Perbandingan Pemasangan Kateter Menetap

selama 12 dan 24 jam Pasca Seksio Sesarea pada Pencegahan

Retensio Urin dan Resiko Infeksi Saluran Kemih
Max Rarung
Bagian Obstetri dan Ginekologi, Fakultas Kedokteran Universitas Sam Ratulangi,
Rumah Sakit Prof.Dr.R.D. Kandou, Manado
Abstract
The objective of this research is to evaluate the occurance of urine retension and bladder
infection
post caesarian section after in 12 hours and 24 hours of catetherisation. Setting of the
research is Obstetric
D Care Unit Room Prof.Dr.R.D. Kandou Hospital, Manado North Sulawesi. The research
design is Open
Clinical Test Research. Subjects are all post sectio caesarean surgery patients in Central
Surgery Unit and
Obstetric Surgery Unit Prof.Dr.R.D.Kandou Hospital, Manado, North Sulawesi. Selection of
patients
was based on inclusion and exclusion cathegory depending on the possibility to collect their
urine samples.
There were 100 samples from 226 cases based on inclusion cathegory. In this research
there’s no
significant difference between 12 hours and 24 hours cathetherisation with urine retension
and bladder
infection. And there’s significant difference between urine volume residual and bladder
capacity with 12
hours and 24 hours cathetherisation. The conclusion of this research is at least 24 hours
cathetherization
is suggested to prevent urine retension in post caesarean section patients.
Keywords: Urine retension, bladder infection, 12 hours and 24 hours catheterization
Abstrak
Tujuan dari penelitian ini adalah untuk mengevaluasi terjadinya retensi urin dan infeksi
kandung kemih
posting bagian caesar setelah 12 jam dan 24 jam catetherisation. Setting penelitian ini adalah
Kebidanan
Room D Perawatan Satuan Prof.Dr.R.D. Rumah Sakit Kandou, Manado Sulawesi Utara.
Desain penelitian adalah Open
Penelitian Klinis Uji. Subyek adalah pasien bedah caesar semua posting sectio Bedah Unit
Pusat dan
Bedah Kebidanan Rumah Sakit Satuan Prof.Dr.RDKandou, Manado, Sulawesi Utara.
Pemilihan pasien
didasarkan pada inklusi dan eksklusi cathegory tergantung pada kemungkinan untuk
mengumpulkan sampel urin mereka.
Ada 100 sampel dari 226 kasus berdasarkan inklusi cathegory. Dalam penelitian ini tidak ada
perbedaan yang signifikan antara 12 jam dan 24 jam cathetherisation dengan retensi urin dan
kandung kemih
infeksi. Dan ada perbedaan yang signifikan antara volume urin kapasitas residual dan
kandung kemih dengan 12
jam dan 24 jam cathetherisation. Kesimpulan dari penelitian ini adalah minimal 24 jam
cathetherization
disarankan untuk mencegah retensi urin pasca pasien operasi caesar.
Kata kunci: Urine retensi, infeksi kandung kemih, 12 jam dan 24 jam kateterisasi

Pendahuluan
Salah satu persiapan seksio sesarea adalah pemasangan kateter folley. Umumnya indikasi
penggunaan kateter menetap adalah untuk pengeluaran urin, meningkatkan luasnya paparan
saat seksio sesarea pada segmen bawah rahim, mengurangi cedera traktus urinarius saat
pembedahan, mengevaluasi keseimbangan cairan dan mencegah retensio urin pasca seksio
sesarea.1-3 Pasca seksio sesarea, kateter menetap dipertahankan agar kandung kemih tetap
kosong guna mengistirahatkan kandung kemih dan mencegah terjadinya regangan yang
berlebihan pada kandung kemih akibat dari gangguan berkemih spontan yang dapat
menyebabkan retensio urin.
Peregangan yang berlebihan dari kandung kemih ini akan menyebabkan regangan pada otot
detrusor sehingga memperlambat fungsi pengosongan kandung kemih. Terganggunya fungsi
kandung kemih ini merupakan faktor predisposisi timbulnya infeksi saluran kemih.
Ghoreishi melaporkan resiko penggunaan kateterisasi persalinan pada seksio sesarea akan
menyebabkan 12- 25% bakteriuria asimptomatis. Sehdev HM mengatakan 2-6%
resiko infeksi saluran kemih akibat pemakaian kateter menetap 24 jam pasca seksio sesarea.1
Rivzi dkk menemukan 1,6% penderita yang mengalami infeksi saluran kemih pada
pemasangan kateter pasca seksio sesarea.

