pard\li1306\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex1
00 {ototnya, sementara terjadi pengendoran me}\fs24\cf0\f0\charscalex100 {kanism
e penutup di dalam uretra. Uretra}\par\pard\li1306\ri0\sl-413\slmult0 \fs24\cf0\
f0\charscalex100 {membuka dan urine memancar keluar. Ad}\fs24\cf0\f0\charscalex
100 {a semacam kerjasama antara otot-otot}\par\pard\li1306\ri0\sl-413\slmult0 \f
s24\cf0\f0\charscalex100 {kandung kemih dan uretra, baik semasa }\fs24\cf0\f0\ch
arscalex100 {fase pengisian maupun sewaktu fase}\par\pard\li1306\ri0\sl-413\slmu
lt0 \fs24\cf0\f0\charscalex100 {pengeluaran. Pada kedua fase }\fs24\cf0\f0\chars

calex100 {itu urine tidak boleh mengal}\fs24\cf0\f0\charscalex100 {ir balik ke d

alam ureter }\par\pard\li1306\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {(re
fluks).}{ }\fs16\cf0\f0\charscalex100 {1,3, 4}\par\pard\li1026\ri0\sl-213\slmult
0 \fs18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl400\slmult0 \fs24\cf0\f0\charscalex100\b {III ANATOMI DAN FISIOLOGI}\b0 \par\par
d\li1386\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Vesika dan uretra dapat
dipandang seba}\fs24\cf0\f0\charscalex100 {gai suatu kesatuan dengan pertumbuhan
nya}\par\pard\li1386\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {yang berasal
dari jaringan }\fs24\cf0\f0\charscalex100 {sekitar sinus urogenitalis.}{\super
\fs16\up4\cf0\f0\charscalex100 {2,3}}\fs24\cf0\f0\charscalex100 { Oleh karena it
u lapisan otot}\par\pard\li1386\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {p
olos keduanya sama, lapisan dalam merupaka}\fs24\cf0\f0\charscalex100 {n lapisan
longitudinal dan lapisan luar }\par\pard\li1386\ri0\sl-413\slmult0 \fs24\cf0\f0
\charscalex100 {membentuk anyaman sirkuler yang mengelilingi}\fs24\cf0\f0\charsc
alex100 { lubang urehra. Anyaman sirkuler ini}\par\pard\li1386\ri0\sl-413\slmult
0 \fs24\cf0\f0\charscalex100 {yang berperan pada keadaan tekanan istira}\fs24\cf
0\f0\charscalex100 {hat atau tekanan penutupan dalam uretra.}{\super \fs16\up4\c
f0\f0\charscalex100 {5,6}}\fs24\cf0\f0\charscalex100 {.}\par\pard\sect\sectd\sbk
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}}}}\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133\margtsxn666\margbsxn240\par
d\li9760\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li9760\ri0\sl-360\slmult0 \fs24\c
f0\f0\charscalex100 {3}\par\pard\li1666\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li
1666\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1666\ri0\sl-306\slmult0 \fs22\cf0\f
0\charscalex100 {Anyaman otot vesika ini menjadi satu lapi}\fs22\cf0\f0\charscal
ex100 {san dengan kelanjutan }\fs22\cf0\f0\charscalex100 {serabut-serabutnya}\pa
r\pard\li1386\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {ditemukan pula di d
inding uret}\fs24\cf0\f0\charscalex100 {ra sebagai otot-otot uretra}\fs24\cf0\f0
\charscalex100 {, dikenal sebagai muskulus}\par\pard\li1386\ri0\sl-413\slmult0 \
fs24\cf0\f0\charscalex100 {sfingter vesicae internus atau muskulus lisosfi}\fs24
\cf0\f0\charscalex100 {ngter. Otot-otot tersebut terletak di bawah}\par\pard\li1
386\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {lapisan jaringan yang elastis
dan tebal dan di}\fs24\cf0\f0\charscalex100 {sebelah luar dilapisi jaringan ika
t. Di}\par\pard\li1386\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {dalam lapi
san elastis yang }\fs24\cf0\f0\charscalex100 {tebal ditemukan lapisan mukos}\fs2
4\cf0\f0\charscalex100 {a dengan jaringan submukosa}\par\pard\li1386\ri0\sl-413\
slmult0 \fs24\cf0\f0\charscalex100 {yang spongius.}{\super \fs16\up4\cf0\f0\char
scalex100 {2}}\par\pard\li1666\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {Di
samping muskulus sfingter vesikae inter}\fs22\cf0\f0\charscalex100 {nus dan lebi
h ke distal sepanjang 2 cm,}\par\pard\li1386\ri0\sl-413\slmult0 \fs24\cf0\f0\cha
rscalex100 {uretra dilingkari oleh suatu la}\fs24\cf0\f0\charscalex100 {pisan ot
ot tidak polos dikena}\fs24\cf0\f0\charscalex100 {l sebagai muskulus sfingter}\p
ar\pard\li1386\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {uretra ekstranus a
tau muskulus rabdosfingt}\fs24\cf0\f0\charscalex100 {er eksternus. Otot ini dapa
t meningkatkan}\par\pard\li1386\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {f
ungsi sfingter vesika dengan menarik uretra}\fs24\cf0\f0\charscalex100 { ke arah
proksimal }\fs24\cf0\f0\charscalex100 {sehingga urethra lebih}\par\pard\li1386\

ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {menyempit. Otot-otot polos vesika

dan uret}\fs24\cf0\f0\charscalex100 {ra berada dibawah pengaruh saraf para}\par
\pard\li1386\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {simpatis dan dengan
demikian berfungs}\fs24\cf0\f0\charscalex100 {i serba otonom. Muskulus rabdosfin
gter}\par\pard\li1386\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100 {merupakan s
ebagian dari otot-otot da}\fs24\cf0\f0\charscalex100 {sar panggul sehingga kekua
tannya dapat}\par\pard\li1386\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {dit
ingkatkan dengan latihan-latihan dasa}\fs24\cf0\f0\charscalex100 {r panggul tert
entu. Muskulus bulbokaver-}\par\pard\li1386\ri0\sl-413\slmult0 \fs24\cf0\f0\char
scalex100 {norsus dan ishiokavernosus juga dapat aktif }\fs24\cf0\f0\charscalex1
00 {ditutup bila vesika penuh dan ada perasaan}\par\pard\li1386\ri0\sl-413\slmul
t0 \fs24\cf0\f0\charscalex100 {ingin berkemih, sehingga tid}\fs24\cf0\f0\charsca
lex100 {ak terjadi inkontinensia.}{\super \fs16\up4\cf0\f0\charscalex100 {2,4}}\
par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133\cols
2\colno1\colw4626\colsr-0\colno2\colw6813\pard\li1306\ri0\sl-213\slmult0 \fs18\c
f0\par\pard\li1306\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1306\ri0\sl-213\slmul
t0 \fs18\cf0\par\pard\li1306\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1306\ri0\sl
-213\slmult0 \fs18\cf0\par\pard\li1306\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1
306\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1306\ri0\sl-213\slmult0 \fs18\cf0\pa
r\pard\li1306\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1306\ri0\sl-213\slmult0 \f
s18\cf0\par\pard\li1306\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1306\ri0\sl-213\
slmult0 \fs18\cf0\par\pard\li1306\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1306\r
i0\sl-213\slmult0 \fs18\cf0\par\pard\li1306\ri0\sl-213\slmult0 \fs18\cf0\par\par
d\li1306\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {Gambar 1 : A. uretra ter
tutup}\par\column\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\
slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0
\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0
\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard
\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\
pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\
par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\
cf0\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {B. uretra terbuk
a}\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133\p
ard\li2293\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {1. Jar. Spongius 2. M
. lisosfingter 3. M. Rabdosfingter}\par\pard\li1026\ri0\sl-226\slmult0 \fs20\c
f0\f0\charscalex100 {
(dikutip dari kepustakaan no.
2)}\par\pard\li1573\ri0\sl-386\slmult0 \fs24\cf0\f0\charscalex100 {Terdapat 3 k
omponen anatomis dari mekani}\fs24\cf0\f0\charscalex100 {sme kontinensia, yaitu
penyangga uretra,}\par\pard\li1306\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100
{sfingter internus dan eksternus}\fs22\cf0\f0\charscalex100 {. Sfingter internu
s yang terlet}\fs22\cf0\f0\charscalex100 {ak setinggi leher vesika, bila}\par\pa
rd\li1306\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {terganggu menimbulkan i
nkontinensia }\fs22\cf0\f0\charscalex100 {stres walaupun penyangga normal, sedan
g}\par\pard\li1306\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {sfingter ekste
rnus mempunyai ke}\fs24\cf0\f0\charscalex100 {mampuan untuk kontraksi volunter.}
\fs16\cf0\f0\charscalex100 {7,10,11,12}{\sub \fs24\cf0\f0\charscalex100 {.}}\par
\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133\pard\se
ct\sectd\sbkpage\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133\margtsxn666\mar
gbsxn240\pard\li9760\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li9760\ri0\sl-360\slm
ult0 \fs24\cf0\f0\charscalex100 {4}\par\pard\li1573\ri0\sl-213\slmult0 \fs18\cf0
\par\pard\li1573\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1573\ri0\sl-306\slmult0
\fs22\cf0\f0\charscalex100 {Bila vesika berisi urine maka otot di}\fs22\cf0\f0\
charscalex100 {nding vesika mulai direnggangkan dan perasaan}\par\pard\li1306\ri
0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {ini disalurkan melalui saraf }\fs22
\cf0\f0\charscalex100 {sensorik ke bagian sakral sumsum tulang belakang. Disini}
\par\pard\li1306\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {rangsangan disal
urkan ke bagian motorik ya}\fs22\cf0\f0\charscalex100 {ng kemudian dapat menimbu
lkan kontraksi}\par\pard\li1306\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {r
ingan pada otot dinding vesi}\fs24\cf0\f0\charscalex100 {ka atau muskulus detrus

or.}\par\pard\li1573\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {Bila isi ves

ika hanya se}\fs22\cf0\f0\charscalex100 {dikit maka kontraksi ringan itu tidak m
enimbulkan}\par\pard\li1306\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {penge
luaran kemih, akan tetapi bila vesika }\fs22\cf0\f0\charscalex100 {terus direngg
angkan maka}\fs22\cf0\f0\charscalex100 { muskulus detrusor}\par\pard\li1306\ri0\
sl-426\slmult0 \fs24\cf0\f0\charscalex100 {berkontraksi lebih kuat dan urine dik
eluar}\fs24\cf0\f0\charscalex100 {kan dengan deras adalah antara 25-30 cmH}{\sub
\fs16\cf0\f0\charscalex100 {2}}\fs24\cf0\f0\charscalex100 {O.}\par\pard\li1306\
ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {Pada keadaan patologik tekanan in
traves}\fs22\cf0\f0\charscalex100 {ika itu dapat naik }\fs22\cf0\f0\charscalex10
0 {sampai 150-250 cmH}{\sub \fs14\cf0\f0\charscalex100 {2}}\fs22\cf0\f0\charscal
ex100 {O untuk}\par\pard\li1306\ri0\sl-400\slmult0 \fs22\cf0\f0\charscalex100 {m
engatasi rintangan di sfingt}\fs22\cf0\f0\charscalex100 {er vesikae dan sfingter
uret}\fs22\cf0\f0\charscalex100 {hra. Muskulus lisosfingter}\par\pard\li1306\ri
0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {melingkari bagian atas urethra dan
menentuka}\fs22\cf0\f0\charscalex100 {n sudut antara urethra dan dasar vesika.}\
par\pard\li1306\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {Otot-otot dasar p
anggul seperti muskulus }\fs22\cf0\f0\charscalex100 {levator ani ikut menentukan
posisi leher}\par\pard\li1306\ri0\sl-426\slmult0 \fs22\cf0\f0\charscalex100 {ve
sika. Bila dasar panggul mengendor maka ur}\fs22\cf0\f0\charscalex100 {etra dan
leher vesika akan bergeser ke}\par\pard\li1306\ri0\sl-400\slmult0 \fs22\cf0\f0\c
harscalex100 {belakang dan vesika dapat dikosongkan. Bila ur}\fs22\cf0\f0\charsc
alex100 {etra ditarik ke depan maka mulut vesika}\par\pard\li1306\ri0\sl-426\slm
ult0 \fs24\cf0\f0\charscalex100 {ditutup.}\fs16\cf0\f0\charscalex100 {3,7,11}{\s
ub \fs24\cf0\f0\charscalex100 {.}}\par\pard\li1573\ri0\sl-413\slmult0 \fs22\cf0\
f0\charscalex100 {Pada wanita dalam posisi berdiri, leher }\fs22\cf0\f0\charscal
ex100 {vesika terletak di}\fs22\cf0\f0\charscalex100 { atas lig. pubouretra.}\pa
r\pard\li1306\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {Ligamen ini merupak
an jaringan fibrous dianta}\fs22\cf0\f0\charscalex100 {ra tulang pubis dan jarin
gan parauretra.}\par\pard\li1306\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {
Posisi uretra proksimal dan }\fs22\cf0\f0\charscalex100 {leher vesika adalah mob
il dan dipengaruhi oleh muskulus}\par\pard\li1306\ri0\sl-413\slmult0 \fs22\cf0\f
0\charscalex100 {dan relaksasinya pada waktu miksi menghila}\fs22\cf0\f0\charsca
lex100 {ngkan sudut vesikouretra bagian posterior.}\par\pard\li1306\ri0\sl-413\s
lmult0 \fs22\cf0\f0\charscalex100 {Secara klinis hubungan uretra proksimal yang
mobil dan dipengaruhi oleh levator ani}\par\pard\li1306\ri0\sl-413\slmult0 \fs22
\cf0\f0\charscalex100 {dengan uretra distal yang terf}\fs22\cf0\f0\charscalex100
{iksasi terdapat pada separ}\fs22\cf0\f0\charscalex100 {oh panjang uretra dan d
isebut}\par\pard\li1306\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {\uc1\u822
0Xlutut uretra\uc1\u8221X. Daerah ini tempat masuk uret}\fs24\cf0\f0\charscalex1
00 {ra ke dalam membran perinei dan terfiksasi }\par\pard\li1306\ri0\sl-413\slmu
lt0 \fs24\cf0\f0\charscalex100 {pada struktur tersebut.}{\super \fs16\up4\cf0\f0
\charscalex100 {10}}\fs24\cf0\f0\charscalex100 {.}\par\pard\li1573\ri0\sl-413\sl
mult0 \fs24\cf0\f0\charscalex100 {Mekanisme yang berperan dalam penyanggaan}\fs2
4\cf0\f0\charscalex100 { leher vesika dan uretra proksimal }\par\pard\li1306\ri0
\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {meliputi 3 struktur yaitu arkus tend
ineus }\fs24\cf0\f0\charscalex100 {fasia pelvis, otot levator ani dan fasia }\pa
r\pard\li1306\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {endopelvik yang men
gelilingi uretra dan vagina.}\par\pard\li1573\ri0\sl-413\slmult0 \fs24\cf0\f0\ch
arscalex100 {Tekanan dalam uretra meningkat bila teka}\fs24\cf0\f0\charscalex100
{nan abdomen meningkat, misalnya pada}\par\pard\li1306\ri0\sl-413\slmult0 \fs24
\cf0\f0\charscalex100 {waktu batuk. Fenomena ini disebut transmis}\fs24\cf0\f0\c
harscalex100 {i tekanan. Ini berarti uretra proksimal}\par\pard\li1306\ri0\sl-41
3\slmult0 \fs24\cf0\f0\charscalex100 {terletak di atas dasar pelvis. Disini}\fs2
4\cf0\f0\charscalex100 { peningkatan tekanan intraabdominal akan}\par\pard\li130
6\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {menyebabkan peingkatan secara s
imultan tekana}\fs24\cf0\f0\charscalex100 {n uretra, sedang di bawah dasar pangg
ul}\par\pard\li1306\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {peningkatan t
ekanan tidak berpengaruh pada }\fs24\cf0\f0\charscalex100 {uretra. Dengan demiki
an, inkotinensia stres}\par\pard\sect\sectd\sbkpage\pgwsxn12240\pghsxn15840\marg

