Objective To explore the clinical value of pelvic floor ultrasound combined with shear wave elastography(SWE)in predicting pelvic floor dysfunction(PFD)in patients after total hysterectomy.Methods Forty-seven women who underwent total hysterectomy for benign uterine diseases were prospectively included as the case group,and 70 married and fertile women who did not underwent hysterectomy during the same period were included as the control group.Pelvic floor ultrasound was used to measure the thickness of levator ani muscle on both sides,the anteroposterior diameter of levator hiatus,and the distance from the bladder neck to the reference line under resting state and maximum Valsalva maneuver,and the bladder neck mobility was calculated.SWE was used to measure the maximum,minimum and mean of Young's(Emax,Emin,Emean)modulus of the levator ani muscle attached to the inferior pubic branch,the muscle belly and the tail under the resting state and the maximum Valsalva maneuver,and the difference value(ΔEmax,ΔEmin,ΔEmean)were calculated,and the differences of the above parameters between the two groups were compared.Multivariate Logistic regression analysis was used to screen the independent influencing factors of PFD.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy of pelvic floor ultrasound combined with SWE in predicting PFD after total hysterectomy.Results The incidence of PFD in the case group was higher than that in the control group(59.6%vs.42.9%),and the difference was statistically significant(P=0.005).The distance from the bladder neck to the reference line under the maximum Valsalva maneuver,the mobility of the bladder neck in the case group were significantly higher than those in the control group(all P<0.05).The thickness of levator ani muscle on both sides in the case group were lower than those in the control group at resting state and maximum Valsalva maneuver,and the anteroposterior diameter of levator hiatus was higher than that in the control group,with statistically significant differences(all P<0.05).The Emax,Emin and Emean of the levator ani muscle attached to the inferior pubic branch,the muscle belly and the tail side in the case group were higher than those in the control group at resting state and maximum Valsalva maneuver,and ΔEmax,ΔEmin and ΔEmean were lower than those in the control group,with statistically significant differences(all P<0.05).Multivariate Logistic regression analysis showed that the anteroposterior diameter of levator hiatus under maximum Valsalva maneuver,Emax of the left levator anal muscle under maximum Valsalva maneuver,ΔEmax and ΔEmean of the left levator anal muscle were independent risk factors for PFD(all P<0.05).ROC curve analysis showed that the areas under the curve for diagnosing PFD after total hysterectomy using the anteroposterior diameter of levator hiatus during maximum Valsalva maneuver,the Emax of the left levator ani muscle belly during maximum Valsalva maneuver,and the ΔEmax and ΔEmean of the left levator ani muscle belly,both individually and combined,were 0.776,0.721,0.625,0.860 and 0.964,respectively.The area under the curve of combined diagnosis was the highest,the corresponding sensitivity was 97.4%,and the specificity was 80.0%.Conclusion Pelvic floor ultrasound combined with SWE can accurately predict PFD in patients after total hysterectomy,and has certain clinical application value.
Ultrasonography,pelvic floorShear wave elastographyTotal hysterectomyLevator ani musclePelvic floor dysfunction
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