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Etiology of post-uterosacral suspension neuropathies

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Abstract

Introduction and hypothesis

The goal of our investigation was to find a neurological explanation for neuropathies reported following some uterosacral ligament suspension (USLS) [2-3].

Methods

We dissected the neural structures beneath the USL in seven female, adult, embalmed cadavers. We made a literature review to determine the spinal nerve sensory fiber composition of each exposed neural structure and the dermatome(s) that it innervates. We then compared anticipated sensory neuropathies for each neural structure with neuropathies following USLS to determine which neural structure entrapment could explain the reported symptoms.

Results

Several neural structures located beneath the uterosacral ligament (USL) are vulnerable to suture entrapment during USLS. Anticipated clinical outcomes of entrapments are discussed.

Conclusions

Entrapment of S2 sensory fibers in the second trunk of the sacral plexus or in the intrapelvic portion of the sciatic nerve is the most plausible etiology for reported neuropathies following USLS

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Abbreviations

S1:

First sacral spinal nerve

S2:

Second sacral spinal nerve

S3:

Third sacral spinal nerve

S4:

Fourth sacral spinal nerve

USL:

Uterosacral ligament

USLS:

Uterosacral ligament suspension

References

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Acknowledgments

We thank Dr. Mark F. Teaford, of the Johns Hopkins University School of Medicine, for allowing us to use specimens that were under his custody.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Art as Applied to Medicine and Cell Molecular Medicine Program, Johns Hopkins University School of Medicine, 1830 E. Monument St., Suite 7000, Baltimore, MD, USA

    M. A. Schön Ybarra & D. Rini

  2. Department of Anatomy and Neurobiology, School of Medicine, University of Maryland, Baltimore, MD, USA

    M. A. Schön Ybarra

  3. Department of Pain and Neural Sciences, School of Dentistry, University of Maryland, Baltimore, MD, USA

    M. A. Schön Ybarra

  4. Department of Obstetrics and Gynecology, Washington Hospital Center, Washington, DC, USA

    R. E. Gutman

  5. Department of Gynecology and Obstetrics, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA

    V. L. Handa

Authors
  1. M. A. Schön Ybarra
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  2. R. E. Gutman
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  3. D. Rini
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  4. V. L. Handa
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Corresponding author

Correspondence to M. A. Schön Ybarra.

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Schön Ybarra, M.A., Gutman, R.E., Rini, D. et al. Etiology of post-uterosacral suspension neuropathies. Int Urogynecol J 20, 1067–1071 (2009). https://doi.org/10.1007/s00192-009-0894-x

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  • DOI: https://doi.org/10.1007/s00192-009-0894-x

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