ROLE OF THE UTEROSACRAL-CARDINAL LIGAMENT COMPLEX IN PROTECTING THE URETER DURING VAGINAL HYSTERECTOMY

OBJECTIVE: To determine the surgical anatomy of the ureter during vaginal hysterectomy. METHOD: Sixty patients undergoing vaginal hysterectomy were studied. All patients had moderate or severe uterovaginal prolapse or complete procidentia. Ureteral position was noted after traction and cutting of each uterosacral-cardinal ligament complex. RESULT: In the 40 patients with moderate or severe uterovaginal prolapse, the ureter did not move significantly when traction was applied to the cervix and there was no upward retraction on the bladder. When the uterosacral-cardinal ligament complex was cut, with forceful traction on the cervix and upward bladder retraction, the ureter was elevated from the operative field. The same was true for those 20 patients with procidentia after cutting the cardinal ligaments. CONCLUSION: Traction and cutting of the cardinal ligaments are the chief factors affecting movement of the ureter during vaginal hysterectomy; this action protects the ureter. Added protection by the cardinal ligament occurs with bladder retraction.