Retensio urin pasca persalinan merupakan salah satu komplikasi yang bisa terjadi pada kasus
obstetri. Retensio urin didefinisikan tidak ada buang air kecil secara spontan selama 6 jam
setelah melahirkan pervaginam. Pada persalinan dengan seksio sesarea didefinisikan tidak
adanya proses berkemih spontan 6 jam setelah pelepasan kateter. Kejadian retensio urin pasca
persalinan tercatat berkisar antara 1,7-17,9%. Pribakti melaporkan 9,1% retensio urin pasca
seksio sesarea di RSUD Ulin Banjarmasin.7 Penelitian Rizvi dkk mendapatkan 11,9%
retensio urin pasca seksio sesarea.6 Penelitian Suskhan di RSUPNCM tahun 1998
mendapatkan kejadian retensio urin pasca seksio sesarea sebesar 17,1% jika kateter
menetap dipertahankan 6 jam. Bila dipertahankan 24 jam, sebesar 7,1%.8 Kemampuan pasien
untuk mengosongkan kandung kemih sebelum terjadi distensi berlebihan harus dipantau.
Lama kateter menetap dipertahankan pasca seksio sesarea masih bervariasi.
Kateter menetap dianjurkan dilepas 12 jam atau 24 jam pasca seksio sesarea.8 Sehdev dari
Departemen Obstetri Ginekologi Universitas Pennsylvania meneliti terdapat 3,2% infeksi
saluran kemih setelah persalinan seksio sesarea oleh karena pemakaian kateter menetap.
Sehdev menganjurkan pemasangan kateter menetap 24 jam pada seksio sesarea untuk
mencegah retensio urin.
Ghoreishi berpendapat kateter menetap dipertahankan 24-48 jam pasca seksio sesarea untuk
mencegah over distensi kandung kemih. Jhonson menganjurkan untuk melepas kateter 6 jam
pasca seksio sesarea.
Ghoreishi mengemukakan semakin lama kateter dipertahankan, resiko infeksi saluran kemih
akan meningkat. Edward dari Centers for Disease Control and Prevention mengatakan
kejadian infeksi saluran kemih tergantung dari cara pemasangan, pengambilan urin, lama
pemakaian, dan kualitas kateter tersebut.4,5 Insidensi infeksi saluran kemih meningkat sesuai
dengan lamanya pemakaian kateter, bervariasi sekitar 3- 33%. Untuk menghindari resiko
infeksi saluran kemih, prosedur pemasangan kateter harus steril dan kateter harus bebas dari
bakteri.7,9,10 Protokol Divisi Uroginekologi Rekonstruksi Departemen Obstetri Ginekologi
FKUI / RSUPNCM – Jakarta, kateter menetap dipertahankan 24 jam pasca seksio sesarea.8

Bahan dan Cara

Penelitian dalam bentuk uji klinis terbuka. Dibagi dalam bentuk 2 kelompok, kelompok
pertama dipasang kateter menetap pasca seksio sesarea dalam 12 jam dan kelompok kedua
dipasang kateter menetap pasca seksio sesarea dalam 24 jam. Penelitian dilakukan di Instalasi
Rawat Inap D Obstetri RSU Prof.Dr. R.D. Kandou Manado hingga besar sampel terpenuhi.
Subyek penelitian adalah seluruh penderita pasca seksio sesarea yang dilakukan di Instalasi
Bedah Sentral dan Kamar Bedah Obstetri RSU Prof. Dr. R. D. Kandou Manado.
Kriteria inklusi
- pasien pasca seksio sesarea transperitoneal profunda.
- Lama operasi <=2 jam
- Tidak ada infeksi sebelumnya
Kriteria eksklusi
Perbandingan Pemasangan Kateter Menetap selama 12 dan 24 jam Pasca Seksio Sesarea
pada Pencegahan Retensio Urin dan Resiko Infeksi Saluran Kemih (Max Rarung)
- Adanya infeksi saluran kemih, infeksi intrapartum dan pastus lama sebelum dilakukan
seksio sesarea.
- Mengalami gangguan berkemih sebelum dilakukan seksio sesarea.
- Telah dilakukan tindakan bedah obstetri seperti ekstrasi vakum atau forceps.
- Pasien dengan keadaan umum lemah, mengalami komplikasi akibat langsung kehamilan
dan yang mempunyai penyakit / kelainan yang tidak langsung berhubungan dengan
kehamilan.
- Bekas seksio sesarea.
- Pasien menolak turut serta penelitian.

