Multidimensional Evaluation Of Pelvic Floor Function After Total Hysterectomy

Objective: To explore the effect of total hysterectomy on pelvic floor function.Methods: From November 2017 to August 2018,36 patients underwent hysterectomy due to benign uterine lesions admitted to Dalian Obstetrics and Gynecology Hospital affiliated to Dalian Medical University were selected and proved to be benign uterine lesions by postoperative pathology.Pelvic floor function symptom questionnaire summary table 20(PFDI-20),pelvic floor function impact questionnaire summary table7(PFIQ-7),pelvic organ prolapse POP-Q index,pelvic floor muscle strength determination,and pelvic floor three-dimensional ultrasound examination were used to evaluate the pelvic floor condition and pelvic floor function of patients before and 6months after operation.Results:Of the 36 patients,30 completed follow-up and related examinations within 6months after operation,and 6 lost patients.Therefore,the results of preoperative and postoperative examinations of 30 patients were analyzed and summarized.The results were as follows: the overall score of PFDI-20 decreased with statistical significance(Z=-3.758,P=0.000).The scores of POPDI-6,CARDI-8 and UDI-6 in the three scales of PFDI-20 were lower than those before operation,and the differences were statistically significant(Z1=-3.296,P1=0.001;Z2=-2.817;P2=0.005;Z3=-2.066;P3=0.039).There was no statistically significant difference in the overall score of PFIQ-7(Z=-1.841,P=0.066).in the three scales of PFIQ-7,there was no statistically significant difference in the score changes of UIQ-7,CARIQ-7 and POPIQ-7(Z1=-1.000,P1=0.317;Z2=0.000,P2=1.000;Z3=-1.633,P3=0.102).There were 26 cases of anterior vaginal wall swelling unchanged before and after operation,1 case of aggravated swelling,3 cases of improved swelling,25 cases of unchanged posterior vaginal wall swelling before and after operation,1 case of aggravated swelling,4 cases of improved swelling.The changes of swelling were not statistically significant(Z1=-0.561,P1=0.575;Z2=-0.732,P2=0.464).There were 15 cases of pelvic floor muscletype I muscle strength unchanged,7 cases of muscle strength increasing,8 cases of muscle strength decreasing,11 cases of muscle type II muscle strength unchanged,9cases of muscle strength increasing,10 cases of muscle strength decreasing.Overall,the pelvic floor type I muscle strength decreased and class II muscle strength increased after operation,but the difference was not statistically significant(Z1=-0.402,P1=0.688,Z2=-1.321,P2=0.186);Fatigue of muscle strength increased with no significant difference(Z1=-1.008,P1=0.313;Z2=-1.886,P2=0.059);There was no significant difference in vaginal dynamic pressure(t=1.276,P=0.212).Analysis of pelvic floor ultrasound examination results: compared with before operation,the distance between bladder neck and pubic symphysis in resting state after operation is increased,and the difference between groups is statistically significant(t=-23.298,P=0.003).The distance between bladder neck and pubic symphysis decreased in Valsalva state,but there was no significant difference between groups(Z=-0.769,P=0.442).The bladder neck mobility increased after operation,and there was no significant difference between groups(t=-0.984,P=0.325).The area of fissure in levator ani decreased,and there was no significant difference between groups(t=-0.873,P=0.383).In resting state,the posterior horn of bladder and urethra of 30 patients were complete before and after operation,and the posterior horn of urethra was closed.In Valsalva state,the opening of posterior horn of bladder and urethra increased compared with that before operation.Postoperative closure of internal urethral orifice was more frequent than before,but there was no significant difference between the two indexes(?2=2.443,P1=0.118,?2=0.162,P2=0.668).In resting state,the rectum of 30 patients is located on the pubic symphysis horizontal line before and after operation.in Valsalva state,the rectum located on the pubic symphysis horizontal line after operation is increased compared with that before operation,and the rectum located below the pubic symphysis horizontal line is decreased compared with that before operation,but the difference between the groups is not statistically significant(?2=2.783,P=0.095).According to pelvic floorcolor Doppler ultrasound evaluation,postoperative bladder mild turgor increased compared with preoperative,but the difference was not statistically significant(Z1=1.074,P1=0.584).There was an increase of 1 case with no rectocele after operation compared with that before operation,and 1 case with obvious rectocele before operation had no rectocele after operation,but the difference was not statistically significant(Z2=1.019,P2=0.601).Conclusion: The results show that there is no adverse effect on pelvic floor function 6months after total hysterectomy,and it can improve the symptoms of urination abnormality,defecation abnormality,pelvic cavity and lower genital tract discomfort caused by uterine diseases.However,further research is needed on whether pelvic floor function changes will occur in patients undergoing hysterectomy in the long term.