lsxn666\margrsxn133\margtsxn666\margbsxn240\pard\li9760\ri0\sl-213\slmult0 \fs18
\cf0\par\pard\li9760\ri0\sl-360\slmult0 \fs24\cf0\f0\charscalex100 {5}\par\pard\
li1306\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1306\ri0\sl-213\slmult0 \fs18\cf0
\par\pard\li1306\ri0\sl-306\slmult0 \fs22\cf0\f0\charscalex100 {akan terjadi bil
a leher vesika}\fs22\cf0\f0\charscalex100 { turun di bawah dasar pelvis. }\fs22\
cf0\f0\charscalex100 {Pada pelvis bagian depan di}\par\pard\li1306\ri0\sl-413\sl
mult0 \fs22\cf0\f0\charscalex100 {dekat uretra, lapisan yang membatasi dind}\fs2
2\cf0\f0\charscalex100 {ing vagina anterior membentuk fasia}\par\pard\li1306\ri0
\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {endopelvik. Stabilisasi lapisan ini
yang menun}\fs22\cf0\f0\charscalex100 {jukkan dimana uretra}\fs22\cf0\f0\charsca
lex100 { dipengaruhi oleh}\par\pard\li1306\ri0\sl-413\slmult0 \fs22\cf0\f0\chars
calex100 {tekanan intraabdominal. Uretra abdominal }\fs22\cf0\f0\charscalex100 {
cenderung bergerak ke dorsal dan kaudal.}\par\pard\li1306\ri0\sl-413\slmult0 \fs
24\cf0\f0\charscalex100 {Gerakan ini dibatasi }\fs24\cf0\f0\charscalex100 {oleh
tahanan pada dinding vagina}\fs24\cf0\f0\charscalex100 { anterior dan fasia endo
pelvik.}{\super \fs16\up4\cf0\f0\charscalex100 {5,6}}\par\pard\li1573\ri0\sl-413
\slmult0 \fs22\cf0\f0\charscalex100 {Inkontinensia stres tidak hanya tergantung
pa}\fs22\cf0\f0\charscalex100 {da penyangga elemen fibrous saja, akan}\par\pard\
li1306\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {tetapi diduga otot lurik,
yaitu bagian pubova}\fs22\cf0\f0\charscalex100 {ginal otot levator an}\fs22\cf0\
f0\charscalex100 {i juga berperanan.}\par\pard\li1306\ri0\sl-413\slmult0 \fs22\c
f0\f0\charscalex100 {Memang otot lurik tidak dapat secara refl}\fs22\cf0\f0\char
scalex100 {eks berkontraksi cukup cepat pada keadaan}\par\pard\li1306\ri0\sl-413
\slmult0 \fs22\cf0\f0\charscalex100 {batuk, akan tetapi karena tekanan batuk }\f
s22\cf0\f0\charscalex100 {diteruskan oleh kon}\fs22\cf0\f0\charscalex100 {traksi
otot lurik}\par\pard\li1306\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {thor
akoabdominopelvik, kontraksi diagfragma pe}\fs22\cf0\f0\charscalex100 {rnafasan,
interkostal dan otot dinding}\par\pard\li1306\ri0\sl-413\slmult0 \fs24\cf0\f0\c
harscalex100 {perut adalah mungkin.}\par\pard\li1573\ri0\sl-426\slmult0 \fs22\cf
0\f0\charscalex100 {Peningkatan tekanan intraabdominal bisa }\fs22\cf0\f0\charsc
alex100 {meningkatkan atau menurunkan aliran}\par\pard\li1306\ri0\sl-373\slmult0
\fs22\cf0\f0\charscalex100 {urine. Hal ini tergantung pada berkontraksi tid}\fs
22\cf0\f0\charscalex100 {aknya otot levator ani. Posisi leher vesika}\par\pard\l
i1306\ri0\sl-386\slmult0 \fs22\cf0\f0\charscalex100 {akan berubah dengan kontrak
si dan relaksasi leva}\fs22\cf0\f0\charscalex100 {tor ani. Terjadi pene}\fs22\cf
0\f0\charscalex100 {balan jaringan ikat}\par\pard\li1306\ri0\sl-386\slmult0 \fs2
2\cf0\f0\charscalex100 {endopelvis yang terletak disekitar leher }\fs22\cf0\f0\c
harscalex100 {vesika, disebut ligamen pubovesikal, yang}\par\pard\li1306\ri0\sl386\slmult0 \fs22\cf0\f0\charscalex100 {menunjukkan kombinasi muskulus pubovesi}
\fs22\cf0\f0\charscalex100 {kal dengan jaringa}\fs22\cf0\f0\charscalex100 {n fib
rous yang}\par\pard\li1306\ri0\sl-386\slmult0 \fs24\cf0\f0\charscalex100 {menyer
tainya.}\par\pard\li1573\ri0\sl-386\slmult0 \fs22\cf0\f0\charscalex100 {Leher ve
sika dan uretra proksimal turun pada saat mulai miksi. Perubahan posisi ini}\par
\pard\li1306\ri0\sl-386\slmult0 \fs22\cf0\f0\charscalex100 {menyebabkan lig. Pub
ovesikal menarik leher vesi}\fs22\cf0\f0\charscalex100 {ka ke arah lebih anterio
r, sehingga}\par\pard\li1306\ri0\sl-386\slmult0 \fs22\cf0\f0\charscalex100 {memp
ermudah pembukaan. Penutupan leher vesi}\fs22\cf0\f0\charscalex100 {ka dapat ter
jadi dengan kompresi leher}\par\pard\li1306\ri0\sl-386\slmult0 \fs24\cf0\f0\char
scalex100 {vesika melawan lig. pubovesikal }\fs24\cf0\f0\charscalex100 {ketika p
osisi retropubik normal.}\par\pard\li1573\ri0\sl-386\slmult0 \fs22\cf0\f0\charsc
alex100 {Pada sfingter interna terdapat bebera}\fs22\cf0\f0\charscalex100 {pa st
ruktur yang dapat mempengaruhi}\par\pard\li1306\ri0\sl-386\slmult0 \fs22\cf0\f0\
charscalex100 {penutupannya. Cekungan bentuk U da}\fs22\cf0\f0\charscalex100 {ri
muskulus detrusor (}\fs22\cf0\f0\charscalex100\i {the detrussor loop}\i0 \fs22\
cf0\f0\charscalex100 {)}\par\pard\li1306\ri0\sl-386\slmult0 \fs24\cf0\f0\charsca
lex100 {mengelilingi bagian anterior leher vesika dan membantu terjadinya penutu
pan.}\par\pard\li1573\ri0\sl-386\slmult0 \fs22\cf0\f0\charscalex100 {Di antara l
apisan ini dan lumen uretra terd}\fs22\cf0\f0\charscalex100 {apat cincin otot po
los dan elastis yang}\par\pard\li1306\ri0\sl-386\slmult0 \*\tx2946\*\tx4386\fs22
\cf0\f0\charscalex100 {dikenal sebagai}\tab \fs22\cf0\f0\charscalex100\i {trigon

al ring,}\i0 \tab \fs22\cf0\f0\charscalex100 {yang berfungsi membantu mekanisme

penutupan leher}\par\pard\li1306\ri0\sl-386\slmult0 \fs24\cf0\f0\charscalex100 {
vesika.}\par\pard\li1573\ri0\sl-386\slmult0 \fs22\cf0\f0\charscalex100 {Aktifita
s sfingter eksterna be}\fs22\cf0\f0\charscalex100 {rasal dari 3 elemen yang berb
}\fs22\cf0\f0\charscalex100 {eda. Otot polos, otot lurik}\par\pard\li1306\ri0\sl
-386\slmult0 \fs22\cf0\f0\charscalex100 {dan elemen vaskuler menyokong tekanan p
enut}\fs22\cf0\f0\charscalex100 {upan uretra pada keadaan istirahat.}\par\pard\l
i1306\ri0\sl-386\slmult0 \fs22\cf0\f0\charscalex100 {Lapisan luar urethra dist}\
fs22\cf0\f0\charscalex100 {al dibentuk oleh otot }\fs22\cf0\f0\charscalex100 {lu
rik sfingter urethrov}\fs22\cf0\f0\charscalex100 {aginal atau ke dalam}\par\pard
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}}}}\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133\margtsxn666\margbsxn240\par
d\li9760\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li9760\ri0\sl-360\slmult0 \fs24\c
f0\f0\charscalex100 {6}\par\pard\li1306\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li
1306\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1306\ri0\sl-306\slmult0 \fs24\cf0\f
0\charscalex100 {daerah di atas membran perineal sebagai }\fs24\cf0\f0\charscale
x100 {kompresor uretra. Otot ini memelihara tonus }\par\pard\li1306\ri0\sl-386\s
lmult0 \fs24\cf0\f0\charscalex100 {kontinensia. }\par\pard\li1573\ri0\sl-386\slm
ult0 \fs24\cf0\f0\charscalex100 {Otot polos uretra terdiri dari}\fs24\cf0\f0\cha
rscalex100 { lapisan longitudinal dan sirk}\fs24\cf0\f0\charscalex100 {uler dan
terletak di dalam}\par\pard\li1306\ri0\sl-386\slmult0 \fs24\cf0\f0\charscalex100
{otot lurik sfingter urogenital, }\fs24\cf0\f0\charscalex100 {terdapat pada 4/5
bagian uret}\fs24\cf0\f0\charscalex100 {ra proksimal. Konfigurasi otot}\par\par
d\li1306\ri0\sl-386\slmult0 \fs24\cf0\f0\charscalex100 {ini berperan dalam konst
riksi }\fs24\cf0\f0\charscalex100 {lumen. Di dalam uretra juga terdapat pleksus
vaskuler,}\par\pard\li1306\ri0\sl-386\slmult0 \fs24\cf0\f0\charscalex100 {yang m
empunyai beberapa AV anastomose. Hal ini membantu penutupan urethra.}\par\pard\l
i1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\
par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-21
3\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1320
\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\p
ard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-213\slmult0 \fs18
\cf0\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-213\slm
ult0 \fs18\cf0\par\pard\li1320\ri0\sl-293\slmult0 \fs20\cf0\f0\charscalex100 {Ga
mbar 2 : 1. Uretra terbuka, 2. Uretra ditutup }\fs20\cf0\f0\charscalex100 {dala
m posisi berdiri, 3. Uretra ditutup dalam posisi}\par\pard\li1306\ri0\sl-226\slm
ult0 \fs20\cf0\f0\charscalex100 {berbaring (dikutip dari kepustakaan no. 2)}\par
\pard\li1306\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1306\ri0\sl-213\slmult0 \fs
18\cf0\par\pard\li1306\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1306\ri0\sl-213\s
lmult0 \fs18\cf0\par\pard\li1306\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1306\ri
0\sl-213\slmult0 \fs18\cf0\par\pard\li1306\ri0\sl-213\slmult0 \fs18\cf0\par\pard
\li1306\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1306\ri0\sl-213\slmult0 \fs18\cf
0\par\pard\li1306\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1306\ri0\sl-213\slmult
0 \fs18\cf0\par\pard\li1306\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1306\ri0\sl213\slmult0 \fs18\cf0\par\pard\li1306\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li13
06\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1306\ri0\sl-226\slmult0 \fs20\cf0\f0\
charscalex100 {Gambar 3 : 1. m. bulbokavernosus, 2. m. iskiokavernosus, keduanya
memperkuat }\par\pard\li1026\ri0\sl-346\slmult0 \fs20\cf0\f0\charscalex100 {
m.rabd}\fs20\cf0\f0\charscalex100 {osfingter (dikutip dari kepus
takaan no. 2)}\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\
sl-453\slmult0 \fs24\cf0\f0\charscalex100\b {IV. JENIS INKONTINENSIA URINE}\b0 \
par\pard\li1386\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Terdapat beberapa
macam klasifikasi inkontinensia urine, di sini hanya dibahas}\par\pard\li1386\r
i0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {beberapa jenis yang paling }\fs24\
cf0\f0\charscalex100 {sering ditemukan yaitu :}\par\pard\li1386\ri0\sl-413\slmul
t0 \*\tx1746\fs24\cf0\f0\charscalex100 {A.}\tab \fs24\cf0\f0\charscalex100 {Inko
ntinensia stres (S}\fs24\cf0\f0\charscalex100 {tres Inkontinence)}\par\pard\li13
86\ri0\sl-413\slmult0 \*\tx1746\fs24\cf0\f0\charscalex100 {B.}\tab \fs24\cf0\f0\

