5. Prolapsus Organ Panggul_dr.rudy Lengkong
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Transcript of 5. Prolapsus Organ Panggul_dr.rudy Lengkong
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Curiculum Vitae
• Nama : dr. Rudy A. Lengkong, SpOG-K• Tempat/Tgl. Lahir : Surabaya, 21 November 1959• Agama : Kristen Protestan• Jenis kelamin : Laki-laki • Pendidikan : - Tahun 1987 Lulus FK Unsrat, Manado
- Tahun 1998 Lulus Spesialis Obstetri Ginekologi
FK Unsrat, Manado - Tahun 2010 Konsultan Uroginekologi FKUI
• Jabatan : 2005 – sekarang Staf Bagian/SMF Obstetri & Ginekologi FK Unsrat / RSUP Prof dr
RD Kandou, Manado
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PROLAPSUS ORGAN PANGGUL
Dr. Rudy Lengkong, SpOG-K
Divisi Uroginekologi Rekonstruksi
Departemen Obstetri dan Ginekologi
Fakultas Kedokteran Universitas Samratulangi
RSUP. Prof. Dr. R. D. Kandou
Manado
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DEFINISI
Turunnya/herniasi isi organ panggul melalui vagina akibat kelemahan struktur penyokong dasar panggul
Herbnik (2008) kelemahan otot, ligamentum & jaringan ikat
Penurunan:Dinding vagina, uterus, kandung kemih, uretra, rektum, usus, puncak vagina
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Jenis-JenisProlapsus Organ Panggul
Uretrokel Sistokel SistouretrokelProlapsus uteri Entrokel Rektokel
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Angka kejadian
50% wanita yang telah melahirkan mengalami prolapsus alat genitalia
20% kasus genekologi yang akan di operasi berasal dari prolapsus alat genitalia
Di RSCM-FKUI 1995-2000 terdapat 240 kasus prolapsus alat genitalia dengan keluhan telah dirawat, terbanyak pada usia 60-70 tahun dan paritas lebih dari 3
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Etiologi
Kelemahan organ-organ penyokong alat genitalia
Fascia endopelvik
Otot-otot dasar pangul (diafragma pelvis)
Otot-otot diafragma urogenitalia
Perineal body dan sfingter ani
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Patologi terjadinya prolapsus Organ Panggul.
Kelemahan otot levator ani dan levator plate
Kelemahan ligamentum endopelviks
Kelemahan otot-otot diafragma urogenitalia dan perineum
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Faktor resiko
Trauma persalinan
Paritas
Tekanan intra abdominal kronik
Usia
Kelainan bawahan
Ras
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Klasifikasi
Stadium I bila bagian prolapsus masih diatas introitus vagina
Stadium II bila bagian prolapsus sudah mencapai introitus vagina
Stadium III bila bagian prolapsus sudah keluar dari introitus vagina
contoh prolapsus uteri
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Gejala & Tanda
Sesuatu yang turun atau keluar dari liang kemaluan
Terasa atau teraba ada benjolan di liang kemaluan
Terasa pegal didaerah belakang atau punggung
Susah berjalan
Perdarahan pervaginam
Inkontinensia urin
Konstipasi
Gangguan bersenggama
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Diagnosis
Anamnesis
Pemeriksaan fisik
Pemeriksaan ginekologi
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Penatalaksanaan
Pencegahan Mengurangi jumlah persalinan
Menghindari partus (kala 2 lama)
Menghindari persalinan pervaginam dengan tindakan
Menghindari pengeluaran plasenta dengan cara Crede
Memperbaiki luka pada jalan lahir pada saat persalinan
Latihan otot-otot dasar panggul sesudah melahirkan (latihan Kegel)
Menghindari tindakan-tindakan atau, kegiatan atau keadaan yang dapat menyebabkan tekanan intra abdominal meningkat
PengobatanKonservatif
Operatif
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Penatalaksanaan
Pengobatan konservativ
Pengunaan pesarium
Pemberian hormon estrogen pada penderita yang sudah tua (post menopause)
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Pengobatan
Operatif
Kolporafi anterior
Kolporafi posterior
Ventofiksasi
Vaginal histerektomi
Kolpoperineorafi
Kolpokleisis
Sakropeksi
Sakrospinosuspeksi
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