Cara
Pasien yang akan dilakukan seksio sesarea transperitoneal profunda dipasang kateter folley
no. 16 trans urethra. Subyek yang masuk kriteria penelitian kemudian ditentukan secara
acak, masuk kateter menetap 12 jam atau 24 jam pasca seksio sesarea.
Setelah kateter menetap selama 12 jam atau 24 jam dipertahankan lalu dilepas. Subyek
penelitian pada masingmasing kelompok dievaluasi selama enam jam. Bila pasien tidak dapat
berkemih, subyek penelitian masuk kriteria retensio urin (overt).
Dilakukan kateterisasi urin, diukur dengan gelas ukur kemudian dilakukan pemeriksaan
urinalisa. Bila penderita dapat berkemih spontan, urin yang keluar diukur dan segera
dilakukan kateterisasi untuk mengetahui sisa urin dalam kandung kemih. Bila urin sisa >=
200 ml, subyek penelitian masuk kriteria retensio urin (covert).
Kapasitas kandung kemih didapatkan dari hasil pengukuran pada retensio urin dengan cara
menjumlahkan volume urin hasil berkemih spontan dengan volume urin sisa hasil kateterisasi
setelah kateterisasi spontan.
Pengukuran kapasitas kandung kemih bersamaan dengan pemeriksaan urinalisa untuk menilai
adanya bakteriuria. Pada penelitian ini dilakukan pemeriksaan urinalisa sederhana untuk
mendeteksi adanya bakteriuria. Hasil analisa yang mendukung kearah infeksi yaitu dengan
diperoleh lebih dari 10 leukosit/LPB.
Analisis data
Analisis data menggunakan perangkat
Software SPSS for Windows versi 15.0
dengan :
1. Analisa deskriptif untuk karakteristik subyek.
2. Uji Fisher Exact untuk menguji kasus retensio urin pasca seksio sesarea.
3. Uji X2 untuk menguji kasus infeksi saluran kemih pasca seksio sesarea.
4. Uji t untuk menguji perbandingan rata-rata kapasitas kandung kemih volume urin sisa dan
lama operasi.

