Junizaf Junizaf
Faculty of Medicine University of Indonesia/ Dr. Cipto Mangunkusomo Hospital Jakarta

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Comparison of effectiveness and side effects of complaints on the use of Sodium dioctyl Sulfosuksinat (DSS)-Sorbitol and Glycerin Klisma for pre-operative preparation in the Department of Obstetrics and Gynecology, Dr . Cipto Mangunkusumo Hospital Valleria, Valleria; Santoso, Budi Iman; Junizaf, Junizaf
Indonesian Journal of Obstetrics and Gynecology Vol. 32 No. 1 january 2008
Publisher : Indonesian Journal of Obstetrics and Gynecology

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AbstractObjective: To compare effectiveness, and side effects of DSS-Sorbitol and glycerin enema for rectal cleansing before elective obstetrics and gynecologic surgery. Design/data identification: Single blind clinical trial. Material and methods: This research was performed on 180 patients who scheduled undergo elective surgery at Department of Obstetrics and Gynecology Cipto Mangunkusumo Hospital, divided to 2 groups i.e. DSS-Sorbitol group (90 patients) and glycerin enema group (90 patients) then randomized. Patients then being asked about their complain and noted on the questionnaire. During the operation, the operator monitored the stool that might be contaminated the operating table.Results: There were 3 (3.3%) patients in glycerin enema group which their faeces contaminated the operating table while in the DSSSorbitol group there was 1 patient (1.1%). No significant difference. Almost all the patients (81 patients) felt comfortable with DSS-Sorbitol if compare with glycerin enema, only 9 patients stated not comfortable with DSS-Sorbitol. Meanwhile, in the glycerin enema group there were 30 patients who did not feel comfortable. This difference was tatistically significant {p = 0.000; OR = 4.50 (1.99 - 10.18)}. There were 58 patients (32%) who had complain which were 42 patients (46.7%) from glycerin enema group and 16 patients (17.8%) from DSS-Sorbitol group. The most frequent complain was abdominal cramp (40 patients from glycerin enema and 10 patient from DSS-Sorbitol group). Other complains that were found in the 2 groups were nausea (2 patients from DSS-Sorbitol and 1 patient from glycerin enema group), cephalgia (2 patients from DSS-Sorbitol and 1 from glycerin enema group), no defecation (1 patients from DSS-Sorbitol and 3 from glycerin enema group). The complain such as bloody stool (3 patients), puffy (3 patients) and the aplicator was hot (1 patient) were only found in the glycerin enema group. One hundred and forty four patients stated their willingness to have rectal cleansing again, which was the most came from the DSSSorbitol group. This willingness were affected by comfortableness and the complain that were caused by each methods.Conclusion: The use of glycerin enema had the same effectiveness with DSS-Sorbitol but DSS-Sorbitol more comfortable and less complains than glycerin enema.Keywords: DSS-Sorbitol, glycerin, preoperative preparation
The prevalence of patients with overactive Bladder on female employees in the Department of Obstetrics and Gynecology Dr. Cipto Mangunkusumo hospital in Jakarta Agustina, N.; Santoso, Budi Iman; Junizaf, Junizaf
Indonesian Journal of Obstetrics and Gynecology Vol. 32. No. 2. April 2008
Publisher : Indonesian Journal of Obstetrics and Gynecology

