Etiology of post-uterosacral suspension neuropathies.
OBJECTIVE
The goal of our investigation was to find a neurological explanation for neuropathies reported following some uterosacral ligament suspension (USLS) [2-3].


METHODS
We dissected the neural structures beneath the USL in seven female, adult, embalmed cadavers. We made a literature review to determine the spinal nerve sensory fiber composition of each exposed neural structure and the dermatome(s) that it innervates. We then compared anticipated sensory neuropathies for each neural structure with neuropathies following USLS to determine which neural structure entrapment could explain the reported symptoms.


RESULTS
Several neural structures located beneath the uterosacral ligament (USL) are vulnerable to suture entrapment during USLS. Anticipated clinical outcomes of entrapments are discussed.


CONCLUSIONS
Entrapment of S2 sensory fibers in the second trunk of the sacral plexus or in the intrapelvic portion of the sciatic nerve is the most plausible etiology for reported neuropathies following USLS.
Schön Ybarra
M A
MA
Department of Art as Applied to Medicine and Cell Molecular Medicine Program, Johns Hopkins University School of Medicine, 1830 E. Monument St., Suite 7000, Baltimore, MD, USA. m-schoen@worldnet.att.net
Gutman
R E
RE
Rini
D
D
Handa
V L
VL
D000328:Adult; D002102:Cadaver; D005260:Female; D006801:Humans; D008022:Ligaments / Q000294:innervation*; D008160:Lumbosacral Plexus / Q000293:injuries*; D009408:Nerve Compression Syndromes / Q000209:etiology*; D011115:Polyneuropathies / Q000209:etiology*; D012867:Skin / Q000294:innervation*; D053825:Suburethral Slings / Q000009:adverse effects*; D013536:Suture Techniques / Q000009:adverse effects