Pembahasan
Pada kelompok kateter menetap12 jam dan 24 jam umur terbanyak adalah 31-40 tahun,
masing-masing 21 kasus (42%) dan 30 kasus (60%). Berdasarkan paritas, didapatkan
multiparitas yang terbanyak pada kelompok kateter menetap 12 jam dan 24 jam masing-
masing 28 kasus (56%) dan 27 kasus (54%). Ghoreishi dan Rizvi mendapatkan tidak ada
korelasi retensio urin pasca seksio sesarea terhadap umur, paritas dan operasi elektif / cito.4,6
Angka kejadian retensio urin didapatkan 4 kasus (8%) pada pemasangan kateter menetap
selama 12 jam pasca seksio sesarea, sedangkan pada yang 24 jam didapatkan kejadian
retensio urin 1 kasus (2%). Tidak ada perbedaan bermakna (p= 0,362) kejadian retensio urin
pasca seksio sesarea kedua kelompok. Pribakti melaporkan ada 9,1% retensio urin pasca
seksio sesarea di RSUD Ulin Banjarmasin. Suskhan dari RSUPNCM Jakarta mendapatkan
kejadian retensio urin pasca seksio sesarea sebesar 17,1% jika kateter menetap dipertahankan
6 jam, sedangkan jika dipertahankan 24 jam angka kejadiannya 7,1%. Resiko 2,4 kali lebih
besar terjadi retensio urin jika kateter menetap di pasang 6 jam dibanding 24 jam.
Pada penelitian ini, seluruh kasus retensio urin diklasifikasikan sebagai retensio urin tersamar
(covert) sebanyak 5 kasus (5%) sedangkanretensio urin yang jelas (overt) tidak ditemukan.
Retensio urin yang tersamar diidentifikasikan dengan peningkatan jumlah urin yang masih
tersisa setelah berkemih spontan, sedangkan retensio urin yang jelas menunjukan
ketidakmampuan untuk berkemih secara spontan setelah 6 jam kateter menetap dilepaskan,
dengan tanda-tanda urgensi dan strangulasi. Rizvi dkk mendapatkan insidensi retensio urin
tersamar ditemukan 0,7% sedangkan retensio urin jelas sebesar 0,14%. Retensio urin
tersamar merupakan suatu fenomena yang bersifat self-limiting dimana biasanya volume
residual akan kembali normal dalam 4 hari.6,11 Kejadian retensio urin pasca seksio sesarea
pada pemasangan kateter menetap 12 jam pasca seksio sesarea lebih besar dibandingkan
dengan 24 jam.
Lama kateter menetap dipertahankan pasca seksio sesarea masih bervariasi, Suskhan
mengatakan rasa nyeri luka insisi dinding perut pasca seksio sesarea yang secara reflek
menginduksi spasme dari otot levator yang menyebabkan kontraksi spastik pada sfingter
urethra.
Rasa nyeri ini yang menyebabkan pasien enggan mengkontraksikan otot-otot dinding perut
guna memulai pengeluaran urin yang menyebabkan retensio urin.8,12 Pada penelitian ini
didapatkan kejadian infeksi saluran kemih 11 kasus (22%) pada pemasangan kateter
menetap 12 jam pasca seksio sesarea sedangkan bila pemasangan menetap 24 jam
kejadiannya sebesar 9 kasus (18%). Uji statistik tidak ada perbedaan yang bermakna
(p=0,617) kejadian infeksi saluran kemih pasca seksio sesarea antara pemasangan kateter
menetap 12 jam dan 24 jam pasca seksio sesarea. Jadi pada penelitian ini tidak ditemukan
adanya perbedaan antara lama pemasangan kateter menetap 12 jam atau 24 jam dengan
kejadian infeksi saluran kemih. Berbeda dengan apa yang dikatakan Ghoreishi, semakin lama
kateter dipertahankan, resiko infeksi saluran kemih akan meningkat; Edward dari Centers for
Disease Control and Prevention mengatakan kejadian infeksi

