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The uterosacral complex: ligament or neurovascular pathway? Anatomical and histological study of fetuses and adults

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Abstract

The aim of this study was to define the anatomical relationships of the uterosacral ligament complex (USLC) and to analyze histologically its content. Three fetal and four adult cadavers were used. Anatomical dissections were carried out. Eight fresh biopsies (four fetal and four adult) of the USLC were analyzed histologically and immunohistochemically. Specimens were stained with hematoxylin eosin safran coloration, with anti-nervous cell antibodies (PS 100) and with anti-smooth muscle antibodies (to visualize vessel walls). By removing the visceral pelvic fascia, nervous fibers were found within the USLC forming the hypogastric plexus. Histologically, the USLC contained connective tissue, nervous fibers, sympathetic nodes, vessels, and fatty tissue. No structured ligamentous organization was identified. The uterosacral “ligament” is a “complex” integrating connective tissue as well as nervous and vascular elements. Radical excisions and USLC suspension during pelvic floor reconstructive surgery should be performed with caution in order to preserve pelvic innervation.

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Abbreviations

USLC:

uterosacral ligament complex

PS 100:

antinervous specific antibodies

HES:

hematoxylin eosin safran

VPF:

visceral pelvic fascia

IHP:

inferior hypogastric plexus

LUNA:

laparoscopic uterosacral nerve ablation

References

  1. Blaisdell FE (1917) The anatomy of the sacro-uterine ligaments. Anat Rec 12:1–22

    Article  Google Scholar 

  2. Jenkins VR (1997) Uterosacral ligament fixation for vaginal vault suspension in uterine and vaginal vault prolapse. Am J Obstet Gynecol 177:1337–1343

    Article  PubMed  Google Scholar 

  3. Shull BL, Bachofen C, Coates KW, Kuehl TJ (2000) A transvaginal approach to repair of apical and other associated sites of pelvic organ prolapse with uterosacral ligaments. Am J Obstet Gynecol 183:1365–1373

    Article  PubMed  CAS  Google Scholar 

  4. Dwyer PL, Fatton B (2008) Bilateral extraperitoneal uterosacral suspension: a new approach to correct posthysterectomy vaginal vault prolapse. Int Urogynecol J 19:283–292

    Article  Google Scholar 

  5. Karram M, Goldwasser S, Kleeman S, Steele A, Vassallo B, Walsh P (2001) High uterosacral vaginal vault suspension with fascial reconstruction for vaginal repair of enterocele and vaginal vault prolapse. Am J Obstet Gynecol 185:1339–1343

    Article  PubMed  CAS  Google Scholar 

  6. Gabriel B, Denschlag D, Gobel H, Fittkow C, Werner M, Gitsch G, Watermann D (2005) Uterosacral ligament in postmenopausal women with or without pelvic organ prolapse. Int Urogynecol J 16:475–479

    Article  Google Scholar 

  7. Gabriel B, Watermann D, Hancke K, Gitsch G, Werner M, Tempfer C, Hausen A (2006) Increased expression of matrix metalloproteinase 2 in uterosacral ligaments is associated with pelvic organ prolapse. Int Urogynecol J 17:478–482

    Article  Google Scholar 

  8. Reisenauer C, Shiozawa T, Oppitz M, Busch C, Kirschniak A, Fehm T, Drews U (2008) The role of smooth muscle in the pathogenesis of pelvic organ prolapse—an immunohistochemical and morphometric analysis of the cervical third of the uterosacral ligament. Int Urogynecol J 19:383–389

    Article  Google Scholar 

  9. Campbell RM (1950) The anatomy and histology of the sacrouterine ligaments. Am J Obstet Gynecol 59:1–12

    PubMed  CAS  Google Scholar 

  10. Butler-Manuel AS, Buttery DKL, A’Hern RP, Polak JM, Barton DPJ (2000) Pelvic nerve plexus trauma at radical hysterectomy and simple hysterectomy. Cancer 89(4):834–841

    Article  PubMed  CAS  Google Scholar 

  11. Maas CP, Trimbos JB, DeRuiter MC, Van De Velde CJH, Kenter GG (2003) Nerve sparing radical hysterectomy: latest developments and historical perspective. Crit Rev Oncol Hematol 48:271–279

