International Journal of Clinical Case Reports, 2025, Vol.15, No.1, 34-43 http://medscipublisher.com/index.php/ijccr 36 Tissue scarring is another significant contributor to PFD. The healing process following surgery often involves the formation of scar tissue, which can lead to fibrosis and reduced elasticity of the pelvic tissues. This scarring can restrict the normal movement and function of the pelvic floor muscles, exacerbating dysfunction (Khatri et al., 2016). Additionally, radiation therapy, commonly used in conjunction with surgery for gynecological cancers, can further damage the pelvic tissues. Radiation can cause fibrosis and atrophy of the pelvic muscles and connective tissues, compounding the effects of surgical trauma and increasing the risk of PFD (Lakomy et al., 2022; Liu et al., 2023). 3.3 Variability in PFD based on the type of malignancy and surgical procedure The incidence and severity of PFD can vary significantly depending on the type of gynecological malignancy and the specific surgical procedure performed. For example, patients undergoing surgery for cervical cancer may experience different patterns of PFD compared to those treated for uterine cancer, due to differences in surgical techniques and the extent of tissue resection required. The variability in PFD is also influenced by the patient's age, body mass index, and pre-existing pelvic floor conditions, which can affect the resilience of the pelvic floor to surgical trauma (Lakomy et al., 2022). Furthermore, the choice of adjuvant therapies, such as radiation, can influence the development of PFD. Patients receiving radiation therapy in addition to surgery are at a higher risk of developing severe PFD due to the compounded effects of radiation-induced tissue damage. This highlights the importance of individualized treatment planning and the need for careful consideration of the potential impact of different surgical and therapeutic approaches on pelvic floor function. 4 Diagnostic Approaches for Pelvic Floor Dysfunction 4.1 Clinical examination and patient history Clinical examination and patient history are fundamental components in diagnosing Pelvic Floor Dysfunction (PFD) following gynecological malignancy surgery. A thorough patient history helps identify symptoms such as urinary incontinence, pelvic organ prolapse, and fecal incontinence, which are common after treatments like surgery and radiation for endometrial cancer. Understanding the patient's surgical history, including the type and extent of surgery, is crucial as it can influence the prevalence and severity of PFD symptoms. Additionally, preoperative counseling is essential to manage expectations and prepare patients for potential PFDs post-surgery (Hall et al., 2018). Clinical examinations typically include a physical assessment of pelvic floor muscle integrity and function (Xu et al., 2024). These assessments can help identify specific dysfunctions, such as stress urinary incontinence or pelvic organ prolapse, which are prevalent among gynecologic cancer survivors (Ramaseshan et al., 2017). The integration of clinical examination with patient history allows healthcare providers to tailor management strategies effectively, ensuring a comprehensive approach to addressing PFD in this patient population (Gleason, 2021). 4.2 Imaging techniques: ultrasound, MRI, and urodynamics Imaging techniques such as ultrasound, MRI, and urodynamics play a pivotal role in the diagnostic process of pelvic floor dysfunction (Boyadzhyan et al., 2008). Ultrasound is a non-invasive method that provides real-time visualization of pelvic floor structures, aiding in the assessment of muscle integrity and function (Gleason, 2021). MRI offers detailed images of the pelvic anatomy, which can be particularly useful in complex cases where precise anatomical delineation is required. These imaging modalities are essential for identifying structural abnormalities that may not be apparent during a physical examination. Urodynamics is another critical diagnostic tool, especially for evaluating urinary dysfunctions. It provides objective data on bladder function, helping to differentiate between various types of urinary incontinence and other lower urinary tract symptoms (Ziętek-Strobl et al., 2020). The use of these imaging techniques, in conjunction with clinical examination and patient history, enhances the accuracy of PFD diagnosis, allowing for more targeted and effective treatment strategies (Opławski et al., 2021).
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