JKM. Vol.8 No.1 Juli 2008: 45 - 51

Saluran kemih tergantung dari cara pemasangan, pengambilan urin, lama pemakaian, dan
kualitas kateter tersebut. Insidensi infeksi saluran kemih meningkat sesuai dengan lamanya
pemakaian kateter, bervariasi sekitar 3- 33%. Untuk menghindari resiko infeksi saluran
kemih, prosedur pemasangan kateter harus steril dan kateter harus bebas dari bakteri.4,5
Sehdev dari Departemen Obstetri dan Ginekologi Universitas Pennsylvania mengatakan, 2-
16% resiko infeksi saluran kemih akibat pemakaian kateter menetap 24 jam pasca seksio
sesarea.
Pada penelitian ini, pemasangan kateter menetap 12 jam pasca seksio sesarea didapatkan
kapasitas kandung kemihnya rerata 402 ml dengan simpangan baku 48,7 ml sedangkan
pada pemasangan kateter menetap 24 jam kapasitas kandung kemih rerata 418,2% dengan
simpangan baku 41,1 ml.
Ada perbedaan bermakna (p=0,038%) diantara dua kelompok. Pada penelitian ini juga
didapatkan volume urin sisa pada pemakaian kateter menetap 12 jam pasca seksio sesarea
rerata 97,7 ml dengan simpangan baku 50,96 ml sedangkan pada pemakaian kateter menetap
24 jam volume urin sisa rerata 55,3 ml dengan simpangan baku 35,36 ml. Volume urin
sisa diukur dari hasil kateterisasi setelah penderita berkemih spontan untuk menilai kasus
retensio urin. Terdapat perbedaan sangat bermakna (p<0,001) volume urin pasca seksio
sesarea antara pemasangan kateter menetap 12 jam dan 24 jam. Hal ini menunjukkan resiko
kejadian retensio urin lebih besar jika pemasangan kateter menetap pasca seksio sesarea lebih
cepat dilepaskan.Ramsay & Torbert dari Departemen Obstetri dan Ginekologi RS Southern
Glasgow, volume residu akan meningkatkan insiden gangguan aliran berkemih sebesar
88,6%.11 Rivzi mendapatkan, resiko dari efek terburuk bila volume residunya antara 500-800
ml yang dapat mengakibatkan kerusakan ireversibilitas dari otot polos detrusor kandung
kemih.
Lamanya pemasangan kateter menetap masih bervariasi karena bila kateter lebih cepat
dilepaskan akan menyebabkan fungsi berkemih ibu belum pulih sehingga dapat terjadi
retensio urin. Pemasangan kateter yang terlalu lama akan memudahkan terjadinya infeksi
saluran kemih sehingga perlu dicari waktu yang ideal lamanya kateter dipertahankan pasca
seksio sesarea.6,11
Simpulan
Tidak ada perbedaan bermakna kejadian retensio urin dan infeksi saluran kemih pada
pemasangan kateter menetap 12 jam dan 24 jam pasca seksio sesarea. Namun ada perbedaan
bermakna volume urin sisa dan kapasitas kandung kemih pada pemasangan kateter menetap
12 dan 24 jam pasca seksio sesarea. Hal ini menunjukkan resiko kejadian retensio urin lebih
besar bila kateter menetap dipertahankan selama 12 jam pasca seksio sesarea. Kejadian
infeksi saluran kemih tergantung dari cara pemasangan, pengambilan urin, lama pemakaian,
dan kualitas kateter tersebut.
Saran
Kateter menetap sebaiknya dipertahankan minimal 24 jam pasca seksio sesarea.
Perbandingan Pemasangan Kateter Menetap selama 12 dan 24 jam Pasca Seksio Sesarea
pada Pencegahan Retensio Urin dan Resiko Infeksi Saluran Kemih (Max Rarung)
Daftar Pustaka
1. Sehdev HM. Caesarean Delivery. Available : : www.emedicine.com/med/topic 3283.htm.
Last update August 6, 2005.
2. Jhonson K. Study find no need to catheterize before c-section. Ob/Gyn News, June 2001:
1-5.
3. Thornhill JA, Fitzpatrick JM. Urinary tract infection. In : Stanton SL, Monga KA Clinical
Urogynecology. 2nd ed. Churchill Livingstone, 2000: 329-41.
4. Ghoreishi J. Indwelling. Urinary catheter in Caesarean Delivery. International Journal Of
Gynaecology and Obstetric 2003; 83 : 267-70.
5. Edward S. Guideline for prevention of catheter – associated urinary tract infection.
Available: www.cdc.gov/gl_catheter_assoc.html. Last update: April 1st, 2005.
6. Rivzi RM, Khan ZS, Khan Z. Diagnosis and Management of post partum urinary
retension. International Journal of Gynaecology and Obststric 2005; 91: 71-2.
7. Pribakti B. Tinjauan kasus retensio urin post pasrum di RSUD Banjarmasin 2002-2003.
Dexa Medica, Januari – Maret 2006; vol 19, no 1; 10-12.
8. Suskhan DJ. Penatalaksanaan retensio urin pasca bedah. Dalam : Junizaf, Eds. Buku Ajar :
Uroginekologi. Sub-bagian Uroginekologi-Rekonstruksi Bagian Obstetri dan Ginekologi
FKUI / RSUPN – CM, Jakarta 2002. hal 63-7.
9. Saultz JW, Tofler WL, Shackles JY. Post pastum urinay retention. Am J Board Fam Pract,
Sept 1991; 4: 341-44.
10. Yip SK, Sahota D, Pang MW, et al. Screening test model using duration of labor for the
detection of post partum urinary retention. Neurology and Urodynamics 2005; 24: 248-53.
11. Ramsay IN, Torbert TE. Incidence of abnormal voiding parameters in the immidiate post
partum period. Neurol Urodyn 2003;
12: 179-83. 12. Kermans G, Wyndale JJ et al. Puerperal
Urinary Retention. Acta Urol Belgica 1996 ; 54 : 376 – 85.