charscalex100 {Inkontinensia desakan (U}\fs24\cf0\f0\charscalex100 {rgency Inkon

tinence)}\par\pard\li1386\ri0\sl-413\slmult0 \*\tx1746\fs24\cf0\f0\charscalex100
{C.}\tab \fs24\cf0\f0\charscalex100 {Inkontinensia luapan (O}\fs24\cf0\f0\chars
calex100 {verflow Incontinence)}\par\pard\li1386\ri0\sl-413\slmult0 \*\tx1746\fs
24\cf0\f0\charscalex100 {D.}\tab \fs24\cf0\f0\charscalex100 {Fistula urine }\pa
r\pard\sect\sectd\sbkpage\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133\margts
xn666\margbsxn240\cols2\colno1\colw9760\colsr-0\colno2\colw1680\pard\li1386\ri0\
sl-213\slmult0 \fs18\cf0\par\pard\li1386\ri0\sl-213\slmult0 \fs18\cf0\par\pard\l
i1386\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1386\ri0\sl-213\slmult0 \fs18\cf0\
par\pard\li1386\ri0\sl-453\slmult0 \*\tx1746\fs24\cf0\f0\charscalex100\b {A.}\b0
\tab \fs24\cf0\f0\charscalex100\b {Inkontinensia Stres}\b0 \par\column\pard\li0
\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-360\slmult0 \fs24\cf0\f0\chars
calex100 {7}\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\mar
grsxn133\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Inkontinensi
a stres biasanya disebabka}\fs24\cf0\f0\charscalex100 {n oleh lemahnya mekanisme
penutup.}\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Keluha
n khas yaitu mengeluarkan urine sewaktu batuk, bersin, menaiki tangga atau }\par
\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {melakukan gerakan me
ndadak, berdiri sesudah berbaring atau duduk.}\par\pard\li2026\ri0\sl-413\slmult
0 \fs24\cf0\f0\charscalex100 {Gerakan semacam itu dapat meningkatkan}\fs24\cf0\f
0\charscalex100 { tekanan dalam abdomen dan karena}\par\pard\li1746\ri0\sl-413\s
lmult0 \fs24\cf0\f0\charscalex100 {itu juga di dalam kandung kemih. Otot uret}\f
s24\cf0\f0\charscalex100 {ra tidak dapat melawan tekanan ini dan}\par\pard\li174
6\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {keluarlah urine. Kebanyakan kel
uhan ini }\fs24\cf0\f0\charscalex100 {progresif perlahan-l}\fs24\cf0\f0\charscal
ex100 {ahan; kadang terjadi}\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\cha
rscalex100 {sesudah melahirkan. Akibatnya penderita harus sering menganti pakaia
n dalam dan}\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {bila
perlu juga pembalut wanita. Frekue}\fs24\cf0\f0\charscalex100 {nsi berganti pak
aian, dan juga jumlah}\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscale
x100 {pembalut wanita yang diperlukan setiap ha}\fs24\cf0\f0\charscalex100 {ri,
merupakan ukuran kegawatan keluhan}\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0
\f0\charscalex100 {inkontinensia ini.}{\super \fs16\up4\cf0\f0\charscalex100 {1}
}\par\pard\li2026\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {Biasanya dalam
pemeriksaan badan tidak }\fs24\cf0\f0\charscalex100 {dijumpai kelainan }\fs24\cf
0\f0\charscalex100 {pada ginjal dan}\par\pard\li1746\ri0\sl-373\slmult0 \fs24\cf
0\f0\charscalex100 {kandung kemih. Pada pemeriksaan vulva ter}\fs24\cf0\f0\chars
calex100 {nyata bahwa sewaktu mengejan dapat}\par\pard\li1746\ri0\sl-386\slmult0
\fs24\cf0\f0\charscalex100 {dilihat dinding depan vagina. Informasi yang pentin
g bisa diperoleh dengan }\par\pard\li1746\ri0\sl-386\slmult0 \*\tx2840\fs24\cf0\
f0\charscalex100 {percobaan}\tab \fs24\cf0\f0\charscalex100\i {Marshall-Marchett
i}\i0 \fs24\cf0\f0\charscalex100 {. Penderita diminta untuk berkemih di WC sampa
i}\par\pard\li1746\ri0\sl-386\slmult0 \fs24\cf0\f0\charscalex100 {habis. Dalam p
osisi ginekologis dimas}\fs24\cf0\f0\charscalex100 {ukan kateter ke dalam kandun
g kemih.}\par\pard\li1746\ri0\sl-386\slmult0 \fs24\cf0\f0\charscalex100 {Ditentu
kan jumlah urine yang tersisa. Ke}\fs24\cf0\f0\charscalex100 {mudian diikuti ole
h pengisian kandung}\par\pard\li1746\ri0\sl-386\slmult0 \fs24\cf0\f0\charscalex1
00 {kemih dengan air sampai penderita me}\fs24\cf0\f0\charscalex100 {rasa ingin
berkemih. Dengan demikian}\par\pard\li1746\ri0\sl-386\slmult0 \fs24\cf0\f0\chars
calex100 {ditentukan kapasitas kandung kemih. Norm}\fs24\cf0\f0\charscalex100 {a
lnya seharusnya 400-450 ml. Kemudian}\par\pard\li1746\ri0\sl-386\slmult0 \fs24\c
f0\f0\charscalex100 {dicoba menirukan stres yang mengakibatk}\fs24\cf0\f0\charsc
alex100 {an pengeluaran urine dengan meminta}\par\pard\li1746\ri0\sl-386\slmult0
\fs24\cf0\f0\charscalex100 {penderita batuk. Jika pada posisi berbarin}\fs24\cf
0\f0\charscalex100 {g tidak terjadi pengeluaran urine, maka }\par\pard\li1746\ri
0\sl-386\slmult0 \fs24\cf0\f0\charscalex100 {percobaan diulang pada posisi berdi
ri denga}\fs24\cf0\f0\charscalex100 {n tungkai dijauhkan satu sama lain. }\par\
pard\li2026\ri0\sl-386\slmult0 \fs24\cf0\f0\charscalex100 {Pada inkontinensia st
res seja}\fs24\cf0\f0\charscalex100 {ti, harus terjadi pengeluaran}\fs24\cf0\f0\
charscalex100 { urine pada saat ini.}\par\pard\li1746\ri0\sl-386\slmult0 \fs24\c

f0\f0\charscalex100 {Kemudian dicoba dengan korentang atau}\fs24\cf0\f0\charscal

ex100 { dengan dua jari menekan dinding depan}\par\pard\li1746\ri0\sl-386\slmult
0 \fs24\cf0\f0\charscalex100 {vagina kanan dan kiri sedemikian rupa }\fs24\cf0\f
0\charscalex100 {ke arah kranial sehingga sisto-uretrokel}\par\pard\li1746\ri0\s
l-386\slmult0 \fs24\cf0\f0\charscalex100 {hilang. Penderita diminta batuk lagi.
Bila sekarang pengeluaran urine terhenti maka}\par\pard\li1746\ri0\sl-386\slmult
0 \fs24\cf0\f0\charscalex100 {ini menunjukkan penderita akan dapat dise}\fs24\cf
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mb}\fs24\cf0\f0\charscalex100 {ah dengan sistometri, sistoskopi serta }\par\pard
\li1746\ri0\sl-386\slmult0 \fs24\cf0\f0\charscalex100 {kalibrasi pada uretra unt
uk me}\fs24\cf0\f0\charscalex100 {nyingkirkan kemungkinan stenosis.}{\super \fs1
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ADD4377C59CF9FF9E6DFCA8039FF000478AC78ABC23A6EB17490DADC5E06FDC87C8CAB95E33C9CE3
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}}}}\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133\margtsxn666\margbsxn240\par
d\li9760\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li9760\ri0\sl-360\slmult0 \fs24\c
f0\f0\charscalex100 {8}\par\pard\li2026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li
2026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2026\ri0\sl-306\slmult0 \fs22\cf0\f
0\charscalex100 {Pada foto rontgen lateral atas sistogra}\fs22\cf0\f0\charscalex
100 {m miksi bisa tampak sudut terbelakang}\par\pard\li1746\ri0\sl-386\slmult0 \
fs22\cf0\f0\charscalex100 {vesikouretra membesar sampai 180}{\super \fs14\up4\cf
0\f0\charscalex100 {0}}\fs22\cf0\f0\charscalex100 { atau lebih. Normalnya}\fs22\
cf0\f0\charscalex100 { sudut ini sekitar 120}{\super \fs14\up4\cf0\f0\charscalex
100 {0}}\fs22\cf0\f0\charscalex100 {.}\par\pard\li1746\ri0\sl-386\slmult0 \fs24\
cf0\f0\charscalex100 {Gambaran ini menegaskan adanya sistokel pada pemeriksaan b
adan.}{\super \fs16\up4\cf0\f0\charscalex100 {1}}\par\pard\li1746\ri0\sl-213\slm
ult0 \fs18\cf0\par\pard\li1746\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1746\ri0\
sl-213\slmult0 \fs18\cf0\par\pard\li1746\ri0\sl-213\slmult0 \fs18\cf0\par\pard\l
i1746\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1746\ri0\sl-213\slmult0 \fs18\cf0\
par\pard\li1746\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1746\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1746\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1746\ri0\sl-21
3\slmult0 \fs18\cf0\par\pard\li1746\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1746
\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1746\ri0\sl-213\slmult0 \fs18\cf0\par\p
ard\li1746\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1746\ri0\sl-213\slmult0 \fs18
\cf0\par\pard\li1746\ri0\sl-320\slmult0 \fs20\cf0\f0\charscalex100 {Gambar 4 : A
natomi Sudut Vesikouretra}\par\pard\li2826\ri0\sl-253\slmult0 \*\tx3186\*\tx4626
\fs20\cf0\f0\charscalex100 {a.}\tab \fs20\cf0\f0\charscalex100 {Normal : }\tab
\fs20\cf0\f0\charscalex100 {Sudut vesikouretra 120}{\super \fs12\up3\cf0\f0\char
scalex100 {0}}\par\pard\li3106\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {
1. simfisi, 2. Uretra, 3. Vesika, 4. Sudut 120}{\super \fs12\up3\cf0\f0\charscal
ex100 {0}}\par\pard\li2826\ri0\sl-253\slmult0 \*\tx3186\*\tx4626\*\tx5346\fs20\c
f0\f0\charscalex100 {b.}\tab \fs20\cf0\f0\charscalex100 {Patologik }\tab \fs20\
cf0\f0\charscalex100 {: }\tab \fs20\cf0\f0\charscalex100 {Sudut vesikouretra 180
}{\super \fs12\up3\cf0\f0\charscalex100 {0}}\par\pard\li3106\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 { 1. simfisi, 2. Uretra, 3. Vesika, 4. Sudut 180}{\s
uper \fs12\up3\cf0\f0\charscalex100 {0}}\par\pard\li2026\ri0\sl-386\slmult0 \fs2
2\cf0\f0\charscalex100 {Diagnosis dengan pengobatan inkontinen}\fs22\cf0\f0\char
scalex100 {sia pada wanita merupakan masalah}\par\pard\li1746\ri0\sl-413\slmult0
\fs24\cf0\f0\charscalex100 {interdisipliner antara urologi dan gine}\fs24\cf0\f
0\charscalex100 {kologi. Di sini pengambilan keputusan yang}\par\pard\li1746\ri0
\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {tepat setidak-tidaknya sama penting
se}\fs24\cf0\f0\charscalex100 {perti mutu pengobata}\fs24\cf0\f0\charscalex100 {
n. Sering terdapat}\par\pard\li1746\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex10
0 {kelainan ginekologis yang juga harus di}\fs24\cf0\f0\charscalex100 {obati. Ke
banyakan diagnostik yang tepat}\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\
charscalex100 {ditegakkan dari kerjasama yang }\fs24\cf0\f0\charscalex100 {baik
antara urolog dan ginekolog.}{\super \fs16\up4\cf0\f0\charscalex100 {1}}\par\par
d\li2026\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {Pada inkontinensia stres
yang ringan, mi}\fs22\cf0\f0\charscalex100 {salnya yang menghabiskan 3-4 pembal
ut}\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {sehari, pende
rita bisa memperoleh perb}\fs24\cf0\f0\charscalex100 {aikan dengan fisioter}\fs2

