Histopathological evaluation of the uterosacral ligament: is this a dependable structure for pelvic reconstruction?
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.


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.


CONCLUSIONS
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.
Cole
Emily E
EE
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232-2765, USA. emily.cole@vanderbilt.edu
Leu
Patrick B
PB
Gomelsky
Alex
A
Revelo
Patricia
P
Shappell
Heidi
H
Scarpero
Harriette M
HM
Dmochowski
Roger R
RR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D005260:Female; D006801:Humans; D008022:Ligaments / Q000473:pathology*; D008875:Middle Aged; D010388:Pelvis / Q000601:surgery*; D012447:Sacrum / Q000473:pathology*; D014596:Uterine Prolapse / Q000601:surgery*; D014599:Uterus / Q000473:pathology*