Comparison of Catheter Residential Installation

for 12 and 24 hours post-caesarean section on Prevention
Urine retention and Risk of Urinary Tract Infections
Max Rarung
Department of Obstetrics and Gynecology, Faculty of Medicine, University of Sam
Ratulangi, Hospital Prof.Dr.R.D. Kandou, Manado
Abstract
The objective of this research is to Evaluate the occurance of urinary retension and bladder
infection
Caesarian section in the post after 12 hours and 24 hours of catetherisation. Setting of the
research is Obstetric
D Care Unit Room Prof.Dr.R.D. Kandou Hospital, Manado North Sulawesi. The research
design is Open Clinical Test Research. Subjects are all post Caesarean section surgery
Patients in Central Surgery Unit and Obstetric Surgery Unit Prof.Dr.RDKandou Hospital,
Manado, North Sulawesi. Selection of Patients was based on inclusion and exclusion
cathegory Depending on the possibility to collect Reviews their urine samples.
There were 100 samples from 226 cases based on inclusion cathegory. In this research there
is no significant difference between 12 hours and 24 hours cathetherisation with urine and
bladder retension infection. And there's a significant difference between the volume of
residual urine and bladder capacity with 12 hours and 24 hours cathetherisation.
The conclusion of this research is at least 24 hours cathetherization is suggested to Prevent
urinary retension in post-caesarean section Patients.
Keywords: Urine retension, bladder infection, 12 hours and 24 hours catheterization