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Objective: To determine the prevalence of overactive bladder (OAB) among female employees at the Department of Obstetric and Gynaecology in Cipto Mangunkusumo Hospital and to understand the tendency of some risk factors that could cause OAB such as age, parity, previous delivery mode, menopause, obesity, and previous hystorgof hysterectomy.Design/data identification: Observational study with cross sectional approach.Material and method: 250 samples of female employees were collected from the Department of Obstetrics and Gynecology Cipto Mangunkusumo hospital. All of them were randomly chosen from those who fulfilled the inclusion criterias, without limitation of age. All of the samples who had OAB symptoms (e.g urgency, frequency, nocturia, with or without urge incontinence) underwent urinalysis and physical examination. Urinary diary had been taken to prove the OAB symptoms if theurinalysis was within normal limit. The term OAB is appropriate if there is no proven infection or other obvious pathology.Results: Among two hundred and fifty samples, there were 86 samples (35.6%) of urinary incontinence and there were 66 samples had had OAB symptoms (e.g urgency, frequency, nocturia, with or without urge incontinence) according to The International Continence Society (ICS) in 2002. The mean age of subjects were 40.8 with the youngest was 20 years old and the oldest was 65 years old, which most of them were in age group 40 - 49 years (36%). All of the subjects who showed OAB symptoms had underwent urinalysis for detecting the presence of bacteriuria, pyuria, glycosuria, and hematuria. Within the sixty-six samples there were 40 samples (60.6%) who had normal urinalysis, 21 samples (31.8%) were glycosuria, and 5 samples (7.5%) were urinary infection. And after being confirmed by urinary diary and physical examination, there were only 39 respondents who had really had OAB symptoms with normal urinalysis and normal physical examination. Among these female employees, the prevalence of OAB was 15.6% and 12.4% was OAB with SIU (mixed type). And there were the tendencies for being OAB at increasing of age, parity, previous delivery mode, menopause status, obesity, and previous hysterectomy.Conclusion: The prevalence of OAB among female employees at the Department of Obstetrics and Gynecology in Cipto Mangunkusumo hospital was 15.6%. There were the tendencies for being OAB at increasing of age, parity, previous delivery mode, menopause status, obesity, and previous hysterectomy.Keywords: overactive bladder, urge incontinence, stress urinary incontinence, urinary diary
Unicornuate Uterus with Rudimentary Horn and Complicated with Endometriosis Wijaya, Liva; Junizaf, Junizaf; Anggraini, Shirley; Nurung, Djoni; Prijono, Prijono; Punarbawa, Punarbawa
Indonesian Journal of Obstetrics and Gynecology Vol. 1. No. 4 October 2013
Publisher : Indonesian Journal of Obstetrics and Gynecology

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Objective: To report the congenital abnormalities of mullerian duct and review its literature.Methods: Case report.Case: A sixteen years old unmarried woman came to our policlinic with chief complain of cyclical abdominal pain (VAS 6). She had regular menstruation. In other hospital, she had diagnosed as suffering from ovarian tumor. Our examination showed that the uterus was unicornuate with rudimentary horn. We did explorative laparotomy. We took out the left cornu and left salpingoophorectomy due to hematosalphing and endometrial cyst. The Visual analogue score after surgery was reduced until VAS 2. Conclusion: Congenital abnormalities of the müllerian ducts are relatively common. Comprehensive examination can diagnose this abnormality earlier, thus intervention can be given as soon as possible.Keywords: abnormalities müllerian ductus, endometriosis
IIIB-IV Degree Perineal Rupture Repair Using Overlapping and End-to-End Techniques with Pudendal Block Anesthesia Pangastuti, Nuring; Junizaf, Junizaf; Pranoto, Ibnu; Santoso, Budi I; Priyatini, Tyas
Indonesian Journal of Obstetrics and Gynecology Volume. 3, No. 3, July 2015
Publisher : Indonesian Socety of Obstetrics and Gynecology

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (261.26 KB) | DOI: 10.32771/inajog.v3i3.46

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Objective: To compare the incidence of persistent sonographic anal sphincter defect, fecal urgency, anal and fecal incontinence after IIIb- IV degree perineal rupture repair using overlapping and end-to-end technique. Method: An open clinical trial with randomization was carried out in July 2010-April 2012. The population consisted of the patients who underwent vaginal delivery in Dr. Sardjito Central General Hospital, Sleman District General Hospital, as well as Tegalrejo, Jetis and Mergangsan Community Health Centers who did no have complaints of fecal urgency, anal incontinence, and/or fecal incontinence, and suffered IIIb-IV degree perineal rupture repaired within less than 24 hours of rupture. The exclusion criteria included conditions in which patients could not undergo repair at the moment (shock, uncooperative patient). Fourty-eight research samples were divided into 2 groups, 24 samples for each of the treatment group (overlapping repair) and the control group (end-to-end repair). Local anesthesia was performed in a pudendal-block manner. Result: Success of the repair was assessed based on the presence of persistent sonographic anal sphincter defects in the 6-week evaluation after repair. Successful repair was higher in the overlapping group than that of the end-to-end group (94.74% vs 81.25%, p=0.31). Clinically and based on the Fecal Continence Scoring Scale (FCSS), evaluation at weeks II and VI indicated successful repair in both groups. Conclusion: There was no difference in the incidence of persistent sonographic anal sphincter defects, fecal urgency, anal incontinence, and fecal incontinence, after IIIb-IV degree perineal rupture repair using overlapping technique in comparison with end-to-end technique. Keywords: end-to-end technique, III-IV degree perineal rupture, obstetric perineal rupture, overlapping technique
Laceration Extension in Median and Mediolateral Episiotomy Utama, Bobby I; Junizaf, Junizaf; Santoso, Budi I; Ermawati, Ermawati; Hakim, Surahman
Indonesian Journal of Obstetrics and Gynecology Vol. 3. No. 1 January 2015
Publisher : Indonesian Journal of Obstetrics and Gynecology

