Low risk of ureteral obstruction with "deep" (dorsal/posterior) uterosacral ligament suture placement for transvaginal apical suspension

UMMS Affiliation

Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery

Publication Date


Document Type



Aged; Female; Humans; Ligaments; Middle Aged; Risk Assessment; *Sacrococcygeal Region; Suture Techniques; Ureteral Obstruction; Uterine Prolapse; Uterus


Female Urogenital Diseases and Pregnancy Complications | Maternal and Child Health | Obstetrics and Gynecology | Surgical Procedures, Operative | Women's Health


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.


Uterosacral ligament, Vaginal surgery, Prolapse, Ureter, Injury

DOI of Published Version



Am J Obstet Gynecol. 2005 May;192(5):1530-6. Link to article on publisher's site

Journal/Book/Conference Title

American journal of obstetrics and gynecology

Related Resources

Link to Article in PubMed

PubMed ID