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 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<0.05). The levator hiatus area (LHA) was significantly larger during the Valsalva maneuver in all postoperative groups compared to the control group (P<0.05). Patients in the 1-3 years and more than 3 years post-surgery groups demonstrated reduced distance from the anterior urethrovesical junction to the reference line and posterior bladder wall distance during both rest and the Valsalva maneuver compared to the control group (P<0.05). Additionally, the more than 3 years post-surgery group indicated an increased bladder neck mobility during the Valsalva maneuver. Real-time SWE measurements showed that PR elasticity was highest during pelvic floor muscle contraction in the control group, followed by the Valsalva maneuver and rest. Among the postoperative groups, PR elasticity at rest was lower than it was in the control group (P<0.05), with further reductions observed during pelvic floor muscle contraction in the 1-3 years and more than 3 years post-surgery groups. Conclusions: Real-time SWE and ultrasonography reveal that hysterectomy with bilateral adnexectomy leads to progressive, quantifiable declines in pelvic floor muscle elasticity and structural support. These findings provide objective biomarkers for postoperative assessment and potential targets for personalized rehabilitation.