    Article  PubMed  CAS  Google Scholar 

  12. Cole EE, Leu PB, Gomelsky A, Revelo P, Shapell H, Scarpero HM, Dmochowski RR (2005) Histopathological evaluation of the uterosacral ligament: is this a dependable structure for pelvic reconstruction. BJU 97:345–348

    Google Scholar 

  13. Buller JL, Thomson JR, Cundiff GW, Sullivan LK, Schon Ybarra MA, Bent AE (2001) Uterosacral ligament: description of anatomic relationships to optimize surgical safety. Obstet Gynecol 97:873–879

    Article  PubMed  CAS  Google Scholar 

  14. Bergmark K, Avall-Lundqvist E, Dickman PW, Henningson L, Steineck G (1999) Vaginal changes and sexuality in women with a history of cervical cancer. New Engl J Med 340:1383–1389

    Article  PubMed  CAS  Google Scholar 

  15. Smith AN, Varma JS, Binnie NR, Papachrysostomo M (1990) Disordered colorectal motility following hysterectomy. Br J Surg 77:1361–1366

    Article  PubMed  CAS  Google Scholar 

  16. Forney JP (1980) Effect of radical hysterectomy on bladder physiology. Am J Obstet Gynecol 138:374–378

    PubMed  CAS  Google Scholar 

  17. Olson A, Smith V, Bergstrom J, Colling J, Clark A (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89:501–506

    Article  Google Scholar 

  18. McCall M (1957) Posterior culdoplasty: surgical correction of enterocele during vaginal hysterectomy; a preliminary report. Obstet Gynecol 10:595–602

    Article  PubMed  CAS  Google Scholar 

  19. Siddique SA, Gutman RE, Schon Ybarra MA, Rojas F, Handa VL (2006) Relationship of the uterosacral ligament to the sacral plexus and to the pudendal nerve. Int Urogynecol J 17:642–645

    Article  Google Scholar 

  20. Flynn MK, Weidner AC, Amundsen CL (2006) Sensory nerve injury after uterosacral ligament suspension. Am J Obst Gynecol 195:1869–1872

    Article  Google Scholar 

  21. Wieslander CK, Roshanravan SM, Wai CY, Schaffer JI, Corton MM (2007) Uterosacral ligament suspension sutures: anatomic relationships in unembalmed female cadavers. Am J Obstet Gynecol 197:672.e1–672.e6

    Article  Google Scholar 

  22. Doyle JB (1955) Paracervical uterine denervation by transaction of the cervical plexus for the relief of dysmenorrhea. Am J Obstet Gynecol 70:1–16

    PubMed  CAS  Google Scholar 

  23. Daniels J, Garry R, Khan KS (2000) Laparoscopic uterosacral nerve ablation: a survey of gynaecological practice in the UK. Gynecol Endosc 9:157–159

    Article  Google Scholar 

  24. Vercellini P, Aimi G, Busacca M, Apolone G, Uglietti A, Crosignani PG (2003) Laparoscopic uterosacral ligament resection for dysmenorrhea associated with endometriosis: results of a randomized, controlled trial. Fertil Steril 80:310–319

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Gynecologic Surgery, Besancon University Medical Centre, 8 Mai 1945 Avenue, 25000, Besancon, France

    Rajeev Ramanah, Robert Maillet & Didier Riethmuller

  2. Anatomy Laboratory, Franche-Comte University Faculty of Medicine, Saint-Jacques Place, 25000, Besancon, France

    Bernard Parratte

  3. Department of Pathology, Besancon University Medical Centre, Fleming Boulevard, 25000, Besancon, France

    Francine Arbez-Gindre

Authors
  1. Rajeev Ramanah
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  2. Bernard Parratte
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  3. Francine Arbez-Gindre
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  4. Robert Maillet
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  5. Didier Riethmuller
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Correspondence to Rajeev Ramanah.

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Ramanah, R., Parratte, B., Arbez-Gindre, F. et al. The uterosacral complex: ligament or neurovascular pathway? Anatomical and histological study of fetuses and adults. Int Urogynecol J 19, 1565–1570 (2008). https://doi.org/10.1007/s00192-008-0692-x

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  • DOI: https://doi.org/10.1007/s00192-008-0692-x

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