Comparison of Bottock Pain on Pelvic Organ Prolapse Patients Post Total

Vaginal Hysterectomy with and without Sacrospinal Ligamentum Fixation at

RSUP Dr. Mohammad Hoesin Palembang

Amir Fauzi
School of Graduate Studies
Management & Science University, Shah Alam, 2016

ABSTRACT
Background :About half the women who have given birth will experience various
forms of POP in their future. POP is not a life threatening disease, but can cause
disfunction of the bladder, colorectal chanel and sexual dysfunction, resulting
indiscomfort and real psychological distress. Management of POP can be
conservative or surgical. Hysterectomies can cause nerve damage and interfere with
the pelvic floor support structure. The surgical procedure of sacrospinosus ligament
fixation itself can cause buttock pain in 10-15% cases. However this side effect
ususally resolves in a matter of the days to months . In this research, we assessed
buttock pain of POP patients post TVH who underwent fixation and patients who
did not undergo fixation of sacrospinous ligament.
Methods: This study is a single blind randomized clinical trial conducted in Rumah
Sakit Mohammad Hoesin Palembang from March to October 2016. There were 80
samples of POP patient that fit in inclusion and exclusion criterias. Frequencies and
data distributions are express in tables, comparison of urinary symptoms was
analyzed using Chi Square on SPSS version 18.0.
Results: From 80 respondents, there is no differences on age, occupation, number of
children, weight and height between both groups. There was significant differences in
buttockpain experienced by respondents in the two groups as the SSFgroup had a
larger value (p = 0,024)
Conclusion : there was significant statistical difference between buttock pain
experienced between patient with and without fixation of sacrospinous ligament.

Key words: Pelvic Organ Prolapse, fixation of sacrospinous ligament, Buttock pain

LATAR BELAKANG secara perabdominam atau

Prolapsus organ panggul (POP) pervaginam. 5 Terdapat lebih dari 40
menurut IUGA/ICS 2010 adalah jenis operasi dalam tatalaksana POP
penurunan satu atau lebih diantara dinding dan semua teknik rekonstruktif
vagina anterior, dinding vagina posterior, memiliki kesamaan dalam penggunaan
uterus (serviks), atau puncak vagina struktur jaringan yang normal untuk
(tunggul vagina pasca histerektomi). 1 fiksasi tunggul vagina. 6
Diperkirakan separuh wanita yang telah Pada dekade terakhir ini, banyak
melahirkan akan mengalami berbagai penelitian menunjukkan fiksasi
bentuk POP pada kehidupannya ligamentum sakrospinosus adalah
dikemudian hari. 2 prosedur pembedahan yang efektif
Penatalaksanaan POP adalah untuk memperbaiki POP terutama
dapat dilakukan secara konservatif dan prolapsus tunggul vagina pasca
pembedahan. 3,4 Prosedur pembedahan histerektomi. 5,7
untuk tatalaksana POP secara umum Tindakan histerektomi sendiri
dikategorikan sebagai obliteratif atau dapat menyebabkan kerusakan syaraf
rekonstruktif, dan dapat dilakukan dan mengganggu struktur penopang
dasar panggul. Prosedur operasi fiksasi range ≤ 63.5 years old .In the non-SSF
ligamentum sakrospinosus sendiri group there were 12 people in the age
dapat menyebabkan nyeri bokong range ≥63.5 years old and 18 people
pada10-15% kasus namun biasanya (60%) in the age range <63.5 years old.
membaik pada hitungan hari sampai The Chi Square test obtained a p value
bulan 8,9,10 of 0,794 (p>0,05) which corfirm there
Fiksasi Sakrospina sangat efektif was no statistically significant
dalam mengontrol prolapsus vagina difference in age groups between the
bagian atas dengan angka kegagalan two groups.
hanya 5-10%. Nyeri bokong pada sisi
yang memiliki jahitan sakrospina Table 1. Characteristics of age
Groups Pvalue
terjadi pada 5-10% wanita. Hal ini Characteristics
SSF Non SSF
dapat sangat nyeri namun biasanya Age (years) 62.8±9.67 63.4±6.92 0.795*
berkurang dalam 6 minggu. Age Groups
 ≥ 63.5 years 14(46.7) 12(40) 0.794**
 < 63.5 years 16(53.3) 18(60)
BAHAN DAN METODE
Penelitian ini merupakan uji
klinik acak berpembanding buta In the SSF group, the majority of
tunggal (single blind randomized the sample population were
clinical trial). Penelitian ini dilakukan housewives, at 86.7% (26 women).
di di Rumah Sakit Mohammad Hoesin This was found to be similar in the
Palembang mulai bulan Maret sampai non-SSF group, where 80% of the
dengan Oktober 2016. sample population were housewives
Jumlah sampel pada penelitian ini (24 women). The Chi Square test
sebanyak 80 pasien prolaps organ obtained a p-value 0.748 (p> 0.05).
panggul yang dilakukan operasi total This indicates that there is no
vaginal histerektomi yang dibagi difference in occupation between the
menjadi dua kelompok yaitu 40 two groups statistically.
responden yang dilakukan fiksasi
sacrospinosus dan 40 responden yang Table 2. Characteristics of ocupation
tidak dilakukan fiksasi sacrospinosus . Groups
P
Characteristics Value
Analisa data pada penelitian ini SSF Non SSF
menggunakan uji Mann Whitney Ocupation , n(%)
menggunakan program SPSS versi.18  Housewives 26 (86.7) 24(80)
 Civil Servant
 Retired 0(0) 1(3.3) 0.748
RESULT  Private 1(3.3) 1(3.3)
3(10) 4(13.3)
The mean age of respondents who
underwent fixation of the sacrospinous Both groups had the same total
ligament (SSF) was 62.8 ± 9.67 number of children in two categories.
years.The mean age of respondents There were 12 women in the category ≥
who did not undergo fixation of the 4 children (40%) and 18 women in the
sacrospinous ligament (Non-SSF) was category < 4 children (60%). The Chi
63.4 ± 6.92 years. The unpaired t-test Square test obtained a p-value of 1.0
obtained a p- value of 0.795 (p> 0.05), (p>0.05). This indicates that there was
which means there is no statistically no difference in the number of children
significant difference in age of between both groups statistically.
respondents between the two groups. In
the SSF group, there were 14 people Table 3. Characteristics of number of children
(46.7%) in the age range ≥63.5 years Groups
P
Characteristics value
old and 16 people (53.3%) in the age SSF Non SSF
 Number of children, between the urinary symptoms
n (%)
 ≥4 12(40) 12(40) 1.000 experienced by both group of women.
 <4 18(60) 18(60)