4\cf0\f0\charscalex100 {api dan senam untuk}\par\pard\li1746\ri0\sl-413\slmult0

\fs24\cf0\f0\charscalex100 {otot-otot dasar panggul. Pada}\fs24\cf0\f0\charscale
x100 { prinsipnya pengobatan inko}\fs24\cf0\f0\charscalex100 {ntinensia stres be
rsifat}\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {operatif.
Dikenal berbagai teknik be}\fs24\cf0\f0\charscalex100 {dah yang semuanya dapat
memberikan}\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {perba
ikan 80-90 kasus. Semua bentuk operasi}\fs24\cf0\f0\charscalex100 { ini berlanda
skan pada prinsip yang}\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscal
ex100 {sama yaitu menarik dinding vagina ke }\fs24\cf0\f0\charscalex100 {arah ve
ntral untuk menghilangkan sistokel }\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf
0\f0\charscalex100 {dan mengembalikan sudut vesiko-uretral menjadi 120}{\super \
fs16\up4\cf0\f0\charscalex100 {0}}\fs24\cf0\f0\charscalex100 { seperti semula. I
ni dapat}\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {terlaks
ana dengan menjahitkan dinding vagi}\fs24\cf0\f0\charscalex100 {na pada perioste
um tulang pubis (teknik}\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charsca
lex100\i {Marshall-Marchetti}\i0 \fs24\cf0\f0\charscalex100 {); dengan mengikatk
an dinding va}\fs24\cf0\f0\charscalex100 {gina lebih lateral pada lig.}\par\pard
\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Pouparti (teknik}{ }\fs24
\cf0\f0\charscalex100\i {Burch}\i0 \fs24\cf0\f0\charscalex100 {); atau dengan be
dah \uc1\u8216Xsling\uc1\u8217X, me}\fs24\cf0\f0\charscalex100 {narik uretra ke
atas memakai}\par\pard\sect\sectd\sbkpage\pgwsxn12240\pghsxn15840\marglsxn666\ma
rgrsxn133\margtsxn666\margbsxn240\pard\li9760\ri0\sl-213\slmult0 \fs18\cf0\par\p
ard\li9760\ri0\sl-360\slmult0 \fs24\cf0\f0\charscalex100 {9}\par\pard\li1746\ri0
\sl-213\slmult0 \fs18\cf0\par\pard\li1746\ri0\sl-213\slmult0 \fs18\cf0\par\pard\
li1746\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {selembar fasia atau bahan
yang tidak dapa}\fs24\cf0\f0\charscalex100 {t diresorpsi serta diikatkan pada fa
sia}\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {abdominalis.
}{\super \fs16\up4\cf0\f0\charscalex100 {1,5}}\par\pard\li2026\ri0\sl-413\slmult
0 \fs22\cf0\f0\charscalex100 {Biasanya keluhan stres dan desakan ber}\fs22\cf0\f
0\charscalex100 {campur aduk. Dalam keadaan seperti ini,}\par\pard\li1746\ri0\sl
-413\slmult0 \fs24\cf0\f0\charscalex100 {sangat penting diagnostik yang cermat }
\fs24\cf0\f0\charscalex100 {yang juga meliputi sistometri dan}\par\pard\li1746\r
i0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {pengukuran aliran. Apabila inkonti
nensia de}\fs24\cf0\f0\charscalex100 {sakan dengan atau tanpa pembentukan}\par\p
ard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {sisa urine diobati den
gan salah satu be}\fs24\cf0\f0\charscalex100 {dah plastik suspensi di atas, maka
pola }\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {keluhan s
emula dapat lebih mengikat.}{\super \fs16\up4\cf0\f0\charscalex100 {1}}\par\pard
\li2026\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Komplikasi terapi bedah i
nkontinensia stre}\fs24\cf0\f0\charscalex100 {s terutama terdiri dari pembentuka
n}\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {sisa urine seg
era dalam fase pascabedah. }\fs24\cf0\f0\charscalex100 {Biasanya masalah ini ber
sifat sementara }\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100
{dan dapat diatasi dengan kateterisasi in}\fs24\cf0\f0\charscalex100 {termiten,
dengan karakt}\fs24\cf0\f0\charscalex100 {er yang ditinggalkan}\par\pard\li1746\
ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {atau lebih baik dengan }\fs24\cf0
\f0\charscalex100 {drainase kandung kemih supr}\fs24\cf0\f0\charscalex100 {apubi
k. Hal ini memungkinkan}\par\pard\li1746\ri0\sl-426\slmult0 \fs24\cf0\f0\charsca
lex100 {pencarian pembentukan sisa urine tanpa }\fs24\cf0\f0\charscalex100 {kate
terisasi. Komplikasi lain biasanya }\par\pard\li1746\ri0\sl-400\slmult0 \fs24\cf
0\f0\charscalex100 {berasal dari indikasi yang}\fs24\cf0\f0\charscalex100 { sala
h. Perforasi kandung ke}\fs24\cf0\f0\charscalex100 {mih dengan kebocoran urine,}
\par\pard\li1746\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {infeksi saluran
kemih yang berkepanja}\fs24\cf0\f0\charscalex100 {ngan dan osteitis pubis pada o
perasi}\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100\i {Marshal
l-Marchetti-Krantz}\i0 \fs24\cf0\f0\charscalex100 { merupakan komplikasi yang ja
rang terjadi.}{\super \fs16\up4\cf0\f0\charscalex100 {1}}\par\pard\li1386\ri0\sl
-213\slmult0 \fs18\cf0\par\pard\li1386\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1
386\ri0\sl-400\slmult0 \*\tx1746\fs24\cf0\f0\charscalex100\b {B.}\b0 \tab \fs24\
cf0\f0\charscalex100\b {Inkontinensia Desakan }\b0 \par\pard\li1746\ri0\sl-413\s

lmult0 \fs24\cf0\f0\charscalex100 {Inkontinensia desakan adalah keluarnya urine

secara involunter dihubungkan }\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\
charscalex100 {dengan keinginan yang kuat un}\fs24\cf0\f0\charscalex100 {tuk men
gosongkannya (urgensi).}{\super \fs16\up4\cf0\f0\charscalex100 {11}}\fs24\cf0\f0
\charscalex100 { Biasanya terjadi}\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\
f0\charscalex100 {akibat kandung kemih tak stabil. Sewaktu pe}\fs24\cf0\f0\chars
calex100 {ngisian, otot detusor }\fs24\cf0\f0\charscalex100 {berkontraksi tanpa}
\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {sadar secara spo
ntan maupun karena dira}\fs24\cf0\f0\charscalex100 {ngsang (misalnya batuk). Kan
dung kemih}\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {denga
n keadaan semacam ini disebut kandung kemih tak stabil. Biasanya}\par\pard\li174
6\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {kontraksinya disertai dengan }\
fs24\cf0\f0\charscalex100 {rasa ingin miksi. Gejala gangguan ini yaitu urgensi,}
\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {frekuensi, noktu
ria dan nokturnal enuresis.}\fs16\cf0\f0\charscalex100 {3,4,9}\par\pard\li2026\r
i0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Penyebab kandung kemih tak stabil
adalah }\fs24\cf0\f0\charscalex100 {idiopatik, diperkirakan didapatkan}\par\pard
\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {pada sekitar 10% wanita,
akan tetapi }\fs24\cf0\f0\charscalex100 {hanya sebagian kecil yang menimbulkan}\
par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {inkontinensia kar
ena mekanisme distal ma}\fs24\cf0\f0\charscalex100 {sih dapat memelihara inkonti
nensia pada}\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {kead
aan kontraksi yang tidak stabil.}\fs16\cf0\f0\charscalex100 {9,10}\par\pard\li20
26\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Rasa ingin miksi biasanya terj
adi, }\fs24\cf0\f0\charscalex100 {bukan hanya karena detrusor (urgensi}\par\pard
\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {motorik), akan tetapi jug
a }\fs24\cf0\f0\charscalex100 {akibat fenomena sensorik (u}\fs24\cf0\f0\charscal
ex100 {rgensi sensorik). Urgensi}\par\pard\sect\sectd\sbkpage\pgwsxn12240\pghsxn
15840\marglsxn666\margrsxn133\margtsxn666\margbsxn240\pard\li9640\ri0\sl-213\slm
ult0 \fs18\cf0\par\pard\li9640\ri0\sl-360\slmult0 \fs24\cf0\f0\charscalex100 {10
}\par\pard\li1746\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1746\ri0\sl-213\slmult
0 \fs18\cf0\par\pard\li1746\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {senso
rik terjadi karena adanya faktor }\fs24\cf0\f0\charscalex100 {iritasi lokal, yan
g sering dihubungkan dengan}\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\cha
rscalex100 {gangguan meatus uretra, divertik}\fs24\cf0\f0\charscalex100 {ula ure
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ar\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {dan serviks.}{\sup
er \fs16\up4\cf0\f0\charscalex100 {4}}\fs24\cf0\f0\charscalex100 { Burnett}{\sup
er \fs16\up4\cf0\f0\charscalex100 {3}}\fs24\cf0\f0\charscalex100 {, menyebutkan
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\fs24\cf0\f0\charscalex100 {pusat, sklerosis multipel, penyakit Parkinson, gang
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calex100 {tumor/batu pada kandung kemih, sistitis ra}\fs24\cf0\f0\charscalex100
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100\b {Inkontinensia Luapan}\b0 \par\pard\li1746\ri0\sl-400\slmult0 \fs24\cf0\f0
\charscalex100 {Inkontinensia luapan yaitu keluarnya ur}\fs24\cf0\f0\charscalex1
00 {ine secara involunter ketika tekanan }\par\pard\li1746\ri0\sl-426\slmult0 \f
s24\cf0\f0\charscalex100 {intravesikal melebihi tekanan maksimal }\fs24\cf0\f0\c
harscalex100 {maksimal uretra akibat dari distensi }\par\pard\li1746\ri0\sl-400\
slmult0 \fs24\cf0\f0\charscalex100 {kandung kemih tanpa adanya aktifitas detruso
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scalex100 {kandung kemih dapat naik tinggi sekali tanpa }\fs24\cf0\f0\charscalex
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s24\cf0\f0\charscalex100 {urine menetes lewat uretra secara intermitten atau kel
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rscalex100 {dan uretra berdasarkan refleks miksi, }\fs24\cf0\f0\charscalex100 {y
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}}}}\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133\margtsxn666\margbsxn240\par
d\li9640\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li9640\ri0\sl-360\slmult0 \fs24\c
f0\f0\charscalex100 {11}\par\pard\li2026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\l
i2026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2026\ri0\sl-306\slmult0 \fs22\cf0\
f0\charscalex100 {Refleks miksi juga dipengaruhi melalui plek}\fs22\cf0\f0\chars
calex100 {sus pelvikus oleh persarafan simpatis}\par\pard\li1746\ri0\sl-426\slmu
lt0 \fs24\cf0\f0\charscalex100 {dari ganglion yang termasuk L}{\sub \fs16\cf0\f0
\charscalex100 {1}}\fs24\cf0\f0\charscalex100 {, L}{\sub \fs16\cf0\f0\charscalex
100 {2}}\fs24\cf0\f0\charscalex100 {, L}{\sub \fs16\cf0\f0\charscalex100 {3}}\fs
24\cf0\f0\charscalex100 {. Pada lesi, dapat te}\fs24\cf0\f0\charscalex100 {rjadi
dua jenis gangguan}\par\pard\li1746\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex1
00 {pada fungsi kandung kemih yaitu :}{\super \fs16\up4\cf0\f0\charscalex100 {1}
}\par\pard\li1746\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1746\ri0\sl-213\slmult
0 \fs18\cf0\par\pard\li1746\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100\b {Les
i Nuklear (tipe LMN)}\b0 \par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charsc
alex100 {Pada lesi di pusat sakral yang me}\fs24\cf0\f0\charscalex100 {nyebabkan
rusaknya le}\fs24\cf0\f0\charscalex100 {ngkung refleks terjadi}\par\pard\li1746
\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {kelumpuhan flasid pada kandung k
emih dan dasar panggul. Sehingga miksi}\par\pard\li1746\ri0\sl-413\slmult0 \fs24
\cf0\f0\charscalex100 {sebenarnya lenyap.}\par\pard\li1746\ri0\sl-213\slmult0 \f
s18\cf0\par\pard\li1746\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1746\ri0\sl-413\
slmult0 \fs24\cf0\f0\charscalex100\b {Lesi Supranuklear (Tipe UMN)}\b0 \par\pard
\li1746\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100 {Lesi terjadi di atas pusa
t}\fs24\cf0\f0\charscalex100 { sakral, dengan pusat miksi }\fs24\cf0\f0\charscal
ex100 {sakral dan lengkung refleks }\par\pard\li1746\ri0\sl-426\slmult0 \fs24\cf
0\f0\charscalex100 {yang tetap utuh, maka hilangnya pengaruh pus}\fs24\cf0\f0\ch
arscalex100 {at yang lebih atas terhadap pusat}\par\pard\li1746\ri0\sl-400\slmul
t0 \fs24\cf0\f0\charscalex100 {miksi. Miksi sakral menghilangkan kesadaran atas
keadaan kandung kemih. Terjadi}\par\pard\li1746\ri0\sl-426\slmult0 \fs24\cf0\f0
\charscalex100 {refleks kontraksi kandung kemih yang terarah kepada miksi yang o
tomatis tetapi}\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {t
idak efisien karena tidak ada koordinasi da}\fs24\cf0\f0\charscalex100 {ri pusat
yang lebih atas. Sering kontraksi}\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0
\f0\charscalex100 {otot dasar panggul bersamaan waktunya de}\fs24\cf0\f0\charsca
lex100 {ngan otot kandung kemih sehingga miksi}\par\pard\li1746\ri0\sl-413\slmul
t0 \fs24\cf0\f0\charscalex100 {yang baik terhalang. Juga kontraksi otot}\fs24\cf
0\f0\charscalex100 { kandung kemih tida}\fs24\cf0\f0\charscalex100 {k lengkap se
hingga}\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {kandung k
emih benar-benar dapat dikosongkan.}\par\pard\li1733\ri0\sl-213\slmult0 \fs18\cf
0\par\pard\li1733\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1733\ri0\sl-213\slmult
0 \fs18\cf0\par\pard\li1733\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1733\ri0\sl213\slmult0 \fs18\cf0\par\pard\li1733\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li17
33\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1733\ri0\sl-213\slmult0 \fs18\cf0\par
\pard\li1733\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1733\ri0\sl-213\slmult0 \fs
18\cf0\par\pard\li1733\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1733\ri0\sl-213\s
lmult0 \fs18\cf0\par\pard\li1733\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1733\ri
0\sl-213\slmult0 \fs18\cf0\par\pard\li1733\ri0\sl-213\slmult0 \fs18\cf0\par\pard
\li1733\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1733\ri0\sl-213\slmult0 \fs18\cf
0\par\pard\li1733\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1733\ri0\sl-213\slmult
0 \fs18\cf0\par\pard\li1733\ri0\sl-413\slmult0 \fs20\cf0\f0\charscalex100 {Gamba
r 5 : Persarafan kd. Kemih, uretra dan otot-otot periuretral. Otot polos uretra

