Evaluating Long-term Pelvic Floor Disorders After Hysterectomy Using Transperineal Ultrasonography

Objective:Female pelvic floor is integrated,and its muscles,nerves,ligaments and other structures are balanced and related to each other.Pelvic floor disorders(PFDs)are a group of diseases caused by weak and damaged pelvic floor support tissues,it mainly manifested as stress urinary incontinence(SUI),pelvic organ prolapse(POP),and sexual dysfunction,etc.The pathogenesis of PFDs is complex and diverse,with pregnancy and delivery being the most important factors.The pelvic floor structure changes after hysterectomy,but the current research on the long-term pelvic floor function after hysterectomy is relatively limited.Most studies focus on the symptoms of PFDs in women after hysterectomy,and there is a lack of in-depth research on the structure and function of the pelvic floor in terms of imaging.Transperineal pelvic floor ultrasound(TPUS)has become the first choice for PFDs evaluation due to its advantages of real-time dynamics and convenient.Therefore,in this study,the combined evaluation of symptomology and TPUS was performed on women 5 years after hysterectomy,so that we have a new understanding of the long-term pelvic floor function and structural status after hysterectomy.Methods: Women who were underwent hysterectomy in Shengjing Hospital affiliated to China Medical University from January 2013 to December 2013 were selected.After phone follow-up,300 women agreed to participate in the study.All subjects had no clinical diagnosis of PFDs.From December 2018 to May 2019,the pelvic floor structure and function questionnaire of Shengjing Hospital and TPUS evaluation were completed,and the evaluation results of 285 women were included in this study.Statistical analysis of the incidence of SUI,vaginal bulging,constipation in the Shengjing Hospital Pelvic Floor Structure and Function Questionnaire and the incidence of abnormal pelvic organs position related to results of TPUS.The risk factors and functional and structure of pelvic floor in women with SUI and abnormal pelvic organs position were further analyzed,and the ROC curve was used to evaluate the diagnostic value of related ultrasound indicators for two disease states.Use Excel 2013 to establish a database,and use SPSS(24.0)statistical analysis software for statistical analysis.The measurement data is expressed as mean ± standard deviation(X ± SD),and the measurement data between groups is tested by t-test.Count data was expressed as a percentage(%).Comparison of count data between groups was performed using the ?2 test or Fisher exact probability method;the test level was statistically significant with P <0.05.Results: 1.By filling in the Shengjing Hospital Pelvic Floor Structure and Function Questionnair,the incidence of SUI in 285 women was 53.68%(153 cases),and the incidence of vaginal bulging was 21.05%(60 cases),and the incidence of constipation was 35.09%(100 cases).According to the results of the questionnaire,285 women were divided into SUI group(153 cases)and non-SUI group(132 cases).2.285 women underwent TPUS examination,the incidence of abnormal pelvic organs position was 50.18%(143 cases),including the incidence of cystocele 48.07%(137 cases),and the incidence of valut prolapse was 5.26%(15 cases),The incidence of rectal bulge was 5.26%(15 cases).285 women were divided into the normal pelvic organ position group(142 cases)and the abnormal pelvic organ position group(143 cases).3.Overweight and obesity are risk factors for SUI;we found that the differences in bladder neck descent(BND)and retrovesical angle(RA)between the SUI groups and non-SUI were statistically significant(P <0.05).Using ROC curve analysis,we found that the values for the diagnosis of SUI of the BND and RA were 19.5mm and 148.5 °,respectively,with sensitivity of 83.0% and 49.7% and specificity of 33.3% and 68.9% and the area under the curve(AUC)was 0.58 and 0.60(P <0.05).4.Vaginal delivery was a risk factor for abnormal pelvic organs position;we found that the differences in levator hiatal lateral diameter(LHLR),levator hiatal anteroposterior diameter(LHAP),and levator hiatal area(LHA)were statistically significant(P <0.05).Using ROC curve analysis,we found that the values for the diagnosis of abnormal pelvic organs position in LHLR,LHAP,and LHA were 4.62 cm,5.59 cm,and 20.34 cm2,respectively with sensitivity of 75.5%,74.1% and 69.2%,and specificity of 67.6%,67.6% and 83.1%,and AUC was were 0.78,0.76 and 0.85(P <0.05).Conclusions: 1.In women who have underwent hysterectomy due to benign lesions,the complexity and specificity of PFDs.2.Overweight and obesity are important risk factor for SUI in women after hysterectomy;urinary tract activity alone cannot objectively assess postoperative SUI.3.Vaginal delivery is an important risk factor for abnormal pelvic organ position in women after hysterectomy,and the structure and function of the levator ani muscle are closely related to the position of the pelvic floor organs.