Aronson, Michael P.Aronson, Patricia K.Howard, Allison E.Morse, Abraham N.Baker, Stephen P.Young, Stephen B.2022-08-232022-08-232005-05-012016-01-20<p>Am J Obstet Gynecol. 2005 May;192(5):1530-6. <a href="http://dx.doi.org/10.1016/j.ajog.2004.10.608">Link to article on publisher's site</a></p>0002-9378 (Linking)10.1016/j.ajog.2004.10.60815902153https://hdl.handle.net/20.500.14038/42768OBJECTIVE: Transvaginal uterosacral ligament fixation (USLF), often called "high" USLF, is associated with a 1.0% to 10.9% ureteral obstruction rate. Anatomic relations and pelvic rotation with positioning imply "high" (cephalad) suture placement may bring sutures closer to the ureter. We examined the ureteral obstruction rate with a "deep" (dorsal/posterior) uterosacral ligament suture placement modification of a standard USLF procedure. STUDY DESIGN: At the University of Massachusetts and Tufts, 411 consecutive patients underwent Mayo culdoplasty utilizing > or = 3 uterosacral sutures placed "deep" bilaterally. Intraoperative cystoscopy was performed. RESULTS: One patient (0.24% [.01%-1.35%]) had ureteral obstruction attributable to USLF. Two had obstruction secondary to concomitant procedures. Compared with previous published series, the odds of ureteral injury secondary to USLF was 4.6 times lower (95% CI 2.31-9.24; P < .0001). CONCLUSION: Placement of USLF sutures "deep" (dorsal/posterior) increases the margin of safety for the ureter and, in this study, decreased the ureteral injury rate nearly 5-fold.en-USAgedFemaleHumansLigamentsMiddle AgedRisk Assessment*Sacrococcygeal RegionSuture TechniquesUreteral ObstructionUterine ProlapseUterusUterosacral ligamentVaginal surgeryProlapseUreterInjuryFemale Urogenital Diseases and Pregnancy ComplicationsMaternal and Child HealthObstetrics and GynecologySurgical Procedures, OperativeWomen's HealthJournal Articlehttps://escholarship.umassmed.edu/obgyn_pp/1238028992obgyn_pp/123