digambar }\par\pard\li1733\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {

bertitik ; Otot lurik dasar panggul dan uretra digambar lurik. (
dikutip dari }\par\pard\li1733\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {
kepustakaan no.2)}\par\pard\sect\sectd\sbkpage\pgwsxn12240\pg
hsxn15840\marglsxn666\margrsxn133\margtsxn666\margbsxn240\pard\li9640\ri0\sl-213
\slmult0 \fs18\cf0\par\pard\li9640\ri0\sl-360\slmult0 \fs24\cf0\f0\charscalex100
{12}\par\pard\li2026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2026\ri0\sl-213\sl
mult0 \fs18\cf0\par\pard\li2026\ri0\sl-306\slmult0 \fs22\cf0\f0\charscalex100 {T
erdapat beberapa macam tes untuk meme}\fs22\cf0\f0\charscalex100 {riksa aktifita
s refleks pada segmen}\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscale
x100 {sakral medula spinalis. Bila}\fs24\cf0\f0\charscalex100 { ada aktifitas sa
}\fs24\cf0\f0\charscalex100 {kral, mungkin lesi jenis supranuklear.}\fs16\cf0\f0
\charscalex100 {1,18}\par\pard\li1746\ri0\sl-413\slmult0 \*\tx2026\fs22\cf0\f0\c
harscalex100 {-}\tab \fs22\cf0\f0\charscalex100\i {Refleks anus}\i0 \fs22\cf0\f0
\charscalex100 { : kulit di dekat anus dirangsang }\fs22\cf0\f0\charscalex100 {d
engan sebuah jarum. Kontraksi}\par\pard\li2026\ri0\sl-413\slmult0 \fs24\cf0\f0\c
harscalex100 {pada sfingter anus bagian luar membuk}\fs24\cf0\f0\charscalex100 {
tikan bahwa refleks ini ada. Jari yang }\par\pard\li2026\ri0\sl-413\slmult0 \fs2
4\cf0\f0\charscalex100 {dimasukan di dalam rektum merasakan bahwa sfinger anus m
enegang.}\par\pard\li1746\ri0\sl-413\slmult0 \*\tx2026\fs24\cf0\f0\charscalex100
{-}\tab \fs24\cf0\f0\charscalex100\i {Refleks bulbokavernosus}\i0 { }\fs24\cf0\
f0\charscalex100 {: sewaktu klitoris dipijit pada pemeriksaan rektal terjadi}\pa
r\pard\li2026\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {kontraksi otot bulb
o dan iskiokavernosus.}\par\pard\li1746\ri0\sl-413\slmult0 \*\tx2026\fs24\cf0\f0
\charscalex100 {-}\tab \fs24\cf0\f0\charscalex100\i {Refleks ketok abdomen}\i0 {
}\fs24\cf0\f0\charscalex100 {: ketokan pada dinding perut di}\fs24\cf0\f0\chars
calex100 {atas simfisis menyebabkan}\par\pard\li2026\ri0\sl-413\slmult0 \fs24\cf
0\f0\charscalex100 {tegangnya sfingter ani. Ini dapat di}\fs24\cf0\f0\charscalex
100 {raba dengan jari didalam rektrum. }\par\pard\li1746\ri0\sl-413\slmult0 \*\t
x2026\fs24\cf0\f0\charscalex100 {-}\tab \fs24\cf0\f0\charscalex100\i {Tes air es
}\i0 { }\fs24\cf0\f0\charscalex100 {: kandung kemih dikosongkan dengan katete}\f
s24\cf0\f0\charscalex100 {r, lalu diisi }\fs24\cf0\f0\charscalex100 {60-90 ml ai
r}\par\pard\li2026\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {es. Jika dalam
waktu satu menit kateter }\fs24\cf0\f0\charscalex100 {beserta air es tertekan k
eluar lagi, }\par\pard\li2026\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {ter
bukti adanya gangguan fungi ka}\fs24\cf0\f0\charscalex100 {ndung kemih jenis sup
ranuklear.}\par\pard\li1386\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1386\ri0\sl466\slmult0 \*\tx1746\fs24\cf0\f0\charscalex100\b {D.}\b0 \tab \fs24\cf0\f0\char
scalex100\b {Fistula urine}\b0 \par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\
charscalex100 {Fistula urine sebagian besa}\fs24\cf0\f0\charscalex100 {r akibat
persalinan, dapat }\fs24\cf0\f0\charscalex100 {terjadi langsung pada waktu}\par\
pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {tindakan operatif sep
erti seks}\fs24\cf0\f0\charscalex100 {io sesar, perforasi dan kran}\fs24\cf0\f0\
charscalex100 {ioklasi, dekapitasi, atau}\par\pard\li1746\ri0\sl-413\slmult0 \fs
24\cf0\f0\charscalex100 {ekstraksi dengan cunam. Dapat juga timbul be}\fs24\cf0\
f0\charscalex100 {berapa hari sesudah partus lama, yang}\par\pard\li1746\ri0\sl413\slmult0 \fs24\cf0\f0\charscalex100 {disebabkan karena tekanan kepala janin t
e}\fs24\cf0\f0\charscalex100 {rlalu lama pada jaringan jalan lahir di}\par\pard\
li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {tulang pubis dan simfisis,
sehingga menim}\fs24\cf0\f0\charscalex100 {bulkan iskemia dan kematian jaringan
di}\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {jalan lahir.
}\par\pard\li2026\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {Operasi ginekol
ogis seperti histerektomi }\fs24\cf0\f0\charscalex100 {abdominal dan vagina}\fs2
4\cf0\f0\charscalex100 {l, operasi plastik}\par\pard\li1746\ri0\sl-413\slmult0 \
fs24\cf0\f0\charscalex100 {pervaginam, operasi radika}\fs24\cf0\f0\charscalex100
{l untuk karsinoma serviks uteri, semuanya dapat}\par\pard\li1746\ri0\sl-413\sl
mult0 \fs24\cf0\f0\charscalex100 {menimbulkan fistula traumatik. Tes sede}\fs24\
cf0\f0\charscalex100 {rhana untuk membantu diagnosis ialah}\par\pard\li1746\ri0\
sl-413\slmult0 \fs24\cf0\f0\charscalex100 {dengan memasukan metilen biru 30 ml }
\fs24\cf0\f0\charscalex100 {kedalam rongga vesika. Akan tampak}\par\pard\li1746\

ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {metilen biru keluar dari fistula

ke dalam vagina.}\par\pard\li2026\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100
{Untuk memperbaiki fistula vesikovaginal}\fs24\cf0\f0\charscalex100 {is umumnya
dilakukan operasi melalui}\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\chars
calex100 {vagina (transvaginal), kare}\fs24\cf0\f0\charscalex100 {na lebih mudah
dan komplikasi kecil. Bila ditemukan}\par\pard\li1746\ri0\sl-413\slmult0 \fs24\
cf0\f0\charscalex100 {fistula yang terjadi pasca persalinan at}\fs24\cf0\f0\char
scalex100 {au beberapa hari pascah bedah, maka}\par\pard\li1746\ri0\sl-413\slmul
t0 \fs24\cf0\f0\charscalex100 {penanganannya harus ditunda tiga bulan. Bi}\fs24\
cf0\f0\charscalex100 {la jaringan sekitar }\fs24\cf0\f0\charscalex100 {fistula s
udah tenang}\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {dan
normal kembali operasi baru dapat dilakukan.}{\super \fs16\up4\cf0\f0\charscalex
100 {2}}\par\pard\sect\sectd\sbkpage\pgwsxn12240\pghsxn15840\marglsxn666\margrsx
n133\margtsxn666\margbsxn240\cols2\colno1\colw9640\colsr-0\colno2\colw1800\pard\
li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0
\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1026\ri0\sl-453\slmult0 \fs24\cf0\f0\charscalex100\b {V. D
IAGNOSIS}\b0 \par\column\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\
sl-360\slmult0 \fs24\cf0\f0\charscalex100 {13}\par\pard\sect\sectd\sbknone\pgwsx
n12240\pghsxn15840\marglsxn666\margrsxn133\pard\li1306\ri0\sl-413\slmult0 \fs24\
cf0\f0\charscalex100 {Hal yang penting dalam menilai wanita de}\fs24\cf0\f0\char
scalex100 {ngan inkontinensia urine adalah dengan}\par\pard\li1306\ri0\sl-413\sl
mult0 \fs24\cf0\f0\charscalex100 {anamnesis dan pemeriksaan fisik yang lengkap.}
{\super \fs16\up4\cf0\f0\charscalex100 {19}}\fs24\cf0\f0\charscalex100 { Pemerik
saan awal tidak selalu}\par\pard\li1306\ri0\sl-413\slmult0 \fs22\cf0\f0\charscal
ex100 {diagnostik, tetapi informasi yang didapat }\fs22\cf0\f0\charscalex100 {ak
an menuntun klinisi dalm memilih test}\par\pard\li1306\ri0\sl-413\slmult0 \fs24\
cf0\f0\charscalex100 {diagnostik yang diperlukan. Pada }\fs24\cf0\f0\charscalex1
00 {umumnya keluhan penderita yaitu:}\par\pard\li1306\ri0\sl-413\slmult0 \*\tx16
66\fs24\cf0\f0\charscalex100 {-}\tab \fs24\cf0\f0\charscalex100 {Kencing keluar
pada waktu bat}\fs24\cf0\f0\charscalex100 {uk, tertawa, bersin dan latihan.}\par
\pard\li1306\ri0\sl-413\slmult0 \*\tx1666\fs24\cf0\f0\charscalex100 {-}\tab \fs2
4\cf0\f0\charscalex100 {Keluarnya kencing tidak dapat ditahan.}\par\pard\li1306\
ri0\sl-413\slmult0 \*\tx1666\fs24\cf0\f0\charscalex100 {-}\tab \fs24\cf0\f0\char
scalex100 {Kencing keluar menetes pada keadaan kandung kencing penuh.}\par\pard\
li1666\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {Pemeriksaan fisik yang len
gkap meliputi pe}\fs22\cf0\f0\charscalex100 {meriksaan abdomen, vaginal, pelvis,
}\par\pard\li1306\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {rektal dan peni
laian neurologis. Pada peme}\fs22\cf0\f0\charscalex100 {riksaan abdomen bisa did
apatkan distensi}\par\pard\li1306\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100
{kandung kemih, yang menunjukkan suatu inkontinen}\fs22\cf0\f0\charscalex100 {si
a luapan, dan di}\fs22\cf0\f0\charscalex100 {konfirmasi dengan}\par\pard\li1306\
ri0\sl-426\slmult0 \fs22\cf0\f0\charscalex100 {kateterisasi. Inspekulo bisa tamp
ak prolaps }\fs22\cf0\f0\charscalex100 {genital, sistokel dan re}\fs22\cf0\f0\ch
arscalex100 {ktokel. Adanya urine}\par\pard\li1306\ri0\sl-400\slmult0 \fs24\cf0\
f0\charscalex100 {dalam vagina terutama pasca histerektomi}\fs24\cf0\f0\charscal
ex100 { mungkin mengetahui adanya massa pelvis.}{\super \fs16\up4\cf0\f0\charsca
lex100 {16}}\par\pard\li1666\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {Test
sederhana dapat dikerjakan setela}\fs24\cf0\f0\charscalex100 {h pemeriksaan fis
ik untuk membantu dalam }\par\pard\li1306\ri0\sl-413\slmult0 \fs24\cf0\f0\charsc
alex100 {menentukan tindakan selanjutnya. Test Q-tip (\uc1\u8216X}\fs24\cf0\f0\c
harscalex100\i {the cotton swab test\uc1\u8217X)}\i0 {\super \fs16\up4\cf0\f0\ch
arscalex100 {16}}\fs24\cf0\f0\charscalex100\i {,}\i0 { }\fs24\cf0\f0\charscalex1
00 {merupakan test}\par\pard\li1306\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex10
0 {sederhana untuk menunjukan ad}\fs24\cf0\f0\charscalex100 {anya inkontinensia
stres }\fs24\cf0\f0\charscalex100 {sejati. Penderita disuruh}\par\pard\li1306\ri
0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {mengosongkan kandung kemihnya, urin
e ditampung. Kemudian spesimen urine diambil}\par\pard\li1306\ri0\sl-413\slmult0
\fs24\cf0\f0\charscalex100 {dengan kateterisasi. Jumlah urine dari kencing dan
kateter merupakan volume kandung}\par\pard\li1306\ri0\sl-413\slmult0 \fs24\cf0\f

