International Urogynecology Journal

, Volume 19, Issue 11, pp 1565–1570

The uterosacral complex: ligament or neurovascular pathway? Anatomical and histological study of fetuses and adults

  • Rajeev Ramanah
  • Bernard Parratte
  • Francine Arbez-Gindre
  • Robert Maillet
  • Didier Riethmuller
Original Article

DOI: 10.1007/s00192-008-0692-x

Cite this article as:
Ramanah, R., Parratte, B., Arbez-Gindre, F. et al. Int Urogynecol J (2008) 19: 1565. doi:10.1007/s00192-008-0692-x


The aim of this study was to define the anatomical relationships of the uterosacral ligament complex (USLC) and to analyze histologically its content. Three fetal and four adult cadavers were used. Anatomical dissections were carried out. Eight fresh biopsies (four fetal and four adult) of the USLC were analyzed histologically and immunohistochemically. Specimens were stained with hematoxylin eosin safran coloration, with anti-nervous cell antibodies (PS 100) and with anti-smooth muscle antibodies (to visualize vessel walls). By removing the visceral pelvic fascia, nervous fibers were found within the USLC forming the hypogastric plexus. Histologically, the USLC contained connective tissue, nervous fibers, sympathetic nodes, vessels, and fatty tissue. No structured ligamentous organization was identified. The uterosacral “ligament” is a “complex” integrating connective tissue as well as nervous and vascular elements. Radical excisions and USLC suspension during pelvic floor reconstructive surgery should be performed with caution in order to preserve pelvic innervation.


Hypogastric plexus Hysterectomy Pelvic organ prolapse Pelvic autonomous nerves Uterosacral ligament 



uterosacral ligament complex

PS 100

antinervous specific antibodies


hematoxylin eosin safran


visceral pelvic fascia


inferior hypogastric plexus


laparoscopic uterosacral nerve ablation

Copyright information

© The International Urogynecological Association 2008

Authors and Affiliations

  • Rajeev Ramanah
    • 1
  • Bernard Parratte
    • 2
  • Francine Arbez-Gindre
    • 3
  • Robert Maillet
    • 1
  • Didier Riethmuller
    • 1
  1. 1.Department of Gynecologic SurgeryBesancon University Medical CentreBesanconFrance
  2. 2.Anatomy LaboratoryFranche-Comte University Faculty of MedicineBesanconFrance
  3. 3.Department of PathologyBesancon University Medical CentreBesanconFrance

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