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Objective: To compare the laceration extension between median and mediolateral episiotomy in women with perineal body sized more than 2.5 cm.Method: A single‐blind RCT study was conducted on 104 women receiving median episiotomy and 104 women receiving mediolateral episiotomy at Dr. M. Djamil Hospital Padang and Reksodiwiryo MilitaryHospital Padang.Result: There was no difference in laceration extension in both groups, but pain in the first 24 hours and pain after day 14 was higher on mediolateral group than the median group (p=0.005 and p=0.008, respectively).Conclusion: There is no difference in terms of laceration extension between median and mediolateral episiotomy, but the pain is higher in the mediolateral group.Keywords: laceration extension, median episiotomy, mediolateralepisiotomy
Prevalence and risk factors of persistent stress urinary incontinence at three months postpartum in Indonesian women Fakhrizal, Edy; Priyatini, Tyas; Santoso, Budi I.; Junizaf, Junizaf; Moegni, Fernandi; Djusad, Suskhan; Hakim, Surahman; Maryuni, Sri W.
Medical Journal of Indonesia Vol 25, No 3 (2016): September
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (435.805 KB) | DOI: 10.13181/mji.v25i3.1407

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Background: Mode of delivery and some certain risk factors have a relationship to postpartum stress urinary incontinence (SUI). For that reason, the objective of this study was to assess the prevalence of postpartum stress urinary incontinence (SUI), the relationship between postpartum SUI and mode of delivery; and the association between SUI and other demographic and obstetric factors.Methods: In this prospective observational cohort study, all primiparous women who were under postpartum care in obstetric and gynecologic ward were recruited. Four hundreds primiparous women with no history of urinary incontinence (UI) who fulfilled the criteria and would like to participate in this study were followed up for three months after delivery. The analysis was done using Stata 12. Bivariate analysis using Chi-square test and multivariate analysis using logistic regression test were done to obtain associated risk factors to postpartum SUI.Results: The prevalence of postpartum SUI was 8.8%. The mode of delivery was significantly associated with postpartum SUI, there were more women who got vaginal delivery that had stress urinary incontinence (14.1%) compared to women caesarean section (7.1%) with OR=2.1 (95% CI=1.05-4.31), this risk increased when vaginal delivery was assisted with vacuum instrument (OR=9.1, 95% CI=3.9-21.6). There was no statistical difference of stress urinary incontinence incidences in patients with emergency or elective caesarean section with OR=0.84 (95% CI=0.28-2.57). Based on multivariate analysis BMI ≥30 kg/m2 at labor, vacuum assisted delivery, birth weight more than 3,360 g, and second stage labor more than 60 minutes appeared to be associated with an increased rate of postpartum SUI.Conclusion: Stress urinary incontinence increased in the early postpartum period of a primiparous woman. Although vaginal delivery increased the risk of postpartum SUI, elective nor emergency caesarean delivery without vaginal delivery id not appear to increase the risk of stress urinary incontinence.
Laceration Extension in Median and Mediolateral Episiotomy Utama, Bobby I; Junizaf, Junizaf; Santoso, Budi I; Ermawati, Ermawati; Hakim, Surahman
Indonesian Journal of Obstetrics and Gynecology Volume. 3, No. 1, January 2015
Publisher : Indonesian Socety of Obstetrics and Gynecology

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (137.647 KB) | DOI: 10.32771/inajog.v3i1.24

