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Relationship of the uterosacral ligament to the sacral plexus and to the pudendal nerve

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Abstract

We describe the anatomy of the uterosacral ligament with respect to the sacral plexus. In six adult female embalmed cadavers, we identified the uterosacral ligament and its lateral nerve relations. Using the ischial spine as the starting point and measuring along the axis of the uterosacral ligament, we noted that the S1 trunk of the sacral plexus passes under the ligament 3.9 cm [95% confidence interval (CI), 2.1–5.8 cm] superior to the ischial spine. The S2 trunk passes under the ligament at 2.6 cm (95% CI; 1.5, 3.6 cm), the S3 trunk passes under the ligament at 1.5 cm (95% CI; 0.7, 2.4 cm), and the S4 trunk passes under the ligament at 0.9 cm (95% CI; 0.3, 1.5 cm) superior to the ischial spine. The pudendal nerve forms lateral to the uterosacral ligament. Our data demonstrate that the S1–S4 trunks of the sacral plexus, not the pudendal nerve, are vulnerable to injury during uterosacral ligament suspension.

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Author notes

  1. Sohail A. Siddique

    Present address: Department of Obstetrics and Gynecology, National Naval Medical Center, 8901 Wisconsin Ave, Bethesda, Maryland, 20889-500, USA

Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Building A, Rm 121, Baltimore, MD, 21224, USA

    Sohail A. Siddique, Robert E. Gutman, Francisco Rojas & Victoria L. Handa

  2. Department of Art as Applied to Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument St., Suite 7000, Baltimore, MD, 21205, USA

    Miguel A. Schön Ybarra

Authors
  1. Sohail A. Siddique
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  2. Robert E. Gutman
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  3. Miguel A. Schön Ybarra
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  4. Francisco Rojas
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  5. Victoria L. Handa
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Correspondence to Sohail A. Siddique.

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Siddique, S.A., Gutman, R.E., Schön Ybarra, M.A. et al. Relationship of the uterosacral ligament to the sacral plexus and to the pudendal nerve. Int Urogynecol J 17, 642–645 (2006). https://doi.org/10.1007/s00192-006-0088-8

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  • DOI: https://doi.org/10.1007/s00192-006-0088-8

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