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  • Title: Histopathological evaluation of the uterosacral ligament: is this a dependable structure for pelvic reconstruction?
    Author: Cole EE, Leu PB, Gomelsky A, Revelo P, Shappell H, Scarpero HM, Dmochowski RR.
    Journal: BJU Int; 2006 Feb; 97(2):345-8. PubMed ID: 16430644.
    Abstract:
    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.
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