Low risk of ureteral obstruction with "deep" (dorsal/posterior) uterosacral ligament suture placement for transvaginal apical suspension
Name:
Publisher version
View Source
Access full-text PDFOpen Access
View Source
Check access options
Check access options
Authors
Aronson, Michael P.Aronson, Patricia K.
Howard, Allison E.
Morse, Abraham N.
Baker, Stephen P.
Young, Stephen B.
UMass Chan Affiliations
Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic SurgeryDocument Type
Journal ArticlePublication Date
2005-05-01Keywords
AgedFemale
Humans
Ligaments
Middle Aged
Risk Assessment
*Sacrococcygeal Region
Suture Techniques
Ureteral Obstruction
Uterine Prolapse
Uterus
Uterosacral ligament
Vaginal surgery
Prolapse
Ureter
Injury
Female Urogenital Diseases and Pregnancy Complications
Maternal and Child Health
Obstetrics and Gynecology
Surgical Procedures, Operative
Women's Health
Metadata
Show full item recordAbstract
OBJECTIVE: Transvaginal uterosacral ligament fixation (USLF), often called "high" USLF, is associated with a 1.0% to 10.9% ureteral obstruction rate. Anatomic relations and pelvic rotation with positioning imply "high" (cephalad) suture placement may bring sutures closer to the ureter. We examined the ureteral obstruction rate with a "deep" (dorsal/posterior) uterosacral ligament suture placement modification of a standard USLF procedure. STUDY DESIGN: At the University of Massachusetts and Tufts, 411 consecutive patients underwent Mayo culdoplasty utilizing > or = 3 uterosacral sutures placed "deep" bilaterally. Intraoperative cystoscopy was performed. RESULTS: One patient (0.24% [.01%-1.35%]) had ureteral obstruction attributable to USLF. Two had obstruction secondary to concomitant procedures. Compared with previous published series, the odds of ureteral injury secondary to USLF was 4.6 times lower (95% CI 2.31-9.24; P < .0001). CONCLUSION: Placement of USLF sutures "deep" (dorsal/posterior) increases the margin of safety for the ureter and, in this study, decreased the ureteral injury rate nearly 5-fold.Source
Am J Obstet Gynecol. 2005 May;192(5):1530-6. Link to article on publisher's site
DOI
10.1016/j.ajog.2004.10.608Permanent Link to this Item
http://hdl.handle.net/20.500.14038/42768PubMed ID
15902153Related Resources
ae974a485f413a2113503eed53cd6c53
10.1016/j.ajog.2004.10.608