0\charscalex100 {kemih. Volume residual menguatkan diagnosis}\fs24\cf0\f0\charsc

alex100 { inkontinensia luapan. Spesimen urine}\par\pard\li1306\ri0\sl-413\slmul
t0 \fs24\cf0\f0\charscalex100 {dikirim ke laboratorium. }\par\pard\li1666\ri0\sl
-413\slmult0 \*\tx2346\*\tx3626\*\tx4453\*\tx5200\*\tx7133\*\tx7760\*\tx9026\fs2
4\cf0\f0\charscalex100 {Test}\tab \fs24\cf0\f0\charscalex100 {diagnostik}\tab \f
s24\cf0\f0\charscalex100 {lanjut}\tab \fs24\cf0\f0\charscalex100 {yaitu}\tab \fs
24\cf0\f0\charscalex100 {sist}\fs24\cf0\f0\charscalex100 {ourethroskopi}\tab \fs
24\cf0\f0\charscalex100 {dan}\tab \fs24\cf0\f0\charscalex100 {diagnostik}\tab \f
s24\cf0\f0\charscalex100 {imaging.}\par\pard\li1306\ri0\sl-413\slmult0 \fs24\cf0
\f0\charscalex100 {Sistourethroskopi dikerjakan }\fs24\cf0\f0\charscalex100 {den
gan anestesi umum maupun ta}\fs24\cf0\f0\charscalex100 {npa anestesi, dapat dili
hat}\par\pard\li1306\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {keadaan pato
logi seperti fist}\fs22\cf0\f0\charscalex100 {ula, ureter ektopik maupun dive}\f
s22\cf0\f0\charscalex100 {rtikulum. Test urodinamik }\par\pard\li1306\ri0\sl-413
\slmult0 \fs24\cf0\f0\charscalex100 {meliputi uroflowmetri dan sistometri. Sist}
\fs24\cf0\f0\charscalex100 {ometri merupakan test yang paling penting,}\par\pard
\li1306\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {karena dapat menunjukan k
eadaan kandung }\fs24\cf0\f0\charscalex100 {kemih yang hiperaktif, normal maupun
}\par\pard\li1306\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {hipoaktif. Diag
nostik imaging meliputi USG,}\fs24\cf0\f0\charscalex100 { CT scan dan IVP yang d
igunakan untuk}\par\pard\li1306\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {m
engidentifikasi kelainan patologi (seperti fistel/tumor) dan kelainan anatomi (u
reter}\par\pard\li1306\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {ektopik).}
\par\pard\li1666\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Test tambahan ya
ng diperlukan un}\fs24\cf0\f0\charscalex100 {tuk evaluasi diagnostik yaitu}{ }\f
s24\cf0\f0\charscalex100\i {\uc1\u8216XPessary Pad Test\uc1\u8217X.}\i0 \par\par
d\li1306\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Penderita minum 500 ml a
ir selama 15 }\fs24\cf0\f0\charscalex100 {menit untuk mengisi kandung kemih. Set
elah }\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn13
3\pard\sect\sectd\sbkpage\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133\margts
xn666\margbsxn240\pard\li9640\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li9640\ri0\s
l-360\slmult0 \fs24\cf0\f0\charscalex100 {14}\par\pard\li1306\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1306\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1306\ri0\sl-3
06\slmult0 \fs22\cf0\f0\charscalex100 {jam, penderita melakukan latihan selama 4
5 }\fs22\cf0\f0\charscalex100 {menit dengan cara : be}\fs22\cf0\f0\charscalex100
{rdiri dari duduk (10}\par\pard\li1306\ri0\sl-413\slmult0 \fs22\cf0\f0\charscal
ex100 {kali), batuk (10 kali),}\fs22\cf0\f0\charscalex100 { joging di tempat (11
kali), menga}\fs22\cf0\f0\charscalex100 {mbil benda dari lantai (5 kali),}\par\
pard\li1306\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {dan mencuci tangan da
ri air mengalir selama 1 menit. Test positif bila berat Pad sama }\par\pard\li13
06\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {atau lebih besar dari 1g. Te}\
fs24\cf0\f0\charscalex100 {st ini dapat menunjukan adanya }\fs24\cf0\f0\charscal
ex100 {inkontinesia stres hanya bila}\par\pard\li1306\ri0\sl-413\slmult0 \fs24\c
f0\f0\charscalex100 {tidak didapatkan kandung kemih yang tidak stabil.}{\super \
fs16\up4\cf0\f0\charscalex100 {23}}\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0
\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-400\slmult0
\fs24\cf0\f0\charscalex100\b {VI. PENANGANAN KONSERVATIF}\b0 \par\pard\li1386\r
i0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Pada umumnya terapi inkontinensia
urine adal}\fs24\cf0\f0\charscalex100 {ah dengan cara operasi. Akan tetapi pada
}\par\pard\li1386\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {kasus ringan at
aupun sedang, bisa dicoba denga}\fs24\cf0\f0\charscalex100 {n terapi konservatif
. Latihan otot dasar}\par\pard\li1386\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex
100 {panggul adalah terapi non operatif yang palin}\fs24\cf0\f0\charscalex100 {g
populer, selain itu juga dipakai obat-}\par\pard\li1386\ri0\sl-413\slmult0 \fs2
4\cf0\f0\charscalex100 {obatan, stimulasi dan pemakaian alat mekanis.}\fs16\cf0\
f0\charscalex100 {11,15,16,17}\par\pard\li1386\ri0\sl-426\slmult0 \*\tx1746\fs24
\cf0\f0\charscalex100 {1.}\tab \fs24\cf0\f0\charscalex100 {Latihan Otot Dasar Pi
nggul (}\fs24\cf0\f0\charscalex100\i {\uc1\u8216XPelvic Floor Exercises\uc1\u821
7X) }\i0 \par\pard\li1746\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100 {Kontine
nsia dipengaruhi oleh }\fs24\cf0\f0\charscalex100 {aktifitas otot lurik urethra

}\fs24\cf0\f0\charscalex100 {dan dasar pelvis. Fisioterapi}\par\pard\li1746\ri0\

sl-426\slmult0 \fs24\cf0\f0\charscalex100 {meningkatkan efektifitas otot ini. Ot
ot }\fs24\cf0\f0\charscalex100 {dasar panggul membantu penutupan urethra}\par\pa
rd\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {pada keadaan yang membu
tuhkan ketahanan }\fs24\cf0\f0\charscalex100 {urethra misalnya pada waktu batuk.
}\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Juga dapat meng
angkat sambungan urethrovesik}\fs24\cf0\f0\charscalex100 {al kedalam daerah yang
ditransmisi}\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {tek
anan abdomen dan berkontraksi seca}\fs24\cf0\f0\charscalex100 {ra reflek dengan
peningkatan tekanan}\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex1
00 {intraabdominal, perubahan posisi dan pengisian kandug kemih.}\par\pard\li202
6\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Pada inkompeten sfingter uretra
, terdapat}\fs24\cf0\f0\charscalex100 { hilangnya transmisi tekanan abdominal}\p
ar\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {pada uretra proksi
mal. Fi}\fs24\cf0\f0\charscalex100 {sio terapi membantu meningkatkan tonus dan k
ekuatan}\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {otot lur
ik uretra dan periuretra.}\par\pard\li2026\ri0\sl-413\slmult0 \fs24\cf0\f0\chars
calex100 {Pada kandung kemih neurogrik, latihan }\fs24\cf0\f0\charscalex100 {kan
dung kemih (\uc1\u8216Xbladder training) telah}\par\pard\li1746\ri0\sl-413\slmul
t0 \fs24\cf0\f0\charscalex100 {menunjukan hasil yang efektif.}{\super \fs16\up4\
cf0\f0\charscalex100 {11}}\fs24\cf0\f0\charscalex100 { Latihan kandung kemih ada
lah upaya melatih}\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100
{kandung kemih dengan cara konservatif, sehi}\fs24\cf0\f0\charscalex100 {ngga s
ecara fungsional kandung kemih}\par\pard\li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\
charscalex100 {tersebut kembali normal dari keadaannya yang abnormal.}\par\pard\
li1746\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Langkah-langkah LKK(Latiha
n kandung kecing) :}\par\pard\li1746\ri0\sl-413\slmult0 \*\tx2106\fs24\cf0\f0\c
harscalex100 {-}\tab \fs24\cf0\f0\charscalex100 {Tentukan tipe kandung kemih neu
rogenik }\par\pard\li1746\ri0\sl-413\slmult0 \*\tx2106\fs24\cf0\f0\charscalex10
0 {-}\tab \fs24\cf0\f0\charscalex100 {Tiap waktu miksi dimulai dengan stimulasi
:}\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133\c
ols2\colno1\colw3906\colsr-0\colno2\colw7533\pard\li2106\ri0\sl-413\slmult0 \fs2
4\cf0\f0\charscalex100 { Tipe UMN}\par\column\pard\li0\ri0\sl-413\slmult0 \fs24\
cf0\f0\charscalex100 {: Menepuk paha dalam, menarik rambut daerah pubis, }\par\
pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133\pard\li2
106\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {
masukkan jari pada rektum.}\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn158
40\marglsxn666\margrsxn133\pard\sect\sectd\sbkpage\pgwsxn12240\pghsxn15840\margl
sxn666\margrsxn133\margtsxn666\margbsxn240\cols2\colno1\colw9640\colsr-0\colno2\
colw1800\pard\li2106\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2106\ri0\sl-213\slm
ult0 \fs18\cf0\par\pard\li2106\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2106\ri0\
sl-213\slmult0 \fs18\cf0\par\pard\li2106\ri0\sl-453\slmult0 \fs24\cf0\f0\charsca
lex100 {Tipe LMN : Metode}{ }\fs24\cf0\f0\charscalex100\i {Crade}\i0 \fs24\cf0\f
0\charscalex100 { atau manuver valsava.}\par\pard\li1746\ri0\sl-413\slmult0 \*\t
x2106\fs24\cf0\f0\charscalex100 {-}\tab \fs24\cf0\f0\charscalex100 {Kateterisasi
: kateter menetap atau berkala.}\par\pard\li1386\ri0\sl-213\slmult0 \fs18\cf0\p
ar\pard\li1386\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1386\ri0\sl-400\slmult0 \
fs24\cf0\f0\charscalex100 {2. Obat-obatan}{ }\fs16\cf0\f0\charscalex100 {11,15,1
6,17}\par\pard\li1666\ri0\sl-413\slmult0 \*\tx2026\fs24\cf0\f0\charscalex100 {a.
}\tab \fs24\cf0\f0\charscalex100 {Alfa Adrenergik Agonis}\par\column\pard\li0\ri
0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-360\slmult0 \fs24\cf0\f0\charscal
ex100 {15}\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\margr
sxn133\pard\li2026\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Otot leher ves
ika dan }\fs24\cf0\f0\charscalex100 {uretha proksimal megandung alfa adrenosepto
r yang}\par\pard\li2026\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {menghasil
kan kontraksi otot polos dan }\fs22\cf0\f0\charscalex100 {peningkatan tekanan }\
fs22\cf0\f0\charscalex100 {penutupan urethra}\par\pard\li2026\ri0\sl-413\slmult0
\fs22\cf0\f0\charscalex100 {obat aktif agonis alfa-reseptor bisa mengha}\fs22\c
f0\f0\charscalex100 {silkan tipe stmulasi ini dengan efek}\par\pard\li2026\ri0\s
l-413\slmult0 \fs24\cf0\f0\charscalex100 {samping relatif ringan..}\par\pard\li1