Abstract
The purpose of this study was to evaluate the occurrence of urinary retention and bladder
infections
post caesarean section after 12 hours and 24 hours catetherisation. Setting this study was
Midwifery
Room D Care Unit Prof.Dr.R.D. Hospital Kandou, Manado in North Sulawesi. The study
design is Open
Clinical Research Test. Subjects were patients cesarean all posts sectio Surgery Unit and
Center
Surgery Obstetrics Hospital Unit Prof.Dr.RDKandou, Manado, North Sulawesi. Selection of
patients
based on inclusion and exclusion cathegory depend on the possibility to collect their urine
samples.
There were 100 samples from 226 cases based on inclusion cathegory. In this study there was
no
significant difference between 12 hours and 24 hours cathetherisation with urinary retention
and bladder
infection. And there is a significant difference between the volume of residual urine and
bladder capacity by 12
hours and 24 hours cathetherisation. The conclusion of this study is at least 24 hours
cathetherization
recommended to prevent urinary retention after cesarean section patients.
Keywords: Urine retention, bladder infections, 12 hours and 24 hours of catheterization
Preliminary One section preparation Caesarean is catheter folley.
Generally the indications for catheter settled is to urine output, increasing extent of
exposure when Caesarean section the lower segment of the uterus, reducing urinary tract
injury when surgery, evaluate the balance of fluids and prevent retained Urinary post section
sesarea.
Post Caesarean section, catheter settled maintained that bladder Urinary remain empty for
resting bladder and prevent strain Excessive bladder due of spontaneous micturition disorders
can cause urinary retention.
Excessive stretching of This will cause the bladder strain on the detrusor muscle that
slows the emptying function bladder. Disruption of the function The urinary bladder is a
factor predisposing emergence tract infections kemih.
Ghoreishi reported risk catheterization use of labor in Caesarean section would cause a
12- 25% bacteriuria asimptomatis. Sehdev HM say 2-6% the risk of urinary tract infections
permanent catheter 24 hours post sesarea.1 section Rivzi et al found 1.6% of patients who
have an infection urinary tract catheter post section sesarea.
JKM. Vol.8 1 July 2008: 45-51
Postpartum urinary retention is one of the complications that can occur in obstetric
cases. Retained Urine is defined no waste water small spontaneously for 6 hours after vaginal
childbirth. At delivery by Caesarean section defined absence of spontaneous urination 6
hours after the release of the catheter. Event postpartum urinary retention recorded ranged
from 1.7 to 17.9%. Pribakti 9.1% reported urinary retention post Caesarean section in
hospitals Ulin Research Banjarmasin.7 Rizvi et al get a 11.9% retention of urine after
Research sesarea.6 section Suskhan in RSUPNCM 1998 gain incidence of urinary retention
post-section Caesarean of 17.1% if the catheter settled maintained 6 hours.
When maintained 24 hours, at 7.1% .8 The ability of patients to empty the bladder before
occurs excessive distension should monitored. Long catheter settled retained after Caesarean
section still vary. Catheter settled recommended removable 12-hour or 24-hour post section
sesarea.8 Sehdev of Department Obstetrics Gynecology University
Pennsylvania examined contained 3.2% urinary tract infection after childbirth.
Caesarean section because of the use of catheter settled. Sehdev recommends catheter settled
24 hours the Caesarean section to prevent retained urin.
Ghoreishi argue catheter settled maintained 24-48 hours post Caesarean section to prevent
over bladder distension kemih.4 Jhonson advocate for removing the catheter 6 hours post
section sesarea.
Ghoreishi suggests the longer the catheter is maintained, the risk of urinary tract infections
will increased. Edward from the Centers for Disease Control and Prevention said the incident
tract infections Urinary depending on how the installation, making urine, duration of use, and
catheter quality tersebut.4,5 The incidence of urinary tract infections increases with the length
catheter, varies approximately 3- 33%. To avoid the risk of infection urinary tract, the
installation procedure catheter must be sterile and must catheter free of bakteri.7,9,10
Protocol Division Uroginekologi Reconstruction of the Department of Obstetrics
Faculty of Medicine Gynecology / RSUPNCM - Jakarta, permanent catheter is maintained 24
hours post section sesarea. Materials and Methods Research in the form of test Clinical open.
Divided in the form of 2 groups, the first group installed catheter settled after caesarean
section within 12 hours and the second group catheter settled post-section Caesarean within
24 hours. Research performed in Inpatient D Obstetrics Hospital Prof.Dr. R.D. Kandou
Manado to large samples are met.
Subjects were all patients with post-cesarean Installation is done in Surgery Central and
Obstetrics Hospital Surgery Room Prof. Dr R. D. Kandou Manado.
Criteria for inclusion
- Patients with post-cesarean transperitoneal deep.
- Length of operation <= 2 hours
- No previous infection
Exclusion criteria
Comparison of Catheter Residential Installation for 12 and 24 hours post-cesarean
on Prevention and Risk retention Urine Urinary Tract Infection(Max Rarung)
- The presence of a urinary tract infection, intrapartum infection and long pastus prior to
Caesarean section.
- Having trouble urinating prior to Caesarean section.
- Has performed surgery obstetrics such as vacuum extraction or forceps.
- Patients with a general state weak, suffered complications from Direct pregnancy and the
have a disease / disorder which are not directly related with pregnancy.
- Former Caesarean section.
- The patient refused to participate research.
Way
Patients who will be Caesarean section transperitoneal deep catheter folley no. 16 trans
urethra. Subjects who qualify research then determined random, entered the catheter settled
12 hours or 24 hours after Caesarean section.
Once the catheter is settled during 12 hours or 24 hours maintained ago removable.
Research subjects in each group were evaluated for six hours. If the patient can not urination,
subjects entered the study Urinary retention criteria (overt).
Urinary catheterization, measured with a measuring cup and then urinalisa examination.
When patients can be spontaneous urination, urine the exit is measured and immediately
catheterization to determine residual urine in the bladder. When residual urine> = 200 ml, the
subject of research entry criteria urinary retention (covert).
Bladder capacity obtained of the results of measurements on retained urine by adding
volume spontaneous voiding urine results with residual urine volume catheterization results
after catheterization spontaneous.
Measurement of bladder capacity together with the examination urinalisa to assess their
bacteriuria.
In this research, urinalisa simple examination for detecting the presence of bacteriuria.
The Results analysis support towards infection ie with acquired more than 10 leukocytes /
LPB.
Data analysis Analysis of data using devices SPSS for Windows version 15.0
with:
1. Descriptive analysis of the characteristics of the subject.
2. Fisher's Exact Test to test cases of urinary retention post-section Caesarean.
3. Test X2 to examine cases of infection Urinary tract after Caesarean section.
4. t test to test comparison average bladder capacity residual urine volume and duration of the
operation.
Discussion
In the catheter group settled 12 hours and 24 hours largest age is 31-40 years,
respectively 21 cases (42%) and 30 cases (60%).
Based on parity, obtained multiparity are most at catheter group settled 12 hours and 24
h respectively 28 cases (56%) and 27 cases (54%). Ghoreishi and Rizvi get no correlation
retained urine after Caesarean section on age, parity and elective surgery / cito.4,6
The incidence of urinary retention found 4 cases (8%) in catheter settle for 12 hours after
Caesarean section, while in the 24 hours earned events retention of urine 1 case (2%).
Nothing significant difference (p = 0.362) events Urinary retention after the second caesarean
section group. Pribakti reported there 9.1% urinary retention after caesarean section The
Hospital Ulin Banjarmasin. Suskhan of RSUPNCM Jakarta gain incidence of urinary
retention post-section Caesarean of 17.1% if the catheter settled maintained 6 hours, whereas
if it is maintained 24 hours incidence rates of 7.1%. Risk 2.4 times Urinary retention was
greater if catheter settled in post 6 hours than 24 jam.7,8 In this study, the entire cases
classified as urinary retention disguised as urinary retention (covert) as much as 5 cases (5%),
while clear urine retention (overt) not found. Urinary retention disguised identified with the
increase the amount of urine that remains after spontaneous voiding, while retained clear
urine indicates an inability to urinate in spontaneously after 6 hours of catheter settled
released, with signs of urgency and strangulation. Rizvi et al get incidence of urinary
retention disguised found 0.7%, while retention of urine clear of 0.14%. Retention of urine
blind is a phenomenon which is self-limiting where usually residual volume will return
normal in 4 hari.6,11 Incidence of urinary retention post Caesarean section on catheter
settled 12 hours after cesarean greater than 24 hours.

