Mechanics of Uterosacral Ligaments: Current Knowledge, Existing Gaps, and Future Directions

Donaldson, Kandace; Huntington, Alyssa; Vita, R. De

doi:10.1007/s10439-021-02755-6

Cited by 11 publications

(7 citation statements)

References 84 publications

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“…The establishment of a successful protocol for hysterectomy and USLS in the Lewis rat will be a useful tool for future researchers investigating surgical components of POP, while minimizing variability in testing the mechanical behavior of the USL. Surgical animal models are beneficial in that they allow researchers to design clinically relevant experiments that control for parity, body mass, disease, and nutrition 34 while mitigating the ethical risk of initial study in humans.…”

Section: Discussionmentioning

confidence: 99%

“…Figure 9 provides an example of data obtained via tensile testing with Figure 9A providing an example of a typical stress-strain plot. Reporting of stress-strain data is recommended as this information is normalized and independent of the size of the specimens 34 and can be better compared across studies. For the intact uterosacral ligament, we report structural properties such as ultimate load (2.9 ± 0.5 N) and stiffness (0.4 ± 0.1 N/mm) as well as normalized material properties such as ultimate stress (2.1 ± 0.4 MPa), ultimate strain (1.6 ± 0.5) and tangent modulus (4.0 ± 1.1 MPa).…”

Section: Notementioning

confidence: 99%

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Development of a Uterosacral Ligament Suspension Rat Model

Miller

Jones²,

Turner³

et al. 2022

JoVE

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Section: Discussionmentioning

confidence: 99%

Section: Notementioning

confidence: 99%

Development of a Uterosacral Ligament Suspension Rat Model

Miller

Jones²,

Turner³

et al. 2022

JoVE

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show abstract

“…The USL is a fan‐like structure, with the ureter accompanying laterally. The mean distance from its distal part located at the cervix, the intermediate part, and the proximal part that near the sacrum to the ureter is 0.9, 2.3, and 4.1 cm, respectively (Buller et al, 2001; Donaldson et al, 2021). The inferior hypogastric plexus is also close to the USL inferiorly and laterally (Aurore et al, 2020).…”

Section: Commentsmentioning

confidence: 99%

Bilateral medial sacrospinous ligament suture for apical suspension through natural spaces: A single‐center study with low perioperative complications

OuYang

Wang

et al. 2022

Clinical Anatomy

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Sacrospinous ligament fixation (SSLF) is one of the most used native tissue approaches for apical suspension with a high rate of perioperative complications. This study aimed to review cases undergoing a modified SSLF and assess its perioperative adverse events. It was a retrospective study of 168 consecutive patients undergoing modified transvaginal SSLF at a single tertiary center from 2017 to 2021. The sutures were placed on the sacrospinous ligament (SSL) approaching the sacrum through natural spaces under direct vision. Moreover, it was performed bilaterally. Patient demographics and perioperative complications were reviewed. The median age was 65 years, and 85.7% (144/168) had stage III–IV prolapse. Among the 168 patients undergoing this modified SSLF, 161 were for uterovaginal prolapse, and seven were for posthysterectomy vaginal vault prolapse. 83.9% (135/161) patients were concomitant with hysterectomy, and 70.2% (118/168) were with anteroposterior colporrhaphy. The median operation time was 82 min (interquartile range [IQR], 61–100 min), and the median intraoperative blood loss was 50 ml (IQR, 30–50 ml). Two cases had pelvic hematoma, and both were cured after expectant treatment. No patient required a homologous blood transfusion, and none complained about buttock or lower limb pain 2 weeks postoperatively. Nor did injury of the ureters, bladder, or rectum occur intraoperatively. This modified transvaginal SSLF procedure was safe and had no severe perioperative complications.

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“…Impaired mechanics of the uterosacral ligament (USL) due to long-term forces is a key tissue in the pathogenesis of POP ( 12 ). Level I support includes the USL complex, which extends from the cervix to the sides of the uterus where it connects to the sacral surface; the USL plays a crucial role in supporting the uterus and vagina ( 13 , 14 ). However, the structural integrity of the USL can be compromised over time due to repeated stretching caused by factors such as pregnancy and standing postures.…”

Section: Introductionmentioning

confidence: 99%

Roles and mechanisms of biomechanical-biochemical coupling in pelvic organ prolapse

Wu,

Zhang,

et al. 2024

Front. Med.

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Pelvic organ prolapse (POP) is a significant contributor to hysterectomy among middle-aged and elderly women. However, there are challenges in terms of dedicated pharmaceutical solutions and targeted interventions for POP. The primary characteristics of POP include compromised mechanical properties of uterine ligaments and dysfunction within the vaginal support structure, often resulting from delivery-related injuries. Fibroblasts secrete extracellular matrix, which, along with the cytoskeleton, forms the structural foundation that ensures proper biomechanical function of the fascial system. This system is crucial for maintaining the anatomical position of each pelvic floor organ. By systematically exploring the roles and mechanisms of biomechanical-biochemical transformations in POP, we can understand the impact of forces on the injury and repair of these organs. A comprehensive analysis of the literature revealed that the extracellular matrix produced by fibroblasts, as well as their cytoskeleton, undergoes alterations in patient tissues and cellular models of POP. Additionally, various signaling pathways, including TGF-β1/Smad, Gpx1, PI3K/AKT, p38/MAPK, and Nr4a1, are implicated in the biomechanical-biochemical interplay of fibroblasts. This systematic review of the biomechanical-biochemical interplay in fibroblasts in POP not only enhances our understanding of its underlying causes but also establishes a theoretical foundation for future clinical interventions.

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Mechanics of Uterosacral Ligaments: Current Knowledge, Existing Gaps, and Future Directions

Cited by 11 publications

References 84 publications

Development of a Uterosacral Ligament Suspension Rat Model

Development of a Uterosacral Ligament Suspension Rat Model

Bilateral medial sacrospinous ligament suture for apical suspension through natural spaces: A single‐center study with low perioperative complications

Roles and mechanisms of biomechanical-biochemical coupling in pelvic organ prolapse

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