Value of real-time three-dimensional perineal ultrasound measurement of valsalva diaphragmatic hiatal area in the diagnosis of FPFD and prediction of postoperative outcomes

ObjectiveTo explore the value of real-time three-dimensional perineal ultrasound measurement of valsalva maneuver pelvic diaphragm hole area in the diagnosis of female pelvic floor dysfunction(FPFD) and prediction of postoperative efficacy of patients.

MethodsSixty-two FPFD patients treated with Prolift operation were selected as the research subjects, while 60 non-FPFD patients with three-dimensional vaginal ultrasound examination were set as the control group.The position and shape of uterus, bladder neck descen(BND) and valsalva maneuver area of pelvic diaphragm in two goups were detected using real-time three-dimensional perineal ultrasound.The receiver operating characteristic(ROC) curve was used to analyze the diagnostic value of three-dimensional ultrasound in patients with FPFD.The pelvic diaphragm hole area, perimeter, anteroposterior diameter and left and right diameters in the maximum valsalva state between before and after surgery in the FPFD group were compared, and the evaluation and predictive value of real-time three-dimensional perineal ultrasound on surgical effects were investigated.

ResultsThe ratio of posterior uterus, BND and valsalva maneuver pelvic diaphragm area in FPFD group were higher than those in non-FPFD group(P < 0.01).Taking whether patients with FPFD as the dichotomous variable(no=0, yes=1), the ROC curve analysis of the value of BND and valsalva diaphragmatic hiatal area in diagnosing FPFD was performed.The results of ROC curve analysis showed that the diagnostic cutoff value, area under the prognosis diagnosis curve, sensitivity and specificity of BND were 21.65 mm, 0.814(95%CI: 0.766-0.862), 70.97% and 75.00%, respectively, and the diagnostic cutoff value, area under the prognosis diagnosis curve, sensitivity and specificity of valsalva maneuver pelvic diaphragm hole area were 20.25 cm², 0.867(95%CI: 0.829-0.906), 82.26% and 70.00%, respectively, the diagnostic efficiency of which was higher.The cure rate and recurrence rate of patients in the FPFD group after 3 months of Prolift surgery were 91.94%(57/62) and 8.06%(5/62), respectively.The area, perimeter, anteroposterior diameter and left-right diameter of the pelvic diaphragm hole after 3 months of operation were significantly lower than those before operation(P < 0.01).

ConclusionsThe real-time three-dimensional perineal ultrasound can provide the pelvic floor anatomical information of valsalva maneuver pelvic diaphragm area, which has great value in diagnosing FPFD.At the same time, it can help doctors grasp the recovery of pelvic floor of patients and can be used to predict the postoperative efficacy of patients.