666\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1666\ri0\sl-213\slmult0 \fs18\cf0\pa

r\pard\li1666\ri0\sl-266\slmult0 \*\tx2026\fs24\cf0\f0\charscalex100 {b.}\tab \f
s24\cf0\f0\charscalex100 {Efedrin}\par\pard\li2026\ri0\sl-413\slmult0 \fs22\cf0\
f0\charscalex100 {Efek langsung merangsang alfa sebaik be}\fs22\cf0\f0\charscale
x100 {ta-adrenoseptor dan juga melepaskan}\par\pard\li2026\ri0\sl-413\slmult0 \f
s22\cf0\f0\charscalex100 {noradrenalin dari saraf terminal obat ini }\fs22\cf0\f
0\charscalex100 {juga dilaporkan efektif pada inkotinensia}\par\pard\li2026\ri0\
sl-413\slmult0 \fs22\cf0\f0\charscalex100 {stres.Efek samping menigkatkan tekana
n darah, kecemasan dan insomnia oleh}\par\pard\li2026\ri0\sl-413\slmult0 \fs24\c
f0\f0\charscalex100 {karena stimulasi SSP}\par\pard\li1666\ri0\sl-213\slmult0 \f
s18\cf0\par\pard\li1666\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1666\ri0\sl-266\
slmult0 \*\tx2026\fs24\cf0\f0\charscalex100 {c.}\tab \fs24\cf0\f0\charscalex100
{Phenylpropanololamine}\par\pard\li2026\ri0\sl-413\slmult0 \fs22\cf0\f0\charscal
ex100 {PPA (Phenylpropanololamine}\fs22\cf0\f0\charscalex100 {) efek stimulasi p
erifer }\fs22\cf0\f0\charscalex100 {sebanding dengan efedrin,}\par\pard\li2026\r
i0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {akan tetapi dengan efek CNS yang t
erkecil. PPA adalah komponen utama obat}\par\pard\li2026\ri0\sl-413\slmult0 \fs2
2\cf0\f0\charscalex100 {influensa dalam kombinasi dengan antih}\fs22\cf0\f0\char
scalex100 {istamin dan anthikholinergik. Dosis 50}\par\pard\li2026\ri0\sl-413\sl
mult0 \fs22\cf0\f0\charscalex100 {mg dua kali sehari. Efek samping mi}\fs22\cf0\
f0\charscalex100 {nimal. Didapatkan 59 % penderita}\par\pard\li2026\ri0\sl-413\s
lmult0 \fs24\cf0\f0\charscalex100 {inkontinensia stres mengalami perbaikan.}\par
\pard\li1666\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1666\ri0\sl-213\slmult0 \fs
18\cf0\par\pard\li1666\ri0\sl-266\slmult0 \*\tx2026\fs24\cf0\f0\charscalex100 {d
.}\tab \fs24\cf0\f0\charscalex100 {Estrogen }\par\pard\li2026\ri0\sl-413\slmult
0 \fs22\cf0\f0\charscalex100 {Penggunaannya masih kontroversi. Bebera}\fs22\cf0\
f0\charscalex100 {pa penelitian menunjukkan efek}\par\pard\li2026\ri0\sl-413\slm
ult0 \fs22\cf0\f0\charscalex100 {meningkatkan transmisi tekanan intra abdominal
pada uretra dengan estrogen}\par\pard\li2026\ri0\sl-413\slmult0 \fs22\cf0\f0\cha
rscalex100 {dosis tinggi oral dan intravaginal. Estr}\fs22\cf0\f0\charscalex100
{ogen biasanya diberikan setelah tindakan}\par\pard\li2026\ri0\sl-413\slmult0 \f
s22\cf0\f0\charscalex100 {bedah pada inkontinensia dengan tujuan}\fs22\cf0\f0\ch
arscalex100 { untuk memperbaiki vaskularisasi dan}\par\pard\li2026\ri0\sl-413\sl
mult0 \fs24\cf0\f0\charscalex100 {penyembuhan jaringan urogential, walaupun belu
m ada data yang akurat.}\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\mar
glsxn666\margrsxn133\pard\sect\sectd\sbkpage\pgwsxn12240\pghsxn15840\marglsxn666
\margrsxn133\margtsxn666\margbsxn240\cols2\colno1\colw9640\colsr-0\colno2\colw18
00\pard\li1386\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1386\ri0\sl-213\slmult0 \
fs18\cf0\par\pard\li1386\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1386\ri0\sl-213
\slmult0 \fs18\cf0\par\pard\li1386\ri0\sl-453\slmult0 \fs24\cf0\f0\charscalex100
\b {3.}\b0 { }\fs24\cf0\f0\charscalex100\b {Stimulasi Elektrik}\b0 \par\column\p
ard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-360\slmult0 \fs24\cf0\f
0\charscalex100 {16}\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsx
n666\margrsxn133\pard\li1666\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Meto
de ini paling sedikit diterima da}\fs24\cf0\f0\charscalex100 {lam terapi walaupu
n sudah rutin digunakan}\par\pard\li1666\ri0\sl-413\slmult0 \fs24\cf0\f0\charsca
lex100 {selama 2 dekade. Prinsip stim}\fs24\cf0\f0\charscalex100 {ulasi elektrik
adalah menghas}\fs24\cf0\f0\charscalex100 {ilkan kontraksi otot lurik }\par\pa
rd\li1666\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {uretra dan parauretra d
engan memakai im}\fs24\cf0\f0\charscalex100 {plant/non-implant (anal atau vagina
l)}\par\pard\li1666\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {elektrode unt
uk meningkatkan tekanan ur}\fs24\cf0\f0\charscalex100 {etra. Aplikasi stimulasi
dengan kekuatan}\par\pard\li1666\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {
rendah selama beberapa jam per hari }\fs24\cf0\f0\charscalex100 {selama beberapa
bulan. Terdapat 64 %}\par\pard\li1666\ri0\sl-413\slmult0 \fs24\cf0\f0\charscale
x100 {perbaikan penderita dengan cara implant, tapi metode ini tidak populer kar
ena sering }\par\pard\li1666\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {terj
adi efek mekanis dan morbiditas kare}\fs24\cf0\f0\charscalex100 {na infeksi. Sed
ang stimulasi non-implant}\par\pard\li1666\ri0\sl-413\slmult0 \fs24\cf0\f0\chars
calex100 {terdiri dari generator mini yang digerakka}\fs24\cf0\f0\charscalex100

{n dengan baterai dan dapat dibawa dalam}\par\pard\li1666\ri0\sl-413\slmult0 \fs

24\cf0\f0\charscalex100 {pakaian penderita dan dihubungkan dengan elektrode anal
/vaginal. Bentuk elektrode }\par\pard\li1666\ri0\sl-413\slmult0 \fs24\cf0\f0\cha
rscalex100 {vaginal : ring, Hodge pessary, silindris.}\par\pard\li1386\ri0\sl-42
6\slmult0 \fs24\cf0\f0\charscalex100\b {4.}\b0 { }\fs24\cf0\f0\charscalex100\b {
Alat Mekanis}\b0 { }\fs24\cf0\f0\charscalex100 {(}\fs24\cf0\f0\charscalex100\i {
\uc1\u8216XMechanical Devices\uc1\u8217X}\i0 \fs24\cf0\f0\charscalex100 {)}\par\
pard\li1666\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100\i {Tampon :}\i0 { }\fs
24\cf0\f0\charscalex100 {Tampon dapat membantu pada inkontinen}\fs24\cf0\f0\char
scalex100 {sia stres terutama bila kebocoran}\par\pard\li1666\ri0\sl-426\slmult0
\fs24\cf0\f0\charscalex100 {hanya terjadi intermitten misal pada wakt}\fs24\cf0
\f0\charscalex100 {u latihan. Penggunaan terus menerus dapat}\par\pard\li1666\ri
0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {menyebabkan vagina kering/luka.}\pa
r\pard\li1666\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1666\ri0\sl-466\slmult0 \f
s24\cf0\f0\charscalex100\i {Edward Spring :}\i0 { }\fs24\cf0\f0\charscalex100 {D
ipasang intravagina. Terdapat 70 % perbaikan pada penderita dg}\par\pard\li1666\
ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {inkontinensia stres dengan pengob
atan 5 bula}\fs24\cf0\f0\charscalex100 {n. Kerugian terjadi }\fs24\cf0\f0\charsc
alex100 {ulserasi vagina.}\par\pard\li1666\ri0\sl-213\slmult0 \fs18\cf0\par\pard
\li1666\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1666\ri0\sl-266\slmult0 \*\tx353
3\fs24\cf0\f0\charscalex100\i {Bonnas\uc1\u8217Xs Device:}\i0 \tab \fs24\cf0\f0\
charscalex100 {Terbuat dari bahan la}\fs24\cf0\f0\charscalex100 {teks yang dapat
ditiup.}\fs24\cf0\f0\charscalex100 { Bila ditiup dapat }\par\pard\li1666\ri0\sl
-413\slmult0 \fs24\cf0\f0\charscalex100 {mengangkat sambungan urethrovesik}\fs24
\cf0\f0\charscalex100 {al dan urethra proksimal.}\par\pard\li1026\ri0\sl-213\slm
ult0 \fs18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\
sl-400\slmult0 \fs24\cf0\f0\charscalex100\b {VII. PENANGANAN OPERATIF}\b0 \par\
pard\li1600\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Penatalaksanaan stres
inkontinensia urine }\fs24\cf0\f0\charscalex100 {secara operatif dapat dilakuka
n dengan}\par\pard\li1600\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {beberap
a cara meliputi :}\par\pard\li1600\ri0\sl-413\slmult0 \*\tx1933\fs24\cf0\f0\char
scalex100 {1.}\tab \fs24\cf0\f0\charscalex100 {Kolporafi anterior}\par\pard\li16
00\ri0\sl-280\slmult0 \*\tx1933\fs24\cf0\f0\charscalex100 {2.}\tab \fs24\cf0\f0\
charscalex100 {Uretropeksi retropubik}\par\pard\li1600\ri0\sl-280\slmult0 \*\tx1
933\fs24\cf0\f0\charscalex100 {3.}\tab \fs24\cf0\f0\charscalex100 {Prosedur jaru
m }\par\pard\li1600\ri0\sl-280\slmult0 \*\tx1933\fs24\cf0\f0\charscalex100 {4.}\
tab \fs24\cf0\f0\charscalex100 {Prosedur sling pubovaginal}\par\pard\li1600\ri0\
sl-266\slmult0 \*\tx1933\fs24\cf0\f0\charscalex100 {5.}\tab \fs24\cf0\f0\charsca
lex100 {Periuretral bulking agent}\par\pard\li1600\ri0\sl-280\slmult0 \*\tx1933\
fs24\cf0\f0\charscalex100 {6.}\tab \fs24\cf0\f0\charscalex100\i {Tension vaginal
tape}\i0 \fs24\cf0\f0\charscalex100 { (TVT)}\par\pard\sect\sectd\sbknone\pgwsxn
12240\pghsxn15840\marglsxn666\margrsxn133\pard\sect\sectd\sbkpage\pgwsxn12240\pg
hsxn15840\marglsxn666\margrsxn133\margtsxn666\margbsxn240\pard\li9640\ri0\sl-213
\slmult0 \fs18\cf0\par\pard\li9640\ri0\sl-360\slmult0 \fs24\cf0\f0\charscalex100
{17}\par\pard\li1600\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1600\ri0\sl-213\sl
mult0 \fs18\cf0\par\pard\li1600\ri0\sl-306\slmult0 \*\tx5960\fs22\cf0\f0\charsca
lex100 {
Tindakan operatif sangat membutuhkan}\tab \fs22\cf0\f0\charscalex1
00\i {informed consent}\i0 { }\fs22\cf0\f0\charscalex100 {yang cermat dan baik}\
par\pard\li1600\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {pada penderita da
n keluarganya karena angka kegagalan maupun rekurensi tindakan }\par\pard\li1600
\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {ini tetap ada. }\par\pard\li1600
\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1600\ri0\sl-213\slmult0 \fs18\cf0\par\p
ard\li1600\ri0\sl-400\slmult0 \*\tx1960\fs24\cf0\f0\charscalex100 {A.}\tab \fs24
\cf0\f0\charscalex100 {KOLPORAPHY ANTERIOR}\par\pard\li1960\ri0\sl-413\slmult0 \
fs24\cf0\f0\charscalex100 {Kolporaphy anterior apakah dilakukan sebagai prosedur
yang terpisah atau}\par\pard\li1960\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex1
00 {bersamaan dengan pembedahan ginekol}\fs24\cf0\f0\charscalex100 {ogi yang lai
n umumnya merupakan}\par\pard\li1960\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex1
00 {operasi ginekologi. Operasi ini merupaka}\fs24\cf0\f0\charscalex100 {n opera
si definiti}\fs24\cf0\f0\charscalex100 {f untuk mengkoreksi}\par\pard\li1960\ri0