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Objective: To compare the laceration extension between median and mediolateral episiotomy in women with perineal body sized more than 2.5 cm. Method: A single‐blind RCT study was conducted on 104 women receiving median episiotomy and 104 women receiving mediolateral episiotomy at Dr. M. Djamil Hospital Padang and Reksodiwiryo Military Hospital Padang. Result: There was no difference in laceration extension in both groups, but pain in the first 24 hours and pain after day 14 was higher on mediolateral group than the median group (p=0.005 and p=0.008, respectively). Conclusion: There is no difference in terms of laceration extension between median and mediolateral episiotomy, but the pain is higher in the mediolateral group. [Indones J Obstet Gynecol 2015; 1: 38‐43] Keywords: laceration extension, median episiotomy, mediolateral episiotomy
Korelasi Akurasi antara Kateter dengan Ultrasonografi Transabdominal untuk Mengukur Volume Kandung Kemih DEWI, T. I.; Santoso, Budi I; KARSONO, B.; JUNIZAF, JUNIZAF
Indonesian Journal of Obstetrics and Gynecology Volume. 30, No. 2, April 2006
Publisher : Indonesian Socety of Obstetrics and Gynecology

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Tujuan: Mencari korelasi antara kateterisasi dengan USG transabdominal untuk mengukur volume KK dan volume urin sisa dan menentukan nilai diagnostik USG transabdominal untuk mendiagnosa retensio urin. Rancangan penelitian: Penelitian ini merupakan studi observasional analitik dengan rancangan potong lintang (cross sectional) untuk menilai korelasi dan menentukan nilai diagnostik. Tempat penelitian: (1) Klinik Anggrek Divisi Fetomaternal Departemen Obstetri dan Ginekologi RS Dr. Cipto Mangunkusumo (RSCM), (2) IGD Lt. III RSCM. Bahan dan cara kerja: Selama kurun Oktober 2003 sampai Agustus 2004, dilakukan pengukuran volume KK dan volume urin sisa pada 90 pasien postpartum nifas hari pertama, kedua dan ketiga. Volume KK dan volume urin sisa diukur secara USG transabdominal dibandingkan dengan hasil pengukuran secara kateterisasi yang merupakan baku emas. Volume KK dianggap merupakan kapasitas KK dan volume urin sisa ialah urin yang masih terdapat dalam KK segera setelah pasien berkemih. USG transabdomina1 digunakan untuk mendiagnosa adanya retensio urin dengan titik potong urin sisa 200 ml dan kateterisasi sebagai baku emas. Dilakukan 3 formula USG (formula 1, 2 dan 3). Hasil: Untuk pengukuran volume KK didapatkan korelasi yang kuat antara USG formula 1, 2 dan 3 dengan tindakan kateterisasi, masingmasing dengan R 0,84, 0,87 dan 0,80, tapi hanya formula 2 USG yang menghasilkan pengukuran volume KK yang tidak berbeda bermakna dengan tindakan kateterisasi. Pada pengukuran volume urin sisa didapatkan korelasi yang kuat antara USG formula 1, 2 dan 3 dengan kateterisasi masing-masing R 0,85, 0,87 dan 0,85, juga hanya formula 2 yang menghasilkan pengukuran urin sisa yang tidak berbeda bermakna dengan tindakan kateterisasi. USG formula 2 dapat mendiagnosa kondisi retensio urin dengan Se 87%, Sp 95,5%, NDP (nilai duga positif) 87% dan NDN (nilai duga negatif) 96%. Kesimpulan: Pengukuran volume KK dan volume urin sisa secara ultrasonografi transabdominal mempunyai korelasi yang kuat dengan tindakan kateterisasi. Sehingga USG transabdominal dapat dijadikan sebagai alternatif dari penggunaan kateter. Hal ini akan membuat tindakan kateterisasi menjadi lebih selektif. Terutama dalam hal diagnostik seperti kondisi retensio urin, sehingga penggunaan USG transabdominal akan mengurangi efek samping berupa infeksi dan trauma akibat penggunaan kateter yang bersifat invasif. [Maj Obstet Ginekol Indones 2006; 30-2: 104-11] Kata kunci: vo1ume KK, volume urin sisa. USG transabdominal, kateterisasi.
Prevalensi penderita Overactive Bladder pada pegawai perempuan di lingkungan Departemen Obstetri dan Ginekologi RSUPN Dr. Cipto Mangunkusumo Jakarta AGUSTINA, N.; SANTOSO, B. I.; JUNIZAF, JUNIZAF
Indonesian Journal of Obstetrics and Gynecology Volume. 32, No. 2, April 2008
Publisher : Indonesian Socety of Obstetrics and Gynecology

