Manajemen Retensio Urin Pasca Persalinan Pervaginam

Abstract

  Retensio urin pascapersalinan (RUPP) adalah ketidakmampuan berkemih spontan atau dapat berkemih spontan 6 jam setelah persalinan dengan residu urin >200 mL. RUPP menimbulkan peregangan kandung kemih berlebihan sehingga mengganggu persarafan dan atonia otot detrusor. Faktor risiko RUPP adalah primipara, persalinan dengan alat, persalinan kala II lama, dan ruptur perineum luas. Gejala klinis berupa buang air kecil (BAK) sedikit atau tidak dapat BAK. Manajemen RUPP dengan residu urin 200-500 mL dilakukan kateterisasi intermiten tiap 6 jam sampai residu urin <200 mL. Jika residu urin 500-1.000 mL dilakukan dauer kateter 1x24 jam dan 6 jam kemudian pasien diminta berkemih spontan, 5 menit kemudian diukur residu urin. Jika residu urin 1.000-2.000 mL, dipasang dauer kateter selama 2x24 jam dan buka tutup kateter/4-6 jam selama 24 jam. Jika residu urin >2.000 mL, dauer kateter 3x24 jam dan bladder training selama 24 jam. Enam jam kemudian diukur volume residu urin dan bila residu urin <200 mL maka volume residu urin dikatakan normal. Pascapersalinan, tatalaksana dilakukan secara simultan dengan pemasangan kateter diikuti pemberian prostaglandin, antibiotik, dan edukasi minum air 2-3 liter perhari. Perlu pemeriksaan klinis yang baik pada pengawasan lama kala II, pengosongan kandung kemih dan tatalaksana robekan jalan lahir.   Post-Partum Urinary Retention Management  Postpartum urinary retention (PPUR) is defined as inability to pass urine spontaneously or able to pass urine spontaneously in 6 hours following delivery with residual urine volume of >200 ml. PPUR is causing overdistention of bladder resulted in neurologic dysfunction and detrusor muscle atonia. Risk factor for PPUR including primipara, assisted vaginal delivery, prolonged second stage of labor and extensive perineal rupture. Clinical symptoms related to PPUR are decreasing urine volume or unable to urinate spontanously. Management in PPUR with residual urine 200-500 ml is by intermitten catether every 6 hours continued with spontaneously urinate and residual urine will be measured after 5 minutes. PPUR management with residual urine 500-1000 ml is by applied dauer catheter 1x24 hours continued with spontaneously urinate after 6 hours and residual urine also will be measured after 5 minutes. PPUR management with residual urine 1000-2000 ml is by applied dauer catheter 2x24 hours, continued with opening and closing catheter every 4-6 hours for 24 hours. If residual urine >2000 ml, dauer cathetetr will be applied for 3x24 hours, continued with bladder training for 24 hours. Residual urine will be measured after 6 hours. The result is normal if residual urine <200 ml. PPUR management is done simultaneously with catheter application, prostaglandin, antibiotics and hydration 2-3 L/day. Good clinical examination and management during prolonged second stage of labor, bladder emptying and perineal ruptur management are needed in preventing post partum urinary retention.  &nbsp