Long catheter settled maintained after Caesarean section is varied, Suskhan said wound pain
incision of the abdominal wall after cesarean which induce a reflex spasm of the levator
muscles that cause spastic contraction of the urethral sphincter.
The pain that causes the patient reluctant to contract the muscles abdominal wall to start
urine output which causes retained urin.8,12 In this study, the incidence of urinary tract
infections 11 cases (22%) on the catheter settled 12 hours after cesarean whereas when
mounting settled 24 time it happened for 9 cases (18%).
Statistical test no differences were significant (p = 0.617) incidence of infection Urinary tract
after caesarean section between the catheter settled 12 hours and 24 hours after Caesarean
section. So in this study was not found the difference between the old catheter settled 12
hours or 24 hours with the incidence of infection urinary tract. In contrast to what Ghoreishi
said, the longer catheter is maintained, the risk of infection Urinary tract will increase;
Edward of the Centers for Disease Control and Prevention said the incidence of infection

JKM. Vol.8 1 July 2008: 45-51

Urinary tract depends on the way installation, making the urine, long use, and the quality
of the catheter The. The incidence of urinary tract infections increases with the length
catheter, varies approximately 3- 33%. To avoid the risk of infection urinary tract, the
installation procedure catheter must be sterile and must catheter free of bakteri.4,5 Sehdev of
Department
Obstetrics and Gynecology, University of Pennsylvania say, 2-16% risk urinary tract
infections resulting from the use catheter settled 24 hours after Caesarean
sesarea.
In this study, installation catheter settled 12 hours after Caesarean Caesarean obtained
bladder capacity bladder average of 402 ml with standard deviation of 48.7 ml while the
catheter settled 24 hour mean bladder capacity 418.2% with a standard deviation of 41.1 ml.
There is a significant difference (p = 0.038%) between the two groups. In this study
also residual urine volume obtained at permanent catheter 12 hours post Caesarean section
with a mean of 97.7 ml standard deviation of 50.96 ml while on a 24-hour settling catheter
mean residual urine volume 55.3 ml with standard deviation of 35.36 ml. The volume of
urine the rest is measured from the catheterization after patients with spontaneous voiding for
assess the case of urine retention.
There a highly significant difference (p <0.001) urine volume after Caesarean section
between catheter settled 12 hours and 24 hours. This indicates a risk greater incidence of
urinary retention ifcatheter settled post Caesarean section more quickly released.
Ramsay & Torbert of the Department Obstetrics and Gynecology Hospital of Southern
Glasgow, residual volume will increased incidence of flow disturbances voiding of 88.6% .11
Rivzi gain, the risk of the worst effects when the volume of the residue between 500-800 ml
which can result in damage irreversibility of the detrusor smooth muscle bladder kemih.
The duration of catheterization settled still vary because if catheter will be released
sooner causing maternal urinary function not recovered so that it can happen retention of
urine. Catheters were too long will make it easier the occurrence of urinary tract infection so
it is necessary to find the ideal time the length of the catheter is maintained post section
sesarea.6,11 Knot There is no significant differencem incidence of urinary retention and
infection urinary tract catheter settled 12 hours and 24 hours post-section Caesarean. But
there is a difference significant residual urine volume and bladder capacity at catheter settled
12 and 24 hours after Caesarean section. This matter shows the incidence of retained risk
urine is greater when the catheter is settled maintained for 12 hours post Caesarean section.
Genesis tract infections Urinary depending on how the installation, making urine, duration of
use, and The catheter quality.
Suggestion Catheters should settle maintained at least 24 hours post Caesarean
section.

Bibliography
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