Quantitative assessment of pelvic floor alterations following hysterectomy and bilateral adnexectomy using shear wave elastography and ultrasonography: a retrospective case-control study

Background: Despite the high prevalence of hysterectomy, the procedure is associated with a significant risk of subsequent pelvic floor dysfunction (PFD). This study aimed to evaluate pelvic floor alterations following hysterectomy and bilateral adnexectomy using real-time shear wave elastography (SWE) and pelvic floor ultrasonography. Methods: This is a retrospective case-control study. A total of 133 patients who underwent hysterectomy and bilateral adnexectomy for benign or malignant pelvic conditions were included. Participants were categorized into three groups based on the time elapsed since surgery: less than 1 year (n=41), 1–3 years (n=45), and more than 3 years (n=47). Additionally, 45 healthy individuals without a history of hysterectomy or bilateral adnexectomy were enrolled as the control group. Pelvic floor ultrasonography was performed to assess parameters at rest and during the Valsalva maneuver. Real-time SWE was used to measure the elasticity of the anterior, middle, and posterior regions of the bilateral puborectalis (PR) muscle during rest, pelvic floor muscle contraction, and the Valsalva maneuver. Comparisons between two groups were conducted using independent t-tests, whereas multiple group comparisons were analyzed using analysis of variance (ANOVA). For intra-group comparisons, paired sample t-tests were used. Results: Pelvic floor ultrasonography revealed that, compared to the control group, all postoperative groups exhibited a reduced urethral inclination angle at rest and an increased angle during the Valsalva maneuver (P