\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {stes inkontinensia. Bagaimanapun sel

ama }\fs24\cf0\f0\charscalex100 {dua dekade teknik operasi ini telah}\par\pard\l
i1960\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {teruji secara cermat dan te
rbukti lebih sp}\fs24\cf0\f0\charscalex100 {esifik untuk menangani kasus ini. }
\par\pard\li1960\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {
Gambaran k
lasik telah dipubli}\fs24\cf0\f0\charscalex100 {kasikan oleh Kelly (1913). Tekni
k operasi}\par\pard\li1960\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {termas
uk penjahitan pada robekan fasc}\fs24\cf0\f0\charscalex100 {ia dari uretra dan k
andung kemih yang}\par\pard\li1960\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100
{kemudian dimodifikasi oleh Kennedy (}\fs24\cf0\f0\charscalex100 {1937). Selanj
utnya seju}\fs24\cf0\f0\charscalex100 {mlah modifikasi}\par\pard\li1960\ri0\sl-4
26\slmult0 \fs24\cf0\f0\charscalex100 {minor telah dilakukan.}\par\pard\li1960\r
i0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {
Melakukan kolporaphy anterio
r memerlukan pemahaman tepat tentang}\par\pard\li1960\ri0\sl-413\slmult0 \fs24\c
f0\f0\charscalex100 {anatomi dan fisiologi struktur dasa}\fs24\cf0\f0\charscalex
100 {r panggul. Beberapa hal yang harus}\par\pard\li1960\ri0\sl-413\slmult0 \fs2
4\cf0\f0\charscalex100 {diidentifikasi adalah :}\par\pard\li2026\ri0\sl-413\slmu
lt0 \*\tx2453\fs24\cf0\f0\charscalex100 {1.}\tab \fs24\cf0\f0\charscalex100 {Muk
osa vagina}\par\pard\li2026\ri0\sl-413\slmult0 \*\tx2453\fs24\cf0\f0\charscalex1
00 {2.}\tab \fs24\cf0\f0\charscalex100 { Peritoneum vesikouterina}\par\pard\li20
26\ri0\sl-413\slmult0 \*\tx2453\fs24\cf0\f0\charscalex100 {3.}\tab \fs24\cf0\f0\
charscalex100 {Fascia pubovesikalis-servikalis}\par\pard\li2026\ri0\sl-413\slmul
t0 \*\tx2453\fs24\cf0\f0\charscalex100\i {4.}\i0 \tab \fs24\cf0\f0\charscalex100
\i {Uretrovesical junction}\i0 \par\pard\li2026\ri0\sl-413\slmult0 \*\tx2453\fs2
4\cf0\f0\charscalex100\i {5.}\i0 \tab \fs24\cf0\f0\charscalex100 {Uretra}\par\pa
rd\li2026\ri0\sl-413\slmult0 \*\tx2453\fs24\cf0\f0\charscalex100\i {6.}\i0 \tab
\fs24\cf0\f0\charscalex100 {Vena-vena pleksus uterovaginal}\par\pard\li2026\ri0\
sl-413\slmult0 \fs24\cf0\f0\charscalex100 {
A}\par\pard\li1026\ri0\sl-213
\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\
ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pa
rd\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-320\slmult0 \fs24\
cf0\f0\charscalex100\b {VIII. RINGKASAN}\b0 \par\pard\li1480\ri0\sl-413\slmult0
\fs24\cf0\f0\charscalex100 {Inkontinensia urine adalah ketidakm}\fs24\cf0\f0\ch
arscalex100 {ampuan menahan kencing. Anamnesis dan}\par\pard\li1480\ri0\sl-413\s
lmult0 \fs24\cf0\f0\charscalex100 {pemeriksaan fisik yang baik, dengan bebera}\f
s24\cf0\f0\charscalex100 {pa prosedur diagnos}\fs24\cf0\f0\charscalex100 {tik ya
ng diperlukan}\par\pard\li1480\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {me
mpunyai hasil yang baik untuk menega}\fs24\cf0\f0\charscalex100 {kkan diagnosis
gangguan ini. Jenis}\par\pard\sect\sectd\sbkpage\pgwsxn12240\pghsxn15840\marglsx
n666\margrsxn133\margtsxn666\margbsxn240\pard\li9640\ri0\sl-213\slmult0 \fs18\cf
0\par\pard\li9640\ri0\sl-360\slmult0 \fs24\cf0\f0\charscalex100 {18}\par\pard\li
1480\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1480\ri0\sl-213\slmult0 \fs18\cf0\p
ar\pard\li1480\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {inkontinensia urin
e yang utama yaitu inkontin}\fs24\cf0\f0\charscalex100 {ensia stres, desakan, }\
fs24\cf0\f0\charscalex100 {luapan dan fistula}\par\pard\li1480\ri0\sl-413\slmult
0 \fs24\cf0\f0\charscalex100 {urine. Penatalaksanaan konservatif dilakukan }\fs2
4\cf0\f0\charscalex100 {pada kasus inkompetem}\fs24\cf0\f0\charscalex100 { sfing
ter uretra}\par\pard\li1480\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {sebel
um terapi bedah. Bila dasar inkontin}\fs24\cf0\f0\charscalex100 {ensia neurogen
atau me}\fs24\cf0\f0\charscalex100 {ntal maka pengobatan}\par\pard\li1480\ri0\sl
-413\slmult0 \fs24\cf0\f0\charscalex100 {disesuaikan dengan faktor penyebab.}\pa
r\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \f
s18\cf0\par\pard\li1026\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100\b {VIII.KE
PUSTAKAAN}\b0 \par\pard\li1573\ri0\sl-373\slmult0 \fs20\cf0\f0\charscalex100 {1.
}{ }\fs20\cf0\f0\charscalex100 {Andrianto P. Urologi Untuk Praktek Umum. EGC. Ja
karta, 1991 : 175-186.}\par\pard\li1573\ri0\sl-346\slmult0 \fs20\cf0\f0\charscal
ex100 {2.}{ }\fs20\cf0\f0\charscalex100 {Prawirohardjo S. Ilmu kandungan. Edisi
I. Yayasan Bina Pustaka. Jakarta, 1991 : 392-404. }\par\pard\li1573\ri0\sl-346\s
lmult0 \fs20\cf0\f0\charscalex100 {3.}{ }\fs20\cf0\f0\charscalex100 {Burnnet LS.
Relaxations, Malpositions, Fistulas, and Incontinence. In : Jones HW, Wentz AC,

}\par\pard\li1573\ri0\sl-346\slmult0 \fs20\cf0\f0\charscalex100 {
Burnnet L
S. Novak\uc1\u8217Xs Texbook of Gynecology. Eleventh Ed. William & Wilkins, 1988
; 467-478. }\par\pard\li1573\ri0\sl-346\slmult0 \fs20\cf0\f0\charscalex100 {4.}
{ }\fs20\cf0\f0\charscalex100 {Marchant DJ. Urinary Incontinence. Obsterics and
Gynecology Annual, 19809 ; 9 : 261-2}\par\pard\li1573\ri0\sl-333\slmult0 \fs20\c
f0\f0\charscalex100 {5.}{ }\fs20\cf0\f0\charscalex100 {Richardson AC, Edmonds PB
, Williams NL. Treatment of Stress Incontinence due to Paravaginal }\par\pard\l
i1573\ri0\sl-346\slmult0 \fs20\cf0\f0\charscalex100 {
Fascial Defect. Obstet
Gynecol 1981 ; 57 : 357-362.}\par\pard\li1573\ri0\sl-346\slmult0 \fs20\cf0\f0\ch
arscalex100 {6.}{ }\fs20\cf0\f0\charscalex100 {Fantl JA, Hurt WE, Bump RC, Dunn
LJ, Choi SC. Urethral Axis and Sphincteric Function. Am J }\par\pard\li1573\ri0
\sl-346\slmult0 \fs20\cf0\f0\charscalex100 {
Obstet Gynecol 1986 ; 155 : 554558.}\par\pard\li1573\ri0\sl-346\slmult0 \fs20\cf0\f0\charscalex100 {7.}{ }\fs20
\cf0\f0\charscalex100 {De Lancey JL. Correlative Study of Paraurehtral Anatomy.
Obstet Gynecol 1986; 68 :91-97 }\par\pard\li1573\ri0\sl-346\slmult0 \fs18\cf0\f0
\charscalex100 {8.}{ }\fs18\cf0\f0\charscalex100 {De Lancey JL. Structural Aspec
ts }\fs18\cf0\f0\charscalex100 {of the Exrrinsic Continence Mechanism. Obstet Gy
necol 1988 ; 72 }\par\pard\li1573\ri0\sl-346\slmult0 \fs20\cf0\f0\charscalex100
{
: 296-301}\par\pard\li1573\ri0\sl-346\slmult0 \fs20\cf0\f0\charscalex100 {9
.}{ }\fs20\cf0\f0\charscalex100 {Low JA, Mauger GM, Dragovic J. Diagnosis of the
Unstable Detrusor : Comparison of an }\par\pard\li1573\ri0\sl-333\slmult0 \fs20
\cf0\f0\charscalex100 {
Incremental and Continuous Infusion Technique. Obstet
Gynecol 1985 ; 65 : 99-103.}\par\pard\li1573\ri0\sl-346\slmult0 \*\tx1933\fs20\
cf0\f0\charscalex100 {10.}\tab \fs20\cf0\f0\charscalex100 {Sand PK, Bowen LW, Os
tegard DR, Brubaker L, Panganiban R. The Effect of Retropubic }\par\pard\li1933\
ri0\sl-346\slmult0 \fs20\cf0\f0\charscalex100 {Urethropexy on Detrusor Instabili
ty. Obstet Gynecol 1988 ; 71 : 818-822.}\par\pard\li1573\ri0\sl-346\slmult0 \*\t
x1933\fs20\cf0\f0\charscalex100 {11.}\tab \fs20\cf0\f0\charscalex100 {Purnomo, D
asar-dasar Urologi. FK>Brawijaya, Malang 2003; 106-119.}\par\pard\li1573\ri0\sl373\slmult0 \*\tx1933\fs20\cf0\f0\charscalex100 {12.}\tab \fs20\cf0\f0\charscale
x100 {Bhatia NN, Bergman A. pessary Test in women W}\fs20\cf0\f0\charscalex100 {
ith urinary Incontinence.}\fs20\cf0\f0\charscalex100 { Obstet Gynecol 1985 ; }\p
ar\pard\li1933\ri0\sl-360\slmult0 \fs20\cf0\f0\charscalex100 {65 : 220-225.}\par
\pard\li1573\ri0\sl-373\slmult0 \*\tx1933\fs20\cf0\f0\charscalex100 {13.}\tab \f
s20\cf0\f0\charscalex100 {Horbach NS, Blanco JS, Ostergar}\fs20\cf0\f0\charscale
x100 {d DR, Bent AE, Cornella JL. A Suburethral Sling Procedure }\par\pard\li193
3\ri0\sl-360\slmult0 \fs20\cf0\f0\charscalex100 {With Polytetrafluoroethylene fo
r the Treatment of Genuine Stress Incontinence in Patients With}\par\pard\li1933
\ri0\sl-373\slmult0 \fs20\cf0\f0\charscalex100 {Low Urethral Closure Pressure. O
bstet Gynecol 1988 ; 71 : 648-652.}\par\pard\li1573\ri0\sl-373\slmult0 \*\tx1933
\fs20\cf0\f0\charscalex100 {14.}\tab \fs20\cf0\f0\charscalex100 {Morgan JE, Farr
ow GA, Stewart FE. The Marlex }\fs20\cf0\f0\charscalex100 {Sling Operation for t
he }\fs20\cf0\f0\charscalex100 {Treatment of Recurrent}\par\pard\li1933\ri0\sl-3
60\slmult0 \fs20\cf0\f0\charscalex100 {Stress Urinary Incontinence : A 16-years
review}\fs20\cf0\f0\charscalex100 {. Am J Obstet Gynecol 1985 ; 151 : 224-226. }
\par\pard\li1573\ri0\sl-373\slmult0 \*\tx1933\fs20\cf0\f0\charscalex100 {15.}\ta
b \fs20\cf0\f0\charscalex100 {Junizaf. Buku Ajar Uroginekologi. FK.UI. Jakarta,
2002 ; 90-96.}\par\pard\li1573\ri0\sl-360\slmult0 \*\tx1933\fs20\cf0\f0\charscal
ex100 {16.}\tab \fs20\cf0\f0\charscalex100 {Josoprawiro. Inkontinensia Urin dan
Gejala Urogin}\fs20\cf0\f0\charscalex100 {etal Terkait Pada Wanita Usia Lanjut.
PIT X,}\par\pard\li1933\ri0\sl-373\slmult0 \fs20\cf0\f0\charscalex100 {Padang. 3
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6\margrsxn133\margtsxn666\margbsxn240\pard\li9640\ri0\sl-213\slmult0 \fs18\cf0\p
ar\pard\li9640\ri0\sl-360\slmult0 \fs24\cf0\f0\charscalex100 {19}\par\pard\li157
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ilkins, 2002 ; 654-680.}\par}