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Tujuan: Mengetahui prevalensi penderita overactive bladder (OAB) pada pegawai perempuan di Lingkungan Departemen Obstetri dan Ginekologi RSUPN Dr. Cipto Mangunkusumo Jakarta serta mengetahui sebaran gangguan OAB tersebut menurut beberapa faktor risiko seperti usia, paritas, cara persalinan, status menopause, obesitas dan riwayat operasi histerektomi. Rancangan/rumusan data: Studi observasional deskriptif dengan rancangan potong lintang. Bahan dan cara kerja: Penelitian ini dilakukan pada 250 orang responden yang bekerja di lingkungan Departemen Obstetri dan Ginekologi RSUPN Dr. Cipto Mangunkusumo Jakarta yang memenuhi kriteria, tanpa batasan usia, yang dipilih secara acak. Lalu diberikan kuesioner yang terdiri dari beberapa pertanyaan dan dilakukan pengukuran tinggi dan berat badan untuk menentukan besarnya nilai indeks massa tubuh (IMT) responden tersebut. Bagi responden yang menunjukkan gejala-gejala OAB dilakukan pemeriksaan urinalisa untuk menyingkirkan adanya infeksi saluran kemih maupun glukosuria. Kemudian bagi responden yang memiliki hasil urinalisa dalam batas normal diberikan lembaran daftar harian berkemih untuk membuktikan adanya pola gangguan OAB. Responden yang terbukti mengalami gangguan OAB tersebut selanjutnya dilakukan pemeriksaan fisik guna menyingkirkan adanya kelainan organ. Hasil: Dari 250 orang responden didapatkan 89 orang (35,6%) yang mengaku mengalami gangguan berkemih (inkontinensia urin) dan sebanyak 66 orang di antaranya menunjukkan gejala klinis OAB sesuai definisi yang telah ditetapkan oleh The International Continence Society (ICS) tahun 2002. Rerata usia subjek penelitian OAB ini adalah 40,8 tahun dengan usia termuda 20 tahun dan usia tertua responden adalah 65 tahun. Responden terbanyak adalah pada kelompok usia 40 hingga 49 tahun yaitu sebanyak 90 orang (36%). Dari 66 orang responden yang menunjukkan gejala OAB terdapat 40 orang (60,6%) yang memiliki hasil urinalisa dalam batas normal, terdapat 21 orang (31,8%) glukosuria, dan yang terdeteksi adanya infeksi saluran kemih (ISK) pada penelitian ini ada 5 orang (7,5%). Setelah dikonfirmasi melalui lembaran daftar harian berkemih pada 40 orang responden yang dicurigai menderita OAB tersebut yaitu yang mempunyai hasil urinalisa dalam batas normal, didapatkan 39 responden yang terbukti menderita gangguan OAB serta tidak ditemukan adanya kelainan pada pemeriksaan fisik. Sehingga ketigapuluhsembilan orang inilah yang akhirnya didiagnosa sebagai penderita OAB (15,6) dengan 31 orang di antaranya merupakan tipe campuran, yaitu selain menderita SIU ia juga menderita OAB secara bersamaan. Usia rerata subjek penderita OAB yang berjumlah 39 orang tersebut adalah 44,5 tahun dengan nilai SD 7,5. Pada penelitian ini terlihat kecenderungan timbulnya gangguan OAB dengan pertambahan usia, cara persalinan pervaginam khususnya dengan bantuan ekstraksi vakum, jumlah paritas, status menopause, obesitas serta riwayat operasi histerektomi. Kesimpulan: Prevalensi penderita OAB pada pegawai perempuan yang bekerja di lingkungan Departemen Obstetri dan Ginekologi RSUPNCM Jakarta adalah 15,6% (39 orang). Faktor usia, cara persalinan, paritas, status menopause, obesitas, dan riwayat operasi histerektomi merupakan faktor-faktor yang cenderung berpengaruh terhadap timbulnya gangguan OAB. [Maj Obstet Ginekol Indones 2008; 32-2: 82-92] Kata kunci: overactive bladder, urge inkontinensia, stres inkontinensia urin, daftar harian berkemih
Perbandingan efektivitas dan keluhan efek samping pada penggunaan Dioktil Sodium Sulfosuksinat (DSS)-Sorbitol dan Klisma Gliserin untuk persiapan pra-operasi di Departemen Obstetri dan Ginekologi RSUPN Dr. Cipto Mangunkusumo VALLERIA, VALLERIA; SANTOSO, B. I.; JUNIZAF, JUNIZAF
Indonesian Journal of Obstetrics and Gynecology Volume. 32, No. 1, January 2008
Publisher : Indonesian Socety of Obstetrics and Gynecology

