Effect of round ligament combined with uterosacral ligament suspension in preventing pelvic floor dysfunction after hysterectomy

ObjectiveTo investigate the effect of round ligament combined with uterosacral ligament suspension in preventing pelvic floor dysfunction after hysterectomy, and the risk factors of pelvic floor dysfunction after hysterectomy.

MethodsOne hundred patients undergoing total hysterectomy due to uterine fibroids and adenomyosis were selected as the research subjects, and randomly divided into experimental group and control group, with 50 cases in each group.The patients in the control group underwent conventional laparoscopic total hysterectomy, and the patients in the experimental group underwent round ligament combined with uterosacral ligament suspension on the basis of the control group.The operation conditions(including operation time and blood loss), pelvic floor dysfunction-related conditions including pelvic organ prolapse quantification(POP-Q) score, pelvic floor impact questionnaire-7(PFIQ-7) score, and pelvic organ prolapse/urinary incontinence sexual questionnaire-12(PISQ-12) score were compared between the two groups.The risk factors and protective factors of pelvic floor dysfunction after hysterectomy were analyzed.

ResultsThere was no significant difference in operative blood loss and operative complications between the two groups(P>0.05), and the operation time in the experimental group was longer than that in the control group(P < 0.05).There was no significant difference in POPQ scores between the two groups at 6 months after operation(P>0.05).The POPQ scores at point Bb(the farthest point from the anterior vaginal wall to the hymen), point C(the point in the anterior fornix of vagina or vaginal stump), and point Bp(the point in the posterior vaginal prolapse, farthest from hymen) in the experimental group at 12 months after operation were significantly higher than those in the control group(P < 0.01).There was no significant difference in PFIQ-7 scores between the two groups before operation(P>0.05), and the PFIQ-7 scores in the experimental group at 6 months and 12 months after operation were significantly lower than those in the control group(P < 0.01).There was no significant difference in PISQ-12 scores in the two groups between before and after treatment(P>0.05).Pelvic floor dysfunction was found in 6 cases(12%) in the experimental group and in 15 cases(30%) in the control group, and the incidence of pelvic floor dysfunction in the experimental group was lower than that in the control group(χ²=4.88, P < 0.05).Univariate analysis showed that the proportion of patients with age >50 years, parity >2 times, without round ligament suspension and without early pelvic floor exercise in patients with pelvic floor dysfunction was higher than that of patients without pelvic floor function(P < 0.05 to P < 0.01).Multivariate analysis showed that age, parity and no early pelvic floor exercise were the risk factors for postoperative pelvic floor dysfunction(P < 0.05), and round ligament suspension was a protective factor(P < 0.01).

ConclusionsRound ligament combined with uterosacral ligament suspension can reduce the incidence of pelvic floor dysfunction after hysterectomy, and age >50 years old, parity >2 times and no early pelvic floor exercise are the risk factors of pelvic floor dysfunction after hysterectomy.