China
Africa
Explore chapters and articles related to this topic
Urologic Involvement
Published in Nazar N. Amso, Saikat Banerjee, Endometriosis, 2022
Jörg Keckstein, Gernot Hudelist, Simon Keckstein
In the parametrium, the ureter is isolated up to its junction with the uterine artery. The artery itself may be spared except in cases of extensive involvement of the cardinal ligament. This is followed by medial exposure of the lateral portion of the superior hypogastric plexus (SHP). The visceral afferent and efferent nerve fibers to the bladder, uterus and vagina and dorsally to the rectum are mainly spared and separated from the uterosacral ligaments in order to preserve the bladder, bowel and sexual functions.
Radical vaginal trachelectomy
Published in J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan, An Atlas of Gynecologic Oncology, 2018
The cardinal ligament is composed of condensed fibrous tissue and some smooth muscle fibers. It extends from the lateral aspect of the uterine isthmus toward the pelvic wall. This fibrous sheath contains the ureter, the uterine vessels and associated nerves, the lymphatic channels and lymph nodes draining the cervix, and some fatty tissue. It is commonly referred to as the parametrium. The cardinal ligament is in continuity anteriorly to the uterovaginal endopelvic fascia, and posteriorly, fibers are integrated with the uterosacral ligament. Since VRT is performed in patients with small lesions, only the medial part (i.e., approximately 2 cm) of the cardinal ligaments is usually taken at the time of a VRT (Figure 11.3).
Does the Way Hysterectomy Is Performed Make a Difference? How to Prevent Prolapse at the Time of Hysterectomy
Published in Victor Gomel, Bruno van Herendael, Female Genital Prolapse and Urinary Incontinence, 2007
Harry Reich, Iris Kerin Orbuch, Tamer Seckin
Level I support, or vertical support, is maintained by superior suspension of the vagina by the cardinal-uterosacral complex. The cardinal-uterosacral complex provides apical support of the upper third of the vagina to the sacrum. The cardinal-uterosacral complex is a mixture of smooth muscle and connective tissue (4). The cardinal ligament is connective tissue that houses the perivascular tissue of the uterine vessels and its constituents are fibrous tissue and nerves (9). The uterosacral ligaments originate from the vertebrae of S2, 3, 4. These ligaments fuse distally and encircle the cervix to form the pericervical ring as they support the upper part of the vagina. Anteriorly the pericervical ring fuses with the pubocervical fascia. Posteriorly, the rectovaginal fascia fuses with the pericervical ring at the level of the ischial spine. Disruption of the cardinal-uterosacral complex results in uterine or vaginal vault prolapse.
Abdominal Hysterectomy with a Uterine Manipulator Minimizes Vaginal Shortening: A Randomized Controlled Trial
Published in Journal of Investigative Surgery, 2021
Huseyin Kiyak, Tolga Karacan, Eser Sefik Ozyurek, Lale Susan Turkgeldi, Pinar Kadirogullari, Kerem Doga Seckin
An increase in the rate of laparoscopic hysterectomy worldwide has led to a decline in the AH cases and lengthened the learning curve for residents and inexperienced surgeons to adequately perform this procedure. Identifying the colpotomy site accurately, which is critically associated with postoperative VL, is also another challenge often encountered in the AH procedure [13, 14]. The experience of a surgeon critically determines success in this step as physical manipulation is required. As such, inadequate experience could lead to deeper colpotomy, there by shortening the VL. We hypothesized that the experience derived from laparoscopic hysterectomy would translate into an improvement of the AH technique. The UM [Clermont-Ferrand (CF), Karl Storz Gmbh & Co., Tuttlingen, Germany] used during colpotomy in the present study includes a mobile, hemi-valve shaped colpotomizer, which elevates the cervix and enables easy identification of the vaginal fornices [15]. Vertical fibers of the paracolpium, which is an anatomical continuation of the cardinal ligament, suspend the vagina from the lateral pelvic walls [16]. Our findings demonstrate that the number of clamps applied to the paracolpium is much lower in the study group as compared to the control group. We speculate that, in contrast to the AH with a UM, a conventional AH requires that the uterosacral and cardinal ligaments be clamped and cut more number of times, which could lead to an apical prolapse of the vaginal apex.
Do Pelvic Organ Prolapse Quantification Examination Ba and D Guide the Selection of Operation for Severe Pelvic Organ Prolapse?
Published in Journal of Investigative Surgery, 2020
Chunbo Li, Huimin Shu, Zhiyuan Dai
The Ba point represents the most distal position of anterior vaginal wall, and the D point is the insertion point of the uterosacral/cardinal ligament at the vaginal apex [21]. The former is the focal point of anterior wall prolapse repair, and the latter is usually used as a measurement to evaluate suspensory failure of the uterosacral/cardinal ligament complex [21]. In the present study, the Ba point, as a master point, was forced to a normal anatomical position, and then, the change of the D point (as a follow point) was evaluated. If the D point following the Ba point reached a normal anatomical position, a surgical model aiming at anterior vaginal wall prolapse was performed. In contrast, a combined surgical model of AVM and SSLF was carried out. From an anatomical perspective, the D point following the Ba point could return to a normal anatomical position, which indicates that there is already decent apical support and that the D point prolapse (apical prolapse) is attributed to the “drag and drop” of anterior wall prolapse (D point: false prolapse). The patients may have better support of the vaginal apex and posterior fornix, as indicated by a more negative D, and thus a method for the anterior wall prolapse is adequate to solve the prolapse. Conversely, a D point presenting “true prolapse,” indicates an inherent tissue weakness of uterosacral ligament associated with apical prolapse. A simple AVM for anterior wall prolapse is inadequate to solve the apical prolapse, resulting in prolapse recurrence. Thus, a SSLF was performed to provide apical support at the same time.
Effect of Laparoscopic Nerve-Sparing Radical Hysterectomy on Bladder Function Recovery
Published in Journal of Investigative Surgery, 2020
Qing Liu, Peiquan Li, Yuxin Sun, Shu Zhang, Kaijiang Liu
The pathologic details of the patients are listed in Table 1. There were no significant differences in the resected lengths of the vagina, sacral ligament and cardinal ligament between the two groups (p > 0.05) (Table 2). The mean duration of the postoperative catheterization in the LNSRH group was 13 d, which was much shorter than that in the LRH group (18 days; p < 0.01). But the residual volumes between the two groups had no significant difference (p > 0.05) (Table 3).