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Tujuan: Untuk mengetahui perbandingan antara pemakaian DSSSorbitol dengan klisma gliserin untuk persiapan pra-operasi dalam hal efektivitas, kenyamanan dan keluhan (efek samping) yang ditimbulkan keduanya. Rancangan/rumusan data: Uji klinis tersamar tunggal. Bahan dan cara kerja: Penelitian ini dimulai pada tanggal 1 April 2006 selama 6 bulan, dilakukan pada 180 orang pasien yang akan menjalani pembedahan elektif di departemen obstetri dan ginekologi RSCM, dibagi atas 2 kelompok yaitu kelompok yang diberi DSS-Sorbitol (90 orang) dan kelompok yang dilakukan klisma gliserin (90 orang). Pengambilan sampel dilakukan secara random. Setelah perlakuan, pasien ditanyakan keluhannya dan dicatat pada kuesioner kemudian selama operasi berlangsung dilakukan pengamatan dan pencatatan apakah ada feses yang keluar di meja operasi. Hasil: Pada kelompok gliserin didapatkan 3 pasien (3,3%) keluar feses saat operasi sedangkan pada kelompok DSS-Sorbitol didapatkan 1 pasien (1,1%). Tidak terdapat perbedaan bermakna antara kedua kelompok. Hampir sebagian besar pasien merasa nyaman dengan pemberian DSS-Sorbitol (81 orang) hanya 9 orang yang menyatakan tidak nyaman. Sedangkan pada kelompok gliserin terdapat 30 orang yang merasa tidak nyaman dan perbedaan ini sangat bermakna {p = 0.000; OR = 4.50 (1.99 - 10.18)}. Terdapat 58 pasien (32,2%) yang mengeluh saat dilakukan klisma atau pemberian DSS-Sorbitol dengan 9 orang diantaranya mempunyai keluhan lebih dari satu (8 orang dari kelompok gliserin dan 1 orang dari kelompok DSS-Sorbitol). Dari 58 pasien tersebut, 42 orang di antaranya diberikan gliserin (46,7%) dan sisanya, 16 orang diberikan DSS-Sorbitol (17,8%). Keluhan yang paling banyak adalah mulas, dikeluhkan oleh 40 pasien dari kelompok gliserin dan 10 pasien dari kelompok DSS-Sorbitol. Keluhan yang lain adalah mual (2 dari kelompok DSS-Sorbitol, 1 dari kelompok gliserin), pusing (2 dari kelompok DSS-Sorbitol, 1 dari kelompok gliserin), dan feses tidak keluar (1 dari kelompok DSS-Sorbitol, 3 dari kelompok gliserin) ditemukan pada kedua kelompok sedangkan keluhan kembung (3 orang), feses berdarah (3 orang) dan alat panas (1 orang) hanya ditemukan pada kelompok gliserin. Sebanyak 114 pasien menyatakan bersedia untuk diulangi persiapan pra-operasi pembersihan rektum ini, dengan proporsi lebih banyak yang bersedia dari kelompok DSS-Sorbitol, tetapi perbedaan tersebut tidak bermakna. Dari perhitungan statistik ternyata kesediaan pasien untuk diberikan kembali klisma gliserin atau DSS-Sorbitol sangat dipengaruhi oleh rasa nyaman dan keluhan yang ditimbulkan oleh masingmasing cara. Kesimpulan: Pemakaian klisma gliserin sama efektifnya dengan pemberian DSS-Sorbitol, namun pemberian DSS-Sorbitol lebih nyaman dan menimbulkan keluhan yang lebih sedikit. [Maj Obstet Ginekol Indones 2008; 32-1: 55-62] Kata kunci: DSS-Sorbitol, gliserin, persiapan pra-operasi