International Urogynecology Journal

, Volume 28, Issue 9, pp 1421–1423 | Cite as

Transvaginal uterosacral ligament suspension for posthysterectomy vaginal vault prolapse repair

  • Rodolfo Milani
  • Matteo Frigerio
  • Federico Spelzini
  • Stefano ManodoroEmail author
IUJ Video


Introduction and hypothesis

Posthysterectomy vaginal vault prolapse repair represents a challenge for urogynecologists. Surgical management can be successfully achieved with native tissue using a vaginal approach with uterosacral ligament (USL) suspension. However, severe complications have been described, mainly related to ureteral injury.


A 57-year-old woman with symptomatic stage 2 vaginal vault prolapse underwent transvaginal USL suspension according to the described technique.


Surgical procedure was successfully achieved without complications. Final examination revealed excellent apical support and preservation of vaginal length. However, ureteral damage represents the major pitfall of USL suspension. This step-by-step video tutorial may represent an important tool to improve surgical know how and minimize the risk of ureteral injury.


Transvaginal USL suspension provides an effective technique for apical support without the use of prosthetic materials. Intimate understanding of pelvic anatomy, direct visualization of ureter, and proper suture positioning are the key points to minimize the risk of complications.


Uterosacral ligament suspension Pelvic organ prolapse Video tutorial Native-tissue repair Vaginal vault prolapse 


Compliance with ethical standards

Financial disclaimers


Conflict of interest



Written informed consent was obtained from the patient for publication of this video article and any accompanying images.

Supplementary material


(MP4 76054 kb)


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Copyright information

© The International Urogynecological Association 2017

Authors and Affiliations

  1. 1.ASST Monza, San Gerardo HospitalUniversity of Milano-BicoccaMonzaItaly
  2. 2.AUSL Romagna, Infermi HospitalUniversity of Milano-BicoccaRiminiItaly
  3. 3.ASST MonzaOspedale San Gerardo, U.O. GinecologiaMonzaItaly

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