Assessment of pelvic floor dysfunction after total hysterectomy: A preliminary study based on transperineal ultrasound and shear wave elastography

Abstract

Objective

To investigate the application of transperineal ultrasound (TPUS) and shear wave elastography (SWE) in the assessment of pelvic floor dysfunction (PFD) after total hysterectomy and to explore associated imaging indicators.

Methods

Forty-seven women who underwent total hysterectomy and 70 healthy women were prospectively enrolled in our study. We recorded relevant clinical information, including age, body mass index (BMI), and obstetric history. All participants underwent TPUS and SWE examination at rest, during contraction, and during the maximum Valsalva maneuver. The intra- and inter-observer repeatability of SWE measurements was assessed. And the comparison of the imaging parameters between the two groups was conducted. Further receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of TPUS and SWE in predicting PFD.

Results

SWE used in this study to quantify LAM elasticity demonstrated satisfactory repeatability with all ICC values higher than 0.75. The incidence of PFD was significantly higher in the case group compared to the control group (57.45 % vs. 38.57 %, P = 0.045). The sagittal hiatal diameter (SHD) was higher while the thickness of the levator ani muscle (LAM) was lower in the case group compared to the normal group (P < 0.05), and the SHD showed a positive correlation with PFD while LAM showed a negative correlation. The elastic modulus values of E_max and E_mean were significantly increased during contraction in the case group (P = 0.011 and P = 0.029). Further ROC analysis showed that TPUS alone and the combination of TPUS with SWE were both effective in diagnosing PFD than SWE alone (AUC = 0.946, 0.971 and 0.642 respectively).

Conclusion

Our research highlights the significance of the visual assessment of PFD using TPUS and SWE. A widened SHD, a thinned LAM and decreased compliance of LAM during contraction may be correlated with increased PFD.