OBJECTIVE: To explore, by histological examination, whether the uterosacral ligament complex is an adequate support structure for vaginal vault suspension and other reconstructive procedures of the female pelvis. MATERIALS AND METHODS: We dissected 14 fresh hemipelves from seven adult female cadavers. The uterosacral complexes were excised from the pelvic sidewall immediately beneath the uterosacral pedicle. The specimens were stained with connective tissue-specific Movat stain and evaluated microscopically for the presence of collagen and/or elastin. RESULTS: Uterosacral tissue similar to that identified during pelvic reconstructive surgery was obtained in all cases. Six of the women had had a hysterectomy. A ligamentous structure with clearly aligned collagen and interspersed elastin was identified in only three specimens, two from one cadaver of a young woman who had not had a hysterectomy. The other specimens had an attenuated, poorly organized layer of collagen immediately beneath the peritoneum. CONCLUSION: We could not consistently identify normal ligamentous tissue in the uterosacral complexes. The overwhelming majority of specimens from women who had had a hysterectomy showed disorganized tissue with reduced cellularity. This reinforces doubts about the integrity of these tissues as structural supports in pelvic reconstructive surgery, particularly in elderly women who have had a hysterectomy.
OBJECTIVE: To explore, by histological examination, whether the uterosacral ligament complex is an adequate support structure for vaginal vault suspension and other reconstructive procedures of the female pelvis. MATERIALS AND METHODS: We dissected 14 fresh hemipelves from seven adult female cadavers. The uterosacral complexes were excised from the pelvic sidewall immediately beneath the uterosacral pedicle. The specimens were stained with connective tissue-specific Movat stain and evaluated microscopically for the presence of collagen and/or elastin. RESULTS: Uterosacral tissue similar to that identified during pelvic reconstructive surgery was obtained in all cases. Six of the women had had a hysterectomy. A ligamentous structure with clearly aligned collagen and interspersed elastin was identified in only three specimens, two from one cadaver of a young woman who had not had a hysterectomy. The other specimens had an attenuated, poorly organized layer of collagen immediately beneath the peritoneum. CONCLUSION: We could not consistently identify normal ligamentous tissue in the uterosacral complexes. The overwhelming majority of specimens from women who had had a hysterectomy showed disorganized tissue with reduced cellularity. This reinforces doubts about the integrity of these tissues as structural supports in pelvic reconstructive surgery, particularly in elderly women who have had a hysterectomy.
Authors: Okechukwu A Ibeanu; Ralph R Chesson; Dane Sandquist; Javier Perez; Kerri Santiago; Thomas E Nolan Journal: Int Urogynecol J Date: 2010-03-24 Impact factor: 2.894
Authors: Kathleen A Connell; Marsha K Guess; Heidi W Chen; Tara Lynch; Richard Bercik; Hugh S Taylor Journal: Reprod Sci Date: 2009-04-16 Impact factor: 3.060
Authors: Jiajia Luo; Cornelia Betschart; Luyun Chen; James A Ashton-Miller; John O L DeLancey Journal: Int Urogynecol J Date: 2013-09-06 Impact factor: 2.894
Authors: Kathleen A Connell; Marsha K Guess; Heidi Chen; Vaagn Andikyan; Richard Bercik; Hugh S Taylor Journal: J Clin Invest Date: 2008-03 Impact factor: 14.808