Median nyeri bokong kelompok

In the SSF group, the number of SSF adalah 1 (0-3) dengan rerata 0,83
respondents with a body weight of ≥ 60 ± 0,79 sedangkan median kelompok
kg were 13 women (43.3%) and 17 non SSF adalah 0 (0-3)dengan rerata
women had a body weight of <60 kg. 0,47 ± 0,86. Dengan uji Mann Whitney
In the non-SSF group, 14 women had a didapatkan p value 0,024 (p < 0,05)
body weight of ≥ 60 kg (46.7%) and 16 yang berarti terdapat perbedaan
women had a body weight of<60 kg signifikan nyeri bokong antar kedua
16(53.3%). The Chi Square test kelompok dimana nyeri bokong
obtained a p-value of 1.0 (p>0.05), kelompok SSF lebih besar
which indicates there was no statistical dibandingkan nyeri bokong kelompok
difference in body weight between the non SSF.
two groups.
Tabel 6. Perbandingan Nyeri Bokong
Table 4. Characteristic of BodyWeight Kelompok
P
P Karakteristik value
Groups SSF Non SSF
Characteristic value
SSF Non SSF Nyeri bokong, 1 (0-3) 0 (0-3) 0.024
Body Weight, n (%) Median (Min-
 ≥ 60 kg 13(43.3) 14(46.7) 1.000 Max)
 < 60 kg 17(56.7) 16(53.3)

In the SSF group, 17 women PEMBAHASAN

were found to have a height of ≥ 150
cm (56.7%) and 13 women were found
to have a height of<150 cm (43.3%). In
the non-SSF group, the height of the
women in each height group was
exactly 50% (15 women in each
group). By using theChi Square test, a
p-value of 0.796 (p>0,05) was
obtained, indicating that there was no
statistical difference in body height
between both groups.
Table 5. Characteristic of Body Height
Characteristic
Group
SSF Non SSF
Body Height, n (%)
 ≥ 150 cm 17(56.7) 15(50)
 < 150 cm 13(43.3) 15(50)
The median of urinary symptoms in the
SSF group was 1.5 (0-4) with a mean
of 1.53 ± 1.25. The median of the non-
SSF group was 1 (0-4) with a mean of
1.5 ± 1.19. With the Mann Whitney
test, a p-value of 0.909 (p> 0.05) was
obtained. This indicated that there was
no significant statistical difference
Pada penelitian ini terdapat
perbedaan signifikan nyeri bokong
antar kedua kelompok dimana nyeri
bokong kelompok SSF lebih besar
dibandingkan nyeri bokong
kelompok non SSF (p = 0,024).
Hasil ini serupa dengan
penelitian oleh Karam dan Walters
yang menyatakan bahwa nyeri
bokong adalah komplikasi yang
umum terjadi dengan prevalens 10-
15%. 11,12
Penelitian yang dilakukan
P
value
Lovatsis dkk menunjukkan nyeri
bokong terjadi sebanyak 18/293
kasus (6,1%) dan menghilang
0.796
spontan 6 minggu paska operasi.
Nyeri pasca operasi mungkin
disebabkan oleh cedera syaraf
akibat posisi pasien yang tidak tepat
selama operasi. Cedera syaraf
banyak ditemukan sebagai
komplikasi paska operasi, selain itu
dapat menyebabkan gangguan
motorik dan sensorik juga sebagai
penyebab nyeri kronis paca operasi.
 Cedera syaraf perineal dapat
dihasilkan dari tekanan terhadap
tindakan apabila pasien tidak
diposisikan secara benar dan diberi
alas/bantalan. Mengurangi lama
operasi akan menurunkan lamanya
pasien dalam posisi yang dapat
menimbulkan cedera. 13
Komplikasi pasca operasi
dapat diturunkan dengan memahami
risiko prosedur pembedahan,
termasuk risiko anestesi, posisi,
teknik pembedahan, implan, dan
infeksi. Neurapraxia dapat dihindarr
dengan posisi yang benar dan diberi
alas pada titik-titik tekanan. Pada
posisi litotomi yang dimodifikasi
untuk kolpopeksi sakral, cedera
syaraf femoral dapat terjadi karena
hiperekstensi pada pinggul dan
harus dihindari.Cedera syaraf
perineal dapat dihasilkan dari
tekanan terhadap tindakan apabila
tidak diposisikan secara benar dan
diberi alas/bantalan. Penempatan
retraktor untuk paparan lapangan
operasi dapat menyebabkan cedera
syaraf, sering biasanya syaraf
femoral karena syaraf itu melalui
otot psoas. 14
KESIMPULAN
Tidak terdapat perbedaan gejala
berkemih antara tindakan SSF dan non
SSF.
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